The Royal College of Physicians was founded in 1518 to regulate medical practice, and one of the key powers contained in its royal charter was the ability to grant licenses to practice medicine in London and its environs:
We [i.e. King Henry VIII] have also granted to the same President and College or Commonalty, and their successors, that no one in the said City [i.e. London], or for seven miles in circuit of the same, shall exercise the said faculty [i.e. medicine], unless he be admitted thereto by the said President and Commonalty, or their successors
Translation of Latin text from MS4917, Charter of incorporation of the College, 23 September 1518.
But how did the college actually decide who was qualified and sufficiently expert in the subject? What was on the medical syllabus before the 20th century?
The earliest surviving rules and syllabus for the RCP examinations come from the statutes of the college codified in and around 1555 by RCP president John Caius (pronounced ‘Keys’).
There were five sections in the exam:
- medical theory
- causes of disease, symptoms and diagnosis
- methods of treatment
- materia medica (substances used in medicines)
- the ‘use and practice of medicine’, which included the conditions under which patients should be purged or bled, the use of soporifics or narcotics, the positions of the internal organs, and the use and measuring of clysters (enemas).
The exams were led by the four censors of the college – fellows elected into the role and responsible for licensing and discipline – along with the college president. If the examiners already knew a candidate and believed him (the exams were only open to men) to be skilled and knowledgeable then he only needed to take the fifth section of the exam. Anyone else had to complete all five sections. The exam took place over several occasions at intervals of three months.
Each of the first four sections of the exam had set texts assigned to them. At each exam the censors would pick three passages from the texts and ask the candidate questions based on them. The candidate was then given copies of the relevant books (without an index in them) and had to find the correct places in the books and explain how they related to the questions.
The set texts all came from the works of the Roman medical author Galen (c.129–c.216) and are laid out in detail section-by-section in the statutes of the college: see the appendix to this post for the full list of 17 titles. It might seem like a pretty substantial list, but it’s only 17 out of the more than 120 works that have been attributed to Galen, whose works were the foundation of the medical curriculum for centuries.
Sadly, there are no copies of Galen’s works in the RCP Heritage Library today that we can identify as the exam copies: perhaps they were used to destruction by generations of nervous candidates and eventually fell apart. There are, however, multiple copies of Galen’s works, many of them annotated by readers in the 16th and 17th centuries, showing how heavily studied his writings were.