<SPAN name="startofbook"></SPAN>
<div id="if_i_000" class="figcenter" style="max-width: 37.5em;">
<ANTIMG src="images/i_000.jpg" width-obs="600" height-obs="391" alt="" />
<div class="caption floatc">THE CENTRE OF LONDON IN 1658, REPRODUCED FROM NEWCOURT’S MAP.</div>
<div class="caption floatr">[<i>Frontispiece.</i></div>
<div class="caption smaller hidepub"><SPAN href="images/i_000large.jpg">(<i>Larger</i>)</SPAN></div>
<div class="caption smaller hidev"><i>(A larger version of this map is available at Project Gutenberg)</i></div>
</div>
<h1 class="wspace"> <span class="gesperrt large">LONDON</span><br/> <br/> <span class="small">(Ancient and Modern)</span><br/> <br/> <i class="smaller">From the Sanitary and Medical<br/> Point of View.</i></h1>
<p class="p2 center vspace wspace"><span class="smaller">BY</span><br/>
<span class="large">G. V. POORE, M.D., F.R.C.P.</span></p>
<p class="p2 center large wspace vspace">CASSELL & COMPANY, <span class="smcap">Limited</span>:<br/>
<span class="small"><i>London, Paris, New York & Melbourne</i>.<br/>
1889.</span></p>
<hr />
<p><span class="pagenum"><SPAN name="Page_iii">iii</SPAN></span></p>
<h2><SPAN name="PREFACE"></SPAN>PREFACE.</h2></div>
<p>This little book is an expansion of two addresses delivered
in January, 1889.</p>
<p>One of these addresses, which deals with the Sanitary
Aspects of Ancient and Modern London, was given in
the Parkes Museum of the Sanitary Institute, and was
written for a mixed audience. The other formed the
subject of the annual address to the Students’ Medical
Society at University College, London, and was written
for an audience which might be expected to have a special
interest in the History of Medicine in London.</p>
<p>Both have already appeared in print; the first in
<cite>Public Health</cite>, the journal of the Society of Medical
Officers of Health; and the second in the <cite>Lancet</cite>.
For the loan of most of the woodcuts the author is
indebted to the Publishers of the <cite>Lancet</cite>, who kindly
undertook, when the lecture was appearing in their
columns, to illustrate it with five illustrations, which were
made especially for the purpose. One illustration has
been supplied by the proprietors of <cite>Public Health</cite>, and
four have been borrowed from “Cassell’s Old and New
London.”</p>
<hr />
<p><span class="pagenum"><SPAN name="Page_v">v</SPAN></span></p>
<h2><SPAN name="CONTENTS"></SPAN>CONTENTS.</h2></div>
<table id="toc" summary="Contents">
<tr>
<td class="tdc chap" colspan="2"><SPAN href="#CHAPTER_I">CHAPTER I.</SPAN></td></tr>
<tr>
<td class="tdc chapsub" colspan="2">LONDON FROM THE SANITARY POINT OF VIEW.</td></tr>
<tr class="small nopad">
<td> </td>
<td class="tdr">PAGE</td></tr>
<tr>
<td class="tdl"><span class="smcap">Situation</span></td>
<td class="tdr"><SPAN href="#hdr_1">7</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Water Supply</span></td>
<td class="tdr"><SPAN href="#hdr_2">10</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Mediæval London</span></td>
<td class="tdr"><SPAN href="#hdr_3">16</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Gardens and Pleasure Grounds</span></td>
<td class="tdr"><SPAN href="#hdr_4">18</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Health of Old London</span></td>
<td class="tdr"><SPAN href="#hdr_5">24</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The London “Death Rate”</span></td>
<td class="tdr"><SPAN href="#hdr_6">31</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Improved Condition of Modern London</span></td>
<td class="tdr"><SPAN href="#hdr_7">34</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">What is the Outlook?</span></td>
<td class="tdr"><SPAN href="#hdr_8">36</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Annual Death-Rate per 100,000 Living of Children under 5 Years of Age from Whooping-cough and Measles during the 10 Years 1871–80</span></td>
<td class="tdr"><SPAN href="#hdr_dr">41</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The Loose End of our Sanitation</span></td>
<td class="tdr"><SPAN href="#hdr_9">44</SPAN></td></tr>
<tr>
<td class="tdc chap" colspan="2"><SPAN href="#CHAPTER_II">CHAPTER II.</SPAN></td></tr>
<tr>
<td class="tdc chapsub" colspan="2">LONDON FROM THE MEDICAL POINT OF VIEW.</td></tr>
<tr>
<td class="tdl"><span class="smcap">Chaucer’s Doctor</span></td>
<td class="tdr"><SPAN href="#hdr_10">50</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Earliest London Practitioners</span></td>
<td class="tdr"><SPAN href="#hdr_11">53</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The Severance of Medicine and Surgery</span></td>
<td class="tdr"><SPAN href="#hdr_12">56</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The Earliest Medical Act</span></td>
<td class="tdr"><SPAN href="#hdr_13">59</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The College of Physicians</span></td>
<td class="tdr"><SPAN href="#hdr_14">60</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The Plague</span></td>
<td class="tdr"><SPAN href="#hdr_15">72</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Secret Remedies</span></td>
<td class="tdr"><SPAN href="#hdr_16">86</SPAN><span class="pagenum"><SPAN name="Page_vi">vi</SPAN></span></td></tr>
<tr>
<td class="tdl"><span class="smcap">The Crusade against Quackery</span></td>
<td class="tdr"><SPAN href="#hdr_17">89</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Medicine in the Days of Pepys</span></td>
<td class="tdr"><SPAN href="#hdr_18">92</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The Barber-Surgeons</span></td>
<td class="tdr"><SPAN href="#hdr_19">95</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The First Anatomy Lectures</span></td>
<td class="tdr"><SPAN href="#hdr_20">97</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The Apothecaries</span></td>
<td class="tdr"><SPAN href="#hdr_21">101</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The Royal Society</span></td>
<td class="tdr"><SPAN href="#hdr_22">101</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Gresham College</span></td>
<td class="tdr"><SPAN href="#hdr_23">103</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The Earliest Hospitals</span></td>
<td class="tdr"><SPAN href="#hdr_24">106</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The Royal Hospitals</span></td>
<td class="tdr"><SPAN href="#hdr_25">110</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Early Hospital Practice</span></td>
<td class="tdr"><SPAN href="#hdr_26">112</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The Pharmacopœias</span></td>
<td class="tdr"><SPAN href="#hdr_27">117</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">The Rise of the Medical Schools</span></td>
<td class="tdr"><SPAN href="#hdr_28">119</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Hospitals Built by Public Benevolence</span></td>
<td class="tdr"><SPAN href="#hdr_29">120</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">Modern Medical Schools and Examinations</span></td>
<td class="tdr"><SPAN href="#hdr_30">123</SPAN></td></tr>
<tr>
<td class="tdl"><span class="smcap">London as a Place of Study</span></td>
<td class="tdr"><SPAN href="#hdr_31">127</SPAN></td></tr>
</table>
<hr />
<p><span class="pagenum"><SPAN name="Page_7">7</SPAN></span></p>
<h2><span class="larger"><span class="gesperrt larger">LONDON</span><br/> <span class="subhead"><span class="small">(<i>Ancient and Modern</i>)</span><br/><br/> From the Sanitary and Medical Point of View.</span></span> </h2></div>
<hr class="narrow" />
<h2 class="nobreak p1 vspace"><SPAN name="CHAPTER_I"></SPAN>CHAPTER I.<br/> <span class="subhead">LONDON FROM THE SANITARY POINT OF VIEW.</span></h2>
<p>In considering the sanitary conditions of a great city like
London, it behoves us to remember that it has been a
place of importance since the days of the Roman occupation
of this country—that is, for some 1,500 years.</p>
<p>A place that has been peopled for centuries is very
apt, in the absence of special precautions, to become
unwholesome by reason of the vast accumulation of
refuse. Roman London is many yards beneath the surface
of the present City. It has been deeply buried, and
by what? By refuse and debris from every source; and
this in itself is necessarily a danger to health, and doubtless
has in times past greatly tended to produce many of
those diseases for which mediæval (and even modern)
London was noted.</p>
<h3 id="hdr_1">SITUATION.</h3>
<p>The situation of ancient London was most convenient
for commerce, and fairly good from a sanitary point of
view. The advantages of its situation have been dwelt
upon by many writers, and were well summed up by
Edward Chamberlayne, who thus speaks of it in his<span class="pagenum"><SPAN name="Page_8">8</SPAN></span>
“Present State of England” (1682), a work which was
analogous in many respects to the “Whitaker’s Almanack”
of the present day.</p>
<p>Chamberlayne says:—“In the most excellent situation
of London the profound wisdom of our ancestors
is very conspicuous and admirable. It is seated in a
pleasant evergreen valley, upon a gentle rising bank in
an excellent air, in a wholesome soil mixed with gravel
and sand upon the famous navigable river Thames, at a
place where it is cast into a crescent, that so each part of
the City might enjoy the benefit of the river, and yet not
be far distant one from the other; about sixty miles from
the sea; not so near, that it might be in danger of surprise
by the fleets of foreign enemies, or be annoyed by
the boisterous wind and unwholesome vapours of the sea;
yet not so far but that by the help of the tide every
twelve hours, ships of great burden may be brought into
her heaving bosom; nor yet so far but that it may enjoy
the milder, warmer vapours of the eastern, southern, and
western seas; yet so far up in the country as it might
also easily partake even of all the country commodities;
in an excellent air upon the north side of the river (for
the villages seated on the south side are noted to be unhealthy
in regard of the vapours drawn upon them by the
sun), but roughed by gentle hills from the north and
south winds.</p>
<p>“The highways leading from all parts to this noble
city are large, smooth, straight and fair; no mountains
nor rocks, no marshes nor lakes to hinder carriages and
passengers.” * * *</p>
<p>Chamberlayne, in speaking of the Thames, is, as well
he may be, loud in its praise:</p>
<p>“The river whereon is seated this great city, for its
breadth, depth, gentle, straight, even course, extraordinary
wholesome water, and tides, is more commodious for<span class="pagenum"><SPAN name="Page_9">9</SPAN></span>
navigation than any other river in the world. * * *
This river opening <em>eastward</em> towards Germany and France,
is much more advantageous for traffic than any other
river of England. To say nothing of the variety of excellent
fish within this river—above all of the incomparable
salmon—the fruitful, fat soil, the pleasant rich meadows
and innumerable stately palaces on both sides thereof;
in a word, the Thames seems to be the very radical
moisture of this city, and in some sense, the natural heat
too; for almost all the fuel for firing is brought up this
river from Newcastle, Scotland, Kent, Essex, etc., or else
down the river from Surrey, Middlesex, etc.”</p>
<p>After dwelling on the shipping and commerce of the
Thames, he concludes his article on London by stating
“that London is a huge magazine of men, money, ships,
horses and ammunition, of all sorts of commodities
necessary or expedient for the use or pleasure of mankind.
That London is the mighty rendezvous of nobility,
gentry, courtiers, divines, lawyers, physicians, merchants,
seamen, and all kinds of excellent artificers, of the most
refined wits, and most excellent beauties; for it is observed
that in most families of England, if there be any
son or daughter that excels the rest in beauty or wit, or
perhaps courage or industry, or any other rare quality,
London is their <em>north star</em>, and they are never at rest till
they point directly thither.”</p>
<p>A writer of a much earlier date, William Fitz-Stephen,
who in 1180 prefixed an account of London to his
biography of Thomas-à-Becket, has also some remarks
about the situation of London, from which I will make a
quotation.</p>
<p>“On the north are cornfields, pastures, and delightful
meadows, intermixed with pleasant streams, on which
stands many a mill, whose clack is so grateful to the ear.
Beyond them an immense forest extends itself, beautified<span class="pagenum"><SPAN name="Page_10">10</SPAN></span>
with woods and groves, and full of the lairs and coverts
of beasts and game, stags, bucks, boars, and wild bulls.”</p>
<p>“The fields above-mentioned are by no means hungry
gravel or barren sands, but may vie with the fertile plains
of Asia, as capable of producing the most luxuriant crops
and filling the barns of the hinds and farmers.</p>
<p>“Round the city and towards the north arise certain
excellent springs at a small distance, whose waters are
sweet, salubrious, clear,” and</p>
<div class="poem-container">
<div class="poem"><div class="stanza">
<span class="iq">“Whose runnels murmur o’er the shining stones.”<br/></span></div>
</div></div>
<h3 id="hdr_2">WATER SUPPLY.</h3>
<p>This final remark of Fitz-Stephen’s leads me to make
a few observations about the water supply of ancient
London, which originally was abundant and excellent.</p>
<p>It is probable that in pre-historic times the rising
ground upon which the “City” is built was an island,
the Thames in those days being much wider and shallower
than at present. Even a writer so late as Fitz-Stephen
mentions the fact that Moorfields was used for skating,
and the derivation of the name “London” which finds
most favour with philologists is from the Celtic <i>Llyn-din</i>,
which means the Lake fortress.</p>
<p>Many watercourses ran from the north into the
Thames, the names of which are still attached to districts
or streets in the Metropolitan area. Thus, beginning at
the East, one has to mention <i>Langbourn</i>, a watercourse
flowing through what is now Langbourne Ward in the
City, taking its course from Aldgate along Fenchurch
Street, and probably flowing into the <i>Wall Brook</i>, a
stream which divided the city into nearly equal halves,
and flowed from Moorgate to Dowgate, through the Bank
of England and the Poultry, and the name of which still
remains in a ward and a street. The river <i>Fleet</i> rose by
Highgate Ponds, and meandered through St. Pancras to<span class="pagenum"><SPAN name="Page_11">11</SPAN></span>
King’s Cross, where is “Battle Bridge;” thence its
course skirted the western side of Clerkenwell, and,
flowing at the foot of Saffron Hill, Snow Hill, Holborn
Hill, and Ludgate Hill, reached the Thames at Blackfriars.</p>
<p>Farther west was <i>Tybourne</i>, which rose at Hampstead
and flowed through what is now the ornamental water in
the Regent’s Park. Then becoming locally known as the
Marybourne, its name was associated with the village of
Marylebone; it then took the circuitous course of what
is now Marylebone Lane, crossed Oxford Street opposite
the end of Davies Street, crossed Brook Street, which
was named from this fact, then flowed at the back of
Bond Street to Bruton Street. In Bruton Street is a
curious circuitous mews, which marks its course, running
to the south-east corner of Berkeley Square, whence the
Tybourne struck west, dividing Devonshire House from
Lansdowne House, where now there is a sunken passage
between the garden walls. Thence it reached Piccadilly
at its lowest point, and flowed through the Green Park to
Buckingham Palace. Here it divided, and reached the
Thames near Vauxhall Bridge to the west, and near
Westminster Bridge to the east, a smaller delta formed
by the eastward branch forming Thorney Island, associated
with the palace of Edward the Confessor and the
monks of St. Peter’s Abbey.</p>
<p>The <i>Westbourne</i> also rose at the foot of the Northern
Hills, flowed through Kilburn and Bayswater, both
suggestive names, through the Serpentine to Knightsbridge,
another suggestive name, and so to the Thames
at Chelsea Bridge, apparently forming by its course the
western boundary of the Grosvenor Estate.</p>
<p>These watercourses have all disappeared, because in
this Christian country there is no respect for the purity of
pure water. They became so swinishly filthy, that for<span class="pagenum"><SPAN name="Page_12">12</SPAN></span>
very shame we have covered them up, and when the time
arrives for covering up the Thames, which we are so
systematically fouling in the same way, I have no doubt
that our engineers will be equal to the task.</p>
<p>It is very interesting to follow the course of these old
streams, and it will be found that the explanation of the
circuitous course of some streets (such, for example, as
Marylebone Lane), is explained by their following the
line of a forgotten rivulet. Nothing can give us a better
idea of the change which has come over London than to
go into the City and search for Walbrook or Langbourne,
or to come west and look for the Tybourne at the end of
Conduit Street and follow its course thence to Piccadilly.
I hope that those who amuse themselves by taking such
a walk as I have advised, will ponder well upon how
much we have lost by being obliged to cover them, and
why we were obliged to cover them, and will take a
lesson from these reflections. If he does that his time
will not be wasted.</p>
<p>In a district so intersected by pure streams, it was an
easy matter to have a well of good water, and throughout
London there were many such wells. Good water, in
fact, abounded on every side, and it is noteworthy that
the Romans have left us no remains of gigantic aqueducts,
such as they knew well how to construct; for the very
good reason that they were not necessary.</p>
<p>The first public waterworks were the Conduits in
Cheapside and Cornhill. Those in Cheapside were supplied
by the Tybourne, the water of which was captured
near what is now Stratford Place, and conducted to the
City in leaden pipes. Lamb’s Conduit was another, the
name of which remains. This was at Holborn Bridge (a
bridge over the Fleet), and its water came from fields
near the Foundling Hospital. There were many other
Conduits, and it must be borne in mind that local names<span class="pagenum"><SPAN name="Page_13">13</SPAN></span>
ending in <em>well</em> generally indicate the position of a neighbouring
water source.</p>
<p>When these watercourses were open London was a
very different place. The Lord Mayor kept his pack of
hounds in those days, and in Aggas’s map, made in the
reign of Elizabeth, one may see the “dogge house” in
Finsbury Fields, for the Lord Mayor was Lord of the
Manor of Finsbury, and here he had his kennels, and
frequently he would go a hunting, and when he made
his tour of inspection of the Conduit heads at Tybourne,
he took his pack with him and combined business with
pleasure. Strype records that in 1562 they hunted a
hare here, and having dined at the Suburban Banqueting
House in Stratford Place, they started out again after
dinner and killed a fox. How much inspection the
watercourses received on these occasions is not certain.</p>
<p>The first waterworks in London were those constructed
by Master Peter Morrys, a Dutch engineer, in 1582.
His plan was to utilise the enormous force with which
the Thames rushed through the nineteen narrow arches
of old London Bridge, and for this purpose the Corporation
granted him a lease of the first arch on the City
side for 500 years, at a rental of 10s. a year, and two years
later the second arch was given on similar terms. In
1701 a third arch was leased to a grandson of Morrys,
and at this time the proprietary rights were sold to Richard
Soams, a goldsmith, for £36,000, who converted it into
a Company of 300 shares of £500 each. In 1761 a
fourth arch of the bridge was given to the Company, and
two other arches were closed to give additional force to
the water-wheels. The passage of the narrow arches of
the bridge was at all times difficult, and the process of
shooting London Bridge, with a fall of some five feet
through the arch, was not without danger. This blocking
of the bridge caused great complaints, but, nevertheless,<span class="pagenum"><SPAN name="Page_14">14</SPAN></span>
the Company continued to ask for more, and with success,
so that in 1767 the first five arches were occupied with
immense water wheels, and two arches on the Surrey side
were similarly occupied. We gather that the Company
at this time also possessed a “fire-engine.” The last wheels
were put up under the advice of Brindley and Smeaton.
The wheels were of the undershot variety, and by their
power 2,000 gallons of water per minute were raised to a
height of 120 feet, through a pipe which passed over the
tower of St. Magnus’ Church. These wheels continued
in use for 240 years, until 1822, when the Act for rebuilding
London Bridge caused their removal. The
pumping machinery was of its kind excellent, but the
mains were very defective, and there was much loss by
leakage, and leakage also caused great damage to the
bridge. The chief mains ran in Bishopsgate Street,
Cheapside, Aldgate, Fleet Street, and Newgate Street.
The fact that the London Bridge Waterworks were in
use until 1822 is important, as showing that the Thames
water up to that time was not so grossly impure as to
preclude the possibility of distributing it for household
purposes without filtration. It is not conceivable that
such a course could be adopted at the present day. The
impurities of Fleet Ditch were due to slop water, and to
material negligently thrown into it, and it was probable
that only during a sharp shower, when the filth of the
streets was washed into it, it reached that state of impurity
which Swift has described. Water-carried sewage, as we
understand it, was not then in common use, and cesspools
were not allowed to empty into the sewers; and Public
Authorities were not expected to relieve individuals of
responsibility and to undertake duties, the satisfactory
accomplishment of which is impossible.</p>
<p>The first of the great water companies was the “New
River,” constructed by Sir Hugh Myddleton and opened<span class="pagenum"><SPAN name="Page_15">15</SPAN></span>
in 1613. This was a conduit on the old pattern, but on
a larger scale, and did not involve the use of pumping
machinery. It brought the water of Chadwell spring in
Hertfordshire, which is 110 feet above ordinance datum,
to the New River head at Clerkenwell, whence it was distributed
through the City. Many additional sources of
water have been added to the original Chadwell spring,
and many powerful pumping engines are now in use by
the New River Water Company, which is still the biggest
of eight metropolitan companies. The areas supplied by
the different water companies may be briefly indicated.
The “New River” supplies the northern part of the
metropolitan area; the “East London,” which dates from
1669, supplies the north-east; the “Kent,” which dates
its early beginnings from 1701, supplies the south-east.
The “Southwark and Vauxhall” in its present form dates
from 1845, the “Lambeth” from 1785, the “Chelsea”
from 1723, the “Grand Junction” from 1811, and the
“West Middlesex” from 1806.</p>
<p>These eight companies supply about 140,000,000 gallons
of water daily (about one half being from the Thames)
to 668,525 houses, by means of 145 engines of 17,145
horse-power, through 4,068 miles of mains, and by the
aid of a capital of £13,150,318.</p>
<p>It is difficult for us to appreciate such a quantity as
140,000,000 gallons, but we may grasp it better if we
imagine this water put into 1,400,000 water-butts, of
100 gallons each, and each 4 feet high. These butts
placed end to end would reach considerably more than
1,000 miles, and that, be it remembered, is a statement of
the daily water supply of this city, which is certainly
well within the mark.</p>
<p>The great fault in the situation of London was the proximity
to it on every side of marshy land. The Thames, as I
have stated, was formerly much wider than at present.<span class="pagenum"><SPAN name="Page_16">16</SPAN></span>
Certain it is that Moorfields to the north was often flooded;
to the immediate east and north-east was marshy ground,
stretching into Essex; to the west was the low district
of Thorney Island, Chelsea, and Fulham, while on the
opposite bank of the Thames was the ground around
Southwark and Lambeth, which was little better than a
swamp, and remained unbuilt upon, except to a very
slight extent, until the end of the last century.</p>
<p>Ague is at present a rare disease in London, although
one still occasionally meets with cases which are apparently
due to local causes. Formerly it was a very
potent cause of death, but the discovery of the use of
“Jesuits’ Bark,” as Cinchona was at first called, and
the gradual and continuous filling up of the soil, combined
with drainage, led to its extinction. Possibly the impregnation
of the soil with coal-gas may have helped to this
end.</p>
<h3 id="hdr_3">MEDIÆVAL LONDON.</h3>
<p>Mediæval London was a town in which the clerical
element predominated. I have upon the screen a very
beautiful drawing which appeared in the <cite>Builder</cite> newspaper,
and which is an imaginative and authoritative
reconstruction of the London of Henry VIII., by Mr. W.
H. Brewer, whose great talents will be obvious to all who
look at his picture. London at that time must have been
exceedingly beautiful, filled as it was by grand ecclesiastical
and monastic institutions.</p>
<p>The artist’s point of view is from some coign of vantage
east of the Tower. In front of him, in the middle distance,
forming at once the centre and apex of the picture, is old
St. Paul’s, with its lofty steeple towering to a height of 500
feet, and placed on an eminence which enhances its
commanding importance.</p>
<p>To the left is the noble river, its broad expanse dotted
with many a craft, and forming a superb sweep to the<span class="pagenum"><SPAN name="Page_17">17</SPAN></span>
south-west, where it is lost beyond the Abbey of Westminster,
which forms the most distant object to the left
of the spectator. The chief feature in the foreground
is “The Tower,” a noble mixture of military, palatial,
ecclesiastical, and domestic architecture. Beyond it, and
to the south, is old London Bridge, probably the most
picturesque structure of the kind that the world has ever
seen, with its quaint houses and graceful chapel, and with
the clear water of the Thames roaring through its nineteen
narrow arches. On the south side of the bridge is the
church of the Priory of St. Mary Overy (St. Saviour’s,
Southwark), as it may still be seen, and near it the great
palace of the Bishops of Winchester, with the marshy
ground of Southwark and Lambeth, and Lambeth Palace
in the distance. Running northward from the Tower is
the castellated city wall, with its brimming ditch filled
with water flowing from the shallow lake of Moorfields.
Between the wall and the spectator is a series of grand
ecclesiastical buildings, with St. Katherine’s Hospital to
the south, and St. Mary Spital to the north, and between
them Eastminster or the Abbey of Grace, the Abbey of
St. Clare in the Minories, and the church of St. Botolph.
Behind the city wall is seen a bewildering wealth of tower
and spire and gabled roof.</p>
<p>By the river bank among wharves and quaint mediæval
warehouses, St. Magnus’ steeple, the stern towers of
Baynard’s Castle, and the buildings of the Blackfriars
are conspicuous; while in the same direction, and beyond
the Fleet river, is Bridewell Palace, the huge tower
of the Whitefriars, the Temple, St. Dunstan’s Church,
Exeter House, Arundel House, the Savoy, and York
Place. Along the eastern limits of the City are St.
Dunstan’s, St. Margaret Pattens, All Hallows Barking,
the great Minster of the Friars of the Holy Cross, and
the still larger Priory of the Holy Trinity in Aldgate.<span class="pagenum"><SPAN name="Page_18">18</SPAN></span>
Near Bishopsgate is the large establishment of the
Augustinians, and beyond this again the Grey Friars,
the Priory of St. Bartholomew, the Charter House, and
the Priory of St. John, Clerkenwell. In the centre of
the City is an almost endless array of parish churches,
with here and there the high-pitched roof of some guild
house, or the residence of a nobleman or wealthy
merchant.</p>
<h3 id="hdr_4">GARDENS AND PLEASURE GROUNDS.</h3>
<p>These ecclesiastical foundations generally had gardens
attached to them, and in the time of Henry VIII. and
the subsequent Tudor monarchs, who discouraged
building in London, the houses were by no means so
closely packed as at present. It is usual to find in
walled cities that the houses are packed as closely as
possible within the walls; but this most certainly was
not the case in London. A glance at Aggas’s or Ryther’s
map (a copy of which is given in Mr. Loftie’s admirable
“History of London”) will convince one of this. The
houses enclose a great deal of garden ground in every
direction, especially in the northern and north-eastern
portions of the city. It was along the river bank that
the crowding of houses was greatest, but even here there
were open spaces; and I must remind you that Pepys,
who lived in Seething Lane in the time of Charles II.,
when the crowding in the City had very much increased,
makes frequent mention of his garden.</p>
<p>Mr. Loftie tells us that in 1276 an inquiry was held
as to the cause of death of one Adam Shott, who had
fallen from a pear tree in the garden of one Laurence,
in the parish of St. Michael Paternoster, which was close
to Thames Street. St. Martin Pomeroy, a church
formerly in Ironmonger Lane, is supposed to have
derived its name from an adjoining orchard. We know<span class="pagenum"><SPAN name="Page_19">19</SPAN></span>
that Sir John Crosbie built Crosbie Place, now a
restaurant, in Bishopsgate Street, on part of the land
forming the gardens of the adjoining Convent of St.
Helen’s. Sir Thomas Gresham’s house in Bishopsgate
Street also had its garden, and we know that the College
of Physicians had a physic garden, first at Amen Corner,
and subsequently in Warwick Lane.</p>
<p>The Priory of the Augustinians, or Austin Friars, included
a large tract of land. A part of it was given to
the Marquis of Winchester, who built Winchester House,
which occupied the site of Winchester Street and
Buildings in Old Broad Street; and Drapers’ Hall was
originally the house of Thomas Cromwell, who made
what till a very few years since was known as Drapers’
Gardens by the simple process of stealing portions from
the gardens of his neighbours, they not daring to quarrel
with so great and so arbitrary a person. Immediately
outside the walls was any amount of open space. The
houses of the nobles along the Strand had each of them
its ornamental garden. The Templars had their garden,
which still remains. The Priory of St. Bartholomew
had its garden; the Carthusians at the Charterhouse had
their garden. Hotspur lived in Aldersgate Street, Prince
Rupert lived in Barbican, and the dismal spot now
known as Bridgewater Square was once occupied by the
Earl of Bridgewater’s house and garden. Old Gerard,
the herbalist, had his garden in Holborn, where he
raised the potato, and he superintended Burleigh’s
garden in the Strand. Hatton Gardens were famous
when Sir Christopher Hatton lived there in state. Gray’s
Inn Garden was planted by Francis Bacon. Grocers’
Hall had its garden, with hedge-rows and a bowling
alley. The Merchant Taylors, the Ironmongers, the
Salters, and the Barber-Surgeons had each of them
gardens attached to their halls. The chief garden, or<span class="pagenum"><SPAN name="Page_20">20</SPAN></span>
pleasure ground, for the citizens was Moorfields. This
was originally a wild, undrained place, which extended
from the City wall right away to the villages of Islington
and Hoxton. According to Loftie, it appears that in
1274 the citizens called in question certain Acts of the
previous Mayor, one Walter Hervey. They accused him
of certain “presumptuous acts and injuries,” and the
first of these appears to have been that “He had not
attended at the Exchequer to show the citizens’ title to
the Moor.” From this it would appear that over 600
years ago Moorfields was regarded as a common for the
use and enjoyment of all, and it appears to have been
used more or less for these purposes down to the close
of the last century, and it is to be found in all maps.
Moorfields was used for archery and for exercising the
train-bands, that is, it was so used after it was drained,
which was first attempted in the fifteenth century. At
one time, the people living near Moorfields put up fences
and showed a disposition to encroach on the moor, but
the citizens, taking the law into their own hands, levelled
the obstructions. When Moorfields had been drained, a
part of it was planted, and it became a fashionable promenade,
and in some maps it is shown as planted with
intersecting avenues. According to Mr. Denton, the
historian of Cripplegate, the northern part of Moorfields
was the property of the Dean and Chapter of St. Paul’s
being leased merely to the Corporation, together with the
Manor of Finsbury. The southern part, however, was,
according to the same authority, the gift of Catherine and
Mary Fynes to the City Corporation in trust for the
citizens. Finsbury Square was built on the northern
part in 1768, and finally, in 1812, the Corporation
obtained an enabling Act from Parliament and put
Finsbury Circus on the lower half, and thus perished the
People’s Park after existing 800 years. The building<span class="pagenum"><SPAN name="Page_21">21</SPAN></span>
upon this open space was a very short-sighted policy,
and it says very little for the spirit of Londoners that
such a policy was able to be carried out. The first
encroachments on Moorfields took place, probably, after
the fire, when thousands of citizens were homeless,
and the Moor was used as a temporary place of encampment.
Many of the houses then erected appear to
have been fairly substantial, and it is probable that encroachments
having been made in consequence of a
sudden and dire necessity, and possession being nine
points of the law, the City of London lost its park.
Part of Moorfields had been used during the plague as a
plague pit, and towards the end of the 17th century the
great burial ground for dissenters, Bunhill Fields, was
here established. The Artillery ground, once the exercising
ground of the train-bands, still remains, and it is
fortunate that the extinction of the Honourable Artillery
Company has been averted and has not resulted in this
“eligible building plot” being leased at so much a square
foot.</p>
<p>Moorfields is gone, the Drapers’ Garden is gone, and
the wealthy City of London has now the proud distinction
of being without any public recreation ground within
its limits.</p>
<p>It is true that the Corporation has bought Epping
Forest, in the county of Essex, and Burnham Beeches,
in the county of Buckinghamshire, and all honour to
them for so doing; but it must be remembered that
a third-class return ticket to Loughton, the centre of
Epping Forest, costs 1s. 7d., and that to go from and
return to Fenchurch Street takes one and a half hours,
while a return third-class ticket from Mansion House to
Slough, which is, I think, the station for Burnham
Beeches, costs 3s. 6d., and the journey to and fro takes
four hours at least, so that if each of the 51,000 people<span class="pagenum"><SPAN name="Page_22">22</SPAN></span>
who reside in the City pay one visit to each of their
parks, they would do so at a minimum cost of nearly
£13,000, and at a necessary loss (collectively) of 281,000
hours, which at 3d. an hour means an additional £3,500.</p>
<p>It is at least doubtful whether, if Moorfields could be
restored as a playground for the City, it would not be
of more use to the City, from the point of view of the
health of those who dwell in it, than are the Essex and
Buckinghamshire estates. Almost every inch of available
ground in the City has been built upon. Goodman’s Fields,
once a farm where Stowe used to buy three pints of milk for
a halfpenny, is now covered with houses. Spitalfields was
once an open space, but it is an open space no longer.
Paternoster Square has its centre packed with buildings,
and for aught I know there is nothing to prevent the
occupation in a similar way of the centres of Finsbury
Square and Circus, Lincoln’s Inn Fields, the Gardens of
the Temple and Gray’s Inn, of Russell and Bloomsbury
Square, and, in short, of every inch of green that can be
turned into money.</p>
<p>The gradual obliteration of open spaces in London is
seen not only in public and semi-public spaces, but also
in the curtilage of private houses. Before the introduction
of our modern system of sewerage and water
supply, it was not possible to build houses without
adequate curtilage for a well and the bestowal of refuse,
and this obvious fact is borne out by a reference to
the maps of 1558, 1658, and 1720, which are hung upon
the screen. It is noteworthy that Newcourt’s map of the
time of Charles II. shows that the houses in the City
were much more closely packed than in the time of
Elizabeth, and it is probable that just before the Plague
and the Fire the crowding of houses was excessive.</p>
<div id="ip_22" class="figcenter" style="max-width: 37.5em;">
<ANTIMG src="images/i_023.jpg" width-obs="600" height-obs="411" alt="" />
<div class="caption">DIAGRAM SHOWING THE SIZE OF LONDON AT DIFFERENT PERIODS BETWEEN 1560 AND 1889.</div>
</div>
<p>The diagram (p. 23) shows the growth of London between
1560 and 1889. The notable features being (<i>a</i>)<span class="pagenum"><SPAN name="Page_24">24</SPAN></span>
the very rapid extension of the London area since 1815,
and (<i>b</i>) the fact that the marshy land south of the
Thames has only been covered with buildings within
comparatively recent times. The frontispiece is a reproduction
of part of Newcourt’s map (1658) showing
that the houses in the centre of London were very densely
packed. It also shows the position of Moorfields, and
the Drapers’ Garden, which are alluded to in the text.</p>
<h3 id="hdr_5">HEALTH OF OLD LONDON.</h3>
<p>That mediæval London was very unhealthy there is
no question, but whether it was more or less unhealthy
than other cities of the time is doubtful. It would be
difficult, however, to conceive a worse state of public
health than that prevalent in old London.</p>
<p>Exact information on the subject is not to be had.
It was not till 1593 that deaths were registered and
published by the parish clerks, but the record of deaths
without a knowledge of population does not make it
possible to hazard even a guess at the death-rate.</p>
<p>The Parish Clerks’ Bills of Mortality show clearly
that from 1593 to the year 1800, <i>i.e.</i>, for 207 years, the
deaths invariably exceeded the births, and often to an
enormous extent, the maximum being reached in the
memorable year 1665, when the deaths were 87,339, as
against 9,967 births. Taking the whole of the 18th
century, it would appear from a table given by Henderson,
in the “Encyclopædia Britannica,” that of the births
and deaths registered, the excess of the latter averaged
about 6,000 a year, or 600,000 for the century. At one
time leprosy was common in London, and we know that
in the reign of Edward III. the “black death,” which
was probably plague, committed frightful ravages, and is
said to have killed 100,000 in London; and this scourge
reappeared at intervals up to the year 1665, the mortality<span class="pagenum"><SPAN name="Page_25">25</SPAN></span>
then being enormously in excess of the very high
mortality which was habitual.</p>
<p>Between 1485 and 1551 there were epidemics of the
sweating sickness, a disease different from plague but
scarcely less deadly.</p>
<p>We all know what epidemics of plague and sweating
sickness did for London, but it may be thought that
epidemics are accidental visitations, and are no criterion
of the general health of the city. The numbers I have
quoted from Henderson will make it impossible for us to
believe that old London was at any time healthy, not
even after the fire and the rebuilding.</p>
<p>What were the chief ordinary diseases of London?
This question may be answered by reference to the bills
of mortality. I will take the year 1661, when 19,771
deaths were registered by the parish clerks, and will note
those diseases which are credited with more than 100
deaths. These were: Abortive and still-born, 511;
chrisomes and infants, 1,400; ague, 3,490; dysentery
(bloody flux, scouring and flux), 314; childbed, 224;
aged, 1,302; apoplexy and suddenly, 108; colic, 186;
consumption, 3,788; convulsions, 1,198; dropsy and
tympany, 967; flox and small-pox, 1,246; griping in the
guts, 1,061; jaundice, 141; imposthume, 160; measles,
188; rickets, 413; rising of the lights, 227; spotted
fever and purples, 335; stopping of the stomach,
170; surfeit, 212; teeth and worms, 1,195. Looking at
the table, and using the best of my judgment in interpreting
it, I should say that about one-fourth of the
deaths were due to the accidents of parturition and the
diseases of infants, and another fourth due to fevers. It
is to be noted also that plague is answerable for 20
deaths, although this was not a plague year.</p>
<p>What were the causes of the high mortality in Old
London?</p>
<p><span class="pagenum"><SPAN name="Page_26">26</SPAN></span>
The situation was not healthy because of the marshy
surroundings of the city. Ague and dysentery were
always present, and were terribly fatal. Not only was
the ground around the city marshy, but it was probably
filthy as well. The old town ditch was used as a
receptacle for all kinds of filth, and the cleansing of it
was a great work, which was only occasionally undertaken.
When Moorfields was drained, and the other
marshy districts improved, one great cause of sickness
disappeared.</p>
<p>The city itself was certainly as foul as could be.
The streets were unpaved, or paved only with rough
cobble stones. There were no side walks. The houses
projected over the roadway, and were unprovided with
rain-water gutters, and during a shower the rain fell from
the roofs into the middle of the street. These streets
were filthy from constant contributions of slops and
ordure from animals and human beings. There were no
underground drains, and the soil of the town was soaked
with the filth of centuries. This sodden condition of
the soil must have affected the wells to a greater or
less extent.</p>
<p>The streets were filthy without, the houses were
filthy within. The rooms of the poor were more like
pig-styes than human habitations, unventilated, and
strewn with rushes, which were seldom changed; and
the wretched inhabitants closely packed in these miserable
hovels must have become very prone to suffer from
infection of all kinds. Another great cause of unhealthiness
was the diet, which amongst the poor was
composed largely of salt meat and fish, and with an
absence of fresh vegetables, so that many of the inhabitants
must have been on the verge of scurvy. The
potato was not imported till the end of the sixteenth
century, and the eighteenth was well advanced before it<span class="pagenum"><SPAN name="Page_27">27</SPAN></span>
became a common article of diet. Much of the improvement
in public health of late years is due to this
wholesome and easily stored vegetable. In the days of
Elizabeth the children of Christ’s Hospital were often ill
from scurvy, and it was not till 1767 that the potato
was introduced into the dietary of St. Bartholomew’s
Hospital.</p>
<p>A most important factor in the causation of disease
was the moral condition of the population, which was
very low, and marked by superstition, ignorance, and
brutality. An age when even the better classes crowded
into Smithfield to see some poor wretch burnt; when
the most brutal punishments were inflicted for comparatively
slight offences; when kings beheaded their subjects
and even their wives, almost as a matter of course; when
the ghastly heads of executed persons stared from the
city gates; when religious-minded Puritans could do
nothing with a misguided king but behead him; and
when restored “monarchy” exhumed the dead bodies of
political offenders in order that it might wreak an unmeaning
vengeance on a corpse; and when even ladies
in good positions in society flocked to see these sickening
exhibitions,<SPAN name="FNanchor_A" href="#Footnote_A" class="fnanchor">A</SPAN> was not an age in which the nobler feelings
of Christianity were easily evoked; and without these
feelings, measures for securing public health, which cannot
be fostered except in connection with public decency,
found no place among the ideas of governors or
governed.</p>
<div class="footnote">
<p><SPAN name="Footnote_A" href="#FNanchor_A" class="fnanchor">A</SPAN> “To my Lady Batten’s; where my wife and she are lately
come back again from being abroad, and seeing of Cromwell,
Ireton, and Bradshaw hanged and buried at Tyburne.”—“Pepys’s
Diary,” Jan. 31, 1660–61.</p>
</div>
<p>The public amusements were many of them brutal
and cruel. Tournaments were less brutal than bear-baiting,
bull-baiting, and cock-fighting, because they<span class="pagenum"><SPAN name="Page_28">28</SPAN></span>
fostered animal courage; but animal courage it most
distinctly was.</p>
<p>Fitz-Stephen mentions the drunkenness of the population
in the 12th century, and there can be little doubt
that when beer was the only drink—the drink which
Queen Elizabeth took for breakfast—a state of fuddle
from drink must have been exceedingly common. From
Chamberlayne’s “Present State of England,” I gather
that in the year after the Fire, 452,563 barrels of strong
beer, at 12s. 6d. the barrel; 580,420 barrels of ale, at
16s. the barrel; and 489,797 barrels of small beer, at
6s. 6d. the barrel, were consumed in London, which (if
we take the population at that time at 500,000) allows
about three barrels, or 108 gallons, or some 1,440 pints
per head per annum.</p>
<p>Again, Chamberlayne, speaking of the causes of the
Great Fire, mentions: 1. “The drunkenness and supine
negligence of the baker and his servants in whose house
it began. 2. The dead time of night wherein it began,
when some were wearied with working, others filled with
drink, and all in a dead sleep.”</p>
<p>The brutality of the people’s amusements continued
down to the end of the last century, and later. Thus in
Pink’s “History of Clerkenwell,” I find the following
advertisement culled from a journal of 1716:—</p>
<p>“At the Bear-garden at Hockley-in-the-Hole, at the
request of several persons of quality, on Monday the 4th of
this instant of June, is one of the largest and most mischievous
bears that ever was seen in England to be baited
to death, with other variety of bull-baiting, and bear-baiting;
as also a wild bull to be turned loose in the Game
Place, with fireworks all over him. To begin exactly at 3
o’clock in the afternoon, because the sport continues long.”</p>
<p>Close by, in Spa Fields, female prize fights were
held, and there is a lively account of one of these encounters<span class="pagenum"><SPAN name="Page_29">29</SPAN></span>
in which “Bruising Peg” terribly damaged
her antagonist. In such a time, of course, foot-pads
abounded, and it was not without danger that persons
crossed Spa Fields after dark; and those who were invited
to Sadler’s Wells, to see a man eat a live cock,
feathers and all, for a wager of £5, were informed that
the New Road and City Road would be patrolled, and
that the return home would be without danger.</p>
<p>Such facts as these, which I could multiply to any
extent, show the rough moral condition of the populace,
and I believe that, with such a state of moral feeling, any
real improvement in public health was impossible.</p>
<p>Another cause of the high death-rate was superstition,
which regarded disease as a “visitation” which had to
be borne without question or inquiry.</p>
<p>With such an attitude towards epidemics, which by
some were regarded as due to an unfortunate conjunction
of certain planets, it is not to be wondered at that the
epidemics were mismanaged; and it is certainly difficult
to imagine any measure better calculated to cause the
spread of the plague than that of forbidding those affected
to leave their houses, and compelling them to stay indoors
and infect the rest of the household. The most
efficient of all measures which we nowadays adopt for
preserving the public health is that of the instant separation
of the sick from among the healthy, a plan which had
been adopted in old time in the case of “leprosy,” and
which we re-introduced in the last century, when the
first small-pox hospital was built.</p>
<p>Another great cause of the high mortality was the
ignorance of the physicians, who were almost as superstitious
as the populace, and who were entirely without
any exact or correct knowledge of their art, which they
practised almost entirely by the light of the old Greek,
Roman, and Arabian writers.</p>
<p><span class="pagenum"><SPAN name="Page_30">30</SPAN></span>
To recapitulate, the causes of the high death-rate
were probably the <span class="locked">following:—</span></p>
<blockquote>
<p>1. The prevalence of ague from the abundant
marshes.</p>
<p>2. The dirt of the city and the houses, and the probable
infection of wells from a soil sodden with putrefactive
matter.</p>
<p>3. The ill-nourished, drunken, and scorbutic condition
of the people, and</p>
<p>4. Their condition of superstition and brutality,
which made any rules for public health impossible.</p>
<p>5. The neglect to separate the infected from the
healthy.</p>
<p>6. The ignorance of the doctors.</p>
</blockquote>
<p>We may get some idea of the state of public health
during the sixteenth and seventeenth centuries by a
reference to the families of monarchs.</p>
<p>The difficulty of rearing children was very largely
experienced in royal families. I have, by the help of
Burke’s “Peerage,” made a list of all the children of
monarchs (other than those who ascended the throne)
whose ages at death are given by that genealogist.</p>
<p>This difficulty of rearing children, which began in the
reign of Edward III., becomes very marked with the
reign of Henry VIII., who, as we are told by Froude,
was disappointed by a succession of still-born children
borne to him by his first wife.</p>
<p>Of the children of James I., three out of five died
under 3; of the children of Charles I., the ages at death
were 29, 26, 20, 15, 4, 1; of eleven children of James II.,
by two wives, one (the old Pretender) attained the age
of 78, and of another the age is doubtful, but eight died
under 4, and two others died at 11 and 15; of the six<span class="pagenum"><SPAN name="Page_31">31</SPAN></span>
children of Anne, one reached the age of 11, and the
remaining six died under 1 year.</p>
<p>With the accession of George I. this difficulty of rearing
royal families appears to have ceased, having been
more or less marked during the reigns of 21 monarchs,
intervening between Edward III. and George I. What
the cause may have been I will not discuss, but I mention
the fact because it is probable that causes which affected
kings affected subjects also.</p>
<p>There can be no doubt that down to the commencement
of the present century London was a veritable fever-bed,
the causes of death being largely malarial fever, spotted
or typhus fever, plague, small-pox, measles, scarlet fever,
and whooping-cough, the two latter being comparatively
recent introductions.</p>
<h3 id="hdr_6">THE LONDON “DEATH RATE.”</h3>
<p>The present writers on London, like their predecessors,
are loud in its praises and blind to its defects, and they
point to a figure which is called “the death-rate,” and ask
us to accept it as evidence that the state of public health
in London is as good as can be.</p>
<p>It is quite true that the death-rate of London is low,
and that it is not much in excess of the country at large,
and is very much below that of some of the big towns
scattered through the kingdom. Nevertheless, before we
accept this figure and rest contented with it, we must take
several facts into consideration.</p>
<p>1. The London of the Registrar-General is very extensive,
and no small part of it is rural or semi-rural in
character. Many of the dwellers in Lewisham, Wandsworth,
Fulham, Hampstead, Hackney, Greenwich, Camberwell,
and Woolwich, can hardly be looked upon as
dwellers in a city, and it must be remembered that the
death-rates in these districts, which contain only from 40<span class="pagenum"><SPAN name="Page_32">32</SPAN></span>
to 8 persons to an acre, tend very materially to reduce the
death-rate of the whole town.</p>
<p>2. London is very largely a city of wealthy and well-to-do
people, most of whom must be looked upon as
sojourners rather than dwellers in the city. Among such
as these, who can command every luxury and necessary
of life, including change of air, death-rates ought to be
low. It is manifestly unfair to contrast the death-rate of
St. George’s, Hanover Square, or Kensington, with the
death-rate of a town packed with the wage-earning class.</p>
<p>3. The mobility of the London population is so great
that it must vitiate any statistics bearing on the health of
the inhabitants. “Londoners” are a mixture of races,
recruited from every clime from China to Peru. They
are, as the phrase goes, “Here to-day and gone to-morrow,”
and probably no one fact quickens their
departure more than ill-health. I am told by the proprietor
of Kelly’s Post Office Directory that the annual
correction of addresses amounts to about ten per cent. of
the whole, so that the London population shifts on an
average completely every ten years, even among classes
who have far more stability than the labouring classes.
It is also well to point out that these changes in the
Directory do not represent all the changes, because in
trade it is common for new individuals to trade under an
old and established name. I find, on comparing the
Directories of 1880 and 1889, that in my own street of
96 houses there have been 87 changes of names, and that
96 houses are now credited with the addresses of 140
individuals, whereas in 1880 the individuals numbered
120.</p>
<p>4. Still more important, as vitiating the value of the
“death-rate,” is the abnormal age distribution in London.
In London (and especially in the central portions of it)
there is a great deficiency of young children and old<span class="pagenum"><SPAN name="Page_33">33</SPAN></span>
people, among whom the death-rate is always highest; the
population of London is largely composed of selected
adults imported from the country, among whom the death-rate
ought to be low.</p>
<p>5. The continued low death-rate of London is very
largely accounted for by the diminishing birth-rate. Thus
the birth-rate for the ten years 1877–86 averaged 34·4 and
the death-rate 21·2, while for the year 1887 the birth-rate
was 31·6 and the death-rate 19·5. This is a diminution
of 2·8 per 1,000 of population in the birth-rate.
This, in a population of 4,250,000, means a deficit of
11,900 children; and as out of every 1,000 children born
in London in 1887, 158 died before they were one year
old (<i>i.e.</i>, 13 per 1,000 more than in England as a whole,
and 66 per 1,000 more than in the county of Dorsetshire),
it is evident that this diminution of the birth-rate entails
a deficit of 1,940 in the total deaths occurring in London
in the year. It is clear from this that in taking account
of a diminishing death-rate we have to take into consideration
the diminishing birth-rate also.</p>
<p>These considerations make it very doubtful whether the
death-rate of London is of much value, as indicating the
amount of disease in the City. Even if we accept it we
must not draw any hasty conclusions that the disease-rate
bears any definite proportion to the death-rate.
There may be much disease with comparatively few deaths,
as was the case with the scarlet fever epidemic of last year,
and there can be no doubt that the improvement and
extension of medical knowledge has very largely diminished
the death-rate of those who are sick. Further, an
enormous proportion of those who fall ill in London return
to the country to die.</p>
<p>A fact which must throw considerable doubt on the
healthiness (<i>i.e.</i>, a real vigorous and robust condition,
which is the true meaning of health) of the population is<span class="pagenum"><SPAN name="Page_34">34</SPAN></span>
the amount of sickness, as evidenced by the ever-increasing
work which is thrown upon the hospitals.</p>
<p>According to a table which was published last June in
<cite>The Hospital</cite>, it appears that in 1887 there were treated
in the London hospitals 79,261 in-patients, and 1,180,251
out-patients, or a total of 1,259,512 persons, excluding
those who received relief in the hospitals belonging to the
Asylums Board (and these were very numerous, owing
to the epidemic of scarlet fever), the workhouse infirmaries,
the lunatic asylums, and idiot asylums. Thus it appears
that in a city whose death-rate was very low more than 25
per cent. of the population had recourse to the hospitals
for relief. We must therefore conclude that the death-rate
and the disease-rate bear no fixed ratio to each other,
especially when we consider that between 2,000 and 3,000
medical men found sufficient work among the population
to furnish them with an income. If deaths be few in
London, it is clear that second-rate health is by no means
exceptional.</p>
<h3 id="hdr_7">IMPROVED CONDITION OF MODERN LONDON.</h3>
<p>Although we have to make many allowances, and take
many things into consideration before we can estimate the
true value of the London death-rate, it is, of course, undeniable
that an enormous improvement in the health of the
City has taken place since the beginning of the present
century. To what is this due?</p>
<p>The chief cause is the increase of knowledge as to the
modes in which diseases are spread. Our knowledge of
the mode in which small-pox, scarlet fever, cholera, and
typhoid are disseminated has led to the establishment of
fever hospitals, and to the improvement of the water-supply,
and the inspection of dairies. It is not only that
the knowledge of doctors has increased, but what is more
important, this knowledge has spread to the public, and<span class="pagenum"><SPAN name="Page_35">35</SPAN></span>
as “self-preservation is the first law of nature,” the public
has assisted in protecting itself.</p>
<p>The practice of vaccination, and the dealing with
epidemics by the method of isolation, have also materially
assisted in diminishing the death-rate.</p>
<p>Another very important point is the disappearance of
malaria. Drainage, the filling up of low-lying places, and
extensive building operations, have banished malaria from
our midst, and this, be it remembered, was not only a
cause of death in itself, but probably tended to make
other diseases more deadly. It is conceivable that the
impregnation of the soil by coal-gas may have helped to
stop the growth of noxious microbes which make the soil
their habitat.</p>
<p>Again, our system of sewers, which has carried filth
away from the dwellings, has probably assisted in improving
the public health. That sewers have done and are doing
much harm as well as good is undoubted, but it is probable
that the balance is so far in their favour. For the present
typhus fever has disappeared, and this is probably due to
two causes—first, the prompt separation of the sick from
the healthy, and secondly, to the fact that we have had
no scarcity for some years. Typhus is due to overcrowding
and want. I have drawn up a scheme which shows by a
curve the average price of wheat from the year 1800 to
1886. From this it appears that the staple article of food
has, broadly speaking, and with some considerable fluctuation,
fallen steadily in price from 1812 to the present
time, when it is at its minimum. Not only wheat, but
all articles of food and clothing, and also fuel, have of
late years been getting steadily cheaper; potatoes and
other vegetables are in common use among the masses,
and thus we have kept away famine diseases, and also
that taint of scurvy, which was undoubtedly a great cause
of ill-health in the middle ages. A most important fact<span class="pagenum"><SPAN name="Page_36">36</SPAN></span>
has been the removal of the in-take of the water companies
to a part of the river containing less sewage than that between
the bridges. It is not enough to be able to rejoice
in a small death-rate. We ought to be able to look ahead
and feel that to the best of our knowledge there is no probability
of the return of a high one, and that our sanitary
arrangements having been set a-going, will continue <i xml:lang="la" lang="la">propriâ
motu</i>. We have to remember that diseases disappear or
become unimportant, and that others become prominent.
In our own day we have seen the rise in importance of
diphtheria and enteric fever, and just at present we seem
to have lost sight of typhus, for a long time the most important
of the febrile diseases. “Leprosy,” which was at
one time common in London, has practically disappeared.
Plague, sweating sickness, and malarial fever have also
gone. Whooping-cough was not recognised till the end of
the sixteenth century, and could not, therefore, have been
as common as it is now. In like manner, scarlet fever
was not distinguished from measles until the seventeenth
century, and from that fact we may infer that
there could have been no epidemics of it, although we
must remember that in the great crowd of fevers it must
have been hard to distinguish individuals. The fact that
diseases wax and wane must be borne in mind, and should
prevent us from indulging in a feeling of false security.</p>
<h3 id="hdr_8">WHAT IS THE OUTLOOK?</h3>
<p>Judged by our present standard of knowledge, have
we a right to hope that London is likely to remain free
from epidemics?</p>
<p>There are certain facts which make me seriously
doubt the permanence of the present state of health in
London.</p>
<p>The first of these is the fact that some of our hygienic
measures have tended to produce overcrowding of<span class="pagenum"><SPAN name="Page_37">37</SPAN></span>
houses, which is infinitely the greatest of all sanitary
evils. Formerly the sanitary arrangements of houses
were such that without some garden or back premises
they would have been uninhabitable, and a reference to
Aggas’s map, or Norden’s map, or Newcourt’s map, will
show that in Old London a large proportion of the houses
had gardens or back premises large enough to be shown
on a map. These maps also show that in Charles II.’s
time, just before the plague, the overcrowding of houses
in London was much more marked than in the days of
Elizabeth. When every drop of water and all the fuel
used had to be carried to the upper storeys by hand,
there were practical inconveniences attending upon very
high houses which prevented them from being built to
any great extent. Now all is changed. Our system of
sewerage has made it possible to build houses with no
curtilage whatever, and with no outlet but a hole, and
the possession of a high pressure of water (the result of
steam power) and the modern system of gas has made
it possible to have houses of any height, without any
great inconvenience to the occupants. “Five hundred
rooms, passenger and luggage lifts to every floor, 1,000
electric lights, hot and cold water laid on to every room,
bath-rooms on every floor,” is the kind of advertisement
put forward by an eight-storeyed hotel without an inch of
curtilage. Without steam power, without water under
pressure, and without water-carried sewage, such Yankee
monstrosities were not possible, whereas nowadays the
loftier the hotel so much the greater is the profit, because
extra storeys do not increase the ground-rent.</p>
<p>On the other hand, the fact that houses can be and
are allowed to be built without curtilage has given an
altogether fictitious value to land, the price of which
varies in this country (according to situation) from about
£200,000 to £10 per acre. It is not surprising that the<span class="pagenum"><SPAN name="Page_38">38</SPAN></span>
bias of landlords and builders is very much in favour of
our present system of Sanitation. Sanitary authorities
are also in favour of it because, having borrowed enormous
sums of money, which have to be paid out of the
rates, they are naturally quite regardless of hygiene if
they can increase the rateable value of the district, and
so make the burden of rate-collection lighter. “Black
care (in the form of rates) sits behind the councillor.”
Everywhere throughout the metropolitan area houses
are being pulled down and replaced by others twice as
high; extra storeys are being added to old houses, and
back-yards and gardens are fetching enormous prices for
building purposes, so that the buildings in the centre of
London have doubled their height and have lost all their
curtilage.</p>
<p>Huge thoroughfares have been driven through London
in all directions, but as the ultimate increase in the
height of the buildings has been proportionately greater
than the increase in the width of the street, locomotion
has become more difficult, our traffic has become more
in need of police regulations, and it has become an
acknowledged rule in the City that if you want to keep
an appointment it is dangerous to take a cab, because
one can thread one’s way with more certainty on foot.</p>
<p>And yet the overcrowding in London does not appear
in official documents. Thus the City of London, on an
area of 668 acres, in 1871 had 9,415 inhabited houses,
and 3,222 uninhabited, and a population just short of
76,000; whereas in 1881 the inhabited houses had fallen
to 6,562, the uninhabited had risen to 4,770, and the
population had fallen to 51,439. Some historian of the
future may draw the conclusion that the decay of London
set in acutely about the year 1871, unless he should perchance
discover that within the same period the rateable
value had risen from £2,500,000 to £3,500,000; that<span class="pagenum"><SPAN name="Page_39">39</SPAN></span>
the day population had risen from 170,000 to 260,000,
and that the number of persons entering the City daily
for business had risen from 657,000 to 739,000. This
population is one mainly of adult males, and since, if
they get ill in the City they don’t die in it, the death-rate
keeps down, and we like to think it is a wholesome place
for a young man to work in. The 50,000 people who
have to live night and day on this square mile of ground
have not a very cheerful time in this wealthy city, where
nature has been most effectually obliterated by the brute
force of the almighty dollar. What chance have they
of any fresh air with a radius of houses extending to
five miles all round them? At one time the Thames
served as a recreation ground, but that was in the days
before the tide rolled in charged with the excrements of
4,000,000 people, and when it was possible to fish and
boat, and perhaps catch a salmon, without the danger of
being sunk by some headlong steam-tug. Until a few
years ago there was a little green spot called Drapers’
Gardens, but now Drapers’ Gardens is occupied by
Throgmorton Avenue, where dwell 322 different firms
of stockbrokers and others, and the nearest recreation ground
is St. James’s Park, three miles off.</p>
<p>I have lately seen a young man, aged 21, with signs
of incipient consumption. He is a fine young fellow,
and three years ago entered one of the large City warehouses
connected with the drapery trade, in the centre of
the City. At first he was employed mainly in the basement,
where gas was burning all day. During times of
extra pressure he often worked from eight in the morning
to past midnight, and when he retired to rest he had to
share a bedroom with other men, the windows being shut.
I believe this is no uncommon case, and I commend it
most heartily to the attention of the “Sweating Committee.”
Occasionally on a Saturday afternoon he got a<span class="pagenum"><SPAN name="Page_40">40</SPAN></span>
game of football, his very slender resources being severely
taxed to pay the railway fare to the spot where the games
are contested.</p>
<p>What has occurred in the City has occurred elsewhere
in London.</p>
<p>I need hardly say that the crowding of houses means
loss of liberty, and increases competition—that competition
is the cause of “sweating” and other miseries.
Having wilfully produced these evils, I for one do not
believe that they are to be removed even by the best
intentioned efforts of city missionaries, nor by young
men’s Christian associations, nor even by music halls,
though tea be the beverage and hymn tunes the melodies.</p>
<p>We have to bear in mind the fact that all writers on
sanitary matters are agreed that of all dangers to health,
overcrowding is the greatest, and that the death-rate rises
in proportion to the density of population. When, therefore,
we allow building to go practically unchecked, and
move the poor out of two-storeyed dwellings into six-storeyed
barracks, we must remember the possible drawbacks
of such a system.</p>
<p>The death-rate of Paris is higher than that of London
(it was nearly 26 per 1,000 in 1881), but the density of
population in Paris is twice that of London, being 117
to the acre, as against 50 in London. Some parts of
Paris are very much more crowded than any parts of
London, and no parts of it have a density of population
so slight as Fulham, Hampstead, Wandsworth, Woolwich,
or Lewisham. The effect of overcrowding on death-rate
is seen very markedly in the city of New York, which
has a population of 1,337,000, which has an almost unlimited
water-supply, and the sewage of which is discharged
direct into the sea. According to the writer in
the “Encyclopædia Britannica,” there is an excessive
crowding of the inhabitants into tenement houses, and<span class="pagenum"><SPAN name="Page_41">41</SPAN></span>
the houses are to a great extent without back entrances.
As a consequence, the death-rate was 26·47 in 1880,
31·08 in 1881, and 29·64 in 1882.</p>
<p>In overcrowded places the danger is great when contagious
disease makes its appearance. The spread of
such diseases as typhus, measles, and whooping-cough is
very much favoured by overcrowding.</p>
<p>I have prepared a table, taken from the Registrar-General’s
decennial abstract, which shows this fact very
clearly with regard to London. I have arranged the
various registration districts of London according to the
density of population, and in another column I have
given the death-rate per 100,000 from whooping-cough
and measles, two diseases which are rarely treated in
hospitals, and which are very prone to follow each other
in epidemics, so that when we have not measles with us
we have whooping-cough, and <i xml:lang="la" lang="la">vice versâ</i>.</p>
<blockquote class="fullsize">
<h3 id="hdr_dr"><span class="smcap">Annual Death-Rate per 100,000 Living of Children under 5 Years of Age from Whooping-cough and Measles during the 10 Years 1871–80.</span></h3></blockquote>
<table id="table41" class="b1" summary="Death-rate 1871-80">
<tr>
<th>District.</th>
<th>Persons to<br/>an acre.</th>
<th>Death-rate per<br/>100,000 from<br/>Measles and<br/>Whooping-cough.</th></tr>
<tr>
<td class="tdl">Westminster</td>
<td class="tdc">250</td>
<td class="tdc">1089 </td></tr>
<tr>
<td class="tdl">St. Giles</td>
<td class="tdc">200</td>
<td class="tdc">1152 </td></tr>
<tr>
<td class="tdl">Holborn</td>
<td class="tdc">200</td>
<td class="tdc">1229 </td></tr>
<tr>
<td class="tdl">Shoreditch</td>
<td class="tdc">200</td>
<td class="tdc">1099 </td></tr>
<tr>
<td class="tdl">Whitechapel</td>
<td class="tdc">200</td>
<td class="tdc">1020 </td></tr>
<tr>
<td class="tdl">St. George’s, E.</td>
<td class="tdc">200</td>
<td class="tdc">1327 </td></tr>
<tr>
<td class="tdl">Bethnal Green</td>
<td class="tdc">166</td>
<td class="tdc">1113 </td></tr>
<tr>
<td class="tdl">Mile End</td>
<td class="tdc">143</td>
<td class="tdc">982</td></tr>
<tr>
<td class="tdl">St. Saviour’s, Southwark</td>
<td class="tdc">143</td>
<td class="tdc">1150 </td></tr>
<tr>
<td class="tdl">Stepney</td>
<td class="tdc">125</td>
<td class="tdc">1220 </td></tr>
<tr>
<td class="tdl">St. Olave, Southwark</td>
<td class="tdc">111</td>
<td class="tdc">1091 </td></tr>
<tr>
<td class="tdl">Marylebone</td>
<td class="tdc">100</td>
<td class="tdc">1145 </td></tr>
<tr>
<td class="tdl">Strand</td>
<td class="tdc">100</td>
<td class="tdc">987</td></tr>
<tr>
<td class="tdl">City</td>
<td class="tdc">100</td>
<td class="tdc">963</td></tr>
<tr>
<td class="tdl">Chelsea</td>
<td class="tdc"> 91</td>
<td class="tdc">856<span class="pagenum"><SPAN name="Page_42">42</SPAN></span></td></tr>
<tr>
<td class="tdl">St. George’s, Hanover Square</td>
<td class="tdc"> 83</td>
<td class="tdc">974</td></tr>
<tr>
<td class="tdl">Pancras</td>
<td class="tdc"> 83</td>
<td class="tdc">1046 </td></tr>
<tr>
<td class="tdl">Islington</td>
<td class="tdc"> 77</td>
<td class="tdc">965</td></tr>
<tr>
<td class="tdl">Kensington</td>
<td class="tdc"> 66</td>
<td class="tdc">992</td></tr>
<tr>
<td class="tdl">Poplar</td>
<td class="tdc"> 59</td>
<td class="tdc">985</td></tr>
<tr>
<td class="tdl">Lambeth</td>
<td class="tdc"> 59</td>
<td class="tdc">960</td></tr>
<tr>
<td class="tdl">London as a whole</td>
<td class="tdc"> 50</td>
<td class="tdc">967</td></tr>
<tr>
<td class="tdl">Hackney</td>
<td class="tdc"> 40</td>
<td class="tdc">698</td></tr>
<tr>
<td class="tdl">Camberwell</td>
<td class="tdc"> 35</td>
<td class="tdc">879</td></tr>
<tr>
<td class="tdl">Greenwich</td>
<td class="tdc"> 35</td>
<td class="tdc">778</td></tr>
<tr>
<td class="tdl">Fulham</td>
<td class="tdc"> 23</td>
<td class="tdc">850</td></tr>
<tr>
<td class="tdl">Hampstead</td>
<td class="tdc"> 17</td>
<td class="tdc">701</td></tr>
<tr>
<td class="tdl">Wandsworth</td>
<td class="tdc"> 15</td>
<td class="tdc">701</td></tr>
<tr>
<td class="tdl">Woolwich</td>
<td class="tdc"> 12</td>
<td class="tdc">794</td></tr>
<tr>
<td class="tdl">Lewisham</td>
<td class="tdc"> 6</td>
<td class="tdc">546</td></tr>
<tr>
<td class="tdl">County of Dorset</td>
<td class="tdc"> 3</td>
<td class="tdc">352</td></tr>
</table>
<p>The above figures show the effects of overcrowding,
on the mortality from two important diseases, very conclusively;
and it is interesting to note how very far the
mortality from these two diseases in Dorsetshire is below
that of even the best parts of London.</p>
<p>Among other diseases which are very common in
London are the tubercular and respiratory diseases.
Thus the mortality from scrofula, tabes mesenterica,
phthisis, and hydrocephalus in London, during the ten
years 1871–80, was (collectively) 349 per 100,000 (no
correction being made for abnormal age distribution),
as against 224 in Dorsetshire, and the death-rate from
respiratory disease was 460, as against 315 in Dorsetshire.
During the fifteen years 1872–1886 I find that 34,254
in-patients have been treated in University College
Hospital. Of these, 3,798 were cases of respiratory
disease, and 2,453 were cases of disease of bones and
joints, a very large proportion of which, according to<span class="pagenum"><SPAN name="Page_43">43</SPAN></span>
recent investigations, are tubercular. Thus we have
6,251 cases of disease (or more than 18 per cent. of the
whole) in which tubercle plays an important part.</p>
<p>There were also 459 cases of enteric fever, 276 cases
of diphtheria, and 1,020 cases of rheumatic fever. These,
taken together, amount to 1,755, or about 5 per cent. of
the whole. Rheumatic fever is one of the common
diseases of London, which attacks young adults, and
very often cripples them for life. It is a disease of great
importance, and appears from the last report of the
Registrar-General to have been on the increase since
1858.</p>
<p>Besides the greater liability to premature death which
is caused by overcrowding, there are other drawbacks
which are scarcely less important. One of these, with
which we are well acquainted in London, is an increase
in the dirtiness and smokiness of the air, which is mainly
due to private fireplaces. When huge piles of offices are
run up in the City or elsewhere, we like to imagine that,
because most of them are tenantless at night, they cause
no inconvenience, forgetting that each office has its fireplace,
which helps to foul the air, and that each office
supplies its quota of sewage to help to foul the river.
The state of the air in London is such that the most
beautiful of all arts, gardening, has become impracticable
from the fact that comparatively few flowers or shrubs
will flourish. This absence of green plants entails a
great loss of nascent oxygen or ozone, which gives to air
its peculiar quality of freshness. It is hardly conceivable
that a high level of health can be maintained in a spot
where vegetable life languishes, animal life and vegetable
life being complementary to each other.</p>
<p>The overcrowding in London has, of late years, been
mitigated by the conversion of old grave-yards into
gardens, thanks to the society over which the Earl of<span class="pagenum"><SPAN name="Page_44">44</SPAN></span>
Meath so ably presides. If cremation as a means of
disposing of the dead should become general, and
spacious cemeteries be replaced by furnaces, it is clear
that these spaces bequeathed us by the dead will not be
available for “lungs” in the London of the future, and
that cremation, unless it be counteracted by suitable
legislation, is certain to intensify our state of overcrowding.</p>
<p>The moral side of overcrowding must not be forgotten,
but it is not necessary to dwell upon it, as the
Whitechapel horrors are still fresh in the memory, and
the difficulty of detecting crime in a labyrinth of hiding-places
has been demonstrated. The first aim of a
sanitary authority should be to prevent overcrowding,
and its most important duty is to control building operations,
a duty which is never performed because buildings
help to pay the rates.</p>
<h3 id="hdr_9">THE LOOSE END OF OUR SANITATION.</h3>
<p>Another reason why it is not possible to regard the
present sanitary condition of London with much complacency
arises from the fact that our sanitarians have
failed to “make both ends meet,” but have left a terrible
loose end to their measures, which is a constant menace
and an increasing danger.</p>
<p>This “loose end” consists of a daily allowance of
150,000,000 gallons of sewage, which our new councillors
have inherited from the late Board, and which is the
result of probably the greatest sanitary blunder ever
committed in the history of the world. The proper destination
of organic refuse is the soil. Nobody doubts
this. Why, therefore, in a moment of weakness, did we
construct six millions’ worth of machinery to throw it in
the water? The great glory of London, time out of
mind, has been the Thames, but now certainly our glory<span class="pagenum"><SPAN name="Page_45">45</SPAN></span>
has departed. Having adopted a method of sanitation
which is based on an utterly wrong principle, the condition
of the Thames must get progressively worse as long
as that method is pursued.</p>
<p>Some persons talk of a sewage farm as a remedy, but
at least 50,000 acres of land would be necessary, and, to
say the least of it, that is not a cheerful outlook for the
ratepayer in these days of agricultural depression.</p>
<p>At present we are spending £50,000 a year on
chemical abominations to mix with the other abominations,
but it is very hard to see how that can improve
matters. The chemicals will certainly not help the
fishing industry, and if added in sufficient quantity they
must absolutely destroy the very small manurial value
possessed by the sewage or its sludge. My own belief is
that the sewage problem in its present form is insoluble.
To deal with and filter slop-water, as is done in Paris, is
comparatively easy, but here in London the problem is
of a wholly different kind, and my firm conviction is that
our present system of “water-carriage” must lead us
deeper and deeper into the mire.</p>
<p>Until the problem of “What to do with our sewage?”
is settled, clearly, we ought to do our best to stop the
growth of the evil. Our present system of sewers ought
to be closed as far as permission to connect fresh houses
is concerned. As it is, the new Council, like the old
Board, will have an uncertain quantity of sewage to deal
with, for old houses are being everywhere pulled down,
and houses of greatly increased capacity erected, and
this of course means a proportionate increase in the
sewage to be disposed of. In the City there are but
50,000 inhabitants in the official sense, but there are by
this time fully 300,000 daily workers and over 700,000
daily visitors to the City, so that, in spite of an official
decrease in population, the increase of sewage from that<span class="pagenum"><SPAN name="Page_46">46</SPAN></span>
particular spot must be enormous. The same class of
facts applies to other districts in the metropolis, so that
the evil at the outfall is not only not improving, but is
increasing daily. It seems to me quite impossible to
make any arrangement for adequately dealing with the
sewage of a district, unless you are able to say beforehand
what is the maximum quantity which will have to be dealt
with. There being no adequate control of building in
London, and no relation between the cubic contents of a
building and the area it occupies (witness Queen Anne’s
Mansions, the huge pile with which we are threatened at
Knightsbridge, and the equally large pile projected in the
Strand, which is to be 135 feet high, according to the
newspapers), it is evident that the volume of sewage
to be dealt with may be doubled or trebled without any
increase of the area drained by the sewers. Under such
conditions as these the sewage problem may well be
insoluble. The first and main duty of any sanitary authority
should be to exercise a wise control over building.
If every house were compelled in the future to have a
curtilage bearing a definite proportion to the cubic contents,
there would be an end of these towers of Babel,
which shut out from us the light and air of heaven; the
price of building land would fall; it would be possible to
make some calculations as to sewage; and the excessive
overcrowding of a city would be prevented. Without such
a regulation great sewage schemes must in the end make
the sanitary condition of a city worse rather than better.</p>
<p>What to do with our sewage is a very difficult problem—an
insoluble problem, I believe, on the present lines.
At present the Metropolitan Board is shipping some of
the solid matter to be dropped into the sea at the mouth of
the Thames. When the Thames Conservancy see this
fine ship, “built in th’ eclipse, and rigged with curses
dark,” bound on its mission of blocking the port of<span class="pagenum"><SPAN name="Page_47">47</SPAN></span>
London, what can they think? They think it worth
while, apparently, to have a man fined for throwing a
basket of rubbish over one of the bridges.</p>
<p>Again, the House of Commons passed a stringent Act
to prevent the pollution of rivers, but when, a year or so
since, their own sewage arrangements were at fault, they
merely constructed an ingenious apparatus to thoroughly
suck the sewage out of their own premises and pass it on
more effectually than before to pollute the river on whose
bank their stately palace stands. What is the good of
legislation without example? If the House of Commons,
at some sacrifice (more fancied than real) of personal
convenience, had adopted measures in accordance with
the spirit of their legislation, I believe we should have
been within a measurable distance of seeing the Thames
once more meriting the name of silvery. A good example
is better than any amount of legislation, and a good
example set in high places is much needed in this matter,
to which there is undoubtedly a moral side.</p>
<p>How to alter the present arrangements in London now
the houses have been almost uniformly deprived of their
curtilage is very difficult. Under such circumstances
“returning were as tedious as go o’er,” but I am myself
inclined to think that the best solution of London’s
sewage difficulty lies in the direction of cremation—certainly
in the direction of decentralisation.</p>
<p>I believe also that at the outskirts much might be
accomplished by an equitable adjustment of sanitary rates,
and by encouraging householders to do for themselves
what no public authority can do so satisfactorily for them.
But as I have dealt with this subject very fully in a paper
on “The Shortcomings of Modern Sanitary Methods,” I
shall say no more at present.</p>
<p>London gets more than half its water from the Thames,
and this is another reason why the sanitary outlook is not<span class="pagenum"><SPAN name="Page_48">48</SPAN></span>
satisfactory. The system of water-carried sewage is now
almost universal, the sewage ultimately taking its course
along the track of the watershed. Wherever water-carried
sewage is in vogue the natural watercourses must get
fouled, and the fouling will be in proportion to population.
The sewage may be deprived of its coarser ingredients by
mechanical or chemical means, but it is not possible to
believe that any of the methods of treating sewage at
present in use render the effluent wholesome enough to
drink without danger. The increase of population in the
valley of the Thames is therefore a distinct danger to
London. The following table gives the population for
1871 and 1881 of some registration districts situated in
the Thames <span class="locked">valley:—</span></p>
<table summary="Thames valley population, 1871 and 1881">
<tr>
<th> </th>
<th class="lrpad">1871.</th>
<th class="lrpad">1881.</th></tr>
<tr>
<td class="tdl">Kingston</td>
<td class="tdc">55,929</td>
<td class="tdc">77,057</td></tr>
<tr>
<td class="tdl">Richmond</td>
<td class="tdc">26,145</td>
<td class="tdc">33,633</td></tr>
<tr>
<td class="tdl">Reading</td>
<td class="tdc">33,340</td>
<td class="tdc">43,494</td></tr>
<tr>
<td class="tdl">Windsor</td>
<td class="tdc">26,725</td>
<td class="tdc">31,992</td></tr>
<tr>
<td class="tdl">Staines</td>
<td class="tdc">20,199</td>
<td class="tdc">23,774</td></tr>
<tr>
<td class="tdl">Uxbridge</td>
<td class="tdc">25,538</td>
<td class="tdc">27,550</td></tr>
<tr>
<td class="tdl">Brentford</td>
<td class="tdc">71,933</td>
<td class="tdc">101,706 </td></tr>
<tr>
<td class="tdl">Eton</td>
<td class="tdc">24,928</td>
<td class="tdc">27,721</td></tr>
<tr>
<td class="tdl">Wycombe</td>
<td class="tdc">38,366</td>
<td class="tdc">40,278</td></tr>
<tr>
<td class="tdl">Henley</td>
<td class="tdc">18,916</td>
<td class="tdc">19,992</td></tr>
<tr>
<td class="tdl">Oxford }</td>
<td class="tdc">21,016</td>
<td class="tdc">21,902</td></tr>
<tr>
<td class="tdl">Headington }</td>
<td class="tdc">22,756</td>
<td class="tdc">28,723</td></tr>
<tr>
<td> </td>
<td class="tdc"><span class="bt">385,791</span> </td>
<td class="tdc"><span class="bt">477,822</span> </td></tr>
</table>
<p>I am well aware that some of the districts in the
above list are below the intake of the water companies,
but the figures serve to show how rapid is the increase
of population in the valley of the Thames, which is one
of the most popular districts in the whole country. This
concentration of people along the banks of the river must
have the effect of lessening the purity of the water which
we drink.</p>
<p><span class="pagenum"><SPAN name="Page_49">49</SPAN></span>
Thus it is evident that what I have called the loose
end of our sanitation is a growing expense and a growing
danger. Hygiene, to be a permanent benefit, should
move along natural lines, and organic refuse ought to be
committed to the soil as quickly as possible, when it
would cease to be a danger, and would prove a source of
profit. If the evil effects of free trade are to be counteracted,
it will be by returning the refuse of our towns free
of cost to the impoverished agriculturist. If we in England
go on as we are going, and if our brethren in the
Colonies follow our example, as they are doing, I believe
our race must become extinct, and it will be a Chinaman
rather than a New Zealander who will sit in contemplation
on the ruins of London Bridge.</p>
<hr />
<p><span class="pagenum"><SPAN name="Page_50">50</SPAN></span></p>
<h2 class="vspace"><SPAN name="CHAPTER_II"></SPAN>CHAPTER II.<br/> <span class="subhead">LONDON FROM THE MEDICAL POINT OF VIEW.</span></h2></div>
<p>It is impossible to appreciate the causes of the insanitary
condition of Old London without a knowledge of the
state of medical education at the time. This chapter
will show clearly that scientific medicine is of comparatively
modern growth, and it will not need any professional
training to distinguish between the superstitious
dogmas of the past and those scientific principles which
have resulted from the systematic study of medicine
by strictly scientific methods. If the scientific study of
medicine should from any cause be checked, there can
be no doubt that we should soon again make acquaintance
with those pestilences which wrought such fearful
havoc in the Middle Ages.</p>
<h3 id="hdr_10">CHAUCER’S DOCTOR.</h3>
<p>In giving an account of the profession of medicine as
seen in London, both in ancient and modern times, one
cannot do better than begin with that “Doctour of Phisik”
described by Chaucer as setting out from the “Tabard”
in Southwark with the other pilgrims bound for the
shrine of St. Thomas of Canterbury about the year 1380.
Chaucer’s lines have been often quoted, but I make no
apology for giving them once more, because the description
of the “doctour” bears the stamp of truth and is
sufficiently minute to bring the individual before <span class="locked">us:—</span></p>
<div class="poem-container">
<div class="poem"><div class="stanza">
<span class="iq">“There was also a Doctour of Phisik,<br/></span>
<span class="i0">In al this world ne was ther non him lyk<br/></span>
<span class="i0">To speke of Phisic and of Surgerye.”<br/></span></div>
</div></div>
<p class="in0">It may be that the poet means to convey the idea that<span class="pagenum"><SPAN name="Page_51">51</SPAN></span>
doctors of the fourteenth century, like some of those of
the nineteenth, were prone to talk “shop.”</p>
<div class="poem-container">
<div class="poem"><div class="stanza">
<span class="iq">“For he was grounded in astronomye.”<br/></span></div>
</div></div>
<p class="in0">Astrology at this time was an essential part of medicine,
and the simplest remedies were not applied without
consulting the stars, so that to be “grounded in astronomye”
was most essential.</p>
<div class="poem-container">
<div class="poem"><div class="stanza">
<span class="iq">“He kept his pacient wondurly wel<br/></span>
<span class="i0">In houres by his magik naturel.<br/></span>
<span class="i0">Wel cowde he fortune the ascendent<br/></span>
<span class="i0">Of his ymages for his pacient.”<br/></span></div>
</div></div>
<p class="in0">Here we have reference to mystical modes of treatment
which were then much in vogue. Amulets and charms
were constantly prescribed; the doctrine of signatures—<i>i.e.</i>,
the giving of those plants having some slight resemblance
to parts of the human body or to some prominent
symptom of disease, for the relief of the organs or diseases
which they resembled—was in every-day use; and the
treating of images in order to affect the original of the
image was a constant practice among witches, and was
probably used by the profession.</p>
<div class="poem-container">
<div class="poem"><div class="stanza">
<span class="iq">“He knew the cause of every maladye<br/></span>
<span class="i0">Were it of cold or hete or moyst or drye,<br/></span>
<span class="i0">And where thei engendrid, and of what humour.”<br/></span></div>
</div></div>
<p class="in0">Here we have allusion to the Hippocratic humoral pathology
as developed by Galen.</p>
<div class="poem-container">
<div class="poem"><div class="stanza">
<span class="iq">“He was a verrey parfight practisour,<br/></span>
<span class="i0">The cause i-knowe, and of his harm the roote<br/></span>
<span class="i0">Anon he yaf the syke man his boote” (remedy).<br/></span></div>
</div></div>
<p class="in0">Quick diagnosis and prompt treatment.</p>
<div class="poem-container">
<div class="poem"><div class="stanza">
<span class="iq">“Ful redy hadde he his apotecaries<br/></span>
<span class="i0">To sende him dragges, and his letuaries,<br/></span>
<span class="i0">For eche of hem made othur for to wynne.<br/></span>
<span class="i0">Here frendschipe was not newe to begynne.”<br/></span></div>
</div></div>
<p class="in0"><span class="pagenum"><SPAN name="Page_52">52</SPAN></span>
It would seem that even in Chaucer’s time the advertising
druggist was as pushing as at present.</p>
<div class="poem-container">
<div class="poem"><div class="stanza">
<span class="iq">“Wel knew he the olde Esculapius,<br/></span>
<span class="i0">And Deiscorides, and eeke Rufus,<br/></span>
<span class="i0">Old Ypocras, Haly and Galien;<br/></span>
<span class="i0">Serapyon, Razis and Avycen;<br/></span>
<span class="i0">Averrois, Damascen and Constantyn,<br/></span>
<span class="i0">Bernard and Gatisden, and Gilbertyn.”<br/></span></div>
</div></div>
<p class="in0">Our friend’s library was tolerably complete, for here we
have a list of the medical “scriptures,” Greek, Roman,
and Arabian, an acquaintance with which was the whole
duty of a physician, and which to doubt was heresy.
The last two names on the list refer to John of Gaddesden
and Gilbert, both English writers, of whom I shall have
a few words to say presently.</p>
<div class="poem-container">
<div class="poem"><div class="stanza">
<span class="iq">“Of his diete mesurable was he,<br/></span>
<span class="i0">For it was of no superfluité,<br/></span>
<span class="i0">But of gret norisching and digestible.”<br/></span></div>
</div></div>
<p class="in0">Doubtless there were many things then which took the
place of pancreatic emulsion and extract of malt.</p>
<div class="poem-container">
<div class="poem"><div class="stanza">
<span class="iq">“His studie was but litel on the Bible.”<br/></span></div>
</div></div>
<p class="in0">This line is frequently quoted to show that the scepticism
with which doctors are often charged is of no modern
growth. The point of the line is, however, to be found
in the fact that Chaucer’s doctor was certainly a priest,
as were all the physicians of his time, and that the practice
of medicine had drawn him away, somewhat unduly
perhaps, from the clerical profession, to which he also
belonged.</p>
<div class="poem-container">
<div class="poem"><div class="stanza">
<span class="iq">“In sangwyn and in pers he clad was al,<br/></span>
<span class="i0">Lyned with taffata and with sendal.”<br/></span></div>
</div></div>
<p class="in0">A robe of scarlet and sky-blue, lined with silk. Equally
gorgeous doctors may be seen at the present time by
those who attend at Burlington Gardens on “Presentation
Day.”</p>
<p><span class="pagenum"><SPAN name="Page_53">53</SPAN></span></p>
<div class="poem-container">
<div class="poem"><div class="stanza">
<span class="iq">“And yit he was but esy in dispence;<br/></span>
<span class="i0">He kepte that he wan in pestilence.<br/></span>
<span class="i0">For gold in phisik is a cordial;<br/></span>
<span class="i0">Therefore he lovede gold in special.”<br/></span></div>
</div></div>
<p class="in0">The priest-physician was fully as fond of his fees as are
any of his successors. But to come to particular instances
which prove the truth of Chaucer’s graphic picture.</p>
<h3 id="hdr_11">EARLIEST LONDON PRACTITIONERS.</h3>
<p>The “Gilbertyn” of Chaucer’s doctor was <b>Gilbertus
Anglicus</b>, an Englishman who wrote a work on medicine
about the year 1290, and it is remarkable from the fact
that it gave the first description of leprosy written by
western writers, leprosy being a disease which has long
ceased to exist in this country. He treated apoplexy
with ants’ eggs, scorpions’ oil, and the flesh of lions;
but where he obtained this latter commodity it is hard
to tell. For urinary calculi he advised the administration
of the blood of a he-goat fed upon parsley and saxifrage.</p>
<p><b>John of Gaddesden</b> was a graduate of Merton College,
Oxford, and wrote his famous medical treatise, “Rosa
Anglica,” about 1305. He is said to have been greedy
of money, and he recommends his contemporaries to
make arrangements about fees before undertaking a case.
He was an ecclesiastic, and was court physician to
Edward II. and Edward III. He tells us that bleeding
is hurtful at the time of the feasts of St. John and St.
Stephen, but necessary at Christmas because of the
custom of overloading the stomach with cakes at that
season. Pigs’ dung was his favourite hæmostatic; and
when the son of the King had small-pox, he was careful
that everything about his couch should be red.</p>
<p>In South’s “Craft of Surgery” is a most interesting
and full account of <b>John of Arderne</b>, one of the earliest
English writers on surgery. This worthy was a specialist<span class="pagenum"><SPAN name="Page_54">54</SPAN></span>
for the cure of fistula, and dwelt at Newark between 1349
and 1370, when he moved to London. His work “Praxis
Medica” is among the Sloane Manuscripts in the British
Museum. He made his great reputation by curing Sir
Adam Everyngham of fistula after he had been pronounced
incurable by the chief doctors in France. He
relates the cases (some of them with details) of other
patients. The most interesting of the writings of John
of Arderne is that entitled “Of ye Manere of ye Leche,”
because it throws a flood of light on professional manners
and ethics in the fourteenth century. The following
paragraphs (taken from South) are well worth quoting;
but in doing so I think it advisable to (in some degree)
modernise the spelling and the expressions:—“First, it
behoveth him that will profit in this craft that he set God
ever before him in all his works, and evermore call
meekly with heart and mouth his help, and occasionally,
according to his power, give of his earnings to the poor,
that they by their prayers may get him grace of the
Holy Ghost. Let him not be found rash or boastful
in his words or deeds. And let him abstein from much
speaking, especially among the great. And let him
answer questions warily, lest he be overtaken by his
words.... Also be a leche not much laughing nor
much playing, and let him as much as may be fly the
fellowship of knaves and disreputable persons. And be
he evermore occupied in things beholding to his craft,
whether he read or study, write or pray, for the exercise
of books whorshippeth a leche.... And above all
this, it profiteth to him that he be found evermore sober,
for drunkenness destroyeth all virtue, and bringeth it to
nought, as sayth a wise man. Be he content in strange
places with the meat and drink there found, using
measure in all things.... Scorn he no man.... And
if there be made speech to him of any leche, neither<span class="pagenum"><SPAN name="Page_55">55</SPAN></span>
set him at nought, nor praise him too much, nor commend
him, but thus may he courteously answer: ‘I
have not any knowledge of him, but I have neither
learned nor heard of him but good and honest.’...
Consider he not over openly the lady or the daughters,
or other fair women in great men’s houses, ‘ne profre
them not to kisse, ... that he come not in to the
indignacion of the lord ne of noon of his.’... When
such men come to the leche to ask help or counsel, it
speedeth that he make seeming excuses, that he may not
incline to their asking without harming or without indignation
of some great man or friend, or for necessary
occupation; or feign he him hurt, or for to be sick, or
some other convenient cause by which he may likely be
excused. Therefore if he will favour to any man’s
asking, make he covenant for his travail and take it
beforehand.... And if he see the patient, pursue
busily the cure then, and ask he boldly more or less,
but ever be he warre of scarce askings, for over scarce
askings setteth at nought both the market and the thing.
Therefore for the cure of fistula in ano, when it is curable,
ask he competently of a worthy man and a great an
hundred marks or forty pounds, with robez and feez of
an hundred shillyns terme of life, by year. And take he
not less than an hundred shillyns, for never in als my
life took I less than an hundred shillyns for cure of that
sekeness.” John of Arderne advises that prognosis should
be very guarded, and that as to the time of recovery it is
good to say double what you think, and if the patient
ask “why he putte him so long a time of curying, sithe that
he heled him by the halfe? Answer he, that it was for
that the patient was strong hearted and suffered well
sharp things, and that he was of good complexion and
had able flesh to heal, and feign he other causes pleasable
to the patient, for patients of such words are proud and<span class="pagenum"><SPAN name="Page_56">56</SPAN></span>
delighted.” The leech is further advised to dress like a
clerk (<i>i.e.</i>, a priest), “for why it seemeth any discrete
man clad with clerk’s clothing to occupy gentlemen’s
boards.” “Have the leche also clean hands and well
shapen nails, cleansed from all blackness and filth.”
There are many other directions for conduct given in
this remarkable document, and sundry extracts from
Scripture are given as suitable for quotation by the bedside:
“And it speedeth that a leech can talk of good
tales and of honest that may make the patient to laugh,
as well of the biblee as of other tragediez.” Finally,
he is charged to most scrupulously observe all professional
confidences. It is evident that John of Arderne was a
consummate man of the world, and knew all the tricks of
his trade. His fees seem to have been enormous, and,
indeed, he is only one out of many examples among our
early professional forerunners who made very large professional
incomes.</p>
<p>Whether Gilbert, Gaddesden, and John of Arderne
were associated with any guild which took upon itself
the duty of protecting the interests of physicians and
surgeons is not known. Certainly they belonged to no
association of which we have any trace remaining. I
shall now endeavour to show how the medical corporations
of London had their origin, and it is necessary to
make a few preliminary remarks.</p>
<h3 id="hdr_12">THE SEVERANCE OF MEDICINE AND SURGERY.</h3>
<p>The physicians and surgeons were originally very
different orders of men. Medicine is in most Christian
countries an offshoot of the clerical profession. So
profitable was the practice of medicine, that not only
monks, but many of the higher clergy, devoted themselves
to it. The union of the two professions of
medicine and divinity existed up to the middle of the<span class="pagenum"><SPAN name="Page_57">57</SPAN></span>
seventeenth century, and evidence of it is still found in
the “Lambeth M.D.,” a degree which the Archbishop of
Canterbury still has the right to confer, but only upon a
legally qualified practitioner. It was thought necessary
by Pope Innocent III. (1198–1216) to forbid the clergy
to undertake any operation involving the shedding of
blood, and by decrees of other popes in the thirteenth
and fourteenth centuries they were forbidden to practise
surgery in any form. In this way medicine and surgery
became divorced, and this forcible and arbitrary separation
of two branches of the same subject served undoubtedly
to hinder the progress of medical knowledge
to an enormous extent. Medicine was thus left mainly
in the hands of scholars, of men who at that time stood
alone in the possession of scholastic learning, while
surgery was handed over to men who had little or no
scholarship, but who amassed a considerable amount of
practical wisdom in the daily struggle with the difficulties
of their craft.</p>
<p>The early physicians, like Chaucer’s “Doctour of
Phisik,” often had an extensive knowledge of the writings
of the Greek, Latin, and Arabian writers, who may be
considered as the medical “fathers.” These were their
scriptures, which to doubt was heresy. They knew
nothing beyond them, and it is not surprising that
priestly medicine, divorced as it was from those practical
matters in overcoming which we alone get wisdom, was
absolutely unprogressive and unproductive. If the early
clerical physicians did little for medicine as a science,
they did a great deal for it as a profession. They were men
of learning and high culture; they had had a university
training; and we shall see that many of them were well
born and had been brought up amongst high-minded
gentlemen; and undoubtedly it is due to the College of
Physicians, and largely to some of its earlier members,<span class="pagenum"><SPAN name="Page_58">58</SPAN></span>
that the profession of medicine has been practised in this
country in a manner which is mainly creditable. Glaring
exceptions, of course, have occurred; but, as a rule, the
men who have neglected to conduct themselves as
gentlemen have met with no encouragement from the
College of Physicians, and I believe it would be difficult
to over-estimate the influence for good which the College
has had in this direction.</p>
<p>The early surgeons were many of them illiterate and
rough. Some of them—perhaps most of them—were, in
this country and in France, evolved from the barbers;
and this is not surprising, for the man who can shave
with dexterity has acquired no small skill in handling
sharp instruments, and must be often called upon to
treat wounds of his own making. It is not surprising
that these men should have been called in to attend to
cases of injury, and we know that they very early added
tooth-drawing and bleeding to their tonsorial art, and
practised all three till a comparatively recent date. War
with its wounds must have made surgery a necessity in
every country, from the time of the siege of Troy downwards;
and Mr. South gives an interesting account of
Thomas Morstede, who was chief surgeon to Henry V.’s
army at Agincourt. Again, many doubtless acquired
their first knowledge by practising on animals, and
it must be remembered that there are now throughout
this country scores of illiterate men who operate with
consummate skill on the lower animals. It appears that
as early as 1308 the barbers of London were incorporated
into a guild, and there appears to have been a gradual
separation of them into those which practised surgery
and those which practised barbery, and in 1460 the
Guild of the Barber-Surgeons was one of the livery companies
of the City. Outside this body there was an
Association of Surgeons, and also an Association of<span class="pagenum"><SPAN name="Page_59">59</SPAN></span>
Physicians, and, according to Mr. South, there appears
to have been in 1423–24 a veritable Conjoint Board of
Physicians and Surgeons, which, however, survived its
birth only a few months. At the time of the accession of
Henry VIII. it appears that public opinion was getting
ripe for legislation.</p>
<h3 id="hdr_13">THE EARLIEST MEDICAL ACT.</h3>
<p>In the third year of the reign of that monarch
(1511–12) an “Act for the Appointing of Physicians
and Surgeons” was passed, the preamble of which was
as follows: “Forasmuch as the science and cunning
of physick and surgery (to the perfect knowledge
whereof be requisite both great knowledge and ripe
experience) is daily within this realm exercised by a
great multitude of ignorant persons, of whom the greater
part have no manner of insight into the same, nor in any
other kind of learning; some also can no letters on the
book, so far forth that common artificers, as smiths,
weavers, and women, boldly and accustomably take upon
them great cures and things of great difficulty, in the
which they partly use scorcery and witchcraft, partly apply
such medicines unto the disease as be very noxious and
nothing meet therefore; to the high displeasure of God,
great infamy to the faculty, and the grievous hurt,
damage, and destruction of many of the King’s liege
people; most especially of them that cannot discern the
uncunning from the cunning. Now therefore ... be
it enacted,” &c. And the Act goes on to provide that
all who practise medicine and surgery (except graduates
of the University) shall be previously examined, approved,
and admitted by the Bishop of London or the Dean of
St. Paul’s, or (for the country) by the bishop of the
diocese, who shall call to his aid for this purpose four
doctors of physick, “and for surgery other expert persons<span class="pagenum"><SPAN name="Page_60">60</SPAN></span>
in that faculty.” The penalty for evading the Act was
£5 for each month of illegal practice. Two years later
an Act was passed giving to the members of the Guild
of Barber-Surgeons (not exceeding twelve) exemption
from bearing arms or serving on inquests.</p>
<h3 id="hdr_14">THE COLLEGE OF PHYSICIANS.</h3>
<p>The time was now at hand when the first step was to
be taken to give the profession a position of independence,
and to allow it to regulate its own affairs without
reference to ecclesiastical dignitaries. We owe this in
all probability to Thomas Linacre, who possessed the
confidence of Cardinal Wolsey, and probably also of the
king. Be that as it may, on September 23rd, 1518,
letters patent were granted constituting the Royal College
of Physicians. By this instrument the College was given
the control of all medical practitioners in London and
within seven miles of it, and none were to be allowed
to practise unless previously examined by the College.
Four years later these powers were extended to the whole
of England, except in the case of University graduates.
The charter and subsequent Act gave ample power to the
College to regulate its affairs, and accorded privileges
and exemptions to the physicians similar to those previously
accorded to the surgeons. The great fact, however,
was the power of controlling the profession, and
it must be remembered that the censors had power to
fine and imprison delinquents. In Henry’s charter six
persons were named—viz., John Chambre, Thomas
Linacre, Ferdinand de Victoria, Nicholas Halsewell,
John Francis, and Robert Yaxley, and it will be interesting
to consider the personality of some of these founders
of the Royal College. The real founder and first president
was <b>Thomas Linacre</b>, who was born in 1460.
Having graduated at Oxford, and become a Fellow of<span class="pagenum"><SPAN name="Page_62">62</SPAN></span>
All Souls in 1484, he went abroad in 1485, and visited
Bologna, Florence (where he enjoyed the friendship of
Lorenzo de Medici), Rome, Venice, and the famous
school of Padua (where he took the degree of M.D.).
In 1501 he was appointed physician and preceptor to
Prince Arthur, and also physician to Henry VII. He
was also physician to Henry VIII., and it is recorded
that he was consulted by many men of note, notably
Cardinal Wolsey and Erasmus. He took holy orders in
1509, and the same year was presented to the rectory of
Merstham, then became prebend of Wells (1510), rector
of Hawkhurst (1510), canon of St. Stephen’s, Westminster,
prebend of York (1517), precentor of York (1519), rector
of Holsworthy, Devon (1518), and rector of Wigan,
Lancashire (1520). This list of eight clerical benefices
in almost as many years—benefices which were probably
given as professional fees, and which were probably
passed on, as soon as given, to a successor “for a consideration”—throws
a curious light on the state of the
Church, and helps us to understand the crash which was
so soon to come. It is interesting, as showing the origin
of the medical within the clerical profession, to remember
that the first President of the College of Physicians
was the rector of four parishes, the occupant of two
prebendal stalls, a canon, and a precentor. We all owe
a debt of gratitude to Linacre. He not only obtained
the charter for the College, but gave his house in Knightrider
Street (which is a street running parallel to part of
Queen Victoria Street, E.C.) as a meeting-place for the
new corporation. All who are competent to judge seem
agreed in stating that Linacre was one of the greatest
scholars of his age, and possessed a knowledge of Latin
and Greek which for that time was quite exceptionally
great. He founded lectureships at Oxford and Cambridge.
He died in 1524, six years after the foundation of the<span class="pagenum"><SPAN name="Page_63">63</SPAN></span>
College, and was buried in Old St. Paul’s, where in
1557 Caius erected a monument with an epitaph of his
own composing. Of <b>John Chambre</b>, the first person
named in the charter, we know little; but it is interesting
to note that he was a Fellow of Merton College, Oxford;
that he studied at Padua; that he was physician to the
king; that he was censor of the College in 1523; that
he was doubly a vicar, doubly an archdeacon, a prebend,
a canon, and a dean, and the treasurer of Bath Cathedral.
He died in 1549. Of the other four persons named in
the charter we know very little, and they need not
detain us. Linacre’s house, which was given by its
owner, was the first home of the College of Physicians,
was occupied by the College until 1614, and remained
the property of the College until 1860, when it was taken
for the Crown by an Act of Parliament. Only the front
part of the house was given by Linacre, the back part
belonging to Merton College, Oxford, which is one of
the many connexions between Merton College and the
College of Physicians. The house represented at p. <SPAN href="#ip_63">61</SPAN>
was certainly not Linacre’s original dwelling.</p>
<div id="ip_63" class="figcenter" style="max-width: 23.875em;">
<ANTIMG src="images/i_061.jpg" width-obs="382" height-obs="600" alt="" />
<div class="caption">LINACRE’S HOUSE. (<cite>From a Print in the “Gold-Headed Cane.”</cite>)</div>
</div>
<p>We have thus seen the science of medicine in London
beginning with the clergy, then organised under the
supervision of bishops and deans, and finally with an
independent controlling body, of which the early members
were many of them in holy orders. It will now be
convenient to trace the subsequent history of the College
of Physicians, and I shall endeavour to bring before the
mind’s eye some of its most remarkable early Fellows,
and in so doing I shall hope to give some idea of the condition
of medicine in London in the days of the Tudor
and Stuart sovereigns. My information on these points
is mainly drawn from Dr. Munk’s learned work, entitled
“The Roll of the Royal College of Physicians of London.”</p>
<p>A very prominent figure in the early history of medicine
in London is <b>John Kaye</b>, or <b>Caius</b>, as he called<span class="pagenum"><SPAN name="Page_64">64</SPAN></span>
himself, well known, by name at least, in connexion with
Gonville and Caius College, Cambridge, which he enlarged
and endowed. Caius was born in 1510, and
studied at Gonville Hall, Cambridge, which was ultimately
to be better known by his own name. He went to
Padua in 1539, and lived in the same house with the
celebrated anatomist, Vesalius. He became professor of
Greek at Padua, and took the M.D. there in 1541. He
became F.R.C.P. in 1547, and settled in London in
1552. He was president of the College in 1555. He
was physician to Edward VI., Mary, and Elizabeth, but
he is said to have been removed from the latter position
because of his Romish tendencies. He died in 1573 at
his house in Bartholomew Close, and was buried in the
chapel of Caius College, with the epitaph “Fui Caius.”
Caius was certainly rich, as is shown by his splendid
munificence at Cambridge. Although he was much
occupied at Cambridge in the latter years of his life, he
was frequently re-elected to the presidency of the College,
the last time being in 1571. The frequent re-election of
a president, who was latterly much of an absentee, may
have been from the hope that the College would ultimately
obtain some of his great wealth, but, if this were so,
(of which indeed there is no evidence), the College was
doomed to disappointment. Caius appears to have had
great regard for form and order. He was the inventor
of the insignia of office—the silver wand, the Book of
Statutes, and the cushion—which are still used by the
president of the College. On the occasion of the funeral
of Dr. Bartlot, in 1556, we learn that the College attended
in state, and that the Book of Statutes, adorned with
silver, was carried before the president. Caius was very
punctilious about the respect to be paid to the dead, and
we find it laid down in the statutes of Caius College that
the president, fellows, and students are to attend the<span class="pagenum"><SPAN name="Page_65">65</SPAN></span>
funerals of subjects used for dissection with as much
reverence and pomp as though it were the corpse of
some more worthy person, because of the advantage
which they had derived from it. Caius kept the accounts
of the College with great accuracy, and in 1560, on the
termination of his first six years of office, handed over
the whole of the funds to his successor, amounting to
£55 13s. 3d. He wrote out the annals of the College
with his own hand, and thus did much to establish order
in the proceedings. His love of what we should call
“ritual” seems to have led him into trouble in his later
years, and a large amount of material connected with
religious ceremonial, which was found in Caius College,
was burnt by order of the vice-chancellor. Caius was
a profound scholar, and edited many of the writings
of Galen, Celsus, and Hippocrates. He was also a
naturalist, and wrote a treatise on British Dogs. His
only original medical work was a “Boke or Counsel
against the Sweat”—a treatise, in fact, on the sweating
sickness. Strangely enough, the first edition was in
English, but its ultimate appearance was in orthodox
Latin. He was much concerned about the faulty pronunciation
of Latin in this country, and tried to introduce
the continental method of pronouncing the vowels,
to which he had become accustomed during his long
residence abroad. He was something of an antiquary,
and proved to his own satisfaction that the University of
Cambridge was founded by “Cantaber,” <span class="smcap smaller">B.C.</span> 394. He
defended the privileges of the College, and in a case
tried before the Lord Mayor in the reign of Elizabeth as
to the right of surgeons to give internal remedies for the
sciatica, &c., the evidence of President Caius seems to
have convinced the Court that they had no such right.
The name of Caius is inseparably connected with the
teaching of anatomy in this country. When King Henry<span class="pagenum"><SPAN name="Page_66">66</SPAN></span>
VIII. in 1540 gave the charter to the Barber-Surgeons
(of which I shall have more to say hereafter), the following
important clause formed part of the charter: “The
said masters or governors of the mystery and commonalty
of barbers and surgeons of London and their successors
yearly for ever, after their said discretions, at their free
liberty and pleasure, shall and may, have and take without
contradiction, four persons condemned, adjudged
and put to death for felony by the due order of the
King’s laws of this realm, for anatomies, without any
further suit or labour to be made to the King’s Highness,
his heirs and successors for the same.” When the first
anatomy lectures were given at Barber-Surgeons’ Hall is
not quite clear; but according to South it was before
1563, and according to Sir George Baker, Dr. Caius was
the first lecturer appointed, and this appointment was
made shortly after his return from Italy, which was in
1547. It was during Caius’s lifetime, and while he was
taking an active interest in the College, although not
actually president (namely, in 1565), that Queen Elizabeth
accorded to the physicians facilities with regard to anatomy
similar to those enjoyed by the Barber-Surgeons; and it
is evident from the statute of Caius College which I just
now read, and which has been kindly brought to my
notice by Mr. Ransom, that Caius made proper arrangements
for the teaching of anatomy in connexion with his
Cambridge foundation. Anatomy is the very groundwork
of medicine, and without it it can have no existence
as a branch of science. Undoubtedly we owe a deep
debt of gratitude to the Barber-Surgeons, to the College
of Physicians, and to Dr. Caius. I cannot dismiss this
remarkable man without further illustrating his character
by recalling three events which took place at the College
during the time that Caius was president. In 1558,
Christopher Langton, M.D., F.R.C.P., was expelled from the<span class="pagenum"><SPAN name="Page_67">67</SPAN></span>
College for “rashness, levity, and foolish contentions
with his colleagues at consultations, as well as for incontinency.”
Five years later, for this latter failing, this
worthy “was carted through London in a ridiculous
attire.” In 1559, John Geynes, M.D., F.R.C.P., was
cited before the College for impugning the infallibility of
Galen. On his acknowledgment of error and humble
recantation he was received into the College. In 1556
the College objected to the admission by the University
of Oxford of one David Laughton, an illiterate coppersmith.
The College laid before Cardinal Pole and the
visitors the following instance of his illiteracy: “<span xml:lang="la" lang="la">Cujus
infantia, cum suggessit ut quomodo <i>corpus</i> declinaretur,
exigeremus, respondit <i>hic</i>, <i>hæc</i>, et <i>hoc corpus</i> accusativo
<i>corporem</i></span>,” adding “<span xml:lang="la" lang="la">egregius certe ex universitate medicus
cui humana vita committeretur</span>.” This objection was
successful. Clearly formal President Caius was not the
man to countenance loose morals, heterodoxy, or bad
grammar. We must not dismiss Caius without alluding
to the Dr. Caius of Shakspeare, as drawn in the “Merry
Wives of Windsor.” Shakspeare’s Caius is described as
a French physician, and throughout the play he is made
to speak broken English. Caius died in 1573, when the
poet was ten years old, and it is very probable that
Shakspeare borrowed the name without thinking of the
man. On the other hand, it must be remembered that
Caius probably spoke Latin like a Frenchman and that
he lost favour at the court of Elizabeth, and it is possible
that Shakspeare may have heard him held up to
ridicule.</p>
<p>But to proceed with the history of the College and
its relations to medical education. In 1581, Dr. Caldwell
and Lord Lumley founded the <cite>Lumleian Lectures
on Anatomy and Surgery</cite>, and the importance of this
foundation will be appreciated when it is stated that<span class="pagenum"><SPAN name="Page_68">68</SPAN></span>
Harvey was Lumleian lecturer from 1615 to 1656, and
that it was in these lectures that the great fact of the
circulation was first demonstrated. In 1587, we find the
College renting a garden for forty marks a year, and
engaging John Gerard, the author of the well-known
“Herbal,” to keep it stocked for them with rare plants.
Gerard himself had a garden in Holborn, where among
other things he propagated the potato.</p>
<p><b>William Gilbert</b>, who was president of the College
in 1600, was the first really scientific Fellow. He was
physician to Elizabeth and James I., and his great work
on magnetism, “De Magnete Magneticisque Corporibus
et de Magno Magnete Telluræ, Physiologia Nova,” commanded
the admiration of Bacon and Galileo, and of
many succeeding generations of scientists. It is a work
worthy of being placed alongside of Harvey’s work
on the Circulation, and the College of Physicians is
honoured to have reckoned him among its presidents.
The importance of Gilbert’s investigations to a great
naval Power seems to have been recognised by Queen
Elizabeth, who, to her great honour, assisted him with a
pension. He died in 1603, aged sixty-three, and was
buried at Colchester. He was the contemporary of
Shakespeare and Bacon, and was one of those who
helped to make the Elizabethan era the wonder of all
subsequent generations.</p>
<p>The post-mortem examination made on the body of
James I. is an interesting record of the state of pathology
in 1625. It is recorded “that the head was found so
full of brains that they could not keep them from
spilling—a great mark of his infinite judgment; but his
blood was wonderfully tainted with melancholy, and the
corruption thereof was the supposed cause of his death.”</p>
<p>I have now to mention the man who, above all
others, has tended by his work to make medicine a<span class="pagenum"><SPAN name="Page_69">69</SPAN></span>
science, and who probably did much by his lectures at
the College to disseminate a knowledge of anatomy and
physiology. Harvey was the first English physiologist,
and lectured for forty-one years at the Royal College of
Physicians on anatomy and surgery. <b>William Harvey</b>
(1578–1657) went to Padua in 1598, and studied under
Fabricius, Minadous, and Casserius, and took his M.D.
in 1602. He came to London in 1604, became F.R.C.P.
in 1607, and succeeded Dr. Wilkinson at St. Bartholomew’s
in 1609. He was Lumleian lecturer in 1615.
He expounded, as is supposed, the doctrine of the
circulation in 1616, and finally published his views in
1628. He was physician to James I. in 1618 (?). In
1638 he was appointed physician in ordinary to Charles I.,
and there is a curious order in the letter-book of the
Lord Steward’s office for the settling a “diett of three
dishes of meat and meale with all incidents thereunto
belonging upon the said Dr. Harvey,” which daily
“diett” was subsequently commuted for £200 a year.
Harvey followed the fortunes of the King, and was at the
Battle of Edgehill in 1642. Meanwhile his house in
London was plundered of goods and anatomical records.
He became warden of Merton College, Oxford, in 1645,
from which post he was ousted by the Parliament in
1646. By the solicitation of Sir George Ent he was
induced to publish his work on Generation in 1651. He
gave a new library and museum to the College of
Physicians in 1653, whereupon the Fellows placed his
statue in their hall, and, in his absence, elected him
president in 1654, which honour, however, he gracefully
declined, and recommended the College to elect Dr.
Prujean instead. He remained Lumleian lecturer until
1656, when he resigned, and presented the College with
his patrimonial estate at Burmarsh, Kent. He died of
the gout in 1657 in his eightieth year. In his will he<span class="pagenum"><SPAN name="Page_70">70</SPAN></span>
says: “I give to the College of Physicians all my bookes
and papers, and my best Persia long carpet, and my blue
satin embroyedyed cushion, one pair of brass and irons,
with fireshovell and tongues of brass, for the ornament of
the meeting-room I have erected for the purpose. Item,
I give my velvet gown to my loving friend Mr. Doctor
Scarborough, desiring him and my loving friend Mr.
Doctor Ent to looke over those scattered remnants of
my poore librarieie, and what bookes, papers, or rare
collections they shall think fit to present to the College,
and the rest to be sold, and with the money buy better.”
Thus, it will be seen that Harvey is not only the greatest
ornament of the College, but also its greatest benefactor.
He was the second in order of time of the great lights of
science connected with the College, Gilbert being the
first. His will is interesting from the choice of his
executors, who were both Fellows of the Royal Society
and leaders of science; and, secondly, by the mention of
the velvet gown, which possibly is the one represented
as worn by Sir C. Scarborough in the picture at Barbers’
Hall. I abstain from any mention of Harvey’s great
discovery, because we all know it and appreciate it, and
no words of mine could increase your admiration.</p>
<p>I may here mention that in 1614 the house in
Knightrider Street had become too small for the business
of the College, and accordingly new premises were taken
on lease from the Dean and Chapter of St. Paul’s at
Amen Corner, at the end of Paternoster Row. A
botanical garden was planted and a theatre was built,
and here it was that Harvey made the College a present
of a great parlour and a museum, which he erected at
his own cost. The garden extended from the Old
Bailey to the Church of St. Martin, Ludgate, and included
the site of the present Stationers’ Hall. The
museum and library soon became enriched by many<span class="pagenum"><SPAN name="Page_71">71</SPAN></span>
contributions, the greater part of which were, however,
unhappily destroyed by the fire in 1666.</p>
<p><b>Dr. Goulston</b> (F.R.C.P. 1611) founded by will the
<cite>Gulstonian Lectures</cite>, to be read “between Michaelmas
and Easter by one of the four youngest doctors of the
College.” <b>Sir Theodore Mayerne</b> (F.R.C.P. 1616),
was by birth a Swiss Protestant, and after serving as
physician to Henry IV. of France, settled in London,
where he became physician to James I. and his Queen,
and subsequently to Charles I. He was the fashionable
physician of his day, and was one of the first to use
chemical medicines, which was looked upon as heretical
by the strict Galenists, who used only “simples,” drawn
from organic nature. He introduced calomel and blackwash,
wrote the dedication to the first edition of the
Pharmacopœia Londinensis (1618), accumulated great
wealth, and died at Chelsea in 1655.</p>
<p><b>Sir Charles Scarborough</b> succeeded Harvey as
Lumleian lecturer, and was lecturer on anatomy to the
Barber-Surgeons. He was physician to Charles II.,
James II., and William III., and was a great mathematician.</p>
<p><b>Baldwin Hamey</b>, jun. (F.R.C.P. 1634), a devoted
Royalist and Churchman, enjoyed a lucrative practice
among amorous Parliamentary Puritans. He presented
the lease of the College in Amen Corner to his colleagues
(1651), contributed largely to its rebuilding
after the fire, and left it a considerable landed estate near
Ongar, in Essex.</p>
<p><b>Francis Glisson</b> (F.R.C.P. 1635), Regius Professor
of Physic at Cambridge, was president of the College in
1667–8-9. He wrote a treatise on Rickets, was a serious
anatomist, wrote a treatise on the Anatomy of the Liver,
and has given us “Glisson’s Capsule” as a record of
his industry and talent. He was one of the original<span class="pagenum"><SPAN name="Page_72">72</SPAN></span>
members of the Royal Society, and one of the few of the
Fellows of the College who stopped in London during
the plague. He was a friend of Anthony Ashley, Earl
of Shaftesbury. We are indebted to Dr. Glisson for
positive additions to our knowledge of the human body,
and he is to be regarded as the third in order of time of
the scientific Fellows.</p>
<p><b>Thomas Wharton</b> (F.R.C.P. 1650), <b>Thomas
Willis</b> (F.R.C.P. 1664), and <b>Richard Lower</b>
(F.R.C.P. 1675) were three earnest and distinguished
anatomists, who added new facts to medicine, and whose
names are still enshrined in our anatomical nomenclature.</p>
<h3 id="hdr_15">THE PLAGUE.</h3>
<p>We now approach the year 1665, so notable for the
terrible pestilence which afflicted London, and we may
well take the opportunity of seeing what was the practice of
physicians at this time. The best account of the plague
is that written by <b>Dr. Nathaniel Hodges</b>, under the
title “Loimologia.” This treatise, originally written in
Latin and published by the author in 1672, was translated
by Dr. John Quincy in 1720. From this valuable work we
gain some insight into the moral and physical conditions
of the population, and of other causes which tended to
increase the virulence of the epidemic. It was at the
close of the year 1664 that cases of plague—a disease
which had previously committed extensive ravages in
London—began to occur, and the fears of the inhabitants
were fomented by astrologers and others, who tormented
the ignorant with prophecies as to the evils which would
occur from the “conjunction of Saturn and Jupiter in
Sagittarius” and the like. Again, the action of the
magistrates, who ordered that infected houses should be
marked with a red cross and the legend “Lord, have
mercy upon us,” and who further set a guard upon such<span class="pagenum"><SPAN name="Page_73">73</SPAN></span>
houses to prevent either ingress or egress, was probably
most mischievous, as tending to spread the infection
amongst all the inhabitants of a house, and to keep it alive
within the confined area of the city. Hodges truly
remarks that the proper course would have been to immediately
remove the infected to proper lodgings provided
without the walls. He continues: “But what greatly
contributed to the loss of people thus shut up was the
wicked practice of nurses (for they are not to be mentioned
but in the most bitter terms). These wretches, out of
greediness to plunder the dead, would strangle their
patients and charge it to the distemper in their throats;
others would secretly convey the pestilential taint from
sores of the infected to those who were well,” &c. If we
are to receive the statement seriously (and Hodges is a
temperate writer), it throws considerable light on the
moral condition of the lower orders.</p>
<p>The first symptom of the plague appears to have been,
as a rule, a violent shivering or rigor, lasting from half an
hour to four or five hours. This was followed or accompanied
by vomiting. Upon this delirium quickly supervened,
and if not restrained the infected would run
“wildly about the streets.” Vertigo, headache, and coma
were also common. The signs of fever were strongly
marked, such as “extreme inquietude, a most intense heat
outwardly, attended by unquenchable thirst within, dryness,
blackness of the tongue, intolerable heat of the
præcordia, and all other usual concomitants of a fever’s
accession.” In many cases there seem to have been well-marked
exacerbations and remissions, but this was not
constantly observed. Insomnia was occasionally troublesome,
and palpitation of the heart appears to have been
often strongly marked. Sweating was a common feature,
and seems often to have been “critical,” the plague
subsiding at once by crisis. Pustules upon the skin,<span class="pagenum"><SPAN name="Page_74">74</SPAN></span>
varying in size from a pea to a nutmeg, and called blains,
as well as buboes affecting the lymphatic glands, were
among the ordinary symptoms. Further, in addition to
these, carbuncles seem to have been very usual, and also
a petechial eruption; and, further, Hodges describes (in
addition to the foregoing pustules, buboes, carbuncles,
and petechiæ) certain prominent spots with pyramidal
heads, which were called “plague tokens” by the vulgar.</p>
<p>The treatment adopted was very far from being of
the so-called “expectant” form which is now so much
followed in the management of patients suffering from
infective disorders. They were put to bed between the
blankets, and the patient was addressed by his physician
“with cheerfulness.” Hodges seems to have discouraged
phlebotomy, but he states that many “let blood largely.”
If the patient did not vomit he was given an emetic, and
this in many cases was followed by an expulsive cathartic.
In all cases were strong diaphoretics administered, and
sweating was encouraged to the utmost. A marvellous
assortment of drugs was poured into the patient. Those
used by Hodges were mostly fresh indigenous herbs, and
he mentions angelica, rue, sage, veronica, centaury,
scabious, pimpernel, marygold, scorzonera, ivy berries,
balm, valerian, garlic, gentian, elder berries, juniper
berries, and dozens of others; but he speaks scornfully
of the Oriental bezoar, powdered unicorn’s horn, and
powder of toads, which many thought very efficacious.
“To all who sweat,” he says, “change of clothes is to be
denied, for the patient takes harm by clean coverings,
not so much from any prejudicial quality of the soap
abounding in them, as from a dampness which is inseparable
from them, and the approach of air which is
unavoidable in the shifting, both of which will check the
sweating.” Sleep was industriously kept off, although
sometimes, through sheer weariness, the patient would<span class="pagenum"><SPAN name="Page_75">75</SPAN></span>
drop into a doze. The diet given was light and generous—eggs,
strong broths, and good wines; but of the usefulness
of gold boiled in the broths Hodges has “nothing
to say.” The patient was most rigidly kept in his bed,
and those who were delirious were tied in them. During
the sweats “the patients were forcibly kept awake,” and
if later in the disease a little sleep was allowed, they
were roused every four hours to take medicine. Scents
were used in the room, and odorous gum resins, such as
styrax, were burnt upon live coals. Blisters were applied
to several parts, such as the nape of the neck and the
insides of the arms and thighs. These blister plasters
were made of pitch, galbanum, wax, cantharides, yeast,
euphorbium, and vinegar of squills, worked into a mass.
The parts thus blistered were not suffered to heal till the
malignity of the disease was spent. “Besides epispasticks,
it is not lost labour to apply proper things to the feet. I
commonly used a plaster made of the compound betony
plaster, adding to it some euphorbium, saffron, and
London treacle, and I found this to do more good than
cataplasms, which some, however, liked better to use,
and were made of bryony root steeped in vinegar, the
flesh of pickled herrings, black soap, rue, scordium, and
arum, with a sufficient quantity of vinegar; sometimes
also pidgeons were applied to the feet.” Similar applications
were also made to the wrists. The buboes were
treated with cataplasms and discutients, and were often
opened by the surgeon and subsequently washed with a
“Lixivium of ashes, scordium, betony, bugloss, sanicle,”
&c., in which also was dissolved some London treacle.
Carbuncles were treated in a similar way, but when the
eschar did not fall off the actual cautery was liberally
applied. In order to prevent the necessity of using a
hot iron, it was suggested that “sometimes the pestilential
venom is to be drawn out by cupping or scarrification<span class="pagenum"><SPAN name="Page_76">76</SPAN></span>
or epispasticks; sometimes also for the same purpose
is applied the bare rump of a fowl, repeated until
these creatures appear not to be hurt by it; for this
natural warmth soothes the vital heat of the part it is
applied to, and entices away the morbifick venom through
the pores; pidgeons, used alive, and warm sheep’s lights
have likewise been observed thus to asswage the acrimony
of this pestilential virulence.”</p>
<p>Hodges is by no means silent on the important subject
of prevention, and he justly says: “When the nature and
peculiar qualities of this disease are known and reported
by physicians, such laws should be provided as might
best conduce to prevent its spreading, if not to its utter
extirpation.” The punishment of those who frighten the
populace by prophecies and the like; the timely separation
of the sick from the well; house-to-house visitation
(which was actually carried out); the disinfection of the
air by fumigations; the daily cleansing of streets, sinks,
and canals (“because stench and nastiness are justily
reckoned the entertainers of infection”); the burning of
pastilles; the killing of “dogs, cats, and other domestic
brutes,” which carry the infection from place to place;
and great attention to personal health, are among the
measures which he advocates. He has no belief in the
benefit to be derived from taking excrement and urine,
which were given as antidotes by some old nurses; but,
on the other hand, he had implicit faith in liberal
potations of sack (“middle-aged, neat, fine, bright, racy,
and of a walnut flavour”). With regard to the use of
tobacco, he says: “I must confess myself at uncertainties
about it, though as to myself I am its professed enemy,
and was accustomed to supply its place as an antidote
with sack.” He did not believe in amulets, which were
then much in vogue; some being alleged to have a
diffusive magnetic value; others drawing the poison out<span class="pagenum"><SPAN name="Page_77">77</SPAN></span>
of the body “as amber attracts straws,” some serving to
invigorate nature. Walnut shells filled with mercury,
arsenic mixed with wax and a variety of other drugs, and
dried toads seem to have been the amulets most generally
worn.</p>
<p>Among the physicians who stayed in London to
minister to the sick, Hodges mentions “Dr. Glisson,
Regius Professor at Cambridge, Dr. Nath. Paget, Dr.
Wharton, Dr. Berwick, Dr. Brookes, and many others.”
And he further states that of these, eight or nine died.
Hodges, however, survived, and he says: “I think it
not amiss to recite the means which I used to preserve
myself from the infection during the continual course of
my business among the sick. As soon as I rose in the
morning early, I took the quantity of a nutmeg of the
antipestilential electuary; then, after the dispatch of
private concerns in my family, I entered into a large
room, where crowds of citizens used to be in waiting for
me; and there I commonly spent two or three hours, as
in an hospital, examining the several conditions and circumstances
of all who came thither; some of which had
ulcers yet uncured, and others to be advised under the
first symptoms of seizure; all which I endeavoured to
dispatch with all possible care to their various exigencies.
As soon as this crowd could be discharged, I judged it
not proper to go abroad fasting, and therefore got my
breakfast. After which, till dinner-time, I visited the
sick at their houses.... After some hours visiting
in this manner I returned home. Before dinner I always
drank a glass of sack, to warm the stomach, refresh the
spirits, and dissipate any beginning lodgement of the
infection. I chose meats for my table that yielded an
easy and generous nourishment, roasted before boiled,
and pickles, not only suitable to the meats but the nature
of the distemper (and, indeed, in this melancholy time,<span class="pagenum"><SPAN name="Page_78">78</SPAN></span>
the city greatly abounded with variety of all good things
of that nature). I seldom likewise rose from dinner
without drinking more wine. After this I had always
many persons come for advice, and as soon as I could
dispatch them I again visited till eight or nine at night,
and then concluded the evening by drinking to cheerfulness
of my old favourite liquor, which encouraged sleep
and an easy breathing through the pores all night. But
if in the daytime I found the least approaches of the
infection upon me, as giddiness, loathing at stomach, and
faintness, I immediately had recourse to a glass of this
wine, which easily drove these beginning disorders away
by transpiration. Yet in the whole course of the infection
I found myself ill but twice; but was soon again cleared
of its approaches by these means, and the help of such
antidotes as I kept always by me.” It should be mentioned
that during the infection Dr. Hodges wore an
“issue” as a preventive measure, and he says: “Whenever
I was most beset with pestilential fumes I could
then immediately perceive a shooting pain in my issue,
and had a great deal of ill-conditioned matter discharge
therefrom; and this I always looked upon as a sure
warning to have timely recourse to alexipharmicks.” The
facts given by Dr. Munk concerning Hodges are the
following: Nathaniel Hodges, son of the vicar of
Kensington, was born in 1629, educated at Westminster,
Cambridge, and Oxford, and appears to have been a
Parliamentarian; M.D., 1659; F.R.C.P., 1672; censor,
1682; Harveian orator, 1683. During the latter part of
his life he received a pension from the City on account
of his services during the plague. He fell into debt, and
died in Ludgate Prison in 1688. There is a tablet to
his memory in St. Stephen’s, Walbrook. Let us not be
hard on this brave man. He did his duty nobly. True,
he was fond of sack and got into debt. Perhaps had his<span class="pagenum"><SPAN name="Page_79">79</SPAN></span>
nature been less generous, and had he been less full of
the milk of human kindness, he might have amassed a
large fortune. He is a noble exception to Chaucer’s
doctrine that “gold in physick is a cordial,” and it would
ill become us to sit in judgment on one who in an important
respect affords us an example of noble conduct.</p>
<div id="ip_79" class="figcenter" style="max-width: 29.9375em;">
<ANTIMG src="images/i_080.jpg" width-obs="479" height-obs="600" alt="" />
<div class="caption">COLLEGE OF PHYSICIANS, WARWICK LANE. ENTRANCE.</div>
</div>
<p>The year 1665 and 1666 were eventful ones for the
College of Physicians. At that time the president was
Sir Edward Alston, who had managed to repair the
financial ruin caused by the civil wars by the expedient
of admitting honorary Fellows, and making them pay for
the honour. It was in this year that Charles II. attended
one of the anatomy lectures, and knighted the lecturer
(Sir George Ent) at its termination. Misfortunes, however,
were in store, and we can hardly say they were
undeserved. When the plague appeared, the president
and most of the Fellows fled from town, and during their
absence the treasure chest of the College was emptied
by thieves. After the plague came the great fire, and in
it the College at Amen Corner was destroyed. When
the College was rebuilt, a new site, not far from the old
one, was chosen. This was in Warwick Lane, Newgate
Street, on a piece of ground purchased from Mr. Hollier,
a surgeon, for £1,200. The new College was designed
by Wren. It was in the form of a quadrangle, with a
botanical garden behind it, running down to the City
walls. The entrance was through a fine gate, and over
this Sir Christopher Wren built a magnificent theatre,
forty feet in diameter, with an octagonal-domed roof.
This theatre was said to be a model of what a theatre
should be. There were, in addition, fine rooms for
transacting the College business, and a good library.
Only about 140 books had been saved from the fire, but
the new College was soon furnished with books by the
library of the Marquis of Dorchester, which that nobleman<span class="pagenum"><SPAN name="Page_80">80</SPAN></span>
bequeathed to it. He appears to have been a learned
and somewhat eccentric man, who studied “all manner
of learning, both divine and human.” He became a
Fellow of the College in 1658, and shortly before had
been made a Bencher of Gray’s Inn. It is impossible
not to regret the fine old College, with its spacious
courtyard and physic garden and its historic associations.
But it would seem as if no purely educational establishment<span class="pagenum"><SPAN name="Page_81">81</SPAN></span>
can flourish in the City of London. The Royal
Society, the College of Physicians, and the College of
Surgeons have all moved away, and Gresham College
alone is left, as if to show the impossibility of flourishing
in the richest city of the day. Much as one may regret<span class="pagenum"><SPAN name="Page_82">82</SPAN></span>
the old College, it is probable that Sir Henry Halford
did right in advising in 1824 a move to Pall-Mall, notwithstanding
that the present house is much smaller than
the old one, and by no means remarkable for the convenience
of its arrangement.</p>
<div id="ip_82" class="figcenter" style="max-width: 37.5em;">
<ANTIMG src="images/i_081.jpg" width-obs="600" height-obs="452" alt="" />
<div class="caption">COLLEGE OF PHYSICIANS, WARWICK LANE. QUADRANGLE.</div>
</div>
<p>Of the London physicians of the seventeenth century
none is better known than <b>Thomas Sydenham</b>. He
was born in 1624, joined the Parliamentary army in 1643,
and became M.B. Oxon. in 1648. In what his medical
education consisted is not clear. It is very doubtful if
he was ever at Montpellier or any foreign school. He
was a great friend of John Locke. He came to London
in 1660, and was a licentiate of the College of Physicians
in 1663. Like the rest of the world, he ran away from
the plague; but, as he lived in Westminster, he did not
probably suffer from the fire. He died in 1689. His
“Medical Observations concerning the History and Cure
of Acute Diseases” was published in 1666, and was
dedicated to Robert Boyle. In the preface of this work
he strongly advocates an attempt at a scientific classification
of disease by a careful comparison of the phenomena
observed in different cases. Accurate diagnosis was the
necessary preliminary to finding a reliable <i xml:lang="la" lang="la">methodus
medendi</i>. His own descriptions of disease are excellent.
Perhaps his account of the gout, from which he suffered,
is more often quoted than any other. He was never a
Fellow of the College of Physicians. There is no evidence
that he ever applied to be made a Fellow. Expressions
are frequent in his writings which seem to
show that he was not on the best of terms with some of
his contemporaries. Sydenham was undoubtedly a man
who could think for himself, and perhaps his chief merit
lies in the fact that he appreciated much of the medical
writing of his time at its true value. It is recorded of
him by Dr. Johnson that, “when Sir Richard Blackmore<span class="pagenum"><SPAN name="Page_83">83</SPAN></span>
first engaged in the study of physic, he inquired of Dr.
Sydenham what authors he should read, and was directed
by Dr. Sydenham to “Don Quixote,” “which,” said he,
“is a very good book; I read it still.” In this answer
of Sydenham’s we perhaps get a clue to his attitude
towards the profession. He was one of the first to use
Peruvian bark in the treatment of ague, and this must
have done much to advance his practice at a time when
London was scourged by malarious fever. One of my
objects is to bring before you personal facts with regard
to some of our professional ancestors, and we get a good
idea of Sydenham in that chapter of his “Schedula
Monitoria” in which he details his own sufferings. It
was in 1660 that he first suffered from the gout, and
shortly afterwards symptoms of renal calculus developed,
and in 1676 he began to suffer from hæmaturia. “This
became,” he says, “afterwards habitual, as often as I
either went along a way on foot, or drove in a carriage,
no matter how slowly, over the paved streets. On an
unpaved road, however, I might drive as far as I chose,
and no such harm would occur.” He tried various
remedies for this trouble without success. “I therefore
made up my mind to try no further, and only guarded
against the affection by avoiding as much as I could all
motion of the body.” When his urine became bloody
he was bled, and he took frequent doses of manna dissolved
in whey as a laxative, and sixteen drops of
laudanum in small beer at bedtime as a hypnotic. As to
the regimen he observed, he says: “On getting out of
bed I drink a dish or two of tea, and ride in my coach
till noon, when I return home and moderately refresh
myself (for moderation is well in all) with some sort of
easily digestible meat that I like. Immediately after
dinner, I drink rather more than a quarter of a pint of
Canary wine to promote the concoction of the food in<span class="pagenum"><SPAN name="Page_84">84</SPAN></span>
the stomach, and to drive away the gout from the bowels.
After dinner I ride in my coach again, and (unless prevented
by business) am driven out for two or three miles
in the country for change of air. A draught of thin
small beer serves for supper, and I repeat this even after
I have gone to bed and am about to compose myself to
sleep. I hope by this julep to cool and dilute the hot
and acrid juices lodged in the kidneys, whereby the stone
is occasioned.” He goes on to state that he prefers the
“hopped small beer,” and “to prevent bloody urine I
take care as often as I drive any distance over the stones
to drink a free draught of this small beer upon getting
into my coach, and also, if I am out long, before my
return, a precaution which has always been sufficient.”
Occasionally he suffered from what may be called a
gastric crisis, and “in this case I drench myself with
more than a gallon of posset, or else of this small beer:
and, as soon as I have got rid of the whole by vomiting,
take a small draught of canary wine with eighteen drops
of the liquid laudanum, and, going to bed, compose
myself to sleep. By this method I have escaped imminent
death more than once.” In an attack of nephritic
colic occurring in a patient of sanguine temperament,
Sydenham took ten ounces of blood from the arm on the
same side with the kidney affected. “After this a gallon
of posset drink, wherein two ounces of marsh-mallow
roots have been boiled, must be taken without loss of
time, followed by the injection of the following enema:
Marsh-mallow roots and lily-roots, of each one ounce;
mallow-leaves, pellitory, bears’ breech, and chamomile
flowers, of each a handful; linseed and fennugreek, of
each half an ounce; water in sufficient quantity. Boil
down to half a pint; strain; dissolve in the clear liquor
two ounces each of kitchen sugar and syrup of marsh-mallow;
mix and make into a clyster. After the patient<span class="pagenum"><SPAN name="Page_85">85</SPAN></span>
has vomited and been purged, a full dose of twenty drops
of liquid laudanum is to be given, or else fifteen or sixteen
grains of Matthew’s pills.” Sydenham lived in Pall-Mall,
and Cunningham in his Handbook of London has
the following anecdote, which is of interest in connexion
with his small beer and canary: “Mr. Fox told Mr.
Rogers that Sydenham was sitting at his window looking
on the Mall with his pipe in his mouth and a silver
tankard before him, when a fellow made a snatch at the
tankard and ran off with it. Nor was he overtaken, says
Fox, before he got among the bushes in Bond Street,
and there they lost him.” Sydenham lived in Pall-Mall
from 1664 to 1689, and was buried in St. James’s Church.
A near neighbour of his was Madame Elinor Gwynne,
over whose garden wall King Charles II. used often
to look as he walked in the Mall in St. James’s
Park. Sydenham, I have said, was a licentiate of the
College of Physicians, and was never a Fellow. In
Chamberlayne’s “Present State of England” for 1682 I
find a list of the Fellows, candidates, honorary Fellows,
and licentiates of the College of Physicians. The name
of Thomas Sydenham does not occur in this list, although
it contains the name of his son, Dr. William Sydenham.
In 1684 Dr. Hans Sloane, a young physician afterwards
to be very famous, took up his abode with Sydenham.
It was not till after Sydenham’s death that his reputation
reached the exalted position in which it has been held.</p>
<p>In the lives of many of the early physicians are interesting
facts which throw considerable light on the
progress of medicine, both as a branch of knowledge and
a profession; but the exigencies of time and space compel
me to be brief.</p>
<p><b>Samuel Collins</b>, who was president of the College in
1695, was one of the earliest comparative anatomists, and
wrote a work entitled “A System of Anatomy treating of<span class="pagenum"><SPAN name="Page_86">86</SPAN></span>
the Body of Man, Beasts, Birds, Fishes, Insects, and Plants.”
I am not acquainted with the work, but the title seems to
indicate that he had enlarged views on the question of
biology. <b>Nehemiah Grew</b>, who was secretary to the
Royal Society in 1677, and an honorary Fellow of the College
in 1682 (and possibly earlier), is said to have been the
first who saw the analogy between animals and plants, and
to establish the fact of sex in plants. In medicine he
introduced Epsom salts, which he obtained by evaporating
Epsom water, so that we owe him a great debt, and
undoubtedly he is one of the greatest men who has been
connected with the College. <b>Sir Edmund King</b> was
surgeon to Charles II., and was made an honorary F.R.C.P.
by command of His Majesty. Charles II. being seized
with apoplexy on Feb. 2nd, 1684, King promptly bled His
Majesty without consultation. His act was subsequently
approved by his colleagues, and he was ordered £1,000
by the Privy Council, which was never paid. <b>Francis
Bernard</b> was apothecary to St. Bartholomew’s Hospital,
and when the staff of that institution ran away from the
plague, Bernard stopped at his post and ministered to the
wants of the patients. For this he was rewarded by being
made assistant physician to the hospital, and became
honorary F.R.C.P. in 1680. He died in 1697, and is
buried in St. Botolph’s, Aldersgate.</p>
<h3 id="hdr_16">SECRET REMEDIES.</h3>
<p>Two centuries ago, and even later than this, it was not
thought unprofessional for a physician to have secret
remedies. Thus Dr. Goddard, who was much trusted by
Oliver Cromwell, who was one of the original members of
the Royal Society, professor at Gresham College, the
friend of Sydenham, and a Fellow of the College in 1646,
was the inventor of “Goddard’s drops.” The most
notable instance of “professional secrets,” however, is<span class="pagenum"><SPAN name="Page_87">87</SPAN></span>
that of the midwifery forceps. This was the secret of
the Chamberlen family, of whom I will mention two.
<b>Peter Chamberlen</b> (M.D. Padua, F.R.C.P. 1628) was
probably the first fashionable obstetrician, and is supposed
to have been the inventor of the forceps. He made an
attempt to organise the monthly nurses, was much employed
about the English court, and had eighteen children
by his two wives. <b>Hugh Chamberlen</b>, the son of
Hugh Chamberlen and the nephew of Peter Chamberlen
(F.R.C.P. 1694), was the most celebrated man-midwife
of his day. He published a translation of Mauriceau’s
Midwifery, and in the preface to that book he says: “I
will now take leave to offer an apology for not publishing
the secret I mention we have to extract children without
hooks where other artists use them; viz., there being my
father and two brothers living that practise this art, I cannot
esteem it my own to dispose of nor publish it without
injury to them, and I think I have not been unserviceable
to my own country, although I do but inform them that
the forementioned three persons of our family and myself
can serve them in these extremities with greater safety
than others.” This is a very pretty specimen of medical
ethics on the part of one who was a censor of the College
as late as 1721. What are probably the original forceps
were accidentally discovered, in 1815, at Woodham
Mortimer Hall, Essex, formerly the residence of Peter
Chamberlen. “They were found under a trap-door in
the floor of the uppermost of a series of closets, built
over the entrance porch,” and may now be seen in the
library of the Royal Medico-Chirurgical Society. Hugh
Chamberlen is buried in Westminster Abbey, where a
Latin epitaph of seventy-two lines, by Bishop Atterbury,
adorns his tomb.</p>
<p>I feel tempted to mention two or three more of the
early physicians who are deservedly famous, but in doing<span class="pagenum"><SPAN name="Page_88">88</SPAN></span>
so I must limit myself to those who flourished mainly in
the seventeenth century.</p>
<p><b>John Radcliffe</b>, who became F.R.C.P. in 1687,
appears to have been a blustering, kindly, and successful
practitioner. He spoke his mind freely, even to
monarchs, and seems to have made his way more by
push than courtesy. His chief claim to be remembered
is as a public benefactor. He accumulated a large
fortune, and founded at Oxford the Radcliffe Library,
Radcliffe Infirmary, Radcliffe Observatory, and Radcliffe
Travelling Fellowship, and also left £500 a year to St.
Bartholomew’s Hospital, London, for improving the
diets of the patients. Radcliffe was only one of many
London doctors who have been great public benefactors.
I have already alluded to Linacre, Caius, Harvey, Baldwin
Hamey, Caldwell, and Croon, and the list may be
enlarged by mentioning Sir Hans Sloane (who founded
the British Museum and gave the Chelsea Garden to
the Apothecaries’ Society), William and John Hunter,
Erasmus Wilson, and Richard Quain—the last and the
most munificent benefactor of this (University) College.</p>
<p><b>Sir Hans Sloane</b> was born in 1660, became F.R.C.P.
in 1687, was president from 1719 to 1735, and died in
1753 in his ninety-fourth year. He was president of the
Royal Society from 1727 (succeeding Sir Isaac Newton),
and retired to Chelsea in 1740, where his name still
lives in Sloane Street and Hans Place. In his youth he
accompanied the Duke of Albemarle to Jamaica, and
returned home with a valuable botanical collection. He
was a great accumulator of archæological and natural
curiosities, and his collection was by his will offered to
the nation at a nominal sum, and thus was founded the
British Museum. Sir Hans Sloane was born in the last
days of the Commonwealth, only three years after the
death of Harvey. In Evelyn’s Diary we read how, on<span class="pagenum"><SPAN name="Page_89">89</SPAN></span>
April 16th, 1691, he (Evelyn) “went to see Dr. Sloane’s
curiosities, being an universal collection of the natural
productions of Jamaica,” &c. He lived in the reign of
Charles II., James II., Anne, William III., George I.,
and George II., and died five years after the birth of
Jeremy Bentham, who was so active in the foundation of
University College.</p>
<h3 id="hdr_17">THE CRUSADE AGAINST QUACKERY.</h3>
<p>Perhaps the main object held in view by those who
were instrumental in establishing the medical corporations
was “protection,” and certain it is that the
monopoly of medical licensing enjoyed by the physicians
and the barber-surgeons in London and seven miles
round was very great. No small amount of the energies
of the College of Physicians was in its earlier days
devoted to the fighting of irregular practitioners, but
this was and is a hopeless battle. We have seen how
Henry VIII. protected the rights of physicians and
surgeons, but then, as now, there was a great deal of
public sympathy for irregular practitioners, and accordingly
we find that in the thirty-fourth and thirty-fifth
year of the reign of Henry VIII. an Act was passed, the
chief clauses of which were to the following effect:—That
the surgeons, “mindful onely of their own lucres, and
nothing the profit or ease of the diseased or patient, have
sued, troubled, and vexed divers honest persons, as well
men as women, whom God hath endued with the knowledge
of the nature, kind, and operation of certain herbs,
roots, and waters, and the using and ministring of them
to such as be pained with customable diseases, as
women’s breasts being sore, a pin and a web in the eye,
uncomes of hands, scaldings, burnings, sore mouths, the
stone, strangury, saucelin, and morphew, and such other
like diseases, &c. &c. Therefore it shall be lawful for<span class="pagenum"><SPAN name="Page_90">90</SPAN></span>
any person to cure outward sores, notwithstanding the
statute of the 3rd of Henry VIII.” The public did not
like being deprived of their favourite quacks and wise
women; and the same feeling undoubtedly obtains at
present in this country, where hundreds of newspapers
are kept afloat almost entirely by quack advertisements,
and the proprietor of a pill and ointment has recently
died possessed of wealth probably greater than that of
all the Fellows of both the Royal Colleges collectively.
These are significant facts, and ought to warn us not
to waste our energies in attempting to oppose human
nature.</p>
<p>Dr. Goodall, in his account of the College of Physicians,
published in 1684, gives many curious details of the conflicts
of the College with quacks and empirics. The
College possessed magisterial power, and, on conviction,
the president and censors had power to fine and imprison.
For instance, in 1632 Francis Roes, <em>alias</em> Vinter, was
accused of undertaking to cure a woman of a tympany,
for which he had made exorbitant charges: “Being asked
what medicines he gave, at first he refused to discover
them, saying he had them noted in his books; but after
long expostulation he named jalap and elatorium (as
he pronounced the word), and, being questioned what
elatorium was made of, he said it was composed of three
or four things, whereof diagridium was one. He was
censured for giving elatorium (a medicine he knew
not), and particularly to a woman at his own house,
whom he afterwards sent home through the open streets,
telling her it was a cordial. He was fined £10 and
committed to prison.” Again, we find one Richard
Hammond, a surgeon, fined £5 and committed to prison
for undertaking to cure a child of the dropsy. It appears
that he administered a clyster composed of molasses,
white hellebore, and red mercury, “which wrought so<span class="pagenum"><SPAN name="Page_91">91</SPAN></span>
violently that the boy died therewith.” John Hope, an
apothecary’s apprentice, gets into trouble for giving a man
two apples of coloquintida boiled in white wine, with
cinnamon and nutmeg. “The medicine wrought both
upwards and downwards; upward he vomited a fatty
matter, and downward he voided a pottle of bloud,” and
ultimately died. This case was remitted to the higher
courts of justice. In 1637 an order was sent from the Star
Chamber “to examine the pretended cures of one Leverett,
who said that he was a seventh son, and undertook the
cure of several diseases by stroaking.” The investigation
of this case lasted over a month, and finally the College
reported that Leverett was an impostor. “In the fourth
year of King Edward VI., one Grig, a poulterer, of Surrey
(taken among the people for a prophet in curing divers
diseases by words and prayers, and saying he would take
no money, &c.), was, by command of the Earl of Warwick
and others and the Council, set on a scaffold in the town
of Croidon in Surrey with a paper on his breast whereon
was written his deceitful and hypocritical dealings; and
after that on the 8th of September set on a pillory in
Southwark, being then Our Lady Fair then kept, and the
Mayor of London with his brethren the aldermen riding
through the fair, the said <em>Grig</em> asked them and all the
citizens forgiveness. Of the like counterfeit physician
(saith Stow) have I noted to be set on horse-back, his
face to the horse-tail, the same tail in his hand for a bridle,
a collar of jordans about his neck, a whetstone on his
breast, and so led through the city of London, with ringing
of basons, and banished.” The above are samples of
dozens of similar cases; and it is interesting to note
that many of these irregular practitioners had powerful
friends, and we find Ministers of State writing on behalf
of some of them, praying that the punishment may be
remitted.</p>
<p><span class="pagenum"><SPAN name="Page_92">92</SPAN></span></p>
<h3 id="hdr_18">MEDICINE IN THE DAYS OF PEPYS.</h3>
<p>In order to complete the picture of the profession in
the seventeenth century, I have abstracted from the Diary
of truthful Samuel Pepys a few facts having a bearing on
medicine. These seem to me to throw no little light upon
the science, practice, and ethics of medicine at his time:—“March
26th, 1660: This day it is two years since it
pleased God that I was cut for the stone at Mrs. Turner’s
in Salisbury-court. And did resolve while I live to keep
it a festival, as I did the last year at my house, and for
ever to have Mrs. Turner and her company with me.
But now it pleased God that I am prevented to do it
openly: Only within my soul I can and do rejoice, and
bless God, being at this time, blessed be His holy name,
in as good health as ever I was in my life.—Oct. 19th,
1663: Coming to St. James’s, I hear that the Queen did
sleep five hours pretty well to-night, and that she waked
and gargled her mouth, and to sleep again; but that her
pulse beats fast, beating twenty to the King’s or my Lady
Suffolk’s eleven. It seems she was so ill as to be shaved
and pidgeons put to her feet, and to have the extreme
unction given her by the priests, who were so long about
it that the doctors were angry. The King they all say is
most fondly disconsolate for her, and weeps by her, which
makes her weep; which one this day told me he reckons
a good sign, for that it carries away some rheume from
the head.—Oct. 20th: Mrs. Sarah —— tells us that the
Queen’s sickness is the spotted fever, and that she is as
full of spots as a leopard.—22nd: This morning, hearing
that the Queen grows worse again, I sent to stop the
making of my velvet cloak till I see whether she lives or
dies.—24th: The Queen is in a good way to recovery;
and Sir Francis Pridgeon [Prujean, President of the Royal
College of Physicians] hath got great honour by it, it<span class="pagenum"><SPAN name="Page_93">93</SPAN></span>
being all imputed to his cordiall.—Jan. 16th, 1667: Prince
Rupert, I hear, is very ill; yesterday given over, but
better to-day.—28th: Prince Rupert is very bad still, and
so bad that he do now yield to be trepanned.—Feb. 3rd:
To White Hall.... Talking, and among other things, of
the Prince’s being trepanned, which was in doing just as
we passed through the Stone Gallery, we asking at the
door of his lodgings, and were told so. We are full of
wishes for the good success, though I dare say but few
do really concern ourselves for him in our hearts. With
others into the House, and there hear that the work is
done to the Prince in a few minutes without any pain at
all to him, he not knowing when it was done. It was
performed by Moulins. Having cut the outward table,
as they call it, they find the inner all corrupted, so as to
come out without any force; and the fear is that the
whole inside of his head is corrupted like that, which do
yet make them afraid of him; but no ill accident appeared
in all the doing of the thing, but with all imaginable
success, as Sir Alexander Frazier did tell me himself, I
asking him, who is very kind to me.—April 3rd: This
day I saw Prince Rupert abroad in the Vane room, pretty
well as he used to be, and looks as well, only something
appears to be under his periwigg on the crown of his
head.—4th: (At the Duke of Albemarle’s.) One at the
table told an odd passage in the late plague, that at
Petersfield (I think he said) one side of the street had
every house almost infected through the town, and the
other not one shut up.—June 28th, 1667: Home, and
there find my wife making of tea, a drink which Mr.
Pelling, the potticary, tells her is good for her cold and
defluxions.—Nov. 21st: With Creed to a tavern, where
Dean Wilkins and others; and a good discourse; among
the rest of a man that is a little frantic, and that is poor
and a debauched man, that the College have hired for<span class="pagenum"><SPAN name="Page_94">94</SPAN></span>
20s. to have some of the blood of a sheep let into his
body, and it is to be done on Saturday next. They purpose
to let in about twelve ounces, which they compute
is what will be let in in a minute’s time by a watch. On
this occasion Dr. Whistler [President of the Royal College
of Physicians] told a pretty story, related by Muffet, a
good author, of Dr. Caius, that built Caius College, that
being very old, and living only at that time upon woman’s
milk, he, while he fed upon the milk of an angry, fretful
woman, was so himself; and then being advised to take
it of a good-natured, patient woman, he did become so
beyond the common temper of his age.—30th: I was
pleased to see the person who had his blood taken out
... saying he finds himself much better since, and as a
new man. But he is cracked a little in his head, though
he speaks very reasonably, and very well. He had but
20s. for his suffering it, and is to have the same again
tried upon him; the first sound man that ever had it
tried on him in England, and but one that we hear of in
France.—June 23rd, 1668: To Dr. Turberville about my
eyes, whom I met with, and he did discourse, I thought,
learnedly about them, and takes time before he did prescribe
me anything, to think of it.—29th: To Dr.
Turberville’s, and there did receive a direction for some
physick, and also a glass of something to drop into my
eyes; he gives me hope that I may do well.—July 3rd:
To an alehouse; met Mr. Pierce, the surgeon, and Dr.
Clarke, Waldron, Turberville, my physician for the eyes,
and Lowre, to dissect several eyes of sheep and oxen,
with great pleasure, and to my great information. But
strange that this Turberville should be so great a man,
and yet to this day has seen no eyes dissected, or but
once, but desired this Dr. Lowre to give him the opportunity
to see him dissect some.—13th: This morning
I was let blood, and did bleed about fourteen ounces<span class="pagenum"><SPAN name="Page_95">95</SPAN></span>
towards curing my eye.—31st: The month ends sadly
with me, my eyes being now past all use almost, and I
am mighty hot about trying the late printed experiment of
paper tubes.—Aug. 11th: Mighty pleased with a trial I
have made of the use of a tube spectacall of paper, tried
with my right eye.”</p>
<p>Cesare Morelli (a music master) wrote thus to Mr.
Pepys on April 11th, 1681: “Honoured Sir,—I did
receive your last letter, dated the ninth of this month,
with much grief, having an account of your painful
fever. I pray God it will not vex your body too much;
and if by chance it should vex you longer, there is here
a man that can cure it with simpathetical powder, if you
please to send me down the pearinghs of the nailes of
both your hands and your foots, and three locks of hair
of the top of your crown. I hope with the grace of God
it will cure you,” &c.</p>
<h3 id="hdr_19">THE BARBER-SURGEONS.</h3>
<div id="ip_95" class="figcenter" style="max-width: 37.5em;">
<ANTIMG src="images/i_096.jpg" width-obs="600" height-obs="498" alt="" />
<div class="caption">BARBER-SURGEONS’ HALL.</div>
</div>
<p>Much as we owe to the College of Physicians, we
owe even more to the early surgeons, and there is certainly
no spot in this city which has a greater interest
for us as students of medicine than the hall of the
Barbers’ Company in Monkwell Street, a street not
far from the General Post Office. The house in
Knightrider Street, the original home of the College
of Physicians, is gone. The house in Amen Corner,
the second home of the College, was burnt. The
Grand College in Warwick Lane was deserted and sold,
and has now completely disappeared. The Barbers’
Hall remains and commands our respect as being on
the original spot, though not the original building where
the study of anatomy took its rise in this country.
The barbers and surgeons have occupied premises in
Monkwell Street certainly since their first incorporation<span class="pagenum"><SPAN name="Page_96">96</SPAN></span>
in 1460, possibly earlier. The present hall was built by
Inigo Jones, and having partially escaped the fire in 1666,
much of the original building remains, and certainly the
present court-room and the elaborately carved shell
canopy over the front door are both works which do
credit to this famous architect. Originally, the hall stood
detached from other buildings, and seems to have had a
fair-sized piece of ground round it, and a garden at the
back; and its theatre, one of Inigo Jones’s best works,
rested on one of the bastions of the old city wall. With
land at its present enormous value, it is not to be wondered
at, though much to be regretted, that the Company
has turned every available inch to account; and the
medical antiquary who now goes in search of this, to us,
almost sacred edifice, will need to be warned that it is
hemmed in and hidden by warehouses. It was in 1540<span class="pagenum"><SPAN name="Page_97">97</SPAN></span>
that Henry VIII. gave a charter to the Barber-Surgeons,
and Holbein’s famous picture of this event is the chief
treasure of the Barbers’ Hall, which contains many other
relics of medical interest. In this picture, which has
been often engraved, and is doubtless familiar to many
of you, there are certain points which merit our attention.
It is a group of nineteen people, and it is probable that
the portraits of all are faithful. The portrait of Henry
VIII. was said by King James I. to be reported “very
like him and well done,” and it is probable that the
portraits of the others are equally good. The king is
seated, and the eighteen persons receiving the charter
are on their knees. These eighteen are arranged in two
groups—a group of three on the right hand of the king,
and a group of fifteen on the left. Those on the right
are probably entitled to take precedence of the others,
they are all members of the king’s household—viz., John
Chambre, the king’s physician, who was, as we have
seen, one of the six persons named in the charter of the
College of Physicians; Sir William Butts, physician to
Henry VIII., and one of the characters in Shakspeare’s
play of that name; and Master J. Alsop, the Royal
apothecary. The fifteen on the left are all surgeons or
barbers. The chief, to whom the king is handing the
charter, is Thomas Vicary, the king’s sergeant-surgeon,
and the first medical officer appointed to St. Bartholomew’s
Hospital; of the others, Ayliffe, Mumford, and Ferris
were king’s surgeons, and Symson, Harman, and Penn
were king’s barbers; of the remaining eight little is
known.</p>
<div id="ip_97" class="figcenter" style="max-width: 37.5em;">
<ANTIMG src="images/i_096b.jpg" width-obs="600" height-obs="395" alt="" />
<div class="caption floatc">HOLBEIN’S PICTURE: HENRY VIII. GIVING A CHARTER TO THE BARBER-SURGEONS.</div>
<div class="caption floatr">[<i>To face p. <SPAN href="#Page_97">97</SPAN>.</i></div>
</div>
<h3 id="hdr_20">THE FIRST ANATOMY LECTURES.</h3>
<p>The original charter to the Barber-Surgeons provided
that the two mysteries of barbery and surgery should
be kept distinct, and it gave facilities for obtaining
the bodies of executed felons for purposes of anatomical<span class="pagenum"><SPAN name="Page_98">98</SPAN></span>
study. There is no doubt that the anatomy lectures at
the Barber-Surgeons’ Hall preceded those given by the
physicians. The necessity of a knowledge of anatomy
must have been felt daily by these early surgeons, and,
like practical men, they took steps to supply their wants.
The giving of these lectures, a physician being appointed
lecturer, was the chief work of the Company. Some of
the particulars collected by Mr. South are of interest, as
showing how this first London School of Anatomy was
worked. Every member of the Company was bound to
attend the anatomy demonstrations, a fine of fourpence
being imposed upon those freemen who were late, and
sixpence upon those who were absent. For each
summons to “an anatomy” the sum of 3s. 4d. was
charged, whether present or absent, and the members of
the Company were bound to come “decently appareyled,
for their own honestye, and also for the worshippe of the
Company.” The anatomical demonstrations appear to
have been public, and their occurrence was a solemn
festival—in fact, in the early days of the Company
“private anatomies” were disallowed, except by special
licence from the court. There were two masters of
anatomy appointed yearly, and two stewards of anatomy
to look after the creature comforts of those who attended
the demonstration. It was also the duty of the masters
and stewards to fetch the body from the place of execution,
which was not always an enviable duty. The actual
lecture and demonstration was given by a fifth officer, a
“reader” specially chosen, who was generally a physician.
The masters of anatomy had to make due provision
for the comfort of the “Dr.,” and they were specially
charged to provide a “matte about the harthe in the
hall,” in order that he might not suffer from cold feet.
They also had to provide two fine white rods for demonstrating,
a wax candle to look into the body, necessary<span class="pagenum"><SPAN name="Page_99">99</SPAN></span>
instruments, and clean white sleeves and aprons for each
day for themselves as well as for the reader. A fine of
40s. was imposed for inattention to these necessary
details. The greatest formality was observed. The
notices of the forthcoming demonstration were issued
according to a regulated formula, which differed according
to the rank in the Company of the person bidden, and,
after assembling in the parlour, a procession to the
theatre was marshalled by the clerk in due form. There
were two demonstrations daily, at noon and at five, and
between the morning and afternoon lecture the court
and officials were “plentifully regaled,” the doctor or
reader “pulling off his own robes and putting on the
clerk’s, which has always been usual for him to dine in.”
These demonstrations went on for three consecutive
days, and at their close the clerk “attends the doctor in
the cloathing room, where he presents him, folded up in
a piece of paper, the sum of ten pounds, and where
afterwards he waits on the masters of anatomy and
presents each of them in the like manner with the sum
of three pounds.” After each public demonstration the
lecturer was allowed to give a private demonstration to
his own pupils for three days, after which the body
was decently interred, and the expenses incurred by
the masters of anatomy (£3 7s. 6d.) were reimbursed.
Seats were provided in the theatre, and the body was
surrounded by a curtain until the demonstration actually
began. Among the curiosities in Barbers’ Hall is a
portrait of Sir Charles Scarborough, the physician to
Charles II., in the act of giving an anatomical lecture
with a “subject” before him, and Alderman Arris at
his side assisting him. Scarborough, who was a good
anatomist and distinguished mathematician, is represented
as seated, dressed in full robes of scarlet and
ermine, wearing a velvet hat with jewelled band and with<span class="pagenum"><SPAN name="Page_100">100</SPAN></span>
lace cuffs, and Alderman Arris is scarcely less gorgeous.
Alderman Arris, together with Dr. Gale, endowed those
lectures, which are still given at the College of Surgeons,
and which are known as the Arris and Gale Lectures.
This Dr. Gale is not to be confounded with Thomas
Gale, sergeant-surgeon to Queen Elizabeth, one of the
earliest English writers on surgery.</p>
<p>It was on Feb. 27, 1662, that Samuel Pepys records
that “about 11 o’clock Commissioner Pett and I walked
to Chyrurgeon’s Hall (we being all invited thither, and
promised to dine there), where we were led into the
theatre; and by-and-by comes the reader, Dr. Tearne,
with the master and company, in a very handsome
manner; and, all being settled, he began his lecture, and
his discourse being ended, we had a fine dinner and good
learned company, many doctors of Physique, and we
used with extraordinary great respect. Among other
observables we drunk the King’s health out of a gilt cup
given by King Henry VIII. to this Company, with bells
hanging on it, which every man is to ring by shaking
after he hath drunk up the whole cup.... Dr.
Scarborough took some of his friends, and I went with
them, to see the body of a lusty fellow, a seaman, that
was hanged for robbery.” The cup to which Pepys
alludes, and other interesting pieces of plate, are still in
the possession of the Company, and they also have an
excellent picture of Inigo Jones by Vandyke, and many
other pictures of interest. There are also to be seen four
silver wreaths worn by the master and wardens on state
occasions, and upstairs is a massive oak table said to be
the original table used for anatomical purposes.</p>
<p>The apprentices of the Company were kept in order.
For example, they were not allowed to wear a beard of
more than fifteen days’ growth, and in case of offence in
this particular the master was fined 6s. 8d. Apprentices<span class="pagenum"><SPAN name="Page_101">101</SPAN></span>
were bound to be able to read and write, and those that
intended practising in London passed what appear to
have been preliminary examinations. “How he knoweth
what ys surgery and also what an anatomy ys, and how
many parts it is; of what the iiij elements and the xij
signes be, which is the first part of examynacion for a
prentyce.” The apprentice was then bound to read to
the court every half-year an epistle, in order that the
court might judge of his progress; and he first became
a probationer and was licensed for so many years, at
the end of which time, subject to good behaviour and
adequate knowledge, he was admitted a master of surgery
and anatomy. The fee for the apprentice’s examination
appears to have been a silver spoon, with his name upon
it, weighing one ounce; and 7d. to the clerk for writing
and seal. The examination fee for the great diploma
appears to have been £6 6s.</p>
<h3 id="hdr_21">THE APOTHECARIES.</h3>
<p>We have seen that the physicians were an offshoot
from the priests and the surgeons an offshoot from the
barbers. In the same way, the apothecaries were
originally linked with the grocers; and it was not till
1617 that James I. gave to the Apothecaries’ Company
an independent charter. The apothecaries were originally
druggists pure and simple, but they took to prescribing,
and this brought them into conflict with the physicians.
In the end the apothecaries were victorious; and finally,
in 1815, they acquired the rights of examining and
licensing, which are practically the same as they now
possess.</p>
<h3 id="hdr_22">THE ROYAL SOCIETY.</h3>
<p>In considering the growth of medical knowledge in
London, we should do very wrong to omit mentioning<span class="pagenum"><SPAN name="Page_102">102</SPAN></span>
the Royal Society, in the establishment of which Charles
II. seems to have taken a lively interest. The first
informal meetings of those who afterwards formed the
nucleus of this important Society were held at Wadham
College, Oxford; and after the Restoration, at Gresham
College, London. Among those mentioned by Chamberlayne
as the founders are Robert Boyle, Sir W. Petty,
the Bishop of Salisbury, the Dean of Wells, Dr. Wallis,
Dr. Goddard, Dr. Willis, Sir Christopher Wren, Lord
Brouncker, John Evelyn, Thomas Henshaw, Sir George
Ent, and Dr. Croone. The actual foundation of the
Royal Society by charter from the King took place on
April 22nd, 1663, and amongst the powers granted to the
Society by their charter was that of taking and anatomising
the dead bodies of persons put to death by order of
the law. Their recognised place of meeting was Gresham
College, but after the fire they met for a time at Arundel
House. “In their discoursings,” we are told, “they lay
aside all set speeches, and eloquent harangues (as fit to
be banished out of all civil assemblies, as a thing found
by woeful experience, especially in England, fatal to peace
and good manners), and everyone endeavours to express
his opinion or desire in the plainest and most concise
manner.” Even at the present day there are not wanting
those who sneer at the “ologies,” and it is therefore not
surprising that in 1682 it should have been necessary to
meet criticism by putting forward a defence of this Society.
“But what advantage and benefit,” says Chamberlayne,
“appears after so many meetings? It is true they have
made many experiments of <em>Light</em> (as the excellent Lord
Bacon calls them), and perhaps not so many experiments
of fruit and profit; yet without doubt some may hereafter
find out no small use and benefit even in those Luciferous
experiments which now seem only curious and delightful;
but it is also as true that the Royal Society hath made a<span class="pagenum"><SPAN name="Page_103">103</SPAN></span>
great number of experiments and inventions very profitable
and advantageous to mankind. They have mightily
improved the naval, civil, and military architecture.
They have advanced the art, conduct, and security of navigation.
They have not only put this kingdom upon planting
woods, groves, orchards, vineyards, evergreens, but
also Ireland, Scotland, New England, Virginia, Jamaica,
Barbadoes, all our plantations, begin to feel the influence
of this Society.” At Gresham College they had a library,
the gift of the Duke of Norfolk, and a repository or
museum, filled with natural curiosities.</p>
<h3 id="hdr_23">GRESHAM COLLEGE.</h3>
<p>This allusion to the Royal Society has brought to
our notice Gresham College, the first home of the Society.
Pepys often alludes to “The College,” meaning
thereby the meetings of the Royal Society in Gresham
College. This College, which ought to have been the
nucleus of a university of London, was founded by Sir
Thomas Gresham, who was born in 1519, and flourished
in the reigns of Edward VI., Mary, and Elizabeth. He
was himself a university man, having been at Caius
College, Cambridge, and he amassed great wealth as a
merchant and financier. He died in 1579, and by his
will he left the bulk of his property to his widow, with
the stipulation that at her death his house in Bishopsgate
Street should be converted into a college, and that it
should have for its endowment the rents arising from
the shops in the Royal Exchange, which in Gresham’s
time amounted to £700 a year. The Corporation and
the Mercers’ Company were the trustees of this fund.
There were seven endowed professorships—viz., astronomy,
physic, law, geometry, divinity, rhetoric, and
music. Gresham’s house in Bishopsgate Street appears
to have been admirably adapted for a college. It was<span class="pagenum"><SPAN name="Page_105">105</SPAN></span>
quadrangular, and had a garden and planted walks, so
that the quiet and seclusion which are essential to study
might have been obtained there. Be the cause what it
may, the College, which escaped the fire, did not flourish.</p>
<div id="ip_105" class="figcenter" style="max-width: 37.5em;">
<ANTIMG src="images/i_104.jpg" width-obs="600" height-obs="373" alt="" />
<div class="caption">GRESHAM COLLEGE.</div>
</div>
<p>The Royal Society left it in 1710, and in 1768 Gresham
House was pulled down to make way for an Excise Office,
the Government granting £500 a year in exchange for
the house and land. After this date the lectures were
given in a room of the Royal Exchange, and in 1843 the
present Gresham College was built at the corner of
Basinghall Street, the house being outwardly not to be
distinguished from the mercantile houses which abound in
the city. The cause of the failure of Gresham College
is doubtful. Dr. Johnson was of opinion that it was due
to the fact that the students paid no fees, and therefore
a powerful stimulus to the professors was wanting. The
condition that the lectures were to be given in Latin as
well as English, a condition reasonable enough in Gresham’s
time, has served as a clog; but probably the chief
cause is to be found in the physical and moral atmosphere
of the city. The corner of Basinghall Street is a very
different place from those “groves of the Academy where
Plato taught the truth.” Here every creature you meet
appears to be in a hurry—certainly in too great a hurry
to get wisdom, which, says the son of Sirach, “cometh
by opportunities of leisure.”</p>
<p>If universities, in the proper sense, have languished
in London, the same cannot be said of learned societies.
London, the great exchange and mart of the world, has
assisted by its numerous and flourishing societies in the
exchange of knowledge and ideas among learned men.
The Medical Society of London was founded in 1773 in
Bolt Court, Fleet Street. The Royal Medico-Chirurgical
Society was founded in 1805. The other medical
societies are all recent creations.</p>
<p><span class="pagenum"><SPAN name="Page_106">106</SPAN></span>
Thus it appears that the College of Physicians and
the Company of Barbers and Surgeons, and also Gresham
College, were the earliest schools of medicine in London,
the only places where anything approaching to systematic
instruction was given.</p>
<h3 id="hdr_24">THE EARLIEST HOSPITALS.</h3>
<p>It was scarcely before the beginning of the eighteenth
century that the hospitals of London began to be of any
importance in the teaching of medicine. The earliest
hospitals in London were leper hospitals, for at one time
leprosy abounded in this city. St. James’s Palace is
built on the site of a hospital for “maidens that were
leprous;” the name Spitalfields reminds us that at one
time there was a “spittle” here for lepers. There were
other hospitals of a similar kind in Southwark and Kingsland.
The next hospitals were mostly institutions founded
by the religious houses, and were very much of the nature
of almshouses, where the wretched, unfortunate, and
diseased were received for a time. The two most important
of these were St. Bartholomew’s Hospital and St.
Thomas’s Hospital, and a few words as to their origin
will not, I think, be uninteresting.</p>
<p>As regards St. Bartholomew’s Hospital, Mr. Morrant
Baker has written a most interesting monograph, entitled
“The Two Foundations,” to which I am indebted for
much that I have to say under this head. This hospital
owes its origin to Rahere, who is said to have been a
minstrel jester at the court of Henry I. Concerning this
pious founder, an aged chronicler (one of the monks of
the Priory of St. Bartholomew) tells us: “Man born and
sprung of low kynage, and when he attained the flower of
youth he began to haunt the households of noblemen and
the palaces of princes; where under every elbow of them,
he spread their cushions with japes and flatterings,<span class="pagenum"><SPAN name="Page_107">107</SPAN></span>
delectably anointing their eyes, by this manner to draw to
him their friendships. And still he was not content with
this, but often haunted the king’s palace (Henry I.), and,
among the noiseful press of that tumultuous court, informed
himself with polity and cardinal suavity, by that
which he might draw to him the hearts of many a one.”
It does not seem at all likely that Rahere ever wore a cap
and bells as a professional jester; but that he was rather
a <i xml:lang="la" lang="la">persona grata</i> about the court, alike for his merry tongue
and his handsome presence, concerning which his effigy
in the church of St. Bartholomew the Great speaks clearly
enough. Dr. Norman Moore, by reference to an early manuscript,
has clearly shown that Rahere was no professional
jester. He was early in life a Canon of St. Paul’s, and Dr.
Moore thinks that he was possibly famous for his wit, just
as Sydney Smith was famous. His fashionable and giddy
life seems to have told upon Rahere, and he ultimately
turned serious, made a pilgrimage to Rome, fell ill there,
saw visions, notably one of St. Bartholomew the Apostle,
who commanded him to go home and build a church and
asylum for the sick and weary in Smithfield. Rahere’s persuasive
powers were effectual in obtaining a site in the
King’s Market, Smithfield, and the foundation of the church
and hospital took place in 1123. As to Smithfield, the
monk’s manuscript continues: “Right unclean it was; and,
as a marsh, dungy, and fenny, with water almost every time
abounding and that that was eminent above the water,
dry, was deputed and ordained to the jubeit or gallows of
thieves, and to the torment of other that were condemned
by judicial authority.” Rahere seems to have brought
his histrionic talents to bear on his good work, for the
chronicler records that by feigning idiocy he attracted the
reverence of the superstitious, and “drew to him the
fellowship of children and servants, assembling himself
as one of them; and with their use and help, stones and<span class="pagenum"><SPAN name="Page_108">108</SPAN></span>
other things profitable to the building lightly he gathered
together.” It is needless to say that many miracles were
performed in the early days of the Priory and Hospital of
St. Bartholomew. It was distinctly a monastic institution,
and more resembled, as Mr. Baker suggests, the sick and
lying-in ward of a modern workhouse than a hospital as
we understand the term. Mr. Baker further suggests
that the jousts and tournaments of Smithfield, as well as
the horse and cattle fair which had been held there from
time immemorial, may have provided the monks with
not a few surgical casualties.</p>
<p>For the following facts concerning St. Thomas’s
Hospital I am indebted to a paper by Mr. Rendle, read
in 1882 before the Royal Society of <span class="locked">Literature:—</span></p>
<p>Those who have travelled from London Bridge to
Cannon Street by the railway, must have noticed the fine
Church of St. Saviour’s, Southwark. This church marks
the site of the ancient Priory of St. Mary Overy, which
was the original home of St. Thomas’s Hospital. Southwark,
in ancient times, was largely occupied by the
clergy. Not far from the Priory of St. Mary was the
Abbey of Bermondsey, and the palatial residences of the
Bishops of Winchester and Rochester. In 1207 the
Priory of St. Mary was burnt down, and with it the
Hospital of St. Mary. At Winchester House was living
at that time Peter de Rupibus, Bishop of Winchester.
This prelate decided to rebuild the hospital in a better
form and on a better site, and accordingly set to work to
obtain funds by means of the usual Charter of Indulgences
addressed to the faithful in 1228. “Behold,” says
Bishop Peter, “at Southwark an ancient hospital, built of
old to entertain the poor, has been entirely reduced to
cinders and ashes by a lamentable fire; moreover, the
place wherein the old hospital has been founded was less
suitable, less appropriate for entertainment and habitation,<span class="pagenum"><SPAN name="Page_109">109</SPAN></span>
both by reason of the straitness of the place and by
reason of the lack of water and many other conveniences;
according to the advice of us, and of wise men, it is
transferred and transplanted to another more commodious
site, where the air is more pure and calm, and the supply
of water more plentiful. But whereas the building of the
new hospital calls for many and manifold outlays, and
cannot be crowned with its due consummation without
the aid of the faithful, we request, advise, and earnestly
exhort you all, and with a view to the remission of your
sins enjoin you according to your abilities, from the goods
bestowed on you by God, to stretch forth the hand of
pity to the building of this new hospital, and out of your
feelings of charity to receive the messengers of the same
hospital coming to you for the needs of the poor to be
therein entertained, that for these and other works of
piety you shall do you may after the course of this life
reap the reward of eternal felicity from him who is the
recompenser of all good deeds and the loving and compassionate
God. Now we, by the mercy of God, and
trusting in the merits of the glorious Virgin Mary and
the apostles Peter and Paul, and St. Thomas the Martyr
and St. Swithin, to all the believers in Christ who shall
look with the eye of piety on the gifts of their alms—that
is to say, having confessed, contrite in heart and truly
penitent—we remit to such twenty days of the penance
enjoined on them, and grant it to them to share in the
prayers and benefactions made in the church of Winchester
and other churches erected by the grace of the
Lord in the diocese of Winchester. Ever in the Lord.
Farewell.” The Prior of St. Mary Overy assisted in the
good work, and several popes confirmed the acts of
their subordinates, and thus St. Thomas’s Hospital was
founded on the site now occupied by part of the London
Bridge Railway Station—a site which was its home from<span class="pagenum"><SPAN name="Page_110">110</SPAN></span>
1228 to 1862. In 1535 there were forty beds at St.
Thomas’s Hospital. In 1507 the hospital was enlarged
and repaired, “the void ground,” called the “Faucon,”
and afterwards the “Tenys Place” and “Closshbane”
(probably connected with the game of skittles), was acquired,
and the following was the bill: “Paid to Mr. Scott
of Kent, and Ann, his wife, for the land forty marks, and
for a gown cloth of damask for the said Ann £3 16s. 8d.—in
all £31 13s. 4d.” When this land, or very nearly
the same, was sold to the South-Eastern Railway Company
in 1862 it fetched £296,000. The total cost of land
and buildings erected in 1507, with the legal expenses,
was £311 6s. 1½d. About the year 1527, James
Nycolson, of “St. Thomas’s Spyttell in Southwark,” had
a printing press within the precincts of the hospital, and
among other notable books produced the Bible known as
“Nycolson’s Coverdale.”</p>
<h3 id="hdr_25">THE ROYAL HOSPITALS.</h3>
<p>When the religious houses were suppressed by
Henry VIII., these hospitals and asylums, which were
part and parcel of them, were suppressed also, and for a
time the poor found themselves deprived of much assistance
to which they had become accustomed. It was
therefore found necessary to re-establish these institutions
on a new footing. This was done by Henry VIII. and
Edward VI., and when we speak of these monarchs as
founders we must remember that they refounded in a
better form that which Henry had previously destroyed.
St. Bartholomew’s was refounded in 1548, and St.
Thomas’s in 1553; and in 1557 the four Royal hospitals—St.
Bartholomew’s, St. Thomas’s, Christ’s Hospital, and
Bridewell—were, in a sense, incorporated together for
purposes of management. Dr. Payne has kindly permitted
me to inspect a little book bearing the date 1557,<span class="pagenum"><SPAN name="Page_111">111</SPAN></span>
and entitled “The Order of the Hospitalls of K. Henry
the viii.th and King Edward the vi.th—viz., St. Bartholomew’s,
Christ’s, Bridewell, St. Thomas’s. By the
Mayor, Cominaltie, and Citizens of London, Governours
of the Possessions, Revenues and Goods of the sayd
Hospitals.” From this it appears that “one Hospital,
called St. Bartholomew’s the little,” was founded by
King Henry VIII., and the other three by his successor.
The governors were to be sixty-six at least, fourteen
aldermen and fifty-two grave commoners, whereof four
were to be scriveners, “to the intent that in every house
may be one or more.” Two of the aldermen were
“governors-general,” one to be called controller and
the other surveyor, while the remaining sixty-four were
divided equally among the four hospitals, three aldermen
and thirteen commoners to each, whereof one was to be
their treasurer. The governors were appointed at a
general court held on St. Matthew’s Day (Sept. 21st), and
held office for two years from Michaelmas Day (Sept. 29th).
On appointment a solemn charge was read to them, in
which the objects of the four hospitals are thus set forth:
“Idelnes, the enemie of all vertue, is suppressed and
banished; the tender youth of the nedy and idle beggars
vertuously brought up; the number of sick, sore, and
miserable people refreshed, harbored, and cured of their
maladies; and the vile and sturdy strumpet compelled to
labour and travaile in profitable exercises.” The latter
paragraph refers especially to Bridewell, which was
originally established as a house of correction “for the
strumpet and idle person, for the rioter that consumeth
all, and for the vagabond that will abide in no place.”
Bridewell has been rendered immortal by Hogarth’s
fourth plate of the “Harlot’s Progress,” but as an institution
it disappeared in 1863. Among the officers of
the Royal Hospitals were “scruteners,” who performed<span class="pagenum"><SPAN name="Page_112">112</SPAN></span>
the duties of “collectors” of legacies and other gifts.
The charge to these officers concluded as follows: “And
finally, when you shall hapen to be in the company of
good, vertuous, and welthy men, you shall to the best
and uttermost of your wits and powers, advance, commend,
and set forth the order of the said Hospital and
the notable commodities that ensue to the whole realme
of England, and chiefly to the citie of London, by erection
of the same; and also how faithfully and truly the
goods geven to their uses are by the Governours thereof
ministered and bestowed.” They were also enjoined to
exhort scriveners to remind testators of the hospital when
making their wills, and to provide the said scriveners
with prospectuses for their information. They were
further enjoined to exhort the bishop and clergy, and
especially the preachers at “Pawles Crosse”: “That
they twise or thrise in the quarter at the leaste, do move
and exhort the people to further the said work.” The
officers attached to each hospital were “the clerke, the
matron, the nurses and keepers of wards, the steward,
the officer appointed to warne the collectors and church
wardens, the cooke, the butler, the porter, the shoemaker,
the chirurgian, the barbour, the bedles.” Another institution
having a similar origin to the Royal Hospitals
is Bethlehem Hospital, or Bedlam. This was founded
by Henry VIII., on the site of the suppressed Priory of
our Lady of Bethlehem. At the end of the seventeenth
century it was moved to a new building in Moorfields,
and finally, at the beginning of the present century, it
was established where it now is, in St. George’s Fields,
Southwark.</p>
<h3 id="hdr_26">EARLY HOSPITAL PRACTICE.</h3>
<p>We get an insight into the methods of practice in the
London hospitals in the sixteenth and seventeenth centuries
from a series of papers in the St. Bartholomew’s<span class="pagenum"><SPAN name="Page_113">113</SPAN></span>
Hospital Reports, written by Sir James Paget, Dr. Church,
and Dr. Norman Moore. In the eighteenth volume of
St. Bartholomew’s Hospital Reports Dr. Norman Moore
gives some interesting facts with regard to the first
medical officer, Thomas Vicary, who was appointed
somewhere near the year 1550. He lived in the hospital,
wore a smart livery which cost fifty-three shillings, was
sergeant-surgeon to Henry VIII. and his three successors,
and wrote a book on anatomy. Thomas Vicary is represented
in Holbein’s picture of Henry VIII. granting
a charter to the Barber-Surgeons. He appears to have
served abroad with the army, and to have been a person
of considerable experience, and to have had a proper
sense of his duty as a professional man and a citizen.
Not so much is to be said for the first physician to St.
Bartholomew’s, Dr. Lopus, a Portuguese Jew, appointed
in 1561, whose main object in this world appears to have
been to get money. He was convicted of conspiring
with the Spaniards to compass Queen Elizabeth’s death
by poison, and in 1594 was hanged at Tyburn. Dr.
Norman Moore gives another graphic picture of an
Elizabethan surgeon in William Clowes, a man who was
an army surgeon attached to the Earl of Leicester, and
who in the intervals of foreign service was attached to
St. Bartholomew’s. Clowes appears to have been a man
of learning and experience, devoted to his art, and well
able to do battle with irregular practitioners. Of these
encounters he doubtless had many, and he gives a lively
description of an interview with a quack vendor of a
balm and plaster. “Then riseth out of his chayre, flering
and gering, this myraculous surgeon, gloriously glittering
like the man in the moon, with his bracelets about his
armes, therein many precious jewels and stones of St.
Vincent his Rockes, his fingers full of rings, a silver case
with instruments hanging at his girdle, and a gilt spatula<span class="pagenum"><SPAN name="Page_114">114</SPAN></span>
sticking in his hat, with a rose and crown fixed on the
same.” Clowes was surgeon to Christ’s Hospital, and we
learn the interesting fact that in his day twenty or thirty
children had the scurvy at a time—a fact due to a diet
largely composed of fish and other salted provisions,
with a scanty allowance of vegetables and a total absence
of potatoes.</p>
<p>Sir James Paget, in an interesting paper (written in
1846 while he was filling the offices of Warden to St.
Bartholomew’s and Lecturer on Physiology) entitled
“Records of Harvey,” gives us some facts regarding
this very great man, which help us to understand London
“hospital practice” as carried on during the reigns of
James I. and Charles I. Harvey was appointed physician
to the hospital in 1609, seven years after taking
his degree at Padua, and seven years before he imparted
his great discovery of the circulation to the College of
Physicians. He was appointed during the lifetime of
his predecessor, Dr. Wilkinson, and was to succeed on
the death or retirement of the latter, and, like candidates
for hospital appointments of the present day, he came
furnished with testimonials, one from the King, and
another from the President of the College of Physicians;
and it is almost needless to say that his application was
granted. On his appointment after the death of Dr.
Wilkinson, the following “charge” was read to him:—“Physician,—You
are here elected and admitted to be
the physician of the poor of this hospital to perform the
charge following—that is to say, one day at the least
through the year, or oftener as need shall require, you
shall come to this hospital and cause the hospitaller,
matron, or porter to call before you in the hall of this
hospital such and so many of the poor harboured in this
hospital as shall need the counsel and advice of the
physician. And you are here required and desired by<span class="pagenum"><SPAN name="Page_115">115</SPAN></span>
us in God His most holy Name, that you endeavour
yourself to use the best of your knowledge in the profession
of physic to the poor then present or any other
of the poor at any time of the week which shall be sent
home unto you by the hospitaller or matron for your
counsel, writing in a book appointed for that purpose
such medicines with their compounds and necessaries
as appertaineth to the apothecary of this house, to be
provided and made ready for to be administered unto
the poor, every one in particular according to his disease.
You shall not for favour, lucre, or gain, appoint or write
anything for the poor, but such good and wholesome
things as you shall think, with your best advice, will do
the poor good, without any affection or respect to be
had to the apothecary. And you shall not take gift
or reward of any of the poor of this house for your
counsel.”</p>
<p>In 1626 Harvey’s stipend, which had been £25 per
annum, was raised to £33 6s. 8d., on condition that he
relinquished his claim to one of the hospital houses. In
1630 he obtained leave of absence from his hospital
duties, having been commanded by the King to travel
with James Stuart, Duke of Lenox. Harvey was at this
time physician extraordinary to the King, and in the
year following was appointed physician in ordinary. Dr.
Andrewes appears to have been appointed as Harvey’s
substitute during his absence, the governors showing
themselves somewhat unwilling to accept Dr. Smith, who
was Harvey’s nominee. It appears that the work of the
hospital increasing, and Harvey being much occupied at
court, Dr. Andrewes was definitely appointed Harvey’s
coadjutor, or, as we should say, “assistant physician,”
with the yearly stipend of £33 6s. 8d. A set of rules
was drawn up by Harvey and accepted by the governors,
which are interesting in two particulars: first, as showing<span class="pagenum"><SPAN name="Page_116">116</SPAN></span>
that Harvey was impressed with the necessity of limiting
the relief afforded by the hospital, and that he foresaw
the inconvenience likely to arise from a press of what we
should call “out-patients;” and secondly, that in the
matter of prescribing internal remedies the chirurgeons
were unable to act independently of the physicians. It
further appears that there were “lock” hospitals in
connection with St. Bartholomew’s, established in Southwark
and Kingsland, in the disused Leper Hospitals
(leprosy having then disappeared from London), for the
reception of venereal cases. That venereal disease had
long been very rife in London appears from the statement
of William Clowes in 1596, that within five years
over 1,000 cases had been cured at St. Bartholomew’s,
and he adds, “I speak nothing of St. Thomas Hospitall,
and other houses about the city, wherein an infinite multitude
are daily cured.” Harvey retired from St. Bartholomew’s
in 1643. In Harvey’s time the staff consisted
of two physicians, three surgeons, one of whom, John
Woodhall, was the author of the “Surgeon’s Mate,” and
in his twenty-four years’ service amputated “many more
than 100 of legges and armes,” with a mortality of 20
per cent., one surgeon for the stone, two surgeons or
“guides” for the lock hospitals, an apothecary, and “a
curer of scald heads.” This latter functionary appears
to have been a woman, and the salary paid to her for her
services varied from £27 in 1623 to £126 in 1642, and
there is evidence to show that she received three or four
shillings for each scald head cured. According to Dr.
Church, at St. Bartholomew’s Hospital, where the diet,
owing to the munificence of Dr. Radcliffe, has, since his
time at least, been exceptionally good, so late as 1767
potatoes do not seem to have been introduced into any
of the diets; greens were given on certain days of the
week, but no other vegetables are mentioned.</p>
<p><span class="pagenum"><SPAN name="Page_117">117</SPAN></span></p>
<h3 id="hdr_27">THE PHARMACOPŒIAS.</h3>
<p>Dr. Church, in an article in St. Bartholomew’s Hospital
Reports (vol. xx.), called “Our Hospital Pharmacopœia,”
gives many interesting facts. The surgeons found their
own drugs in 1549, and they were allowed £18 a year
“because things pertaining to their faculty be very dear.”
In a note appended to an old formula in the St. Bartholomew’s
Pharmacopœia for a poultice, of which cow-dung
was one ingredient, Dr. Church says: “Those who
have not had the curiosity to look back at the old
Pharmacopœias of the London Colleges of the sixteenth
and seventeenth centuries, can hardly imagine the disgusting
nature of the substances they contained. In the
catalogue of the official simples of our own London
College for the year 1689 occur—‘Homo Vivens: Capilli,
ungues, saliva, cerumen, sordes, sudor, urina, stercus,
sanguis, calculi, semen, lac, menses, secundinæ. Homo
mortuus: Cadaver caro, cutis, pinguedo, ossa, cranium,
cerebrum, cor, fel, manus.’ And this at a time when
R. Morton, Edward Tyson, Hans Sloane, and Richard
Blackmore were Fellows of our College and Sydenham
a Licentiate.... It is not until the fifth edition
of the Pharmacopœia of our London College that we
get rid of the old traditions handed down from the
earliest periods of medicine. The 1746 Pharmacopœia
may be said to mark a perfect revolution, or rather, I
should say, reformation in the annals of pharmacy.” This
purging of the Pharmacopœia of disgusting things, “for
the most part superstitiously and doatingly derived from
oracles, dreams, and astrological fancies,” was largely due
to Dr. Plumptre, who was president of the College from
1740 to 1746, and the extent of it may be gained from
the fact that the “simples,” which numbered 645 in the
fourth edition, had, in the fifth, dwindled to 208. Many
of the formulæ previously in use had been derived from<span class="pagenum"><SPAN name="Page_118">118</SPAN></span>
the East, and notably from a learned pharmacologist
called John of Damascus, concerning the date of whom
authorities agree to differ.</p>
<p>The complexity of some of the old formulæ was
prodigious. The antidote of Matthiolus against poisons
and plague contained 131 ingredients, and Venice treacle,
which was largely prescribed by Sydenham and even later
physicians, contained over sixty. In the sixth (1788)
edition of the Pharmacopœia, sixty-three articles which
appeared in the fifth edition were discontinued.</p>
<p>Among those who stayed at his post during the
plague must be mentioned Dr. Francis Bernard, apothecary,
and subsequently physician (1678) to St. Bartholomew’s
Hospital. To rightly estimate his conduct
we must remember that the governors of the hospital,
as well as the physicians had deserted it. Dr. Church
gives the following extracts from the minutes of the
Court: “Held at the ‘Green Man,’ near Laieton, in the
county of Essex, Sept. 28th, 1665. Forasmuch as it was
now understood that the two doctors were remiss to
officiate or procure their business to be done as it ought
to be. It was therefore thought fit for Dr. Bernard, the
apothecary, whose ability is so well approved, should
prescribe at the present for the patients in the said
doctors’ stead, until further orders thereon.” At the
same Court the salaries of the two doctors, Dr. Micklethwaite
and Dr. Tearne, were ordered not to be paid.</p>
<p>The treatment of the patients in the early days of
the hospitals was occasionally a little severe. Thus Dr.
Steele of Guy’s has kindly furnished me with a few
extracts made from one of the old committee books of
St. Thomas’s: “1567. Patients were ordered to be
whipped at the cross for misdemeanour. 1573. A
hand-mill was ordered to grind corn to keep patients
from idleness. 1598. Foul patients (<i>i.e.</i>, venereal),<span class="pagenum"><SPAN name="Page_119">119</SPAN></span>
notoriously lewd livers, were ordered when cured to be
punished at the cross before being discharged.” This
reads like great severity, but severity was probably necessary
in Southwark, which was rather a rough suburb of
London. Thus an old map of Southwark given in Mr.
Rendle’s paper shows that in the year 1542 there were
some eighteen large inns, of which the “Tabard” or
“Talbot” was one. Here also in later times was Paris
Garden, bull rings, bear rings, the Globe Theatre, and
lastly, the brothels or stews which were under the control
of the Bishop of Winchester, the denizens being known
as Winchester geese. Perhaps, therefore, it is not surprising
that in this map are shown two sets of pillories
and cages, and that the governors of the hospital found
strong measures to be necessary to maintain discipline.</p>
<h3 id="hdr_28">THE RISE OF THE MEDICAL SCHOOLS.</h3>
<p>The anatomical lectures given by the Barber-Surgeons
and Physicians were for a long time the only sources of
practical anatomical knowledge; but the want of more
opportunities for dissecting began in time to be felt by
the apprentices of the surgeons employed at the hospitals.
In the later days of the Barber-Surgeons’ Company difficulties
were experienced in obtaining subjects for dissection,
and there is evidence to show that the officials having
charge of executions were bribed to let the bodies of felons
pass into private hands. William Cheselden (1688–1752)
was one of the chief offenders in holding “private anatomies,”
which were contrary to the rules of the Company.
Cheselden was renowned as an anatomist and surgeon,
and did much to perfect the operation of lateral lithotomy,
and must be looked upon as the real founder of the
medical school of St. Thomas’s. Before his time, however
(viz., in 1695), complaint was made that the surgeons
of St. Thomas’s taught surgery to other than their own<span class="pagenum"><SPAN name="Page_120">120</SPAN></span>
apprentices; and in 1702 the governors of St. Thomas’s,
while recognising the right of the surgeons to take pupils,
ordained that “none shall have more than three cubbs at
one time, nor take any for less than a year.” “Private
anatomies” began gradually to be more common, and in
1717 we come upon a record of “body-snatching,” when
“the widow of William Childers made complaint that her
husband’s corps, after its buryal in the burying place in
Moorfields, was taken up by the gravedigger and sold to
some surgeons, which corps was stopped at an inn in a
hamper to be sent to Oxford” (Church). In 1726 the
anatomical museum at St. Bartholomew’s was commenced
by John Freke, which is strong evidence of the growth of
anatomical teaching, and in 1734 mention is made in the
records of “the dissecting-room belonging to this house.”</p>
<p>It was not till 1750 that leave was obtained for the
regular making of post-mortem examinations at St. Bartholomew’s.
In 1767 an operating theatre was erected; and
finally, in 1822, an anatomical theatre was built for John
Abernethy, who was really the founder of the Medical
School of St. Bartholomew’s.</p>
<h3 id="hdr_29">HOSPITALS BUILT BY PUBLIC BENEVOLENCE.</h3>
<p>It was in the eighteenth century that the Royal
Hospitals were found to be insufficient for the wants
of the population, and private benevolence began to
supply the deficiencies of Royal foundations. The
Westminster Hospital is said to have been the first
hospital established by subscription—viz., in 1719, the
present building dating from 1732. I can do little
more than mention these hospitals; but in doing so, with
their dates, I would call attention to the fact that most
of them were originally built in what were then the
outskirts of the town, just as St. Bartholomew’s was outside
the walls, and St. Thomas’s in the unimportant<span class="pagenum"><SPAN name="Page_121">121</SPAN></span>
suburb of Southwark. Guy’s was founded in 1722 by
Thomas Guy, a bookseller, and, according to recent information,
a publisher. He is said to have made his
money partly by selling Bibles, partly by buying up sailors’
prize tickets, and partly by successful speculations at the
time of the South Sea Bubble. Be that as it may, he
spent over £18,000 on the building of his hospital, and
endowed it with another £220,000. St. George’s was
founded in 1733; the London Hospital in 1740; the
Lock Hospital in 1746; Queen Charlotte’s Lying-in Hospital
in 1752; the Small-pox Hospital (originally at King’s
Cross) in 1746; the Middlesex Hospital in 1745; St.
Luke’s Hospital for Lunaticks in 1751; the Ophthalmic
Hospital, Moorfields, in 1804; Charing-cross Hospital
(originating from a dispensary existing in 1818) in 1831;
the Royal Free Hospital in 1828; University College
Hospital in 1833; King’s College Hospital in 1839;
Brompton Consumption Hospital in 1844; and St. Mary’s
Hospital in 1851. The above list includes only some of
the chief hospitals of London, and it is impossible to over-estimate
the service they have done to humanity, not
only by relieving distress, but in disseminating a knowledge
of medicine and surgery.</p>
<p>In bringing this part of my address to a close, I have
only to mention that in 1745 the surgeons finally separated
from the barbers. They obtained a new charter and
removed to Surgeons’ Hall in the Old Bailey, where
they remained till 1800, when they again removed to the
present house in Lincoln’s Inn Fields, and became the
Royal College of Surgeons of England.</p>
<p>In treating of a subject like that which I have chosen,
it becomes necessary to adopt some plan of limitation,
otherwise one would talk interminably. On this account
I have resolved to give no details concerning the great
London physicians and surgeons who flourished in the<span class="pagenum"><SPAN name="Page_122">122</SPAN></span>
eighteenth and the beginning of the nineteenth centuries.
If, therefore, I say nothing of Arbuthnot, Akenside, Mead,
Pringle, Smellie, Baker, William and John Hunter, Cline,
Sharpe, Percival Pott, Abernethy, Sir Charles Bell, Liston,
Brodie, Astley Cooper, John Abernethy, William Lawrence,
and many others, it is not from want of appreciation
of their merits, but merely because to do so would
take me too far. I purpose, therefore, to skip over the
eighteenth and the beginning of the nineteenth century,
and conclude my paper with a few remarks on the teaching
of medicine in modern London.</p>
<div id="ip_122" class="figcenter" style="max-width: 37.5em;">
<ANTIMG src="images/i_122.jpg" width-obs="600" height-obs="371" alt="" />
<div class="caption">SURGEONS’ HALL, OLD BAILEY.</div>
</div>
<p>Fifty years ago medical schools were very different
from what they are now. The teaching was far less
thorough, the examinations far less complete. For
example, according to Sir James Paget (“St. Bartholomew’s
Hospital Fifty Years Ago”), it was the universal
custom for students to be apprenticed in the country,
and to spend eighteen months in London before going up
for the College and Hall. The examination at the
College of Surgeons was conducted by ten examiners, who
sat at a semicircular table, was entirely <i xml:lang="la" lang="la">vivâ voce</i>, and lasted<span class="pagenum"><SPAN name="Page_123">123</SPAN></span>
twenty minutes. The teaching for these examinations
was entirely by lectures, and it was no uncommon thing
for one man to lecture on more than one subject. Thus,
at St. Bartholomew’s, Stanley, who was surgeon to the
hospital, lectured on anatomy and physiology, and the
senior physician on medicine and chemistry, while of
clinical instruction there was practically none. The
operating was swift and dexterous, the mortality after it
great, “for there was scarcely a thought about blood
infections ... none would hesitate to go straight from a
dissection of a dead body to an operation on a living one,
and at the first dressing of an amputation or any large
wound the stench of the decomposing bloody fluid running
from it was enough to infect the whole ward.” The nursing
at that time was of a rough order. The nurses were often
intemperate, and almost always women who morally and intellectually
might fairly be classed among the lower orders.</p>
<div id="ip_123" class="figcenter b2" style="max-width: 37.5em;">
<ANTIMG src="images/i_122b.jpg" width-obs="600" height-obs="415" alt="" />
<div class="caption floatc">UNIVERSITY COLLEGE, GOWER STREET.</div>
<div class="caption floatr">[<i>To face p. <SPAN href="#Page_123">123</SPAN>.</i></div>
</div>
<h3 id="hdr_30">MODERN MEDICAL SCHOOLS AND EXAMINATIONS.</h3>
<p>Things are very different now, and it is only fair
to state that this College and the University of London
were undoubtedly the pioneers in that great improvement
in medical education and medical examinations
which has taken place during the reign of Her Majesty.
University College was established in 1828, and within ten
years of that date we find an illustrious staff of professors,
nearly every one of whom has had an important share in
increasing our knowledge of natural science in its widest
sense. Turner and Thomas Graham, the latter certainly
the greatest chemist of his time, were teaching chemistry;
Lindley and Grant, each of them pre-eminent in his own
department of knowledge, held the chairs of botany and
comparative anatomy; while Dionysius Lardner, a man
of great learning, in whom the power of expounding and
lecturing was developed to an extraordinary degree, was<span class="pagenum"><SPAN name="Page_125">125</SPAN></span>
professor of natural philosophy. Quain and Sharpey were
teaching anatomy and physiology, and writing the world-famous
text-book still known as “Quain and Sharpey.”
Carswell was professor of morbid anatomy, and producing
the series of marvellous water-colour drawings illustrative
of his subject which are, and ever must be, reckoned
among the greatest treasures of our museum. Samuel
Cooper and Liston were teaching surgery; Anthony Todd
Thompson, materia medica; Davis, midwifery; Gordon-Smith,
medical jurisprudence; while Elliotson and C. J. B. Williams,
who but lately was the sole survivor of his
then colleagues, were setting an example in the teaching of
medicine the effect of which is doubtless felt amongst us
still. Here, then, more than fifty years ago, was a medical
school complete in the modern sense. Our teaching has been
altered in its details, and has tended to become more and
more practical, but in principle it is the same now as it
was then. Each branch of knowledge which is necessary
for a medical man is provided for and controlled by a
separate professor; and it is a remarkable fact, and
redounds greatly to the foresight and wisdom of our
founders, that the number of professorial chairs remains
the same, the only addition being the all-important one of
Public Health and Hygiene, in the establishment of which
we were again the pioneers among medical schools. If
imitation be the sincerest form of flattery, we ought to
feel proud, for every school in London is now formed
more or less perfectly on the model established here in
1828. Fifty years ago, as Sir James Paget reminds us,
medical examinations were conducted in practically the
same manner as that which is immortalised by Smollett
in the pages of “Roderick Random.” But fifty years ago
was founded the University of London, an institution
which lives and progresses in spite of torrents of abuse,
and which has had a greater effect for good upon medical<span class="pagenum"><SPAN name="Page_126">126</SPAN></span>
education in this country than all the other universities
and medical corporations put together. The great merit
of the University of London consists, not in the severity
of its examinations (in which particular it is fully equalled
by the corporations), but in the <em>training</em> which it obliges
each of its graduates to undergo, and when the General
Medical Council some few years since reported on the
final professional examinations, without reference to the
two earlier examinations, it showed a want of appreciation
of the principles which have guided this University. The
University of London from the first decided that no one
should become even an undergraduate who had not
mastered his A B C, not merely the A B C of mathematics
and certain selected languages, but the A B C of
science also. There are many who still cavil at the breadth
of the matriculation, and seem to forget that it comprises
no subject that a decently educated man can in the present
day ignore. It is argued that this wide smattering
of knowledge which the matriculation involves is wrong,
and that the best training for the mind is to master one
subject thoroughly, a thing which nobody in this world
ever did, and schoolboys of sixteen least of all. The
correlation of knowledge is so complete that no one can
attempt to master any one branch without some knowledge
of many other branches; and in this fact is found
the justification for the first examination which a medical
student has to undergo. Which of the subjects of the
matriculation is unnecessary for a decently educated doctor?</p>
<div id="ip_126" class="figcenter" style="max-width: 37.5em;">
<ANTIMG src="images/i_124.jpg" width-obs="600" height-obs="316" alt="" />
<div class="caption">LONDON UNIVERSITY, BURLINGTON GARDENS.</div>
</div>
<p>The Preliminary Scientific Examination is the most
abused of all, but in making a knowledge of natural philosophy,
chemistry, and biology precede the study of
anatomy and physiology the University of London is
undoubtedly right, and there are signs that the other
examining bodies are coming round to the same opinion.
Of the final examination I need say nothing. There are<span class="pagenum"><SPAN name="Page_127">127</SPAN></span>
those who say (even eminent persons, and notably one Aberdeen
graduate) that the effect of the University of London
has not been good, and that the medical graduates are
not “practical” men. This assertion is too ridiculous
to require an answer, for it is notorious that the London
medical graduates have had more than their fair share
in all the practical advances made by medicine in the last
half century; and in medicine, surgery, midwifery, and
public health they have more than held their own. It
is very possible that a scientific training makes it rather
difficult for a conscientious man to be dogmatic, and until
the public is more highly educated than at present, the
dogmatic practitioner is sure to have a large <i xml:lang="fr" lang="fr">clientèle</i> and
will pass for a practical man. Scientific medicine has
made enormous advances; but for a knowledge of the
little arts, not always honest arts, which tend to increase
our gains, John of Arderne was quite equal to any
practitioner of the present day. He was, in one sense,
pre-eminently a practical man, but whether we should do
well to imitate him is more than doubtful.</p>
<h3 id="hdr_31">LONDON AS A PLACE OF STUDY.</h3>
<p>There can be no doubt that, as a place to study
medicine, London is, because of its enormous population,
unrivalled.</p>
<p>In the year 1887, according to <cite>The Hospital</cite>, there
were treated at the London hospitals and dispensaries
79,261 in-patients and 1,180,251 out-patients, or a total
of over one million and a quarter, exclusive of those who
received relief at the workhouse infirmaries, sick asylums,
and lunatic asylums. It is true that a considerable portion
of these patients are not so readily available for
the student as they might be. The following are the
numbers of patients (according to <cite>The Hospital</cite>) treated
at the hospitals attached to medical schools in 1887:—</p>
<p><span class="pagenum"><SPAN name="Page_128">128</SPAN></span></p>
<table summary="Patients treated in 1887">
<tr>
<th> </th>
<th>In-patients.</th>
<th class="lrpad">Out-patients.</th>
<th class="lrpad">Total.</th></tr>
<tr>
<td class="tdl">St. Bartholomew’s</td>
<td class="tdc">6,000</td>
<td class="tdc">150,000 </td>
<td class="tdc">156,000 </td></tr>
<tr>
<td class="tdl">London</td>
<td class="tdc">8,260</td>
<td class="tdc">95,760</td>
<td class="tdc">104,020 </td></tr>
<tr>
<td class="tdl">University College</td>
<td class="tdc">2,964</td>
<td class="tdc">44,382</td>
<td class="tdc">47,346</td></tr>
<tr>
<td class="tdl">Guy’s</td>
<td class="tdc">5,204</td>
<td class="tdc">38,004</td>
<td class="tdc">43,208</td></tr>
<tr>
<td class="tdl">Middlesex</td>
<td class="tdc">2,413</td>
<td class="tdc">27,714</td>
<td class="tdc">30,127</td></tr>
<tr>
<td class="tdl">St. Mary’s</td>
<td class="tdc">3,315</td>
<td class="tdc">26,637</td>
<td class="tdc">29,952</td></tr>
<tr>
<td class="tdl">St. Thomas’s</td>
<td class="tdc">4,643</td>
<td class="tdc">25,000</td>
<td class="tdc">29,643</td></tr>
<tr>
<td class="tdl">Westminster</td>
<td class="tdc">2,580</td>
<td class="tdc">20,912</td>
<td class="tdc">23,492</td></tr>
<tr>
<td class="tdl">Charing Cross</td>
<td class="tdc">1,686</td>
<td class="tdc">20,306</td>
<td class="tdc">21,992</td></tr>
<tr>
<td class="tdl">King’s College</td>
<td class="tdc">1,811</td>
<td class="tdc">17,248</td>
<td class="tdc">19,059</td></tr>
<tr>
<td class="tdc">Total</td>
<td class="tdc"><span class="bt">38,876</span> </td>
<td class="tdc"><span class="bt">465,963</span> </td>
<td class="tdc"><span class="bt">504,839</span> </td></tr>
</table>
<p class="in0">This gives a total of 1,386 different patients for every day
throughout the year. It is certain that no city in the world
offers a field for medical study in any way equal to that
of London. I think it is much to be regretted that, for
qualified men, a composition ticket admitting freely to
the practice of all the hospitals in London is not arranged
for. If such a ticket were issued, and qualified men
anxious to prolong their studies might, in return for a
payment, feel themselves free to visit any or all of the
great London hospitals, there can be no doubt that we
should have a great afflux of students. I very much
doubt the wisdom of the policy of trying to attract numbers
of students by lowering the examination tests for a
degree. This is an educational age, and we must not
forget that some of the boys at the Board Schools have
possibly a juster notion of physiology than had many of
our professional ancestors. Science is being taught to all
more and more every day. The druggist is now a highly-educated
man, and nurses are being drawn more and
more from the educated classes. If the medical profession
is to hold its own and to grow in popular esteem, it must
be chary about lowering its educational standards at a
time when the education of all classes is advancing.</p>
<p class="p2 center smaller"><span class="smcap bt">Printed by Cassell & Company, Limited, La Belle Sauvage, London, E.C.</span></p>
<div class="transnote">
<h2><SPAN name="Transcribers_Notes"></SPAN>Transcriber’s Notes</h2>
<p>Punctuation, hyphenation, and spelling were made consistent when a predominant
preference was found in this book; otherwise they were not changed. Archaic
spellings were not changed.</p>
<p>Simple typographical errors were corrected; occasional unbalanced
quotation marks retained.</p>
<p>Ambiguous hyphens at the ends of lines were retained.</p>
<p>Index not checked for proper alphabetization or correct page references.</p>
<p>Page <SPAN href="#Page_36">36</SPAN>: “propriâ motu” appears to be a misprint for “proprio motu”.</p>
<p>Page <SPAN href="#Page_66">66</SPAN>: Transcriber added “from” in the phrase “was expelled from the”.</p>
<p>Page <SPAN href="#Page_107">107</SPAN>: “by that which” was misprinted as “by the which”;
changed here.</p>
<p>Page <SPAN href="#Page_121">121</SPAN>: “with another £220,000” was misprinted as
“with other £220,000”; changed here.</p>
</div>
</div>
<SPAN name="endofbook"></SPAN>
<div style="break-after:column;"></div><br />