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.