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“It hath left behind it so foul and filthy broad scars, that touched the lives of four persons”: Stories of Medical Malpractice in Elizabethan England

Henry VIII grants a Royal Charter to the Company of Barbers and Surgeons

In the preface to his 1588 treatise on surgery, Elizabethan surgeon William Clowes declared to his reader that “mine intent is not to hold my tongue at abuses” (A prooued practise sig. A1r). Thus began a section in which he discussed several stories of medical malpractice.1 In one, he described a “pernicious pill” that had been used on four people by two ship surgeons, who had been misled into thinking it a cure-all. Clowes felt duty-bound to report the ill effects of this pill and warn others away from its use. He wrote: 

And in my simple judgement, no good man ought to countenance, allow, excuse, smother, or conceal so perilous a medicine, sith it hath left behind so foul and filthy broad scars, that touched the lives of four persons. (sig. A2r-v)

He then went on to identify the four affected people by name, occupation, and area of residence.

Naval surgeon, London medical practitioner, and member of the Barber-Surgeons’ Company, Clowes (1543/4-1604) often remarked on others’ dubious practices in his writing (Murray). In his treatise on syphilis, Clowes targeted one person in particular: immigrant Valentine Russwurin (Chamberland; Harkness 57-96).2 Among other offenses, Clowes claimed that Russwurin had pretended to cure patients of bladder stones by concealing a stone that he then had faked pulling out of their bodies. 

In these stories about Russwurin, Clowes emphasized patient suffering, both physical and monetary. He described how they had spent money on so-called cures only for their maladies to worsen, in some cases to the point of death. One woman who Russwurin had supposedly pretended to cure of bladder stones was afterward prescribed a powder that “did so blister her mouth her nose and face, and likewise the inward parts of her body, that she never afterward received any sustenance, but died most pitifully” (A briefe and necessarie treatise 10). And, as he had in the example of the pill, Clowes reported the names of individuals who had allegedly died due to Russwurin’s negligence (11).

Historian Andrew Wear has noted the role that discussions of ethics and bad practice played in the contest to define correct medical practice (“Discourses”; “Medical Ethics”). Accusations of negligence or deliberate harm were powerful rhetorical devices, and they stemmed partly from the desire to portray some practitioners positively in contrast to others. This type of self-promotion was essential in the complex early modern medical landscape. Several types of practitioners existed (surgeons, physicians, apothecaries, barbers), all tasked with different roles that in practice could overlap. In theory, university-trained physicians were at the top of the medical hierarchy, but scholars have shown that this was not a simple given: physicians expended much effort in increasing their authority and influence (Murphy). Unlicensed medical practitioners proliferated in cities like London, to the consternation of licensed practitioners (Pelling). Conflict within single groups also existed. For instance, certain individuals in the London Barber-Surgeons’ Company (including Clowes) sought to differentiate themselves from less learned members (Chamberland).

While allegations of malpractice proved useful tools for self-promotion, they also reflected deeply felt concerns about the state of medicine (Wear, “Medical Ethics” 98). Moreover, stories of bad practice gave practitioners the opportunity to discuss the regulation of medicine. After recounting the tale of the “pernicious pill,” Clowes remarked in reference to the person who had spread the word about the supposed cure: 

if such kind of knaves might be well punished for example sake, by the hands of the Magistrate for such offences, so should the young Students in the Art be less deceived. (A prooued practise sig. A2v)

Here, Clowes was participating in contemporary discussions about how to organize and control medical practice. During the sixteenth century, authorities took various steps to control English medical practice, especially in London. The College of Physicians, a key medical institution that played important roles in licensing the practice of medicine in London, was incorporated in 1518 (Pelling 1). The London Barber-Surgeons’ Company was established in 1540, uniting the existing Barbers’ Company and Fellowship of Surgeons (Dobson 9, 17-18). More broadly, practitioners and others were discussing and debating ideals of medical practice (Bishop; Bishop and Gelbier; Wear).

Clowes’s sentiments about the need to reveal and punish negligent medical practitioners were shared—and perhaps taken even further—by his friend and fellow Barber-Surgeons’ Company member, John Banister (1532/3-1599?) (Griffin). Banister advocated for greater control over the practice of medicine. In his view, the authorities were key to the punishment of negligent practitioners. If they failed to act, they were allowing malefactors to grow more confident and multiply. In one publication, Banister complained of the “slackness and untimely clemency” of those “unto whom authority is given, to establish orders and reform malefactors” (A needefull, new, and necessarie treatise sig. C4r).

Banister repeated this complaint in a prefatory dedication written for Clowes’s surgical treatise. He praised Clowes’s intention to expose malefactors and called for more action from the Magistrate:

Man’s health (I say) craveth it at your [Clowes’s] hands to decipher such counterfeits in all their colors, that they may (at least) be avoided of the people, though they be not also punished of the Magistrate, which notwithstanding were most of all to be wished. (A prooued practise sig. B4r)

For Banister, negligent and harmful medicine were serious offenses. He explained their severity with an analogy to murder and bodily harm, underscoring the idea that unskillful medical practitioners deserved punishment:

The Law sayeth, He that killeth or maimeth, must be killed or maimed, the guilty conscience then assumeth thus: But I have killed or maimed, and so this conclusion, commeth upon him, therefore I ought to be killed or maimed again, all writers in Surgery do give this proposition, All unskillful men do wickedly abuse this Art, and ought to be punished, then the guilty conscience everywhere maketh this assumption: But I am an unskillful man, now followeth the conclusion on the neck of it, Therefore I do abuse the Art, and ought to be punished. (sig. B4r)

Banister used the language of law and order to argue for the necessity of official control over medical practice. Clowes relied on specific stories of malpractice to the same effect, focusing on patients’ physical and monetary suffering to evoke a response in his readers.

1  I use the term “malpractice” in its literal sense of “bad practice” rather than in reference to any official, legal definition. For early modern definitions of malpractice, see Wear, “Medical Ethics in Early Modern England,” cited below.
2  As a foreign-born practitioner, Russwurin was particularly  susceptible to accusations such as Clowes’s. I do not intend to lend credence to these accusations, only to examine their purpose in Clowes’s writing. For more discussion of Russwurin, see the works of Chamberland and Harkness, cited below.

Image: King Henry VIII granting a Royal Charter to the Barber-Surgeons’ Company. Engraving by B. Baron, 1736, after H. Holbein, 1542. Via Wellcome Collection (Public Domain).

Works Cited
Banister, John. A needefull, new, and necessarie treatise of chyrurgerie. Thomas Marshe, 1575.
Bishop, M. “The Ethics of Dental Practice in London in the Sixteenth Century. 2. Sir Thomas More’s ‘Ordinances’ for the Barber-Surgeons, 1530.” Br Dent J, vol. 213, no. 2, 2012, pp. 77-80.
Bishop, M. G. H., and S. Gelbier. “Ethics and Utopia: Public Health Theory and Practice in the Sixteenth Century. An Essay Comparing the Henrician Medical Act of 1540 and More’s 1530 Ordinances, with Thomas More’s Novel ‘Utopia’ of 1516.” Br Dent J, vol. 195, no. 5, 2003, pp. 251-55.
Chamberland, Celeste. “Between the Hall and the Market: William Clowes and Surgical Self-Fashioning in Elizabethan London.” Sixt Century J, vol. 41, no. 1, 2010, pp. 69-89.
Clowes, William. A briefe and necessarie treatise, touching the cure of the disease called morbus Gallicus. [Thomas East] for Thomas Cadman, 1585.
—. A prooued practise for all young chirurgians. Thomas Orwyn for Thomas Cadman, 1588.
Dobson, Jessie. Barbers and Barber-Surgeons of London: A History of the Barbers’ and Barber-Surgeons’ Companies. Blackwell Scientific, 1979.
Griffin, Andrew. “Banister [formerly Banester], John (1532/3 -1599?), surgeon.” Oxford Dictionary of National Biography, 2015,  DOI:10.1093/ref:odnb/9780198614128.001.0001/odnb-9780198614128-e-1280.
Harkness, Deborah. The Jewel House: Elizabethan London and the Scientific Revolution. Yale UP, 2007.
Murray, I. G. “Clowes, William (1543/4-1604), surgeon.” Oxford Dictionary of National Biography, 2004, DOI: 10.1093/ref:odnb/ 9780198614128.001.0001/odnb-9780198614128-e-5716.
Murphy, Hannah. A New Order of Medicine: The Rise of Physicians in Reformation Nuremberg. U Pittsburgh Press, 2019.
Pelling, Margaret. Medical Conflicts in Early Modern London: Patronage, Physicians, and Irregular Practitioners, 1550-1640. Clarendon, 2003.
Wear, Andrew. “The Discourses of Practitioners in Sixteenth- and Seventeenth-Century Europe.” The Cambridge World History of Medical Ethics, edited by Robert B. Baker and Laurence B. McCullough, Cambridge UP, 2009, pp. 379-90.
—. “Medical Ethics in Early Modern England.” Doctors and Ethics: The Historical Setting of Professional Ethics, edited by Andrew Wear, Johanna Geyer-Kordesch, and Roger French, Brill, 1993, pp. 98-130.

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