Mead’s Medical London

London in the eighteenth century was noisy, smoky, dirty, and thronging with people. You might not be blamed for thinking that little has changed, but a surge in population from 675,000 in 1750 to 900,000 just fifty years later meant that the city was bursting at the seams, and not in the best of health.

Richard BarnettRichard Barnett, a writer, teacher and broadcaster on the cultural history of science and medicine and Wellcome Trust Engagement Fellow, is leading a walking tour on Saturday 4 October as a special event accompanying the The Generous Georgian: Dr Richard Mead. I asked him some questions about medicine in eighteenth-century London to get more of an idea about the city in which Richard Mead lived and worked.

Me: In your first book Medical London: City of Diseases, City of Cures, you wrote that the history of medicine can be better traced in London than anywhere else. What makes you say that?

Richard Barnett: First and most of all, I’m a Londoner by adoption and I love the city, its many faces and all the stories it embodies. Really one can’t speak of London’s history but rather of its histories: the villages and monasteries engulfed by a rapacious metropolis; the scrum of competing practitioners and therapies from which the medical profession emerged, the experiences of patients and physicians, mad-doctors and quacks, Roman oculists and Limehouse acupuncturists, aristocrats and refugees, dockers and monarchs. London was the first great global city and the first industrial capital, and so many of our contemporary arguments over public health found their roots here. For centuries this was the front line of an ongoing conflict between health and disease, civilisation and nature. What could be more unnatural than a city?

Do you think living in eighteenth-century London was inherently unhealthy?

The slum street in Westminster known as “Snow’s rents” © Wellcome Library, London

The slum street in Westminster known as “Snow’s rents” © Wellcome Library, London

One of the recurring themes in London’s history is the idea of the city as a kind of pockmark on the glowing skin of the nation. This is a sick city – history and geography, chance and necessity, have made it so – and disease has always been part of everyday life for its citizens. But this image was particularly powerful in the eighteenth century, as the city grew and people began to contrast new kinds of urban, industrial, mercantile society with older agricultural, rural ways of life. Cities like London were dirty, busy, noisy, and many physicians claimed to observe the effects of this kind of lifestyle on their inhabitants. Londoners might be poisoned or exhausted or driven mad by city life, and of course we still express these concerns today, though in a radically different framework.

Can any of the key centres of eighteenth-century medicine in London still be seen?

Engraving of Guy’s Hospital, 1761 © Wellcome Library, London

Guy’s Hospital, London, 1761 © Wellcome Library, London

Many contemporary medical institutions would have been familiar to Dr Mead and his colleagues – Guy’s, Bart’s, Tommy’s, the Royal College of Physicians, the (later Royal) College of Surgeons. But actual physical or architectural traces of eighteenth-century medicine are pretty thin on the ground. The Royal College of Surgeons and the Old Operating Theatre will give you a flavour of what surgery was like at the end of the century, but if you want to witness eighteenth-century medicine at its Enlightenment apex, take a stroll through the main quad at Guy’s, or visit William Hogarth’s painted staircase at Bart’s.

What role did hospitals play during the period?

St Bartholomew’s Hospital, London, 1723 © Wellcome Library, London

St Bartholomew’s Hospital, London, 1723 © Wellcome Library, London

We’re quite accustomed to the notion that specialist medical (and especially surgical) treatment should take place in a hospital, but in the eighteenth century this was far from the case. Until the Reformation hospitals in England were overseen by monks and nuns, and provided medical care as part of a mission to the very poorest in society. Following Henry VIII’s break with Rome almost all London’s religious hospitals were shut down – numbers fell from around 200 to less than half a dozen in the space of a generation – and by Dr Mead’s time London’s hospitals were places of secular civic charity, overseen by committees of the great and the good. Leading physicians and surgeons might serve as advisors, or attend for a day or so every week for free – the origin of the hospital consultant.

What would a consultation with a physician such as Dr Mead have been like?

A maid shows an old man his smallpocked face in a hand mirror. Coloured lithograph by Langlumé, 1823 © Wellcome Library, London

A maid shows an old man his smallpocked face in a hand mirror. Coloured lithograph by Langlumé, 1823 © Wellcome Library, London

Mead would most likely have visited his patients in their houses; elite eighteenth-century medicine is often called ‘bedside medicine’, and much medical business would have been transacted at the bedside of the patient, reflecting the disparity in status between the physician and his wealthy clients. Mead would have carried out some basic kinds of physical examination – the patient’s pulse, the condition of their urine and stool – but the rules of genteel comportment discouraged physical contact, and the most important diagnostic tool for this kind of medicine was the patient’s own account of their condition. Mead would have listened carefully to what the patient had to say, and tried to work out what aspects of their lifestyle and environment were responsible for the breakdown of their health.

Having access to a physician doesn’t always seem to have been an advantage. Were there any common treatments or medicines that were actively dangerous?

In modern terms, most of them. Classical Hippocratic medicine aimed to rebalance the patient’s constitution, mostly through adjusting the patient’s behaviour and diet, but also through spectacular physical therapies like bleeding and purging. Mead’s patients would have seen a bout of ipecac-induced vomiting or the loss of a pint or two of blood as evidence that their physician was working hard to cure their condition – though a twenty-first-century physician might take a rather different view.

A surgeon bleeding the arm of a young woman, 1784 © Wellcome Library, London A surgeon bleeding the arm of a young woman, 1784 © Wellcome Library, London

A surgeon bleeding the arm of a young woman, 1784 © Wellcome Library, London

How could one distinguish between a bonafide physician and a quack?

In the most basic sense, a physician possessed a medical degree (typically from Oxford or Cambridge, Edinburgh or Glasgow, Leiden or Montpellier – London had no university until 1826). But as Sir Humphrey might say, ‘physician’ and ‘quack’ were irregular nouns: I am an elite physician, you are an unorthodox practitioner, he is a quack. The historian Roy Porter showed that ‘quack’ was more a term of abuse than a coherent and stable professional identity, a way of bad-mouthing your competitors in the eighteenth century’s cut-throat medical marketplace. From the patient’s perspective, the kind of medical treatment available had much more to do with the size of your purse than the qualifications of your practitioner.

Eighteenth-century medicines contained some ingredients that would horrify modern consumers. What is the most disgusting, or absurd, concoction that you have come across?

There are so many to choose from, but ‘mummia’ – powdered Egyptian mummy – is possibly the most curious. From the fifteenth century to the eighteenth European apothecaries sold this dark, pungent powder, sometimes actually prepared from mummified humans, sometimes merely powered asphalt, as a tonic. Try asking for it in Superdrug.

Dr Mead was involved in the promotion of smallpox inoculation, and carried out a clinical trial in Newgate Prison. Was this use of inmates a common practice?

William Cheselden giving an anatomical demonstration in the anatomy-theatre of the Barber-Surgeons’ Company, London, ca. 1730/1740 © Wellcome Library, London

William Cheselden giving an anatomical demonstration in the anatomy-theatre of the Barber-Surgeons’ Company, London, ca. 1730/1740 © Wellcome Library, London

Common might be an overstatement, but it was not unknown. Attitudes to incarceration and punishment were changing radically in the eighteenth century, and medicine – especially surgery – was becoming implicated in the machinery of justice, especially the dissection of executed murderers. Prisoners might, rarely, be offered a pardon in exchange for trying a new therapy or submitting to a new operation, though this was not always a matter of choice, and not always limited to convicts. When the Spanish empire wanted to take vaccination to the Americas, it sent two dozen orphan boys on the month-long voyage; as one recovered, the next was infected from his lesions.

In your book Medical London you addressed two thousand years of London’s medical history. If you could travel in time to just one period, which would it be and why?

I’d like to visit London before it was even Londinium; to see the Thames valley in the Neolithic, and to try and understand something of how our ancestors thought about their bodies, their minds and their souls.

The next post will be on quacks, the medical charlatans of the eighteenth century. Do check back in on Friday 3 October for that.


Richard Barnett is a writer, teacher and broadcaster on the cultural history of science and medicine. His first book, Medical London: City of Diseases, City of Cures, released in 2008, was a Book of the Week on BBC Radio 4, and his latest book – The Sick Rose, on art and anatomy in an age of revolution – was described by Will Self in the Guardian as ‘superbly erudite and lucid’. Barnett received the 2006 Promis Prize for poetry, and his first collection, Seahouses, will be published by Valley Press in 2015. He has taught the history of science, medicine and evolutionary theory at the University of Cambridge and the University of London, and in 2011 received one of the first Wellcome Trust Engagement Fellowships. He is online at richardbarnettwriter.com, and on Twitter @doctorbarnett.

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An Interview with a Gold-Headed Cane

Gold-headed Cane © The Royal College of Physicians

Dr Mead’s gold-headed cane, wood, gilt © The Royal College of Physicians

Nowadays people might associate doctors with their stethoscopes, but from the seventeenth to the nineteenth centuries people would have thought of the physician’s cane.

The use of these canes dates back to classical times, and their purpose was similar to the sinister-looking beaks of the masks worn by plague doctors. It was commonly thought that contagion was spread by putrid air, so the beaks of masks and the hollow knobs that topped the canes were filled with aromatics such as herbs, lavender or myrrh to protect the physicians from bad air.

Hogarth's The Company of Undertakers or a Consultation of Physicians,  1736 © Wellcome Library, London

Hogarth’s The Company of Undertakers or a Consultation of Physicians, 1736, showing the physicians smelling the aromatics in their canes <br> © Wellcome Library, London

The canes of wealthy physicians became extremely ornate, with hollow perforated heads made from ivory or precious metal.

This particular cane had six owners, whose arms are engraved on its golden head. Its prestigious owners meant that the phrase a ‘gold-headed cane physician’ was used to indicate high standing within the profession.

William Macmichael (1783-1839), a physician and medical biographer, wrote a book about the six owners, entirely narrated by the cane itself. It gives an account of the lives of each of the owners in turn, as experienced by their constant companion the cane.

I visited the cane at its home in the collection of the Royal College of Physicians of England, and asked it a few questions about the upcoming exhibition dedicated to its former owner.

Me: Were you excited to hear that the Foundling Museum was hosting an exhibition about Dr Mead?

The Cane: Every Fibre thrilled within me at the Consciousness of the heartfelt Delight with which my kind and generous Master would have grasped me, could he have forseen how he would be honoured in this way.

How do you feel about being part of the exhibition yourself?

Title page from The gold-headed cane by William MacMichael © Wellcome Library, London

Title page from The gold-headed cane by William MacMichael
© Wellcome Library, London

When I was deposited in the Library at the Royal College of Physicians, with the Observation that I was no longer to be carried about, but to be kept amongst the Relics of that learned Body, it was impossible to avoid secretly lamenting the Obscurity which was henceforth to be my Lot. Formerly the Entrée of Palaces had been open to me – I had been freely admitted into the Houses of the great and the rich – but now I thought I was doomed to Darkness, to be surrounded by the musty Manuscripts of defunct Doctors.

I have grown accustomed to my current Abode, but it will be most exciting to venture out to Brunswick Square and see the many Visitors who will surely flock to learn more about my second Master.

If you had to rank your owners by preference, what order would you put them in?

I have passed through many gentle and erudite Hands, and it would be a nigh impossible Task to rank them in such an Order. However, Sir John Radcliffe, as my first Master, will always occupy a special Place in my Heart, or at least he would if I had one.

John Radcliffe, M.D (1652-1714) by Godfrey Kneller © The Hunterian, University of Glasgow 2014 - previously in Mead's own collection

John Radcliffe, M.D (1652-1714) by Godfrey Kneller © The Hunterian, University of Glasgow 2014
– previously in Mead’s own collection

What is your earliest memory?

Of my early State and separate Condition I have no recollection whatsoever. It may reasonably enough be supposed that it was not till after the Acquisition of my Head that I became conscious of Existence, and capable of Observation. I believe that my first Memory is of being vigorously polished in preparation for being delivered to Sir Radcliffe, of whose Existence I was not yet aware, being so recently cognisant of my own.

Do you have any exciting stories from your time with Dr Mead?

I was closely connected with Medicine for a Century and a Half, and can consequently, without Vanity, look upon myself as the Depositary of many important Secrets. I have witnessed many striking Scenes, chief among them being that at Newgate Prison during Dr Mead’s Investigation of the new Method of Smallpox Inoculation.

Tom Rakewell in a cell in the Fleet Prison. Engraving by T. Cook after W. Hogarth, 1797 © Wellcome Library, London

Tom Rakewell in a cell in the Fleet Prison. Engraving by T. Cook after W. Hogarth, 1797 © Wellcome Library, London

The Prison itself was a dreadful Contrast to the grand and stately Buildings I was accustomed to. The hellish Noise – a Clamour of roaring and swearing – coupled with the Sight of the terrible and tragic Crowd inside the prison walls made me most afraid. However, the firm Grip of my Master was a great Comfort to me.

Seven Felons underwent the Procedure, with varying degrees of Dignity. The seventh was a young Girl of eighteen years of age, who was greatly alarmed by my master’s Experiment with the Chinese Method of Inoculation. He introduced into her Nostrils a Tent, wetted with Matter taken out of ripe Smallpox Pustules, which was not at all to her Liking. Nevertheless, the Trial was a Success, and she fell ill and subsequently recovered just as my Master had intended.

How will you pass the time before the start of the exhibition?

My Silence and Solitude in my appropriately Grand Cabinet do allow for calm Reflection and Observation, of which I have had much in the past One Hundred and Eighty-nine Years. I believe I must be Condition Reported before leaving my Home at the Royal College of Physicians, and then I will be ready for my Journey!

 

Many thanks to the cane for this interview. The exhibition begins today, so come and visit when you can – the cane will be very happy to see you.

My next post will be an interview with Dr Richard Barnett, a writer, teacher and broadcaster on the cultural history of science and medicine, discussing London and medicine in Mead’s lifetime.

Introducing Dr Mead

FM50

Allan Ramsay, Dr Richard Mead, 1747 © Coram in the care of the Foundling Museum

I have the very great honour of introducing Dr Richard Mead (1673-1754), an eminent physician, philanthropist and collector of the eighteenth century.

His extraordinary list of patients included Queen Anne, George II, Sir Isaac Newton and Antoine Watteau, but he also found the time to dedicate his time and expertise to the Foundling Hospital which benefited from his patronage and medical advice.

Dr Mead amassed a magnificent library and art collection over his lifetime, displayed in a stunning gallery designed by the architect James Gibbs, sadly demolished to make way for Great Ormond Street Hospital.

I have been in correspondence with Dr Mead, and he has kindly agreed to this series of posts about his life and interests, even allowing me to include a few interviews with the doctor himself…

How did you feel when you found out that the Foundling Museum was planning an exhibition about you?

Naturally I am honoured, but I have to say that I consider it a little overdue. My Friend Sir Hans Sloane has had a far more prominent posthumous Reputation, despite our similar Careers and Collections. It is certainly time to redress the Balance.

Is it true that you fought a duel to defend your views on the treatment of smallpox?

John Woodward, by and published by; after William Humphrey; Unknown artist, mezzotint, published 1774, © National Portrait Gallery, London

Unknown artist, John Woodward, mezzotint, 1774 © National Portrait Gallery, London

There are various differing Accounts of that Evening, and I would like to set this in a clear Light. Dr John Woodward is, or rather was, an ill-bred, vain, and ill-natured Man who presumed to challenge my Views on the Use of Purgatives in the Treatment of Smallpox. His Pamphlet Campaign aiming to discredit me caused me considerable Irritation and when I challenged him to demand an Apology it led to an Altercation. I was, of course, the Victor, but he subsequently published a ridiculous and libellous Account of the Incident.

Why did you choose Non sibi, sed toti as your motto?

I have always been of the Opinion that one should use one’s Talents for the greater Good. Far too many people are intirely too concerned with Themselves. ‘Not for oneself, but for all’ is a Motto that many more should choose to follow.

Why did you decide to become involved with the Foundling Hospital?

One used to walk thro’ the Streets of London and Westminster, and behold the utmost Affluence and Splendor on the one hand; and the extremest Wretchedness on the other. Captain Coram’s Programme for the Foundling Hospital was a most worthy Endeavour and I therefore omitted no Opportunity to contribute what I could.

The Foundling Hospital, Holborn, London. Coloured engraving after L. P. Boitard, 1753 © Wellcome Images

The Foundling Hospital, Holborn, London. Coloured engraving after L. P. Boitard, 1753 © Wellcome Images

Can you tell us any scandalous stories about any of your more illustrious patients?

It is of the utmost Importance for a Physician to keep the Confidences of his Patients, but seeing as all of my Patients have been dead for over two hundred Years, I feel that I can disclose a few Details. For example, Sir Isaac Newton, a good Friend as well as a Patient, admitted to me on his Death Bed that he remained a Virgin.[1]

Over your lifetime you had your portrait painted many times. Could you say which one is your favourite?

I never liked Mr Arthur Pond’s Depiction and I am not overjoyed to see that it has been included in the Exhibition. However, the Portrait by my good Friend Allan Ramsay now on display at the Foundling Museum has always been a favourite.

I’ve had rather a bad cough for a few weeks now, what would you recommend?

Catching cold is often the Result of Obstructed Perspiration. I would advise Rest, Fluids, the lightest of Foods, an Infusion of Balm and Citrus and be sure to avoid extremes in Temperature. I must lastly remark that many attempt to cure a cold by getting drunk. But this, to say no worse of it, is a very hazardous and fool-hardy Experiment.

 

Many thanks to Dr Mead for permitting me to interview him. This is the first of a series of posts exploring the life of Dr Mead. My next post will look at Mead’s gold-headed cane, featured in the exhibition.

The Foundling Museum’s exhibition The Generous Georgian: Dr Richard Mead  opens on the 26th September and runs until the 4th January 2015.

[1] In Voltaire’s Lettres Philosophique,  ‘Letter XIV. On Descartes and Sir Isaac Newton’, Voltaire writes that Newton ‘never had any commerce with women – a circumstance which was assured me by the physician and surgeon who attended him in his final moments’, the physician being Mead.