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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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