Doron medicum —the gift of medicine: How a rare 17th century medical translation positively impacted the community and predicted current analgesic techniques

Abstract

In 1683, a self-proclaimed apothecary physician and London professor of physick by the name of Guilelmus (William) Salmon authored a pharmacopoeia titled Doron medicum, the ‘gift of medicine’ (Greek/Latin translation). This text formulates an English supplement to the Latin Materia medica (16th century), discussing internal and external compound medicines of the late 17th century. This pharmacopoeia enabled those incapable of reading Latin to provide medical care to a challenging post-plague community. Opiology, mercury, dragon’s blood, willow bark, animal preparations and therapies now considered obscure, provide insight into therapies at the time. Early critical care treatments in haemorrhage control and pain management are described.

Doron medicum preceded the controversial opening by the College of Physicians of the first London Dispensary in 1698, and was published in a maturing period of medical governance and healthcare establishment in London. During the 17th century, great competition and debate existed between the Royal College of Physicians and the apothecaries. Throughout such debates, William Salmon advocated for access to medical care for the poor and recognition of an allied approach to healthcare.

This paper discusses Salmon’s contribution to medicine, which has been poorly transcribed in medical history. A selection of opiate-based analgesic therapies, early critical care strategies and animal preparations are revisited. A small chronicle of William Salmon’s life and professional achievements will be reviewed. Debate surrounding the opening of the first London Dispensary will be discussed in relation to William Salmon’s contribution, echoing ongoing contemporary challenges in healthcare over 300 years later.

Introduction

During the 17th century, following the foundation of the Worshipful Society of Apothecaries in London in 1617, great competition existed between the Royal College of Physicians and the apothecaries. ¹ This competition encouraged substantial debate about the logistics of opening the first London Dispensary by the College of Physicians and the subsequent provision of cheap medicines. ¹

In 1683, a self-proclaimed apothecary physician and London professor of physick by the name of Guilelmus (William) Salmon authored a pharmacopoeia titled Doron medicum, the ‘gift of medicine’ (Greek/Latin translation). Chronologically, this text followed from Salmon’s Latin to English translation (1678) of the fourth edition of the Royal College of Physicians’ London pharmacopoeia or dispensatory (1677), ² and as he states in the preface to the Doron medicum: ³

Doron Medicum: THE PREFACE.

I. IN Our Translation of the London Dispensatory, we did intend to Compleat that Book, with all such necessary Additions as the Modern way of Practising requires; but finding the Book to swell beyond its designed Limits; whereby, had I done, what I first designed, it would not only have been very Cumbersome, but also past the possibility of being bound up in one Volume, I was necessitated to cut off much of the matter; and so much the more, for as much, as that it was in great hast of coming forth, and designed to be Sold at an easy price.

II. But that the first Design should not totally fall to the ground, I have reduced the Surplus of what the former could not receive into the following Method; and in the two last Books, the Titles of the Chapters both in the Dispensatory, and in the Supplement Answer one another, the latter containing only what the former wants.

Salmon’s translation of the Royal College of Physicians’ Pharmacopoeia followed on from Nicholas Culpeper’s translation (published in 1649) of the second 1618 edition. ⁴ Neither of these translations were officially sanctioned by the Royal College of Physicians and were attempts by the authors to strengthen the power of the apothecaries. Culpeper in his introduction states:

I am confident there be those in this Nation that have wit enough to know that the Papists and the College of Physicians will not suffer Divinity and Physick to be printed in our mother tongue, both upon one and the same grounds, and both colour it over with the same excuses. ⁴

Salmon’s Doron medicum discusses internal and external compound medicines of the late 17th century, shedding light on therapies now considered obscure by contemporary comparison. ³ Opiology, mercury, dragon’s blood, man’s skull, unicorn’s horn and other fantastical ingredients provide insight into the medicines during this time. The principles of opiology are extensively discussed, documenting analgesics, dose–response trials and early pain management utilised during this period. ³

This Doron medicum preceded the controversial opening by the College of Physicians of the first London Dispensary in 1698, and was published in a maturing period of medical governance and healthcare establishment in London. Salmon was involved in these disputes between the physicians and apothecaries, and documented evidence exists portraying the rivalry between Salmon and the physicians. Although over 30 books were authored by Salmon and widely published, his documented contribution to medicine remains scarce among historical literature, with criticism remaining.

This paper aims to discuss William Salmon and his contribution to medicine during the 17th century. It also aims to revisit Doron medicum, a selection of opiate-based analgesic therapies, early critical care management and animal preparations from a time considered one of the largest scientific revolutions in history.

William Salmon

Salmon, a medical empiric, was born on 2 June 1644 and died in 1713. ⁵ Known as an apothecary physician or ‘professor of physick’, his will documents his title as a physician surgeon by the advanced stage of his career. ⁶ However, during the 17th century, occupation titles were not strictly governed and clinicians often portrayed themselves by many titles. ⁷ His enemies suggested he travelled with a mountebank (one who deceives others for money), dealing with his stock in trade. ⁸ Some suggested he worked as a ‘zany’, or assistant to a mountebank, performing hoop vaulting, tricks and sleight of hand. ⁸ However, a paucity of literature exists in support of these claims.

Although there is no evidence that Salmon undertook university medical education, this was not uncommon in the 17th century. ¹ During this time, it was acceptable to secure a practising licence through church or royal patronage. ¹ At the age of 27 (1671), he commenced practising physic in London for patients that may have been considered incurable and denied admission to St Bartholomew’s Hospital. ⁵ Eight years later he relocated to Red Balls Tavern in Salisbury Court, off Fleet Street. ⁵ Between 1684 and 1692, his practice moved to the Blue Balcony near Holborn Bridge. ⁵ Throughout his career, he published, translated and edited numerous medical, botanical, drawing, engraving, religion and physiognomy (how passions and emotions are racially represented in portraits) books. ⁵ Salmon published Botanologia in 1676, which continued to be referenced for over a century. ⁹ It was also popular in 18th century New York, suggesting his books were internationally distributed. ⁹

Doron medicum: ‘the gift of medicine’

Doron medicum (first edition 1683) was published by Dawks, Chiswell, Wotton and Conyers in London, grossing 250 pounds and selling for five shillings per book. ¹⁰ According to Salmon, Doron medicum (‘the gift of medicine’) translated the Materia medica from Latin to English with ‘all such necessary additions as the modern way of practicing requires’. ³ This translation enabled those not capable of reading Latin to provide medical care to the broader community.

The practice of opiology occupies a large volume of this text (chapter XXII, pp. 144–202), highlighting the extensive knowledge of opiates, their botany, preparation, pharmacology and early application in pain medicine. ³ An introduction to the general effects of opioids (pp. 144–168) is followed by many examples of specific compounding techniques (see Appendix 1). ³

The Oxford physician Thomas Willis, famous for the discovery of the circle of Willis, is credited and quoted in Salmon’s text for his description of opiate effects: ³

Before we come to the Exemplary part of compounding Opiates, (that this our Opiologia may be compleat) we shall shew you the Kinds, Natures, Qualities, and several Operations of Opium, both good and evil: and because that Famous and Learned Man, Dr. Willis, has exquisitely performed the same, we shall (ceasing at present our own Conceptions) give you here the Epitomy of what he has said concerning Opium in particular, and Opiatick Medicaments in general; but in a different Method. ³ pp. 144–145

8. Opiates as they are endowed with many great Vertues and excellent Properties, so also have they some evil ones, and oftentimes deadly effects. We have seen it by the sad experience of some, who have no sooner taken an Opiate, but they have fallen into a perpetual Sleep; and some, who by taking too great, or untimely a Dose, have rendered their Lives unhappy and unprofitable afterwards, by the hurt of the principal Faculties: Some by taking one Dose, have fallen into so profound a Sleep, that they could never be awakened. They have lived indeed 3 or 4 days, having their Pulse, Respiration and Heat well enough; yet not to be recalled to Sence and Waking, by any Medicines or Tortures: Some by taking it, have slept moderately, or almost nothing at all; yet not long after, have grown very bad, languished, drawn their breath very difficulty, their Pulse, natural Heat, and Strength of Body momentarily decaying, in such sort, as not to be restored by any Cordials; these lingering on by degrees lost their Lives. One by taking an Opiate, has presently fallen into his last and deadly Sleep, complaining of a great weight and coldness of his Stomach, by and by he was affected with a notable Languor, a sinking down of his Spirits, and a coldness of the extream parts; and within a few hours after, complaining of the dimness of his Sight, and then of quite Blindness, he streightway expired. The reason of this suddain destroying of Life is this, that the Narcotick Particles of the Opiate, do forthwith, and vehemently affect either the Cerebrum or Brain, or the Cerebellum, where, by oppressing the Animal Spirits, as well the outmost Spirits as the internal or inmost, they become greatly profligated and overthrown; where by their Forces, being altogether suppressed, then presently a deep Sleep, or an invincible Drowsiness and Stupefaction follows, which forthwith induces Death, the Pulse and Respiration being in a good state for some time. ³ pp. 150–151

Laudanum features extensively and the botanical knowledge, extraction techniques, methods of compounding and dose–response theories indicate that pain management and early analgesia were well established. ³ During this time, laudanum was widely employed for both analgesic and non-analgesic indications, including nephritis, gout, restlessness, heart failure, acute haemorrhage and hysteria. ³ There are over 250 different compounds mentioned for the treatment of painful conditions, which emphasises that attempts to alleviate pain have existed for a long time, and judging by the ingredients of many of the compounds, these were among the more successful therapies of the time.

Extensive knowledge of the many varieties of poppy were documented: ³

3. The red Erratick, or Corn Poppy has a great Hypnotick Quality, much greater than any of the former things, though far less more gentle, and more benign, than that of the white or Black Poppy; and therefore in some cases it is very needful and may be more secure in its use. ³ pp. 146–147

4. The White Garden Poppy is the next to be considered: From the Heads and Seeds of this Poppy is made Diacodium, both liquid, as in Syrups and solid, as in Tablets or Lozenges, and that according to the prescripts of many famous men. ³ p. 147

5. The Black Garden Poppy, is that of which our Opium is made, being a concentrated Juice flowing from the wounded Heads or Leaves of the said Poppy being ripe. ³ p. 148

In an early prediction of pharmacogenetics, Salmon theorises the various effects of opiates among different populations: ³

7. Now because the Animal Spirits may be of a differing texture in divers Bodies, therefore Opiates may work more strongly and virulently on some than on others. The Turks, who had an adult Blood, and in whom more fixt Spirits and less volatile are bred, eat Opium without hurt, or at least without danger of Life but the Europeans, who have more subtil and purer Spirits, can not do so. ³ p. 150

Early dose–response theories were discussed with the use of animal models:

7. Dogs will devour Opium in a great quantity, without Sleepiness or Death; but a small Dose of it will presently kill a Cat: for that the Spirits of this Creature are so very volatile and pure, that they cannot at all endure the Narcotick Sulphur. ³ p. 150

Early therapies in critical care include the prescription of laudanum and the essence of dragon’s blood for the management of haemorrhage. ³ Dragon’s blood is a potent, bright red latex obtained from the tree Croton lechleri. It contained taspine, now known to have regenerative, antiviral, antibacterial, antifungal and anti-ageing properties. ¹¹ When formulated, it carried a bright red appearance, perceptually similar to blood and dried forming a protective barrier on wounds. As a result, dragon’s blood found its administration in haemorrhage. There are many other compounds for alleviation of bleeding with a complex one specially for traumatic bleeding:

Decoctum Traumaticum nostrum, Our Diet for wounded people. It takes away all manner of Pain and soreness of Wounds, drives and casts out all filth, Splinters, and Pieces of Bones, and then heals in few daies, though the wound be dangerous. It cures all Fistula’s, inward and outward Sores, stanches inward bleeding, and cures the Kings-Evil to admiration. ³ p. 539

Other obscure therapies are outlined in Salmon’s chapter on animal preparations (pp. 304–315 and see Appendix 2). Peacock dung for the treatment of epilepsy or vertigo, peacock compounding and urine petrified in horse dung are discussed. ³ Peacocks were dissected and bruised, distilled to a dry matter and the volatile salt utilised for vertigo, falling sickness and diseases of the brain. ³ Prior to being established as a mythical creature, unicorn’s horns (now acknowledged as narwhal teeth), were thought to have healing powers and antidote properties in the 17th century. Pills of laudanum, unicorn’s horn, oil of a man’s skull and coral were recommended for epilepsy and vertigo. ³ Frog’s ashes were used for wound haemorrhage, scurvy and hair regrowth when applied topically. ³ The blood of a fit and healthy man (not of red hair!) was recommended for the treatment of frailty in the elderly, circulation derangements, all nervous system conditions and scurvy. ³

Mercury features frequently in Salmon’s medical texts.

‘Powerful in extirpating all obnoctious humors of the body. Cures perfectly a perepnumonia, empyema, pleurisy. Roots out the very essence of the pox, gout, scurvy, leprosy. Tincture used for ulcers of venereal disease’. ³

Over the years, Doron medicum became forgotten in historical literature and only criticism remained. Salmon’s preparations such as his ‘family pills’ were considered obscure and unusual, for which he was criticised. ¹² James Yonge wrote a literary attack in Sidrophel vapulans, claiming Salmon published unfounded treatments for many ailments, had a lack of medical training and only re-translated or published other people’s work, while selling it under his authorship. ¹² Salmon claimed editing the book for ‘ease of use’ and acknowledged employing the theories, compounds and preparations of others. ³

Medicine during the 17th century

In London, medicine was ungoverned, with great competition between the College of Physicians and the Worshipful Society of Apothecaries. ¹ The College of Physicians was founded by King Henry VIII by royal charter in 1518, while the Worshipful Society of Apothecaries of London was incorporated by royal charter in 1617 after splitting from the Grocer’s Company. ⁷

Albert Lyons described the 17th century as the age of the scientific revolution. ¹³ During the 17th century, a university medical qualification (Oxford or Cambridge) focused on the arts, with a strong emphasis on astrology, philosophy and religion. ¹ This remained the dominant form of medical education until the early 18th century. ¹ Practice was dominated by Galenism, the theory of balance and the four humours (blood, phlegm, yellow bile and black bile). ¹³ Aligned with Paracelsus’ (Philippus Aureolus Theophrastus Bombastus von Hohenheim, 1493–1541) influence, patient outcomes governed the use of new medications. ¹³ Paracelsus advocated the use of minerals such as silver and mercury, of which mercury was further encouraged by van Helmont (Jan Baptist van Helmont, 1580–1644). ¹³ Medicine was experimental and prescribed treatments were poorly governed, most considered obscure by current standards. Medical specialists were categorised: physicians treated internal ailments, barber-surgeons treated external ailments and apothecaries compounded medicines.

In the 1660s animosities increased between the physicians and the apothecaries with some acrimonious pamphlets published. The physicians requested a monopoly on practising physick, recommending against apothecaries providing medical treatment due to concerns about malpractice. ¹⁴ There were three major physician pamphlets with a reply from the apothecaries.^15–18 Salmon, while a doctor but not affiliated with either the College of Physicians or the Society of Apothecaries, weighed into these disputes which were largely about who would control the patient–medical contract. He sided with the apothecaries on behalf of the public interest.

Salmon responded to the physicians by stating,

‘They have learnedly abstracted the whole art and practice of physick to five things – the corte, steel, opium, mercurium dulcis and blood sucking’. ^{19 (p. 16)}

He suggested apothecaries had a greater understanding of compounding, botany and pharmacology. ¹⁹ He claimed that the medicines compounded by physicians in the Londonensis pharmacopoeia were unstable, requiring update to ensure medications would not spoil. ³ He claimed a good physician should be educated in physick, surgery, apothecary and have experience, for which he stated having over 30 years. ¹⁹ Salmon stated that the physicians wanted to, ‘monopolize all the practice of physick into their own hands’. ¹⁹ His commentary suggest that he advocated for other medical practitioners and surgeons, supporting a more multidisciplinary approach to healthcare.

The medical provision paradigm shifted during the Great Plague of London (1665–1666). ¹ Only the wealthy could afford to obtain medical care from physicians and the poor/middle-class subsequently sought the aid of apothecaries. ²⁰ As a result, a large majority of the poor demographic were affected. ¹ It has been suggested that many physicians left London during this time. ¹ Following the Great Plague, confidence in the apothecaries resulted in the poor/middle-class seeking their aid with great loyalty. ²⁰ At the restoration of the College of Physicians in 1678, apothecaries significantly outnumbered physicians practising in London, with no more than 80 physicians and about four times the number of apothecaries. ¹ Pirohakul and Wallis’s research into medical accounts from the 17th and 18th centuries suggested that apothecaries appeared in 69% of accounts seeking medical assistance, compared to physicians, who appeared in 35%. ⁷ This indicates that patients may have seen both specialists on some occasions, but that the majority had been seen by apothecaries. Apothecaries requested the sole ability to sell and compound medicines, which the physicians thought unacceptable. ¹

At the conclusion of the 17th century, Salmon was involved in the great dispute surrounding the opening of the first London Dispensary. Pertinent issues included clinical governance, access to medical care for the poor and institution of an allied healthcare system for apothecaries, surgeons and physicians. This dispute coincided with further establishment of medical governance from the Royal College of Physicians after King Henry VIII’s royal endorsement. ¹ During this time, a medical practitioner could practice illegally with little impunity due to a lack of enforcement by regulatory bodies. ²⁰

In ‘The State of Physick in London’ (1698), which the College of Physicians published,

It is very evident, that the excessive increase of his company (apothecaries) is more pernicious to the public, than that of any their tradesman whatsoever: Not only because their price of medicines, which at present is unreasonably great, must in the proportion to the growing of their number increase. Rates of their medicines, at their exorbitant price should make amends for their want of business so that none hardly but rich people can be at the expense, and great many poor people are for to die for want of physick. Medicines should be prepared at the College and given to the poor at prime cost. Members of the College, as many as pleased, should subscribe by ways of charity, ten pound a piece, towards burning and preparing those medicines. Physicians should attend, two of them at a time at The College every week, Wednesdays and Saturdays at three o’clock in the afternoon, to give advice. ¹⁴

In a literary counterattack, Salmon wrote, ‘A Rebuke to the Authors of A Blew-Book called The State of Physick in London’, in which he refers to the physicians and their treatment of the rich by stating,

Their chief care is, that these may be regulated the best way for the benefit of the rich. These are the only persons which can feed them liberally, and give them often and large fees.

If poor people have any money, they may have medicines of them for it, but if they have no money, positively, they must go without it, and this is without any circumlocution, is the downright sense of the matter. ¹⁹ p. 21

Salmon stated,

‘How are their medicines given to the poor, when they only sell them, and will let no body have them without money? Poor people have not moneys with them to buy bread, or other necessities’. ^{19 (p. 22)}

He also stated,

‘I give to all poor people, not only my advice gratis, but proper remedies or medicines for the cure of their distempers freely, and that without money or price’. ^{19 (p. 28)}

The apothecaries’ contribution to medicine broadened when their role took on that of general practice, landmarked by the Rose case (1701–1704). ²¹ This case involved John Seale, a poor butcher, who claimed treatments by William Rose (apothecary) made him ‘never the better but much worse’. ²² Court proceedings ruled in favour of the physicians; however, judgement was reversed when apothecaries applied for a Writ in Error in the House of Lords. ²² Parliament restricted apothecaries charging for their medical review, only for the medicines supplied. ²² This ruling established an apothecary with the right to practise physick in London, paving the way for their establishment of general practice medicine. ²²

Salmon’s contribution

Despite providing published support for the Society of Apothecaries during the dispute, there is no evidence that Salmon was a member of said society or received any qualification from their hall. In addition, he is not listed as being registered with the Royal College of Physicians. Although he translated into English the fourth edition of the London pharmacopoeia, there does not appear to be any evidence that Salmon was associated with the development of this 1677 edition of the London pharmacopoeia in Latin, which in effect was virtually a reprint of the third edition of 1650 ‘with a few additional formulae’. ²³

His translation in 1678²⁴ appears to have been motivated in a similar manner to the translation of the second edition of 1618 by Nicolas Culpeper published in 1649, ⁴ which was to make the original publication in Latin available to a wider public, and which as Culpeper stated was ‘Translated into English for the public Good; And fitted to the whole ART of Healing’.

Both these translations into English were opposed by many of the college physicians of the time. A subsidiary reason may have been to allow apothecaries to make up ‘compositions even if they did not fully understand the Latin of the pharmacopoeia’. Both Culpeper’s and Salmon’s translations angered the physicians because their remedies were now exposed to the apothecaries, and in fact the public. As the current Royal College of Physicians website states: ²⁵

The timing of the publication of the Pharmacopoeia was significant. In 1617 the king had created the Worshipful Society of Apothecaries. For the best part of a century since its foundation in 1518, the college had retained an element of control over the apothecaries through their regulatory powers. The college annals are full of accounts of apothecaries being fined or imprisoned. The college also had the power to inspect apothecary shops in London and to burn or destroy any drugs being sold which the physicians deemed unsuitable.

The creation of the Worshipful Society of Apothecaries dealt a significant blow to the college’s control of the apothecaries. Although the College retained the right to licence all apothecaries in London, they could no longer prevent them from practising medicine or limit them to only dispensing treatments that had been prescribed by a College physician. The Pharmacopoeia in Latin allowed the College to regain some of the control that was lost in 1617.

Subsequently in 1694 Salmon translated Pharmacopoeia Bateana or Bate’s dispensatory from Latin into English. ²⁶

King Henry VIII confirmed, by several acts of parliament in Chapter VIII (34 and 35 Henry VIII, c11), the ability of the Royal College of Physicians to govern practitioners not licenced by the College of Physicians or the church from practising medicine in London, or within seven miles around it. ²⁷ The Royal College of Physicians archives show a declaration by the president and College in an action of debt of £25 against William Salmon, being the fine amount for practising physick without a licence of the college (Easter term, 5 William III, 1693) (personal communication, Royal College of Physicians).

Salmon was accused of being a charlatan in light of his obscure therapies; however, the practice of evidence-based medicine was immature and most treatment at this time was experimental for all practitioners. Although referred to as a ‘quack’ by contemporaries, his literary success and participation in debate suggest Salmon was a learned man and advocate, with a great understanding of the medical system. Despite being criticised for his practice principles, medical society isolation and lack of medical education, Salmon’s numerous publications were widely employed in clinical practice and the preparation of medicine. ⁸ Unlike many contemporaneous medical authors, Salmon did not attempt to claim all that he was writing about as solely his ideas or practice, as he often quoted his contemporaries, crediting them with the ideas or the special knowledge.

It is evident that Salmon was a strong advocate for medical access equality and aid in poverty. His rebuke portrays a sound understanding of the financial requirements involved in the production and provisions of medication. ¹⁹ He had concerns regarding the plan proposed for the first dispensary, financial outlays and other logistics not yet accounted for by the physicians. ¹⁹ Medical equality, funding and supply is an ongoing challenge for healthcare systems, echoing what played out over 300 years ago in London. This debate also highlights advocacy in spite of poverty and equality for all patrons of varied socioeconomic status.

This paper discusses Doron medicum—a supplement to the new London Dispensary. Treatments of mercury, animal matter, man’s skull and dragon’s blood portray some of the obscure medications used by Salmon during this time. This work highlights early systemic therapies, botanical treatment of haemorrhage, and the strong understanding of pain management. Although often referred to as a ‘quack’, his literary publications and participation in debate supports consideration that Salmon was a learned man, and an advocate for allied specialists and equality for the poor. His literary counterattack suggests a sound understanding of the medical system at the time. By editing, translating and publishing broad texts of various disciplines, he provided access to a resource that could be widely employed by all. His influence towards resource provision and support of allied healthcare echoes contemporary challenges in medicine. Although much of the attention has been paid to the controversy and slandering between opponents during this time, the underlying issue of medical care, resource provision, aid for poverty and financial support for public health resonates.