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

by George Vivian Poore

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.