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.