Physickers are the “nobles” standing at the (social) apex of the “Healer” trades.
A Physicker is a Scholar character who has been through the education required of the Magister and has forged onward to earn a doctoral degree in the much more complex and difficult field of Physick [Medicine] – herbal cures, concocted medicines, and the process of healing and support therapy – at one of the various universities under the monopoly of the Church.
In game terms, the Physicker Trade is a module or skill set to be added onto that of the Magister, a continuation of that path. That is why it is titled “Physicker-Magister.” The notation “(PhD)” is a reminder of the fact that it represents further study and the receipt of a higher degree
Unlike the other “Healer” trades in the game, Physickers in the context of the game are diagnostician and clinician scholars. They study the texts and learn the indications revealing the various sorts of maladies to which people are prone and the various sorts of diseases which can lay them low or even kill them if not treated correctly and in timely fashion.
Physickers are theoreticians. The main focus of the Physicker’s skill is in diagnosis of illness. They are versed in the symptoms and sources of all known afflictions and all of the time-tested and proven remedies and means of alleviating those symptoms and provide the Herbals and apothecaries with a brisk business through the remedies they prescribe.
Historically, the nature of the Physicker’s practice was almost entirely in theory, working with the mind, not so much the hands.
When the Plague hit Europe about 1348, the Physickers came under fire in the aftermath for the fact that they never even physically saw their patients. No matter how ineffectual, the Surgeons at least tried to do something.
While they are well versed in all of peoples’ little day-to-day complaints and their cures, Physickers are also schooled in the most dangerous, contagious, and debilitating diseases as well as the symptoms and effects of certain poisons and drugs and the methods for combating them, far beyond the scope of the Herbal’s practice, regardless of the (temporary) relief the men of that art might be able to administer on their own.
While they do not generally study the art of the Herbal or Apothecary to learn how to make the various preparations they order for their patients, those fields of study are represented by their own degrees, which are also available if a player wishes to include them in building a Physicker character. They are, ultimately, considered somewhat beneath the Physicker’s dignity socially, however, should he decide to display that knowledge.
This knowledge doesn’t guarantee the character the ability to discern the nature of every illness he comes across, though. In order to aid sick, drugged, or poisoned patients, to guard their lives and ease their plights or relieve them of their maladies, the Physicker must make a successful diagnosis check on d100. To do this, he must have some evidence to go on, the patient himself to study, a residue of the tainted substance in a cup or dish, in the mouth, or the substance itself, or knowledge of where an illness was contracted, of what the patient was bitten by, the tainted weapon the patient was struck by.
The Physicker must have a very skilled and observant assistant (Barber or Surgeon or both) as a go-between or visit the patient personally, but for him to do so is considered putting his own health at risk and he is considered a public commodity, a bulwarkk of the public’s continued good health, so he is constantly counseled against taking such risks.
With a successful Asses/Diagnose check, the Physicker may proceed to administer curatives that effectively reduce the level of POT of any identified, known poison or drug or known illness in the body of a patient by (AWA att. mod.) + (TR), or maladies obviously related by nature to those known by up to [(AWA att. mod.) + (1 per 2 TR’s)], or unknown, foreign afflictions or poisons by [(AWA att. mod.) + (1 per 4 TR’s)].
The Physicker may never reduce the level of POT of any malady, poison, or drug below one (1), that is, he cannot eliminate it entirely. The patient’s body must still deal with the threat, it must still run its course, though at 1 the patient will likely get over it quickly. The advantages of the Physicker’s ministrations will be felt by the patient as soon as he begins to administer treatment. When treating a malady, poison, or drug, the Physicker will be unable to raise the patient’s effective CND, as the skills of a healer will for healing wounds and broken bones, though if the patient has suffered loss or injury to bodily faculties of some sort due to the malady, drug, or poison the Physicker may start therapeutic treatments after the influence has passed through the system and aid the patient’s recovery from those effects, for which the CND bonus due to his ministrations and herbal therapy may be applied.
The society of women is stringently maintained separate from that of the men in the period of the game. It is not considered meet or fit in the period of the game that any physicker [male] see a woman exposed, unclothed, as is often necessary to examine, diagnose, and/or treat the special complaints of women. A woman residing out in the countryside might visit a man engaged in Leechcraft, but only on a general or common complaint and he would never examine her bodily. A Midwife is a woman’s first choice for care. Only Midwives are allowed to be closeted with pregnant women to act as midwives.
Note that, while it is definitely possible for a woman to study the healing arts and become as knowledgeable and proficient as any man in the arts of physick, women are barred from getting their education formally acknowledged due to the university ban on women. They may not attend university to receive such a doctoral degree.
Of all the health care practitioners, only the society of Physicians specifically proscribed women practitioners historically. Whether or not the GM follows this practice in his game world requires a judgement call on his part.
IF the GM follows the historic standard, the player of the female character might be made a Midwife-Physic or Obstetrix, or Barber-Physic. Reputation for knowledge and efficacious treatments are more important, in the long run, than the sheepskin (PhD).
Trust and reputation are vital to the practice of ALL of the Healer trades. A solid reputation can take years to establish, but can be brought crashing down by a single disgruntled client if he has enough social clout, or by his family in the event of a death. In this regard, even the lofty Phhysicker remains vulnerable.
The GM is advised to consider allowing this liberal (for the period) attitude to be general throughout the land. Of all the healthcare practitioners noted in the historical record, women seem to have been most common as Barbers. No doubt the numbers of Midwives was at least as great but occasioned less note.
You must determine how the situation on this matter stands in your game world.
This in NO way bars women from being Barbers or Surgeons to start with or extending their skills later to become such with further training, or from taking education to gain the skills of a Physicker by apprenticeship to a Master willing to teach her privately, as opposed to trying to go to university for it. MANY nunneries in the period of the game offered education in physick the equal of any university, the women trained by them simply lacked the resulting diploma. The nunnery school could just as easily provide a Physicker-trained woman with potent bona fides, widely accepted expecially among the society of women.
The Physicker’s education includes extensive training in anatomy and physiology, identifying broken bones, strains and sprains, and the uses of surgery (NOT the actual skills of Surgery). The Physicker also learns the theory of field medicine, cleaning, closing, and binding wounds and setting broken bones, binding and isolating strains and sprains and manipulating dislocated joints back into place. Here again, these are not skills the Physicker practices by his own hand, only things know about so they can prescribe treatment, especially informing them when they should refer and even defer to the specialists who can best serve the needs of the patient.
All Physickers are familiar with the uses of the Barbers’ and Surgeons’ arts but, here again, the Physicker has no actual skill himself in that department, and must call in a surgeon for his patients when their services are needed, unless the player takes care to make sure he is equipped with the Surgeons’ Trade, too. Even if he should have the Surgeon skills, the character who has obtained the Physicker’s status will scandalize his colleagues if he should continue to practice surgery in person. It is beneath his dignity. The Surgeon is everywhere considered to be the social inferior of the highly educated Physicker. Assisting and observing the surgeons he calls in may enable him to maintain that skill at its current SL, however (GM’s discretion).
Training for a degree in Physic includes extensive education in the whole gamut of herbs known [empirically] to be of medical use. Their studies in the substances handled by Apothecaries and the plant remedies of the Herbals are the cornerstones of the cures they dispense. The Physicker’s knowledge of herbs encompass herbs of all climatic region, regardless of the specific habitat in which they grow, irrespective of the boundaries of feofs and nations. If the local Herbal tells the Physicker he doesn’t know of an herb, the Physicker can inquire with Herbals who are merchants, who can send inquiries to their agents in other regions to locate what he needs when the curative he requires is particularly difficult to find or grows only in some other region or even climate.
The Physicker’s knowledge of herbs gives him the ability to prescribe readily and accurately and to administer correct dosages of any herbal preparation, it does not include the skill of making any herbal preparation beyond the most simple by his own hand. The Physicker’s knowledge of healing herbs is almost as extensive as any trade Herbal’s, but it is restricted to those with medicinal uses only, not to those that should be avoided/whose effects are deleterious to the body, nor those which are specifically poisonous, though many of those with which they are familiar may certainly be dangerous in certain doses or applications, or to those who are otherwise healthy, and he is certainly aware of those. Those that have other uses, whether domestically, especially for cooking, or industrially, are the province solely of the Herbal. The physician also lacks the knowledge of how to identify herbs live in situ in the wild, where or what time of year is best to pick them, or how to prepare them to put them up and store them while still preserving their medicinal virtues. These all lie solely within the trade knowledge of the Herbal.
Unlike the Herbal, the Physicker has no opportunity to learn the Forage sub-skill, but is forced to administer his herbs pre-prepared from his kit, or give/send the patient’s attendant/primary caregiver a prescription to be taken down to the local Apothecary or Herbal to be filled.
Physickers in Society
The Physicker’s trade provides a real social advantage in the prestige of the university certification (degree), a sealed document on parchment that allows him to work in any city or town, to work for the nobility and municipal bodies, and to command the highest fees for his services.
Physickers jealously guard their knowledge, rank and privilege, and the wealthy patrons from whom they receive it. It is those wealthy patrons that protect them from those who would trample on their prerogatives, and that safety most commonly kills any interest they might have in forming a guild. Historically, since they were allowed “benefit of clergy” before the law, the Church was (essentially) thei Physickers’ “guild.” Between these two facts, no other more formal organization was needed.
When there was pressure among the commons, the barbers and Midwives, leeches and herbals, to organize in guilds for their protection and regulation, the healers at the top of the ladder failed to support them. In the period, the Physickers stood aloof through most of the history of the forming of the guilds of Barbers, and from all of the bickering and protestations of those of the Healer trades beneath them that accompanied it. Their own needs were already addressed.
The GM is certainly free to institute guilds for the common healer trades. Their victory in negotiating with the crown might even require Physickers to join those guilds – OR it might expressly bar them from participating in them, or stipulate that they lose all benefitt of clergy by joining them (GM’s discretion)
As a highly educated and paid professional, the Physicker is also responsible for public health, regardless of whether the locale in which he is located retains a Physicker specifically for that purpose or not. He must report cases of contagion and deadly disease and isolate them, report dangerous contaminants when he finds them leaking into the public water supply or contaminating the earth, and so forth, to the authorities if they retain no specific Physicker to look after the public health, or to the local Physicker retained for that purpose when there is one. This is his special bailiwick or responsibility, above and beyond the other practitioners of “Healer” trades.
Being a Physician is a very prominent social position in the period of the game, marked by a particular form of dress and definite expectations in regards to manner.
“In clothes and other apparel he should be honest, and not liken himself in apparel and bearing to minstrels, but in clothing and bearing he should show the manner of clerks. For why? It seems that any discreet man clad in clerks’ garb may occupy the boards of gentlemen. And be he courteous at the lord’s table, and be he not displeasing in words or deeds to the guests near by, hear he many things but let him speak few …. And when he should speak, let the words be short, and as far as possible, fair and reasonable and without swearing. Beware that there never be found double words in his mouth for then none will believe him.”
“[He] should be well-mannered, bold in many ways, fearful of dangers, that he should abhor the false cures or practices. He should be affable to the sick, kindhearted to his colleagues, wise in his prognostications. He should be chaste, sober, compassionate, and merciful; he should not be covetous, grasping in money matters, and then he will receive a salary commensurate with his labors, the financial ability of the treatment, and his own dignity.”
The customary dress of his trade consists of robes of purple with scarlet gloves, and perhaps a scarlet biretta (scarlet being among the most expensive of dyes).
The Physician’s prestige is based on his extensive and esteemed university education, but for some on the clerical status, also.
Only 5% of cleric-scholars historically are recorded to have been Physicians, however.
Less than half of the Physickers trained at university ever took anything more than minor orders. Less than 1% of practicing Physickers on record were clerics in orders. Of those, about 60% took higher orders. Of these only about 10% owned books, of whom only 5% owned 2 books, 3% owned 3 books, and only 2% owned 4 books or more.
Yes, books were THAT precious, historically. I think making these facts true also in the medieval fantasy game world changes the light in which they are viewed. Suddenly they become VERY valuable for the purposes of collecting booty and negotiating ransoms.
Along with their esteemed colleagues the Apothecaries, Physicians are most common among those employed for service at the royal court, and considered quite influential. They might trade in spices like an Apothecary, or play the real estate market like the nobles, most at least dabbled in land. Some gentry sons became Physicians, but not Surgeons, that was considered déclassé, a step down to a manual craft-trade, one tainted by blood at that. With the greatest amount of education (costing a pretty penny) and the highest social standing on receiving their doctorate, Physickers charge the highest fees.
Physickers or Physicians are by far the smallest in number among those who offer healthcare in the game world. In London in the period of the game, the proportion of Physicians to population was 400 : 1. Not a very good ratio for those in need, and one of the best ratios to be found in the cities of the period of the game.
The Physicker’s “Speculum”
Over the course of his studies, the Physicker is required to put Linguist, Literatus, and Scrivener skills to good use during the course of his education in keeping records of his lessons and lab work. By the time he completes his doctorate, he has also compiled a Speculum.
The Speculum is an encyclopædic overview, in this case of the Physicker’s art, knowledge and skills, a notebook that compiles lists and notes regarding all known maladies, afflictions, parasites, drugs, and poisons, their symptoms, origins/causes and currently practiced cures, including any applicable herb lore associated, as the international community of Physicians is familiar with it, their uses, with notes and diagrams of all the useful parts so the Physicker can confirm that what he ordered from the Herbal is indeed what was received.
This is a source book of trade knowledge kept on hand for general reference, containing knowledge to guide further exploration of the Physick, and to aid in managing and coordinating the lore he gathers as his skill and knowledge grow.
The main volume of the Physicker’s Speculum contains (AWA x 10) + [(TR) x (40 – AWA)] pages.
Over the course of time spent earning each TR, once brought into play, the Alchemist is assumed to accumulate an additional (40 – AWA) pages (on average) of scribbled notes, thoughts, insights, theories and discoveries to add to his Speculum.
IF the Alchemist has the Herbal and/or Apothecary Trade(s) and/or the Forage Life Skill, the player must add those TR’s and/or SL’s to his Alchemist TR for the initial volume in determining the number of pages and also to the SL’s of the individual Trade Skill specialties for each additional volume of his Speculum he must keep, for these broaden the depth of the Lore the Alchemist possesses regarding the secrets of the Trade and the individual Trade Skill fields of study.
Once brought into play, the Alchemist character is expected to continue to keep his Speculum after the fashion of a journal, recording his on-going work and researches, every project he has completed, his successes and failures, over the course of his career, used as a reference to consult as he formulates new projects, and to refresh his memory when he wishes to repeat old ones.
The character is responsible for maintaining all his Speculum volumes as he rises in TR and SL’s, so it’s important he makes sure the materials are kept on hand for maintaining these records, and that they are replenished when the increases in his SL’s indicate those materials have been depleted.
Since a Physicker doesn’t actually treat patients himself, but works through others, he can dictate treatments and monitor the conditions of as many as (AWA + TR) cases at once.
While they are well-versed in the all aspects and procedures of support therapy and its great value to the patients, it is practiced best by Leeches and Midwives, Barbers to a lesser extent.
Physickers are familiar with such services by description, but they have no training in winding bandages, in applying dressings or removing them, in bed-side manner, in actually physically caring for the sick or infirm. Those retained in court appointments may be found providing personal attention for the cream of the nobility and the royal family as called upon, but directing servants in all efforts at support therapy services. This allows them to maintain their reputation and dignity.
The three main functions of the Physicker are his ability to Assess/Diagnose either by examination and description, preferably by another “Healer,” or by personal observation and examination, Prescription of treatment, and Assess/Prognosis of the course an ailment is most likely to take, based on current condition and all available information concerning the patient, including recent activities and health history. The first two of these are the most frequently tested skills. The last may get just as much, use, but when the prognosis is bad it is rarely revealed.
These are considered the (sub-skills) of the trade.
The AV’s for all of these are based on the Physicker’s AWA.
All Physickers are granted Herb Lore at a SL equal to their Physicker TR’s at the start of play. If the character has it from another Trade, then a bonus is added according to the rules for SL bonuses for repeated skills. Once brought into play, its SL rises in response to use, normally.
The DV’s for exercising their knowledge of the lesser healing arts are found in the notes for those lesser trades (Barber, Surgeon, Herbal, Midwife, Leech).
Diseases and all other maladies are rated in levels of effect called Potence (POT), like poisons, drugs, and all similar substances.
The DV’s for both diagnosing and prescribing treatment for illness’ are equal to the POT of the illness. Many of the diseases that haunt the people of the period of the game are likely to be familiar, but many of them no longer pose as dire a threat in the modern world as they do to the denizens of a medieval fantasy game world (see.
The breakdown of diseases and their symptoms, their level of effect or virulence, and their effects on the characters themselves in game terms can be found under the heading “The GM’s Toolbox”.
The DV for treating illness’, poisons, and victims of drugging is equal to their respective levels of POT.
The Healers in Society
& The Guilds of the Healers
Socially, Barbers are rated on an equal footing with Apothecaries, but in London, the Apothecaries were also part of the large and very powerful Grocers’ guild. Often very wealthy, they were very much merchants before doctors. The Physicians, impressed with the Surgeons’ skills and knowledge, associate with them freely. Thus, they enjoy the same level of patronage, and neither had any need of the protection afforded by the institution of a guild. On the other hand, both Physicians and Surgeons maintained exclusive fellowships of the trade, to patronize a given chapel, take care of the aged and infirm of the craft, the widows and orphans left behind, and perform such charitable works as they were able, after the custom of the period.
Surgeons can generally command better pay than Barbers and the other healers due to their greater training and experience. All Surgeons are adept at all the procedures of the Barber’s craft, except that it is a matter of pride in their extensive and specialized skill that Surgeons do not cut hair, give shaves, or deal with teeth, except in extreme cases where oral surgery is required to remove bad flesh. Those employers who are their social betters don’t often make that distinction, however, and they often called upon their private surgeons to perform the functions of a barber. When those employers keep them on retainer in their households, feeding and housing them and supporting their good names and reputations, the wise surgeon quietly and dutifully complies.
Being protected because of their use to the nobility, Surgeons never have a need of a guild proper to preserve their rights, but they do gather in fraternities, social groups usually patronizing a particular local church or chapel. These fraternities are just as exclusive as the guilds, without the political clout or standing before the law of a guild.
Some of the Surgeons of the London Fellowship had university education. All could read, and many wrote practical treatises. Some were among the most distinguished doctors of their time (skills and royal patronage resulting from their service in the 100 years’ war, as noted).
As far as public trade, female Barbers or Midwives cannot practice their craft on any but other women for profit. This does not bar them from acts of charity, though propriety must be observed. It is not considered fit that any man should see a woman naked even for the cause of her health, especially if she be married, so the women must provide for their own care and the men make all the relevant medical texts available for their use. This does not mean that they will tolerate the competition in the workplace, however, when it comes to treating men or children. While their skills certainly allow them to treat men and children, if their male competitors find out they are profiting from those patients, they are likely to get hauled up before the municipal authorities, unless the goodwife practices her craft in the country, beyond the jurisdiction of any guild or municipal authority.
There is an ancient taboo attached to Trades that shed blood. Butchers, executioners, Barbers and Surgeons weren’t just craftsmen, but were men of crafts considered to be “tainted” by blood. For the purposes of the game, there will be no moratorium on the cutting up of cadavers, however, so knowledge of anatomy will be rival that achieved during the Renaissance.
The overwhelming majority of healthcare practitioners will be Barbers, especially in the shire towns. Their majority rules the craft. The tests required by the Barber’s guild in London became general throughout the realm after the advent of the Plague, however, with the proliferation of quacks and charlatans preying on the misery of the people. The testing reduced the number of practitioners and restored the trade to profitability.
For the purposes of the game, it is likely that no such general calamity need be necessary for the tests to have been made general for the weal and good health of the subjects of every realm in the Demesne of the Light.
Since the Surgeons are a craft and not a product of university training governed by the Church, for the purposes of the game, there is no moratorium on the dissection of cadavers assumed by the interference of the Church in the Surgeons’ craft, so the level of knowledge and skill available in RoM game worlds are actually more on a par with the achievements of the Renaissance, much more safe and effective.
We are also proposing that what was true in London be made true in general for game purposes. The Surgeons’ skill and knowledge of anatomy was a far cry greater than the general run of Barbers. Outside the city, however, it was all too often true that the Barber and Surgeon were on equal footing.
Historically, the Barber-surgeons eventually rivaled the true Surgeons in skill due to a lack of wars in which to learn their craft, and so were united with their rivals by an act of Parliament in 1540.
Printing brought proliferation of succinct, common language how-to books to the hands of the general public, simplified translations and the “mysteries” revealed to be complete hokum.
You must decide how much technology and of what sorts you allow in your (essentially) perpetually medieval game world. If only for the capabilities of magick to fulfill the same role, books of all sorts should be much more readily available, though the price won’t be any lower if produced by magick than for a hand-scribed copy. The prices of books remain elevated. Only the mechanical press was able to put easy multiple copies in the hands of the people quickly, historically, and with minimal cost.
The Sunday work issue was a perennial one for the Barber Trade, as their services always in demand. In 1445, Barbers along with blacksmiths were finally required by statute to offer their services EVERY day, with no provision for Sabbath observation.
Due to the obvious need and the lack of interference in most worldly matters by the Church of the Light in the game worlds of RoM (in contrast to the historic medieval Church), the dispensation from observance of the Sabbath for the care of the sick and injured on Sundays could be general and long established in the era of your game world in which your game takes place.
Historically, when the king traveled, especially on campaign, Surgeons and Barbers figure most prominently for healthcare services, although there are always a Physician and/or Apothecary or two, also.
The Plantagenets had military Surgeons that went with them on campaign, but they never brought them to court. Henry III instituted the post of Chief Surgeon in the royal party 1233-54. This, when the norm was to travel with a Physician and an Apothecary, as mentioned.
The great esteem in which the Surgeons were held in medieval England stemmed largely from their extensive experience with tending the wounded during the 100 years’ war across the Channel with France. Battle provides all the bodies needed to truly learn the craft. By 1350, English Surgeons were the best in all of Europe.
Henry VIII kept mostly Italians as Surgeons trained in universities practicing a new surgery resulting from more accurate appraisals of anatomy and physiology, and integrated with physic. These were the best to be found in the Renaissance.
Many Barbers could be found in the Goldsmith’s guild doing dental work in gold and silver. This avenue will be open to the Barber character if he is also equipped with the Gold-Smith Trade. The Surgeons had the same association with the Gold-Smiths. In the 1380’s, the Bradmores were famous as makers of surgical instruments, hence also Smiths. Surgeon-Smiths often held positions in the royal mint, and were usually members of the Goldsmith’s guild.
The Barbers were prominent in Bristol politics, taking a major part in the Corpus Christi plays, as opposed to London where they merely held the watch at Newgate.
Guild regulations in Bristol were much more concerned with medical practice, more like the guild in London – including dentistry, bone setting, sale of medicines, and the usual cupping and leeching. The Barbers had their social substructure of fraternities and charities, like any other guild, as well.
Most guilds are administration-oriented, all about preserving the status quo and the monopoly held by the masters. The London guild was somewhat more concerned with training and regulation, historically, but also with innovation, unlike most other guilds elsewhere. In the same vein, the guild book of the Barber-Surgeons of York served as a sort of Communal reference for the craft, in addition to containing most of the records of the guild. Over time it became not just one book, but an entire library. New blank pages were always available for recording new members as well as new knowledge and techniques, “mysteries” of the craft. This practice is assumed to be the general practice among the craft guilds of the worlds of RoM. The guild chapter in each town will keep its own records and its members will constantly seek to improve the extent of its library.
This practice tends to sharpen the competition between the guild chapters in different towns, making them unlikely to share knowledge but use it instead as leverage for politicking between chapters, to increase reputation and prestige as a means of attracting new members, business, and patronage. This also gives the guild-member PC’s a great way to benefit their guild and make a name among their peers. It is also a great hinge-pin for a number of different sorts of adventures in which guild-member PC’s might get involved, dragging their comrades along.
1370, The Barber’s Hall in London noted as having a library. 1376, books appear in Barbers’ wills bequeathed to other Barbers or to their guild library.
1400, public lectures on surgery and anatomy were held by the guild.
Though in the great minority among healthcare practitioners in the period of the game, “a sophisticated kind of physic was taught and practiced” at the nunneries”. This was a charitable service provided for travelers and the indigent in need.
Everyone, it seems, wanted in on the trade in surgery, it seems, if they had the slightest chance at encroaching on the Trade. In 1430, wax-makers petitioned to practice surgery, too, by virtue of the fact that they “like Barbers, used wax for embalming” – so Barbers were doing embalming as well. The Barbers had the wax-makers tested before the Mayor according to the guild rules, the wax-makers failed and their request was quashed.
In 1258, the long robes denoting the rank of Barber-Surgeon were instituted. Apprenticeships were made mandatory at 7 years in duration, up to 10 years if the master deemed fit, and the limit set on the number of apprentices a Barber could take on at 4 or 5.
The concentration of those providing healthcare services varied greatly, but their numbers always seem to be spread very thin. Norwich, had a population of c. 10,000 in 1300 when they had somewhere between 12 and 20 masters. That is roughly a 650 : 1 ratio of citizens to Barbers. They enjoyed a much greater pattern of continuity of the Trade in the family line there, also, with almost 1/10th followed by either sons or daughters. The ratio of patients to Barbers in Coventry was much better at c. 200 : 1. They had 20-30 active Barbers in a town of roughly 6,500.
John Harrow was a surgeon in royal service; made Chief of Surgeons twice during the French campaigns; was a member of the Fishmonger’s Company (as such, a Merchant also); financier; was made a judge in malpractice cases and a Searcher for the Port of London (worth £10/yr in income); he accumulated extensive properties.
Thomas Morstede, Esq. was court Surgeon, made a Searcher for the Port of London for 25 years (worth £10/yr in income); was twice made the Chief of Surgeons during the French campaigns; a war hero; a teacher and famous author (a fair book of Surgery, used as a standard text thru the 15th century). He was the driving force behind the foundation of a college of medicine. He had £154 in land and £200 in debts receivable at his death.
Margery Cobbe of Devon used her Leechcraft in the service of Elizabeth, wife of Edward IV, for which she received a pension of £10 a year – the same amount given to royal physicians.
John Crophill of Essex was a well-educated but self-made man, primarily a bailiff on the manor of Wix Priory for 30 years, an ale-conner, and “doctor”, he was literate so the various texts on medicine were available to him, and saw patients on more than 12 vills scattered across southern Suffolkshire and northern Essexshire. He practiced Leechcraft for more than 20 regular patients, including local gentleman and their wives, with fees ranging from 12d. to 2s. His position as bailiff allowed him to buy some medicaments at wholesale rates. All told, a comfortable living.
Master William was a “sergeant surgeon” in royal service and a cleric in minor orders. He received £10 a year, equal in honor to a royal physician. At his demise, he owned a house and 13 shops in London, and had an additional 50s. a year in income.
In 1251, Master William took on an assistant named Henry of Saxeby. Henry and his son, Nicholas, were gentlemen by birth. That same year, a Thomas of Weseham saved the life of the king.
In 1252, Thomas was invited to court and made the trip there.
In 1254, Thomas started serving with Master William and Henry.
In 1255, Master William died and Henry of Saxeby was made “sergeant surgeon”.
In the midst of the persecutions leading up to the expulsion of the Jews in 1290, Thomas Weseham used his position at court to buy up Jewish properties in Norwich, London, and Oxford at well below market value. He eventually received a number of annuities for his service, was knighted, and made both a royal Moneyer and a Forester.
It took 2 years after saving the king’s life for Thomas to be granted a position at court with Master William and Henry. It was common for such rewards to take a while to be decided on and then put in place. The GM should take note of this. The pace of life in an agrarian world in one based on the turning of seasons, not of minutes or “what have you done for me lately”.
William Hamon was prior of the Benedictine cell of Catges (Oxfordshire) and served as a royal surgeon from 1341-67, for which he was awarded a base salary of £30 a year.
Peter of Newcastle was surgeon to three kings, Edward I, II, and III.
In 1298, Peter’s own “personal valet” was also a surgeon, named John Marshal (very likely it was his apprentice, or a Journeyman he picked up to mentor). Peter was a merchant running a number of ships out of London, dealing regularly with the pepperer’s guild; he was commissioned to supply the royal court with medicines, in favor over the traditional appointment of a royal Apothecary. With his dealings with the pepperer’s guild, it is possible that Peter was actually an Apothecary and indeed a member of the pepperer’s guild, but he is not noted as such.
Despite the “taint” of blood, Philip of Beauvais, a “sergeant” Surgeon in 1304, became a wealthy courtier.
Roger Heyton served Edward III in the 1330’s and 1340’s, with an undersurgeon named Jordan of Canterbury. After the Battle of Crécy, Roger was considered indispensible and given a manor in Wales worth 50£ a year, and an annuity of £20, as well. Like Philip of Beauvais, he became a wealthy courtier.
This should give the player and GM alike some idea of what sorts of opportunities can be found for advancement in the healer-Trades.
The State of Medicine
in a Medieval Fantasy World
Historically, medieval medicine in Europe was a mixture of existing ideas from antiquity, spiritual influences such as the “shamanistic complex” and a “social consensus.” In this era, there was no tradition of scientific medicine, and even first-hand observations were always interpreted hand-in-hand with spiritual influences.
The underlying principle of medieval medicine was the theory of humours. This was derived from the ancient medical works, and dominated all western medicine up until the 19th century. The theory stated that within every individual there were four humours, or principal fluids – black bile, yellow bile, phlegm, and blood, these were produced by various organs in the body, and they had to be in balance for a person to remain healthy. Too much phlegm in the body, for example, caused lung problems; and the body tried to cough up the phlegm to restore a balance. The balance of humours in humans could be achieved by diet, medicines, and by “blood-letting”, using leeches (the origins of the term “Leechcraft” for country healers).
The four humours were also associated with the four seasons, black bile-autumn, yellow bile-summer, phlegm-winter and blood-spring.
Astrology and Astronomy are also closely allied with the healers’ trades. The signs of the zodiac are associated with certain humours through the elements by which they are divided, thus dovetailing with these beliefs perfectly. Even now, some still use words “choleric”, “sanguine”, “phlegmatic” and “melancholy” to describe personalities.
The use of herbs dovetailed naturally with this system as well, the success of herbal remedies being ascribed to their action upon the humours within the body according to the subject’s nature and health complaint. The use of herbs also drew upon the medieval doctrine of signatures which for the purposes of the game states that the Light has provided some form of alleviation for every ill, and that these things, be they animal, vegetable or mineral, carry a certain mark or “signature” upon them that provides an indication of their usefulness.
For example, the seeds of skullcap (used as a headache remedy) can appear to look like miniature skulls; and the white spotted leaves of Lungwort (used for tuberculosis) bear a similarity to the lungs of a diseased patient. A large number of such resemblances should exist in the context of the gameworld (GM’s discretion).
Most monasteries developed herb gardens for use in the production of herbal cures, and these remained a part of folk medicine, as well as being used by some professional physicians. Books of herbal remedies were produced, one of the most famous being the Welsh, Red Book of Hergest, dating from around 1400.
Due to the plethora of additional information available to the denizens of the RoM gameworlds in regards to the body structures due to the availability of cadavers to dissect with no Church-declared moratorium to forbid it, and the availability of magick to read the state and needs of the body, and herbals with magick to read the plants for their true virtues so that the curative properties are guaranteed to be true, along with a much more practical and empirical approach, medicine and the qualities of cures available in the gameworld will easily be as effective as modern medicine – perhaps even moreso, if fact, due to the additional information from Spirit and magick which the healers are not so foolish as to ignore.
Galen of Pergamum, also a Greek, was the most important physician of this period and is second only to Hippocrates in the medical history of antiquity. In view of his undisputed authority over medicine in the Middle Ages, his principal doctrines require some elaboration. Galen described the four classic symptoms of inflammation (redness, pain, heat, and swelling) and added much to the knowledge of infectious disease and pharmacology.
Starting in the areas least affected by the disruption of the fall of the Roman Empire, a unified theory of medicine develop, based largely on the writings of the Greek physicians on physiology, hygiene, dietetics, pathology, and pharmacology. From his dissections, he described the heart valves and determined the purpose of the bladder and kidneys. Galen’s most important work, however, was in the field of the form and function of muscles and the function of the areas of the spinal cord, credited with the discovery of how the spinal cord controls the contraction of various muscles.
The Italian physician Girolamo Fracastoro, 1478 – 1553, was the first to propose that epidemic diseases might be caused by objects outside the body that could be transmitted by direct or indirect contact. This is already well understood by those of a medieval gameworld where there is magick to discover such influences in the body and trace them back to their sources by the principle of (spiritual ) contagion and the Law of Resonance.
Much later, in 1628, William Harvey explained the circulation of blood through the body in veins and arteries. It was previously thought that blood was the product of food and was absorbed by muscle tissue.
In the gameworld this mistake could never be made; they understand the need for food to supply energy and nutrients to make blood, and the importance of certain iron-bearing plants like spinach in the diet to aid that process, and also the fact that blood DOES carry the pneuma, or life spirit, as the famous Greek healer Galen stated, but further, that it circulates through the body bringing life, nutrients, energy to all body systems and aiding in repairing damage and building a healthy body, as well as the removal of metabolic waste and toxins from the body.
Contrary to popular belief, bathing and sanitation were NOT lost in Europe with the collapse of the Roman Empire. Bathing did not fall out of fashion in Europe until shortly after the Renaissance, when it was replaced by the heavy use of sweat-bathing and perfumes. This was due to the fact that it was thought in Europe that water could carry disease into the body through the skin. Considering the effects of run-off from fields where animals grazed and relieved themselves into the local water systems. and the fact that the diseases from the waste of those animals could enter the body through any scratch or other innocent perforation of the skin, they were not all that wrong.
Medieval Church authorities believed that public bathing created an environment open to immorality and disease, but the value of cleanliness to general health and the peoples’ insistence on maintaining such personal standards will far outweigh any opposition the Church might mount, especially with the medical community coming down on the side of cleanliness and public health.
The French army doctor Ambroise Paré, born in 1510, revived the ancient Greek method of tying off blood vessels. After amputation the common procedure was to cauterize the open end of the amputated appendage to stop the hemorrhaging. This was done by heating oil, water, or metal and touching it to the wound to seal off the blood vessels. Pare also believed in dressing wounds with clean bandages and ointments, including one he made himself composed of eggs, oil of roses, and turpentine. He was the first to design artificial hands and limbs for patients who had had amputations. On one of the artificial hands, the two pairs of fingers could be moved for simple grabbing and releasing tasks, and the hand looked perfectly natural underneath a glove.
All of these advances in medicine, which took hundreds of years to accumulate after the High Middle Ages, could easily have already accumulated towards the basic store of medical knowledge in what is essentially a perpetually medieval world.
While all these advances in medicine are basically physical and structural in nature and concern, it should NOT be assumed that the effects of spiritual influences will have been ignored. Galen also excelled in diagnosis and prognosis. The importance of Galen’s work cannot be overestimated, for through his writings knowledge of Greek medicine was subsequently transmitted to the Western world by the Arabs.
Illness is widely acknowledged in the worlds of RoM to stem from a spiritual imbalance, the root of the word disease being “dis-ease”, perhaps some extreme burden of stress or emotion. On rare occasions in the game world illness can even result from impiety or failure of faith commonly addressed by the practice of penance and pilgrimage as a means of curing illness, when the nature of the illness allows. Many monastic orders, particularly the Benedictine monks, considered the care of the sick as their chief work of mercy (opus Dei).
On the other hand, those that are caused by airborne objects could well be shepherded by evil spirits to oppress the people and afflict them, or such spirits may from time to time make sure that those illness-causing objects that are passed from one to another by a vector like a handshake, or the handle of a tool or a door, window shutter or cupboard remains viable to affect as many people as the spirit can contrive. A preponderance of Vice on one’s soul can make one susceptible to the depredations of such evil spirits.
During the High Middle Ages and through the Renaissance, trade routes were the perfect means of transportation for disease. Eight hundred years after the Byzantine plague of Justinian, the bubonic plague returned to Europe. Starting in Asia, the Plague, also called the “Black Death”, reached the Mediterranean and western Europe in 1348, killing 25 million Europeans in six years. This was roughly 1/3rd of the total population, and in the worst-affected urban areas up to 2/3rd’s. Of course, the preceding 6 years of famine specifically in England didn’t help matters there at all when the Plague arrived.
Before the Mongols left the city of Kaffa they besieged in the Crimea, the dead or dying bodies of the plague-infected soldiers were loaded onto catapults and launched over city’s walls to spread the infection to those inside. This incident was among the earliest known examples of biological warfare and is credited as being the source of the spread of the Black Death into Europe.
While such virulent disease would be devastating even in the game world, with the knowledge of healing gathered and maintained with the aid of magick over the centuries, it is likely that it would not hit as hard as it did historically in those areas where the Herbals and Physicians were sufficiently represented. In addition, with magick to fall back on to supply The greatest danger would be in running out of the herbal cures and those needed to relieve the symptoms in the most densely populated areas, due to the high rate of infection.
Anglo-Saxon translations of classical works like Dioscorides Herbal survive from the 10th Century, showing the persistence of elements of classical medical knowledge. Compendiums like Bald’s Leechbook (circa 900), include citations from a variety of classical works alongside local folk remedies.
The revival of methodical medical instruction from standard texts in the west can be traced to the church-run Schola Medica Salertnitana in southern Italy in the 11th century. At Salerno, medical texts from Byzantium and the Arab world were readily available, translated from the Greek and Arabic at the nearby monastic centre of Monte Cassino. The Salernitan masters gradually established a canon of writings, known as the ars medicinæ or “art of medicine”, or articella, “little art”, which became the basis of European medical education for several centuries.
From the founding of the universities of Paris (c. 1150), Bologna (c. 1158), Oxford (c. 1167), Montpelier (c. 1181) and Padua (c. 1222), the initial work of Salerno was extended across Europe, and by the 13th century medical leadership had passed to these newer institutions. To qualify as a Doctor of Medicine took 10 years including original Liberal Arts training, and so the numbers of such fully qualified physicians remained comparatively small.