London (Ancient and Modern) from the Sanitary and Medical Point of View

by George Vivian Poore

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.

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.

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.