The Medical Marketplace • 97lege’s members dusted off their manuals from earlier epidemics, revising
their contents slightly as “Certain Necessary Directions for the Preservation
and Cure of the Plague.” The king and mayor had their special copies, and
citizens could find the work in any apothecary shop (see map 3 ) and most
bookstalls around town. Listed were foods to be avoided (raw cucumbers,
melons, and cherries were considered particularly dangerous) and foods to
eat and directions on how to raise or prevent fevers (depending on the stage
of the sickness) and how to balance the humors.
The belief in four “humors” in the human body—blood, phlegm, yellow
bile or choler, and black bile had been passed down from the great Greek
physician, Galen (a.d. 130– 201 ), to the seventeenth century. Medical stu-
dents, after passing their B.A. and M.A. at Oxford or Cambridge, studied
classical medical texts for seven years to earn an M.D. (Some shortened the
process by getting a quick degree at a European university.) To practice, most
doctors sought a license, typically from the College of Physicians, through a
perfunctory examination or from an Anglican bishop (whose licensing au-
thority was based on a belief in the close connection between spiritual and
physical healing). The members of the College of Physicians in London
were a very select group, numbering about fifty.
According to the Galenic medicine practiced by these physicians, every
individual had a particular “constitution” with its own humoral variation.
One’s humors could be altered by diet, exercise, sleep, elimination (including
sexual activity), the emotions, and the quality of air—known to medicine as
the six “nonnaturals” because they covered everything necessary to health
over which a person had some control. A patient could run up a sizable bill
as his or her doctor fine-tuned humors with a regimen suitable to the pa-
tient’s individual condition. The standard regimens included bleeding, purg-
ing, sweating, and vomiting. The seasons came into play as well. In spring a
person might have more blood, and bloodletting could restore a healthy bal-
ance. The onset of an illness, which presumed a corruption or putrefaction of
the humors, called for evacuation to eliminate the putrid matter.^3 To an or-
thodox Galenist, the poison of plague called for an especially strong applica-
tion of all the eliminating tools, including bleeding.
These aristocrats of the medical establishment looked down on everyone
else, including the apothecaries and surgeons, whom they asserted were mere
“empiricks,” plying their trade like any artisan without the theoretical knowl-
edge that alone made medicine intelligible. They did not have the last word,
however, even within their own doctors’ ranks. For some time a breakaway
group of academically trained caregivers, calling themselves “chymical physi-