In 1571, Joachim Camerarius offered Nuremberg’s city council what would become a blueprint of medical reform. His Short and Ordered Considerations for the Formation of a Well-Ordered Medicine arrived at an unmistakable diagnosis of the city’s medical practice: Nuremberg’s condition was bad. Fraudulent practitioners proliferated and bad medicine boomed. Camerarius proposed to establish a college where learned municipal physicians (Stadtärzte) could confer to regulate the city’s medical marketplace. It was a bold move. For he aspired nothing less than a new order of medicine in which all of Nuremberg’s medical practitioners – from apothecaries to midwives to barber-surgeons – were subordinated to its municipal physicians. By the end of the sixteenth century, as Hannah Murphy’s lively A New Order of Medicine demonstrates, this new order had become thoroughly naturalised.
Murphy tells this riveting story in six chapters and connects it to debates in the history of medicine, scholarship, and material texts, showing how the medical practice of Galenic physicians was deeply textual and allowed for much more experimentation than has hitherto been assumed and their professional stripes might suggest.
Chapter one examines Valerius Cordus’s Dispensatorium, the first official German pharmacopeia, and the ways in which paper technologies guided reform and regulation in Nuremberg. Focusing on the “civic life of recipes”, Murphy shows how Cordus’s Dispensatorium, a register for pharmaceutical remedies, quickly morphed into an instrument to regulate Nuremberg’s much-critiqued pharmacy. The Dispensatorium codified remedies and effectively limited apothecaries’ “expertise to written channels, to known ingredients, and to certain processes” (p. 39). Murphy’s decision to approach this largely unstudied pharmacopeia as “a social text” (p. 42) yields a rich picture of how “paper, politics, and medical practice would come to overlap both within and around physicians’ practices” (p. 17) – one of the central threads running through the book.
The demise of apothecaries, as chapter two illustrates, meant the rise of the physicians. Murphy shows how this was a drawn-out process deeply connected to civic governance: As physicians sought to insert themselves into the urban elite, they began to claim for themselves the role of advisor. Civic order, they argued, depended on good medicine; and since they were the guardians of proper medicine they merited a place in the city’s higher echelons. Establishing their position and authority was also contingent on marrying well. Required by oath to keep “house and heart” (p. 53) in the city, physicians looked for patrician women to set up their households and medical practice – and sometimes even a dynasty of medical practitioners. One of the great contributions of this chapter is its description of the relationship between medical authority and urban development: “[R]ather than medicine changing the city” – as one pervasive narrative of medicalisation and modernity would have it – Murphy shows how “it was through the city that physicians formulated their view of the emerging profession” and came “to see themselves as practicing and patrician, urban and urbane in turn” (p. 48).
Chapters three to five examine the learned practices of Nuremberg’s physicians. Murphy surveys their activities as anatomists, readers, and correspondents and demonstrates how their medical practice was deeply grounded in textual culture. Volcher Coiter, a university-educated and grave-robbing physician, not only turned to the body to gain knowledge but also relied on texts for his treatments. For Georg Palma, a Galenic physician whose substantial library Murphy describes in detail, reading recipes inflected his medical practice. It was through correspondence that Camerarius and others developed a community of likeminded individuals to discuss recipes and advance their botanical knowledge.
The final chapter returns to the attempt at medical reform. It traces the debates between the physicians and apothecaries about their respective positions in the medical marketplace. Although the latter were not willing to give up their privileges, they did in the end lose out. Nuremberg’s medical ordinance of 1592, effectively ratified much of what Camerarius had proposed in 1571. That physicians were so shockingly successful had everything to do, Murphy argues, with a burgeoning “intellectual sphere that was prompted by the problem of practice” (p. 170). What defined good medicine and how to practice it? For answers to this elusive question, Nuremberg’s city council turned to its physicians in whom they found trusted experts eager to establish their authority. But it was also a textual phenomenon. Murphy reminds us that “the process of reform” was ultimately “a process in which problems were written down” (p. 168) and codified in legislation.
Eclectic in its approach, A New Order of Medicine advances a number of exciting arguments. Nevertheless, at times, the book could have served the reader better had its overarching arguments been articulated more explicitly. Arguably its greatest contribution to the history of medicine, developed throughout the book, concerns the development of Galenic medicine. Nuremberg’s new order of medicine emerged, Murphy shows, from within Galenic medicine and not in opposition to it. Examining physicians at work reveals how the Galenic medicine that they embodied led to new forms of medical practices and new ways of making knowledge. But it did not, Murphy cautions us, preclude experimentation or empirical observation. One particularly powerful example of this tension concerns Coiter’s treatment of the Duke of Bavaria’s personal horse trainer. An early proponent of case studies, Coiter “won control over the patient as a result of his learned prowess (i.e., his knowledge of Galen) but that knowledge was ultimately not what he relied on when treating the patient” (p. 72). Medical practice, in other words, required forms of experimentation that went beyond what traditional Galenic medicine taught. Murphy thus rightly emphasises the importance of Galenic medicine for the “experimental, material, empirical approaches that underwrote the ‘new science’ of the seventeenth century” (p. 189).
Other aspects of the argumentation would have profited from deeper contextualisation. Murphy frequently contrasts Nuremberg with Italy but it never amounts to a full comparison. Neither does she fully engage with the literature that has recently emerged on the notion of expertise. This is particularly unfortunate since in this period medical professionals in Italy positioned themselves, in the words of Brad Bouley, “at the top of the evolving medical pyramid” not unlike their Nuremberg colleagues. These physicians aligned with the Catholic Church to have their authority bolstered and those of other practitioners – midwives, apothecaries, household healers – contested. If these two worlds are as different as Murphy suggests, how and why was the social ascent of the physician contingent on similar dynamics?
This reviewer also thought that the chapters on the Nuremberg physicians’ learned practices sometimes lacked specificity. Murphy’s description of Palma’s reading practices in chapter four, for instance, mentions Palma’s many books and notebooks but hardly engages with their content. As a consequence, the real relationship between reading medicine and practicing it remains rather general. The distinction Murphy makes in chapter five between Camerarius’s epistolary networks and larger Republic of Letters (pp. 129–130, 131) also feels forced. Neither is it immediately clear how – if at all – swapping botanical specimens and exchanging letters inflected the actual treatment of patients in Nuremberg. On a more critical note, there were quite a number of infelicitous errors in the transcriptions and translations of original sources which more rigorous scrutiny or copy-editing could have prevented.
Murphy’s descriptions of medicine as a material and tactile practice are beautifully crafted, and among the finest of the book. It is her attention to the nitty-gritty of the physician’s work – and to medical practice as involving “the hands and the book, the body and botany” (p. 173) and theory and practice – that ultimately makes A New Order of Medicine a rewarding read not only for historians of urban medicine but also for those of scholarship, science, and early modern textual culture.
 Bradford A. Bouley, Pious Postmortems: Anatomy, Sanctity, and the Catholic Church in Early Modern Europe, Philadelphia 2017, p. 4.