Plate 6 from Nova Reperta
by Johannes Stradanus

Medical Hierarchies


There were many kinds of medical practitioners in early modern England. Physicians were educated at university and treated ailments on the inside of the body. Surgeons were trained via apprenticeship and dealt with problems on the outside of the body, from fractures to boils to venereal disease. Apothecaries, also apprentice-trained, were supposed to make up the medicines prescribed by physicians, but in practice, they functioned as general practitioners to much of the population who could not afford a physician's fees. In addition to these three groups of practitioners, there were midwives, herb-women, oculists, dentists, and a range of "empiric" practitioners, sometime labeled "quacks" by their opponents.

The radical herbalist and medical practitioner Nicholas Culpeper combined traits of all of these kinds of practitioners. Culpeper was well versed in university Latin, but he was apprenticed to an apothecary, had a surgeon's interest in anatomy, and wrote a crucial midwifery text. In his own day, he was vilified as an empiric by some. Historians of medicine consider Culpeper an important figure both for his long-lived text on herbal medicine, The English Physitian (1652), and for his Directory for Midwives (1651), a book that emphasized reproductive anatomy, sometimes to the exclusion of midwives' knowledge gained from experience.

Because his father had died before he was born, Culpeper was brought up by his maternal grandfather. Culpeper went up to Cambridge to study theology and follow in his grandfather's footsteps as a minister. However, after his fiancée was killed by lightning when they planned to elope, Culpeper left Cambridge and apprenticed himself to a London apothecary. He had long been interested in astrology and occult philosophy, and began to practice medicine among London's poor. In the 1640s he joined the Parliamentary Army during the English Civil War. At the first Battle of Newbury he received a chest wound by a musket ball that likely hastened his premature death at the age of 38.

Culpeper's first major work, A Physicall Directory (1649), was an English translation of the College of Physicians' Pharmacopeia, the Latin text that listed medicinal preparations that apothecaries could legally prepare. In theory, the College of Physicians oversaw all of medical practice, but in actuality, their reach far exceeded their grasp. However, when Culpeper translated their Latin Pharmacopeia into English, he made recondite knowledge open to all who could read. Worse yet, he accused physicians of prescribing fancy, expensive, imported medicines when local herbs, picked in a hedgerow or bought for tuppence, would serve as well.

Culpeper's The English Physitian, or an astrologo-physical discourse of the vulgar herbs of this nation (1652) solidified his reputation with the general public. Though the English Physitian was not the first herbal remedy book to be published in England, nor even the first to champion the use of English herbs for English ailments, its appeal has been lasting. Less scholarly and more accessible to general audiences than earlier herbals, it not only lists medicinal uses of hundreds of herbs, it also follows the format of popular medical books of the time by providing recipes for various syrups and concoctions to improve health, and by offering remarks on how astrology influences various herbs and their preparations. While the book lacked the woodcut illustrations that made its competitors much more expensive, Culpeper's radical language, offering remedies to anyone who could read his book, seems to have ensured the book's continuing popularity.

An equally popular work of Culpeper's was his Directory for Midwives: or, A guide for women, in their conception, bearing and suckling their children, published a year earlier than The English Physitian. Scholars speculate that Culpeper's grief over losing his children—only one of seven lived to adulthood—was his impetus for writing this work. It both recycled much of the knowledge that previously was to be gained from the authoritative obstetrical text prior to this time—Eucharius Roesslin's A Rosegarden for Pregnant Women and Midwives (published in German in 1513)—and made new claims for the importance of anatomy. The English midwifery text The Byrth of Mankynde (1540) is an English translation of a Latin edition of Roesslin's work. Five years later, Thomas Raynalde's edition of The Byrth of Mankynd included the frequently borrowed anatomical figures from Vesalius's influential work De Corporis Humani Fabrica (1543), although the text does not focus upon anatomical knowledge.

In contrast, Culpeper's A Directory for Midwives insists that midwives need to know anatomy; indeed, he belittles midwives trained by apprenticeship because they do not possess such knowledge. His text opens by discussing "the anatomy of the vessels of generation," by which he meant the male vessels of reproduction. This was not a trivial point, for it immediately distinguished him from traditional midwives, whose purview did not extend to male bodies. Culpeper continued with a discussion of "the formation of the child in the womb," and he repeatedly urged female midwives to gain exact knowledge of female reproductive anatomy in order to become proficient at their craft. The posthumous 1671 edition contains two foldout illustrations boundClick Here for a Larger View in the front. These did not appear in the first edition; in fact, the first edition had very few illustrations, remarkable for a text that emphasized anatomy over other ways of knowing. One of the two foldout illustrations in the 1671 Directory for Midwives includes images reminiscent of pre-Vesalian illustrations of women in childbirth—particularly an image of a fleshy fetus iClick Here for a Larger Viewn a tucked position with its hands wrapped around its knees. But a fetal skeleton and anatomical organs, with their parts clearly labeled, are also included. The second foldout illustration in A Directory for Midwives depicts a full-bodied fetus placed on the torso of a woman. The woman's legs are severed at the thighs, and she lacks a head and upper extremities; meanwhile, below the infant, the woman's reproductive tissues unfold like the petals of a flower. Similar to the first illustration, this one reveals a tension between earlier representations of childbirth, where exteriority and the fruitfulness of women are emphasized, and newer empirical representations, which focused on the dissection of internal reproductive organs and tissues. The 1671 edition thus carries forward Culpeper's polemical advocacy of the necessity of anatomical knowledge for midwives, while also drawing into the argument visual modes of representing anatomical knowledge.

Pamela Lieske
Kent State University, Trumbull

Mary Fissell
Johns Hopkins University

Suggested Reading

Fissell, Mary. "Making Bodies Speak: Prophets and Midwives." In Making Books into Bodies: Women and Popular Medicine in Early-Modern England. Forthcoming.

Tobyn, Graeme. Culpeper's Medicine: A Practice of Western Holistic Medicine. Shaftesbury: Element, 1997.

Wear, Andrew. Knowledge and Practice in English Medicine 1550-1680. Cambridge: Cambridge University Press, 2001.

On the Web

The English Physitian