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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..ecbc6fa --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #54904 (https://www.gutenberg.org/ebooks/54904) diff --git a/old/54904-0.txt b/old/54904-0.txt deleted file mode 100644 index 5044598..0000000 --- a/old/54904-0.txt +++ /dev/null @@ -1,4116 +0,0 @@ -The Project Gutenberg EBook of London (Ancient and Modern) from the -Sanitary and Medical Point of View, by G. V. Poore - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: London (Ancient and Modern) from the Sanitary and Medical Point of View - -Author: G. V. Poore - -Release Date: June 14, 2017 [EBook #54904] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK LONDON, FROM SANITARY, MEDICAL VIEW *** - - - - -Produced by deaurider, Charlie Howard, and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - - - - - - - - - -Transcriber’s Note: Italics are indicated with _underscores_, bold text -with =equals signs=. - - - - -[Illustration: THE CENTRE OF LONDON IN 1658, REPRODUCED FROM NEWCOURT’S -MAP. - - [_Frontispiece._ -] - - - - - LONDON - - (Ancient and Modern) - - _From the Sanitary and Medical - Point of View._ - - - BY - G. V. POORE, M.D., F.R.C.P. - - - CASSELL & COMPANY, LIMITED: - _London, Paris, New York & Melbourne_. - 1889. - - - - -PREFACE. - - -This little book is an expansion of two addresses delivered in January, -1889. - -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. - -Both have already appeared in print; the first in _Public Health_, the -journal of the Society of Medical Officers of Health; and the second -in the _Lancet_. For the loan of most of the woodcuts the author is -indebted to the Publishers of the _Lancet_, 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 _Public Health_, -and four have been borrowed from “Cassell’s Old and New London.” - - - - -CONTENTS. - - - CHAPTER I. - - LONDON FROM THE SANITARY POINT OF VIEW. - - PAGE - SITUATION 7 - - WATER SUPPLY 10 - - MEDIÆVAL LONDON 16 - - GARDENS AND PLEASURE GROUNDS 18 - - HEALTH OF OLD LONDON 24 - - THE LONDON “DEATH RATE” 31 - - IMPROVED CONDITION OF MODERN LONDON 34 - - WHAT IS THE OUTLOOK? 36 - - 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 41 - - THE LOOSE END OF OUR SANITATION 44 - - - CHAPTER II. - - LONDON FROM THE MEDICAL POINT OF VIEW. - - CHAUCER’S DOCTOR 50 - - EARLIEST LONDON PRACTITIONERS 53 - - THE SEVERANCE OF MEDICINE AND SURGERY 56 - - THE EARLIEST MEDICAL ACT 59 - - THE COLLEGE OF PHYSICIANS 60 - - THE PLAGUE 72 - - SECRET REMEDIES 86 - - THE CRUSADE AGAINST QUACKERY 89 - - MEDICINE IN THE DAYS OF PEPYS 92 - - THE BARBER-SURGEONS 95 - - THE FIRST ANATOMY LECTURES 97 - - THE APOTHECARIES 101 - - THE ROYAL SOCIETY 101 - - GRESHAM COLLEGE 103 - - THE EARLIEST HOSPITALS 106 - - THE ROYAL HOSPITALS 110 - - EARLY HOSPITAL PRACTICE 112 - - THE PHARMACOPŒIAS 117 - - THE RISE OF THE MEDICAL SCHOOLS 119 - - HOSPITALS BUILT BY PUBLIC BENEVOLENCE 120 - - MODERN MEDICAL SCHOOLS AND EXAMINATIONS 123 - - LONDON AS A PLACE OF STUDY 127 - - - - -LONDON - -(_Ancient and Modern_) - -From the Sanitary and Medical Point of View. - - - - -CHAPTER I. - -LONDON FROM THE SANITARY POINT OF VIEW. - - -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. - -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. - - -SITUATION. - -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 “Present State -of England” (1682), a work which was analogous in many respects to the -“Whitaker’s Almanack” of the present day. - -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. - -“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.” * * * - -Chamberlayne, in speaking of the Thames, is, as well he may be, loud in -its praise: - -“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 navigation than any other river in -the world. * * * This river opening _eastward_ 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.” - -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 _north star_, and -they are never at rest till they point directly thither.” - -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. - -“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 with woods and groves, and full of the lairs and -coverts of beasts and game, stags, bucks, boars, and wild bulls.” - -“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. - -“Round the city and towards the north arise certain excellent springs -at a small distance, whose waters are sweet, salubrious, clear,” and - - “Whose runnels murmur o’er the shining stones.” - - -WATER SUPPLY. - -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. - -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 _Llyn-din_, which means the Lake -fortress. - -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 _Langbourn_, 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 _Wall Brook_, 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 _Fleet_ rose by Highgate Ponds, -and meandered through St. Pancras to 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. - -Farther west was _Tybourne_, 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. - -The _Westbourne_ 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. - -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 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. - -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. - -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. - -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 -ending in _well_ generally indicate the position of a neighbouring -water source. - -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. - -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, 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. - -The first of the great water companies was the “New River,” constructed -by Sir Hugh Myddleton and opened 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. - -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. - -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. - -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. 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. - -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. - - -MEDIÆVAL LONDON. - -Mediæval London was a town in which the clerical element predominated. -I have upon the screen a very beautiful drawing which appeared in the -_Builder_ 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. - -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. - -To the left is the noble river, its broad expanse dotted with many a -craft, and forming a superb sweep to the 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. - -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. 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. - - -GARDENS AND PLEASURE GROUNDS. - -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. - -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 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. - -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 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 -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. - -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. - -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 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. - -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. - -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. - -[Illustration: DIAGRAM SHOWING THE SIZE OF LONDON AT DIFFERENT PERIODS -BETWEEN 1560 AND 1889.] - -The diagram (p. 23) shows the growth of London between 1560 and 1889. -The notable features being (_a_) the very rapid extension of the -London area since 1815, and (_b_) 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. - - -HEALTH OF OLD LONDON. - -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. - -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. - -The Parish Clerks’ Bills of Mortality show clearly that from 1593 to -the year 1800, _i.e._, 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 then being -enormously in excess of the very high mortality which was habitual. - -Between 1485 and 1551 there were epidemics of the sweating sickness, a -disease different from plague but scarcely less deadly. - -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. - -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. - -What were the causes of the high mortality in Old London? - -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. - -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. - -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 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. - -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,[A] 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. - - [A] “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. - -The public amusements were many of them brutal and cruel. Tournaments -were less brutal than bear-baiting, bull-baiting, and cock-fighting, -because they fostered animal courage; but animal courage it most -distinctly was. - -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. - -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.” - -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:-- - -“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.” - -Close by, in Spa Fields, female prize fights were held, and there is -a lively account of one of these encounters 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. - -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. - -Another cause of the high death-rate was superstition, which regarded -disease as a “visitation” which had to be borne without question or -inquiry. - -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. - -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. - -To recapitulate, the causes of the high death-rate were probably the -following:-- - - 1. The prevalence of ague from the abundant marshes. - - 2. The dirt of the city and the houses, and the probable - infection of wells from a soil sodden with putrefactive matter. - - 3. The ill-nourished, drunken, and scorbutic condition of the - people, and - - 4. Their condition of superstition and brutality, which made any - rules for public health impossible. - - 5. The neglect to separate the infected from the healthy. - - 6. The ignorance of the doctors. - -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. - -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. - -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. - -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 children -of Anne, one reached the age of 11, and the remaining six died under 1 -year. - -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. - -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. - - -THE LONDON “DEATH RATE.” - -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. - -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. - -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 to 8 persons to an acre, tend -very materially to reduce the death-rate of the whole town. - -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. - -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. - -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 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. - -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.e._, 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. - -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. - -A fact which must throw considerable doubt on the healthiness (_i.e._, -a real vigorous and robust condition, which is the true meaning of -health) of the population is the amount of sickness, as evidenced by -the ever-increasing work which is thrown upon the hospitals. - -According to a table which was published last June in _The Hospital_, -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. - - -IMPROVED CONDITION OF MODERN LONDON. - -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? - -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 as “self-preservation is the -first law of nature,” the public has assisted in protecting itself. - -The practice of vaccination, and the dealing with epidemics by the -method of isolation, have also materially assisted in diminishing the -death-rate. - -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. - -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 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 _propriâ motu_. 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. - - -WHAT IS THE OUTLOOK? - -Judged by our present standard of knowledge, have we a right to hope -that London is likely to remain free from epidemics? - -There are certain facts which make me seriously doubt the permanence of -the present state of health in London. - -The first of these is the fact that some of our hygienic measures have -tended to produce overcrowding of 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. - -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 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. - -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. - -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 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. - -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 game of football, his very slender -resources being severely taxed to pay the railway fare to the spot -where the games are contested. - -What has occurred in the City has occurred elsewhere in London. - -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. - -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. - -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 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. - -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. - -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 _vice versâ_. - - - 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. - - Death-rate per - District. Persons to 100,000 from - an acre. Measles and - Whooping-cough. - Westminster 250 1089 - St. Giles 200 1152 - Holborn 200 1229 - Shoreditch 200 1099 - Whitechapel 200 1020 - St. George’s, E. 200 1327 - Bethnal Green 166 1113 - Mile End 143 982 - St. Saviour’s, Southwark 143 1150 - Stepney 125 1220 - St. Olave, Southwark 111 1091 - Marylebone 100 1145 - Strand 100 987 - City 100 963 - Chelsea 91 856 - St. George’s, Hanover Square 83 974 - Pancras 83 1046 - Islington 77 965 - Kensington 66 992 - Poplar 59 985 - Lambeth 59 960 - London as a whole 50 967 - Hackney 40 698 - Camberwell 35 879 - Greenwich 35 778 - Fulham 23 850 - Hampstead 17 701 - Wandsworth 15 701 - Woolwich 12 794 - Lewisham 6 546 - County of Dorset 3 352 - -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. - -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 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. - -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. - -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. - -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 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. - -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. - - -THE LOOSE END OF OUR SANITATION. - -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. - -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 -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. - -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. - -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. - -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 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. - -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 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. - -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. - -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. - -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. - -London gets more than half its water from the Thames, and this is -another reason why the sanitary outlook is not 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 valley:-- - - 1871. 1881. - Kingston 55,929 77,057 - Richmond 26,145 33,633 - Reading 33,340 43,494 - Windsor 26,725 31,992 - Staines 20,199 23,774 - Uxbridge 25,538 27,550 - Brentford 71,933 101,706 - Eton 24,928 27,721 - Wycombe 38,366 40,278 - Henley 18,916 19,992 - Oxford } 21,016 21,902 - Headington } 22,756 28,723 - --------- --------- - 385,791 477,822 - -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. - -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. - - - - -CHAPTER II. - -LONDON FROM THE MEDICAL POINT OF VIEW. - - -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. - - -CHAUCER’S DOCTOR. - -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 us:-- - - “There was also a Doctour of Phisik, - In al this world ne was ther non him lyk - To speke of Phisic and of Surgerye.” - -It may be that the poet means to convey the idea that doctors of the -fourteenth century, like some of those of the nineteenth, were prone to -talk “shop.” - - “For he was grounded in astronomye.” - -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. - - “He kept his pacient wondurly wel - In houres by his magik naturel. - Wel cowde he fortune the ascendent - Of his ymages for his pacient.” - -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.e._, 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. - - “He knew the cause of every maladye - Were it of cold or hete or moyst or drye, - And where thei engendrid, and of what humour.” - -Here we have allusion to the Hippocratic humoral pathology as developed -by Galen. - - “He was a verrey parfight practisour, - The cause i-knowe, and of his harm the roote - Anon he yaf the syke man his boote” (remedy). - -Quick diagnosis and prompt treatment. - - “Ful redy hadde he his apotecaries - To sende him dragges, and his letuaries, - For eche of hem made othur for to wynne. - Here frendschipe was not newe to begynne.” - -It would seem that even in Chaucer’s time the advertising druggist was -as pushing as at present. - - “Wel knew he the olde Esculapius, - And Deiscorides, and eeke Rufus, - Old Ypocras, Haly and Galien; - Serapyon, Razis and Avycen; - Averrois, Damascen and Constantyn, - Bernard and Gatisden, and Gilbertyn.” - -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. - - “Of his diete mesurable was he, - For it was of no superfluité, - But of gret norisching and digestible.” - -Doubtless there were many things then which took the place of -pancreatic emulsion and extract of malt. - - “His studie was but litel on the Bible.” - -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. - - “In sangwyn and in pers he clad was al, - Lyned with taffata and with sendal.” - -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.” - - “And yit he was but esy in dispence; - He kepte that he wan in pestilence. - For gold in phisik is a cordial; - Therefore he lovede gold in special.” - -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. - - -EARLIEST LONDON PRACTITIONERS. - -The “Gilbertyn” of Chaucer’s doctor was =Gilbertus Anglicus=, 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. - -=John of Gaddesden= 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. - -In South’s “Craft of Surgery” is a most interesting and full account -of =John of Arderne=, one of the earliest English writers on surgery. -This worthy was a specialist 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 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 delighted.” The leech is further advised to -dress like a clerk (_i.e._, 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. - -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. - - -THE SEVERANCE OF MEDICINE AND SURGERY. - -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 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. - -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, 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. - -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 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. - - -THE EARLIEST MEDICAL ACT. - -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 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. - - -THE COLLEGE OF PHYSICIANS. - -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 =Thomas Linacre=, who was born in 1460. Having -graduated at Oxford, and become a Fellow of 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 College, and was buried in Old St. Paul’s, where -in 1557 Caius erected a monument with an epitaph of his own composing. -Of =John Chambre=, 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. 61 was certainly not -Linacre’s original dwelling. - -[Illustration: LINACRE’S HOUSE. (_From a Print in the “Gold-Headed -Cane.”_)] - -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.” - -A very prominent figure in the early history of medicine in London is -=John Kaye=, or =Caius=, as he called 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 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,” B.C. 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 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 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: “Cujus -infantia, cum suggessit ut quomodo _corpus_ declinaretur, exigeremus, -respondit _hic_, _hæc_, et _hoc corpus_ accusativo _corporem_,” adding -“egregius certe ex universitate medicus cui humana vita committeretur.” -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. - -But to proceed with the history of the College and its relations to -medical education. In 1581, Dr. Caldwell and Lord Lumley founded the -_Lumleian Lectures on Anatomy and Surgery_, and the importance of this -foundation will be appreciated when it is stated that 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. - -=William Gilbert=, 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. - -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.” - -I have now to mention the man who, above all others, has tended by -his work to make medicine a 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. =William Harvey= (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 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. - -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 -contributions, the greater part of which were, however, unhappily -destroyed by the fire in 1666. - -=Dr. Goulston= (F.R.C.P. 1611) founded by will the _Gulstonian -Lectures_, to be read “between Michaelmas and Easter by one of the four -youngest doctors of the College.” =Sir Theodore Mayerne= (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. - -=Sir Charles Scarborough= 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. - -=Baldwin Hamey=, 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. - -=Francis Glisson= (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 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. - -=Thomas Wharton= (F.R.C.P. 1650), =Thomas Willis= (F.R.C.P. 1664), and -=Richard Lower= (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. - - -THE PLAGUE. - -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 =Dr. Nathaniel Hodges=, 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 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. - -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, 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. - -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 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 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.” - -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 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. - -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, 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 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. - -[Illustration: COLLEGE OF PHYSICIANS, WARWICK LANE. ENTRANCE.] - -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 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 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 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. - -[Illustration: COLLEGE OF PHYSICIANS, WARWICK LANE. QUADRANGLE.] - -Of the London physicians of the seventeenth century none is better -known than =Thomas Sydenham=. 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 _methodus medendi_. 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 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 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 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. - -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. - -=Samuel Collins=, 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 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. =Nehemiah Grew=, 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. =Sir -Edmund King= 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. -=Francis Bernard= 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. - - -SECRET REMEDIES. - -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 that of the midwifery forceps. -This was the secret of the Chamberlen family, of whom I will mention -two. =Peter Chamberlen= (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. =Hugh Chamberlen=, 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. - -I feel tempted to mention two or three more of the early physicians who -are deservedly famous, but in doing so I must limit myself to those -who flourished mainly in the seventeenth century. - -=John Radcliffe=, 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. - -=Sir Hans Sloane= 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 -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. - - -THE CRUSADE AGAINST QUACKERY. - -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 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. - -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, _alias_ 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 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 _Grig_ -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. - - -MEDICINE IN THE DAYS OF PEPYS. - -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 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 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 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.” - -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. - - -THE BARBER-SURGEONS. - -[Illustration: BARBER-SURGEONS’ HALL.] - -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 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 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. - -[Illustration: HOLBEIN’S PICTURE: HENRY VIII. GIVING A CHARTER TO THE -BARBER-SURGEONS. - - [_To face p. 97._ -] - - -THE FIRST ANATOMY LECTURES. - -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 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 -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 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. - -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. - -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 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. - - -THE APOTHECARIES. - -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. - - -THE ROYAL SOCIETY. - -In considering the growth of medical knowledge in London, we should do -very wrong to omit mentioning 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 _Light_ (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 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. - - -GRESHAM COLLEGE. - -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 -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. - -[Illustration: GRESHAM COLLEGE.] - -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.” - -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. - -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. - - -THE EARLIEST HOSPITALS. - -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. - -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, 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 _persona grata_ 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 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. - -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 -Literature:-- - -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, 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 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.” - - -THE ROYAL HOSPITALS. - -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, 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 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. - - -EARLY HOSPITAL PRACTICE. - -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 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 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. - -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 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.” - -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 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. - - -THE PHARMACOPŒIAS. - -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 the East, and notably -from a learned pharmacologist called John of Damascus, concerning the -date of whom authorities agree to differ. - -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. - -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. - -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.e._, -venereal), 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. - - -THE RISE OF THE MEDICAL SCHOOLS. - -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 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.” - -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. - - -HOSPITALS BUILT BY PUBLIC BENEVOLENCE. - -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 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. - -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. - -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 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. - -[Illustration: SURGEONS’ HALL, OLD BAILEY.] - -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 _vivâ voce_, and lasted 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. - -[Illustration: UNIVERSITY COLLEGE, GOWER STREET. - - [_To face p. 123._ -] - - -MODERN MEDICAL SCHOOLS AND EXAMINATIONS. - -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 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 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 _training_ 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? - -[Illustration: LONDON UNIVERSITY, BURLINGTON GARDENS.] - -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 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 -_clientèle_ 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. - - -LONDON AS A PLACE OF STUDY. - -There can be no doubt that, as a place to study medicine, London is, -because of its enormous population, unrivalled. - -In the year 1887, according to _The Hospital_, 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 _The -Hospital_) treated at the hospitals attached to medical schools in -1887:-- - - In-patients. Out-patients. Total. - St. Bartholomew’s 6,000 150,000 156,000 - London 8,260 95,760 104,020 - University College 2,964 44,382 47,346 - Guy’s 5,204 38,004 43,208 - Middlesex 2,413 27,714 30,127 - St. Mary’s 3,315 26,637 29,952 - St. Thomas’s 4,643 25,000 29,643 - Westminster 2,580 20,912 23,492 - Charing Cross 1,686 20,306 21,992 - King’s College 1,811 17,248 19,059 - ------ ------- ------- - Total 38,876 465,963 504,839 - -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. - - -PRINTED BY CASSELL & COMPANY, LIMITED, LA BELLE SAUVAGE, LONDON, E.C. - - - - -Transcriber’s Notes - - -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. - -Simple typographical errors were corrected; occasional unbalanced -quotation marks retained. - -Ambiguous hyphens at the ends of lines were retained. - -Index not checked for proper alphabetization or correct page references. - -Page 36: “propriâ motu” appears to be a misprint for “proprio motu”. - -Page 66: Transcriber added “from” in the phrase “was expelled from the”. - -Page 107: “by that which” was misprinted as “by the which”; changed -here. - -Page 121: “with another £220,000” was misprinted as “with other -£220,000”; changed here. - - - - - -End of the Project Gutenberg EBook of London (Ancient and Modern) from the -Sanitary and Medical Point of View, by G. V. 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padding-right: 1em;} - -} - </style> - </head> - -<body> - - -<pre> - -The Project Gutenberg EBook of London (Ancient and Modern) from the -Sanitary and Medical Point of View, by G. V. Poore - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: London (Ancient and Modern) from the Sanitary and Medical Point of View - -Author: G. V. Poore - -Release Date: June 14, 2017 [EBook #54904] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK LONDON, FROM SANITARY, MEDICAL VIEW *** - - - - -Produced by deaurider, Charlie Howard, and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - - - - - - -</pre> - - -<div id="if_i_000" class="figcenter" style="max-width: 37.5em;"> - <img src="images/i_000.jpg" width="600" height="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"><a href="images/i_000large.jpg">(<i>Larger</i>)</a></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"><a id="Page_iii">iii</a></span></p> - -<div class="chapter"> -<h2><a id="PREFACE"></a>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"><a id="Page_v">v</a></span></p> - -<div class="chapter"> -<h2><a id="CONTENTS"></a>CONTENTS.</h2> -</div> - -<table id="toc" summary="Contents"> - <tr> - <td class="tdc chap" colspan="2"><a href="#CHAPTER_I">CHAPTER I.</a></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"><a href="#hdr_1">7</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">Water Supply</span></td> - <td class="tdr"><a href="#hdr_2">10</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">Mediæval London</span></td> - <td class="tdr"><a href="#hdr_3">16</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">Gardens and Pleasure Grounds</span></td> - <td class="tdr"><a href="#hdr_4">18</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">Health of Old London</span></td> - <td class="tdr"><a href="#hdr_5">24</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The London “Death Rate”</span></td> - <td class="tdr"><a href="#hdr_6">31</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">Improved Condition of Modern London</span></td> - <td class="tdr"><a href="#hdr_7">34</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">What is the Outlook?</span></td> - <td class="tdr"><a href="#hdr_8">36</a></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"><a href="#hdr_dr">41</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The Loose End of our Sanitation</span></td> - <td class="tdr"><a href="#hdr_9">44</a></td></tr> - <tr> - <td class="tdc chap" colspan="2"><a href="#CHAPTER_II">CHAPTER II.</a></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"><a href="#hdr_10">50</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">Earliest London Practitioners</span></td> - <td class="tdr"><a href="#hdr_11">53</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The Severance of Medicine and Surgery</span></td> - <td class="tdr"><a href="#hdr_12">56</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The Earliest Medical Act</span></td> - <td class="tdr"><a href="#hdr_13">59</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The College of Physicians</span></td> - <td class="tdr"><a href="#hdr_14">60</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The Plague</span></td> - <td class="tdr"><a href="#hdr_15">72</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">Secret Remedies</span></td> - <td class="tdr"><a href="#hdr_16">86</a><span class="pagenum"><a id="Page_vi">vi</a></span></td></tr> - <tr> - <td class="tdl"><span class="smcap">The Crusade against Quackery</span></td> - <td class="tdr"><a href="#hdr_17">89</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">Medicine in the Days of Pepys</span></td> - <td class="tdr"><a href="#hdr_18">92</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The Barber-Surgeons</span></td> - <td class="tdr"><a href="#hdr_19">95</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The First Anatomy Lectures</span></td> - <td class="tdr"><a href="#hdr_20">97</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The Apothecaries</span></td> - <td class="tdr"><a href="#hdr_21">101</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The Royal Society</span></td> - <td class="tdr"><a href="#hdr_22">101</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">Gresham College</span></td> - <td class="tdr"><a href="#hdr_23">103</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The Earliest Hospitals</span></td> - <td class="tdr"><a href="#hdr_24">106</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The Royal Hospitals</span></td> - <td class="tdr"><a href="#hdr_25">110</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">Early Hospital Practice</span></td> - <td class="tdr"><a href="#hdr_26">112</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The Pharmacopœias</span></td> - <td class="tdr"><a href="#hdr_27">117</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">The Rise of the Medical Schools</span></td> - <td class="tdr"><a href="#hdr_28">119</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">Hospitals Built by Public Benevolence</span></td> - <td class="tdr"><a href="#hdr_29">120</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">Modern Medical Schools and Examinations</span></td> - <td class="tdr"><a href="#hdr_30">123</a></td></tr> - <tr> - <td class="tdl"><span class="smcap">London as a Place of Study</span></td> - <td class="tdr"><a href="#hdr_31">127</a></td></tr> -</table> -<hr /> - -<p><span class="pagenum"><a id="Page_7">7</a></span></p> - -<div class="chapter"> -<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"><a id="CHAPTER_I"></a>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"><a id="Page_8">8</a></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"><a id="Page_9">9</a></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"><a id="Page_10">10</a></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"><a id="Page_11">11</a></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"><a id="Page_12">12</a></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"><a id="Page_13">13</a></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"><a id="Page_14">14</a></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"><a id="Page_15">15</a></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"><a id="Page_16">16</a></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"><a id="Page_17">17</a></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"><a id="Page_18">18</a></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"><a id="Page_19">19</a></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"><a id="Page_20">20</a></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"><a id="Page_21">21</a></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"><a id="Page_22">22</a></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;"> - <img src="images/i_023.jpg" width="600" height="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"><a id="Page_24">24</a></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"><a id="Page_25">25</a></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"><a id="Page_26">26</a></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"><a id="Page_27">27</a></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,<a id="FNanchor_A" href="#Footnote_A" class="fnanchor">A</a> 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><a id="Footnote_A" href="#FNanchor_A" class="fnanchor">A</a> “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"><a id="Page_28">28</a></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"><a id="Page_29">29</a></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"><a id="Page_30">30</a></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"><a id="Page_31">31</a></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"><a id="Page_32">32</a></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"><a id="Page_33">33</a></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"><a id="Page_34">34</a></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"><a id="Page_35">35</a></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"><a id="Page_36">36</a></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"><a id="Page_37">37</a></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"><a id="Page_38">38</a></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"><a id="Page_39">39</a></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"><a id="Page_40">40</a></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"><a id="Page_41">41</a></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"><a id="Page_42">42</a></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"><a id="Page_43">43</a></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"><a id="Page_44">44</a></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"><a id="Page_45">45</a></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"><a id="Page_46">46</a></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"><a id="Page_47">47</a></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"><a id="Page_48">48</a></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"><a id="Page_49">49</a></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"><a id="Page_50">50</a></span></p> - -<div class="chapter"> -<h2 class="vspace"><a id="CHAPTER_II"></a>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"><a id="Page_51">51</a></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"><a id="Page_52">52</a></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"><a id="Page_53">53</a></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"><a id="Page_54">54</a></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"><a id="Page_55">55</a></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"><a id="Page_56">56</a></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"><a id="Page_57">57</a></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"><a id="Page_58">58</a></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"><a id="Page_59">59</a></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"><a id="Page_60">60</a></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"><a id="Page_62">62</a></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"><a id="Page_63">63</a></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. <a href="#ip_63">61</a> -was certainly not Linacre’s original dwelling.</p> - -<div id="ip_63" class="figcenter" style="max-width: 23.875em;"> - <img src="images/i_061.jpg" width="382" height="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"><a id="Page_64">64</a></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"><a id="Page_65">65</a></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"><a id="Page_66">66</a></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"><a id="Page_67">67</a></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"><a id="Page_68">68</a></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"><a id="Page_69">69</a></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"><a id="Page_70">70</a></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"><a id="Page_71">71</a></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"><a id="Page_72">72</a></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"><a id="Page_73">73</a></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"><a id="Page_74">74</a></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"><a id="Page_75">75</a></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"><a id="Page_76">76</a></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"><a id="Page_77">77</a></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"><a id="Page_78">78</a></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"><a id="Page_79">79</a></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;"> - <img src="images/i_080.jpg" width="479" height="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"><a id="Page_80">80</a></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"><a id="Page_81">81</a></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"><a id="Page_82">82</a></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;"> - <img src="images/i_081.jpg" width="600" height="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"><a id="Page_83">83</a></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"><a id="Page_84">84</a></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"><a id="Page_85">85</a></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"><a id="Page_86">86</a></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"><a id="Page_87">87</a></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"><a id="Page_88">88</a></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"><a id="Page_89">89</a></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"><a id="Page_90">90</a></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"><a id="Page_91">91</a></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"><a id="Page_92">92</a></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"><a id="Page_93">93</a></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"><a id="Page_94">94</a></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"><a id="Page_95">95</a></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;"> - <img src="images/i_096.jpg" width="600" height="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"><a id="Page_96">96</a></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"><a id="Page_97">97</a></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;"> - <img src="images/i_096b.jpg" width="600" height="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. <a href="#Page_97">97</a>.</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"><a id="Page_98">98</a></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"><a id="Page_99">99</a></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"><a id="Page_100">100</a></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"><a id="Page_101">101</a></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"><a id="Page_102">102</a></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"><a id="Page_103">103</a></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"><a id="Page_105">105</a></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;"> - <img src="images/i_104.jpg" width="600" height="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"><a id="Page_106">106</a></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"><a id="Page_107">107</a></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"><a id="Page_108">108</a></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"><a id="Page_109">109</a></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"><a id="Page_110">110</a></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"><a id="Page_111">111</a></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"><a id="Page_112">112</a></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"><a id="Page_113">113</a></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"><a id="Page_114">114</a></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"><a id="Page_115">115</a></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"><a id="Page_116">116</a></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"><a id="Page_117">117</a></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"><a id="Page_118">118</a></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"><a id="Page_119">119</a></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"><a id="Page_120">120</a></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"><a id="Page_121">121</a></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"><a id="Page_122">122</a></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;"> - <img src="images/i_122.jpg" width="600" height="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"><a id="Page_123">123</a></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;"> - <img src="images/i_122b.jpg" width="600" height="415" alt="" /> - <div class="caption floatc">UNIVERSITY COLLEGE, GOWER STREET.</div> - <div class="caption floatr">[<i>To face p. <a href="#Page_123">123</a>.</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"><a id="Page_125">125</a></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"><a id="Page_126">126</a></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;"> - <img src="images/i_124.jpg" width="600" height="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"><a id="Page_127">127</a></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"><a id="Page_128">128</a></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="chapter"><div class="transnote"> -<h2><a id="Transcribers_Notes"></a>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 <a href="#Page_36">36</a>: “propriâ motu” appears to be a misprint for “proprio motu”.</p> - -<p>Page <a href="#Page_66">66</a>: Transcriber added “from” in the phrase “was expelled from the”.</p> - -<p>Page <a href="#Page_107">107</a>: “by that which” was misprinted as “by the which”; -changed here.</p> - -<p>Page <a href="#Page_121">121</a>: “with another £220,000” was misprinted as -“with other £220,000”; changed here.</p> -</div> -</div> - - - - - - - - -<pre> - - - - - -End of the Project Gutenberg EBook of London (Ancient and Modern) from the -Sanitary and Medical Point of View, by G. V. 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