Poisonous Experiments

Photo of the descending floor of the cave

Photo of the descending floor of the cave

In 1695 Mead set out on a Grand Tour of Italy. He visited the curious Grotta del Cane near Naples and noted its strange ‘venomous exhalations’. This intrigued Mead, who had a particular interest in poisons. He went on to do extensive research on poisons and venom, and his writings on these subjects led to him becoming regarded as an expert.

I met with Dr Mead to ask him about his work on this dangerous and unconventional subject.

Did your experience at the Grotta del Cane on your tour of Italy prompt you to make more experiments on your return?

I wished to carry my Searches farther, so I used to entertain myself at Leisure Hours with Experiments on Vipers and other Venomous Creatures; examining now and then the Texture of Arsenic, Mercury Sublimate, and the like Malignant Substances.

Rattle-snake with section of rattle and tooth, 1731 © Wellcome Library, London

Rattle-snake with section of rattle and tooth, 1731 © Wellcome Library, London

What were you hoping to discover?

My Design was to try how far I could carry Mechanical Considerations in accounting for those surprising Changes which Poisons make in an Animal Body.

I believe that Mathematical Studies, that is, Demonstration and Truth, are essential for the practice of Physick. Mathematical Learning is the distinguishing mark of a Physician from a Quack. He who lacks this necessary Qualification will be as ridiculous as one without Greek or Latin.

How would you go about extracting the venom?

I have oftentimes by holding a Viper advantageously, and enraging it till it struck out its Teeth, made it to bite upon something solid, so as to void its Poison.

Brown viper with Arum lily, 1731 © Wellcome Library, London

Brown viper with Arum lily, 1731 © Wellcome Library, London

A risky method! Is it true that for one experiment you drank venom?

My Aim was to disprove the popular Notion that Venom is poisonous even if you drink it. I enlisted certain Friends, one of whom dared to taste the Venom undiluted. We all agreed that it tasted very sharp and fiery, as if the tongue had been struck through with something scalding or burning. He who had chosen the undiluted Venom suffered a grievously swollen Tongue, but none of us suffered the Symptoms of Poisoning.

This shows that it is senseless for Physicians to advise against the Removal of Poison from Wounds by sucking. However, in sucking out the Poison, one must take care that there be no Ulcer in the mouth, as this may allow the Venom to enter the Blood.

Infant Hercules Strangling the Serpent, tailpiece from Richard Mead, A Mechanical Account of Poisons, 3rd ed., (London, 1745). © Wellcome Library, London

Infant Hercules Strangling the Serpent, tailpiece from Richard Mead, A Mechanical Account of Poisons, 3rd ed., (London, 1745).
© Wellcome Library, London

In your treatise A Mechanical Account of Poisons (1702), you often refer to classical perceptions of vipers.

The Viper has always been so Notorious for its Venom that the most remote Antiquity made it an Emblem of what is Hurtful and Destructive. Nay, so terrible was the Nature of these creatures, that they were very commonly thought to be sent as Executioners of Divine Vengeance upon Mankind for Enormous Crimes which had escaped the Course of Common Justice.

Does venom lose its potency once out of the venomous creature?

My Experiments have shown this not to be the case. Moreover, the Ancients, who knew much concerning the Nature of Poison, provide many further examples. Galen, mentioning the Story of Cleopatra, relates that she killed herself by pouring the Venom of an Asp into a Wound made in her Arm by her own Teeth.

Do vipers have medicinal qualities of themselves?

Vipers have many profitable qualities. Patients ought to eat frequently of Viper-Jelly, or Broth; or rather, as the ancient manner was, to boil Vipers, and eat them like Fish; if this Food will not go down, tho’ really very Good and Delicious Fare to make use at least of Wine, in which Vipers have for a long time been infused. This will quicken the Circulation of the Blood and scourge the Blood Vessels.

 

Once again, many thanks to Dr Richard Mead for taking the time out of his busy schedule for this interview.

 

The Foundling Museum is exploring Dr Mead ‘in the round’, as a physician, patron, philanthropist and collector, in the exhibition The Generous Georgian: Dr Richard Mead – running until 4 January 2015.

 

The next post will look at Mead’s thoughts on the influence of the sun and moon on our health.


 

This post draws on Mead’s writings to answer a series of questions posed in an imaginary conversation.

Advertisements

Venomous Exhalations

Photo of the descending floor of the cave

Photo of the descending floor of the cave

Dr Mead was fascinated by venom from the very start of his career. While at Leiden University, he took an interest in poisons and their anecdotes, and on his Grand Tour of Italy he was especially intrigued by a cave near Naples where he observed what he referred to as ‘venomous exhalations’. His observations caused the development of his thoughts on why air is so necessary to life.

The cave in question was the Grotta del Cane, found on the shore of Lake Agnano – a lake which fills the crater of the extinct Agnano volcano. In actual fact, it is not a cave, but a volcanic feature called a mofetta, or a fumarole – an aperture caused by the discharge of carbon dioxide. The Grotta is like a small corridor which slopes down into the ground, and it is this sloping floor which gives it its name.

Carbon dioxide is heavier than oxygen, so a shallow lake of noxious gas forms at the bottom of the ‘cave’. People walking inside will not notice any difference because their heads will be above the lake of carbon dioxide. However, smaller animals such as dogs will soon suffocate due to the lack of oxygen.

Etching of Lake Agnano. Three men take a dog into the grotto to demonstrate the asphyxiation of the dog. On the left, two local men suspend an asphyxiated dog in the lake in order to revive it: two tourists attend the experiment © Wellcome Library, London

Etching of Lake Agnano. Three men take a dog into the grotto to demonstrate the asphyxiation of the dog. On the left, two local men suspend an asphyxiated dog in the lake in order to revive it: two tourists attend the experiment © Wellcome Library, London

Visits to the Grotta del Cane became extremely popular with the tourists who flooded into Italy in the eighteenth and nineteenth centuries. So-called guides would demonstrate the deadly effects of the cave by walking dogs inside. When the animals keeled over the guides would take them outside to revive them or throw them into the lake to wake them up. Johann Wolfgang von Goethe, in his Italian Journey (Italienische Reise – published 1816–17), writes about the cave, as does Alexandre Dumas (writing in 1841-1843), who notes this gruesome attraction.

Mead visited the cave in 1695 on his tour of Italy and was extremely interested in the effects of these particular ‘venomous exhalations’. He wrote:

from the Ground arises a thin, subtle, warm Fume, visible enough to a discerning Eye, which does not spring up in little parcels here and there, but is one continued Stream, covering the whole Surface of the bottom of the cave; and has this remarkable difference from common Vapours, that it does not, like Smoak, disperse itself into the Air, but quickly after its rise falls back again, and returns to the Earth.

Mead notes that experiments are often made with dogs in order to demonstrate the deadliness of the fumes, but also mentions other more horrible tests:

Charles the Eighth of France prov’d it with an Ass; and two slaves put into it by order of D. Pietro di Toledo, Viceroy of Naples, with their Heads held down to the Earth, were both kill’d.

A couple of tourists are shown a demonstration of the cave's lethal effects

A couple of tourists are shown a demonstration of the cave’s lethal effects. The guide holds up the dog which has already passed out.

In the text, Mead dismisses the possibility of the fumes being a real poison seeing as any animal that comes out in time will quickly recover. He therefore theorises that “the blood may be supplied with something from the air, whatever it be, necessary to life”. Although Mead would not have known about the existence of oxygen, he understood that the air contains something crucial to life which is then transmitted into the blood through the lungs.

What Mead didn’t know was that there was quite a different mystery to be found at the end of the corridor…

Diagram of the sloping corridor © Rosario Varriale

Diagram of the sloping corridor © Rosario Varriale

In 2001 Rosario Varriale, an expert in caves from the Centre for Speleological Research of Naples, cleared out the interior of the corridor (equipped with an oxygen tank) and discovered a chamber measuring thirty-two square metres at the bottom. The chamber was partially blocked-off, with a stepped “walkway” around the sides, and traces of cocciopesto (pottery fragments mixed with lime or sand used to make plaster or mortar) on the floor. Up in one of the corners of the room was an opening that must once have served as a sort of sky-light. The temperature in the chamber reached as high as 60ºC.

The chamber found at the bottom © Rosario Varriale

The chamber found at the bottom © Rosario Varriale

One theory is that the grotto was dug out to be used as a steam room or thermal bath in the 3rd-2nd century BC. There is a complex of Roman baths from the time of Hadrian, (117-138 AD), nearby. Presumably at this time the carbon dioxide had not yet broken into the chamber, or was somehow kept from building up inside it.

If Mead had known it would have been a perfect mix of antiquities and poisons to match his interests. However, the fumes prevented even him from entering.

 

The Foundling Museum’s current exhibition, The Generous Georgian: Dr Richard Mead, reunites key objects from Mead’s life and collection, including a number of his medical treatises on a broad range of subjects from poisons to the plague.

 

The next post will be an interview with Dr Mead, discussing his experiments with poisons.

The Foundling Laboratory: inoculation and experimentation

Sir William Watson

Sir William Watson

The Foundling Hospital was an ideal testing ground for new medical ideas & methods. The children all followed the same diet and regime, meaning that there were very few variable factors.

This gave doctors a unique opportunity for controlled studies, and Sir William Watson, a physician at the Hospital from 1767 until his death in 1787, took advantage of this to test different methods of smallpox inoculation[1] in one of the first controlled clinical trials.

He was interested in perfecting the procedure of inoculation, and conducted carefully-documented experiments to find the best method. Inoculation involves taking some fluid or pus from someone infected and then pressing it into a scratch in the skin of a healthy person, provoking a mild outbreak of the disease. This outbreak is generally much less serious than if they were to contract it naturally.

Watson tested dozens of foundling children who were being inoculated in the off-site infirmaries to determine the best source of smallpox fluid. There was no consensus at the time and he wanted to find out whether fluid from an early pustule or a more mature lesion would provoke a milder outbreak of the disease in the inoculated patient.

He also tested the efficacy of common treatments of the time to prepare patients for inoculation: which included the use of mercury, jalap, rose syrup and senna (these last three being mild laxatives).

Watson conducted three experiments: one using fluid from an early smallpox lesion; another from a mature lesion; and the last from a late lesion. In each experiment, the children were inoculated at the same time and place, and with the same material. The only difference was the other general medical treatment they might have received. Watson’s systematic research had much in common with modern clinical trials.

his drug jar has the label “SYR: ROSARSOL”, which can be translated from the Latin as “syrup of roses”. This was a preparation mentioned in ancient Greek texts and for many centuries was used mainly as a purgative and laxative. Made in England 1670-1740 © Wellcome Library, London

This drug jar has the label “SYR: ROSARSOL”, the Latin for “syrup of roses”. This preparation is mentioned in ancient Greek texts and for many centuries was used as a purgative and laxative. Made in England 1670-1740 <br> © Wellcome Library, London

To assess the effects of the different procedures he, or rather the infirmary nurses, counted the number of pustules on each child. In the end none of the laxative treatments was shown to be especially useful, although he noted that the use of mercury along with a laxative had less of an effect because the mercury stayed in the body for less time.

The mildness of the outbreak caused by inoculation in fact depends on the mildness of the strain of smallpox which is used. There were about seventeen strains of smallpox around in Watson’s London, split into two groups – variola major and variola minor (the latter being much milder). There is some evidence that the strains present from 1750 to 1850 were milder than those before and after.

Watson’s work laid the groundwork for later advances in inoculation, as well as in the development of controlled trials. The Foundling Hospital was his laboratory.

 

Visit the Foundling Museum’s current exhibition, The Generous Georgian: Dr Richard Mead, which highlights the contribution of an eminent physician, collector and patron to the Foundling Hospital. Find out about Mead’s pioneering role in establishing state-of-the-art medical treatment at the Hospital, including the inoculation of the foundlings against smallpox.

 

My next post will look at a mysterious cave that Dr Mead visited on his tour of Italy, which prompted his deep interest in poisons.


[1] For more information on Watson’s experiments, go to http://www.jameslindlibrary.org/illustrating/articles/william-watsons-use-of-controlled-clinical-experiments-in-1767

 

Smallpox at the Foundling Hospital

From the moment when the first thirty babies were admitted to the Foundling Hospital on 25 March 1741, the Governors of the Hospital were determined to do as much as possible to protect foundlings from ‘the speckled monster’.

Admission of the Children to the Hospital by Ballot © Coram, in the care of The Foundling Museum

Admission of the Children to the Hospital by Ballot © Coram, in the care of The Foundling Museum

At this point inoculation for smallpox was available to the wealthy but it was not yet common practice. However, with committee members such as Dr Richard Mead, the Foundling Hospital developed a progressive health policy.

All staff at the Hospital had to have survived smallpox and all the children that had not had smallpox ‘in the natural way’ were to be inoculated at the age of three before they entered the hospital.

When babies were admitted they were immediately sent to wet nurses outside the city. These women were paid to look after the children for the first few years of their lives, after which they returned to the hospital between the ages of three and five. It was only then that the foundlings were inoculated.

The period when the infants were being looked after outside the hospital was by no means safe. Of the 1,328 children sent to nurse between 1741 and 1756, over 40% died before they could return to London. This is certainly high, but child mortality was often this high in the period, even among wealthy families – the second Duke and Duchess of Richmond had twelve children, only seven of whom lived to adulthood.

The most common causes of death recorded for foundlings when out to nurse in the country were ‘convulsions’, ‘consumption’ and ‘whooping cough’. Surprisingly, the Foundling Hospital’s inspectors only reported seven deaths from smallpox.

Thomas Coram with an infant in a basket in front of the Foundling Hospital. Line engraving by J. Brooke, 1751, after B. Nebot, 1741 © Wellcome Library, London

Thomas Coram with an infant in a basket in front of the Foundling Hospital. Line engraving by J. Brooke, 1751, after B. Nebot, 1741 © Wellcome Library, London

Inoculation upon the children’s return to the city was done in off-site infirmaries so that the children would not infect others at the Hospital while still contagious. By the end of April 1756, two hundred and forty-seven children had been inoculated and only one child had died as a result. The General Committee was so proud of this record that it ordered that details should be sent to newspapers for publication.

Between 1756 and 1773 there were thirty-six deaths from smallpox – 27% of all of the deaths in the hospital. There may have been more than this, as the cause of death was not always recorded, but Governors and medical staff knew how serious smallpox could be so would have been anxious to make sure that every death from smallpox was noted.

This number of deaths must have surprised the Governors – their system of inoculation was not working as well as it should have done. There were possibly some cases where nurses thought their charges had had smallpox when this was in fact not the case. There may also have been some cases where inoculation had not ‘taken’ for some uknown reason.

The Foundling Hospital by John Haygarth. Line engraving by W. Cooke, 1827, after J. H.

The Foundling Hospital, Holborn, London: a bird’s-eye view of the courtyard. Coloured engraving by T. Bowles after L. P. Boitard, 1753. © Wellcome Library, London

Compared to their peers, even the wealthy, the foundlings were well protected from ‘the speckled monster’. Although the death figures seem high, the Foundling Hospital’s health policy did much to prevent serious outbreaks of smallpox, long before inoculation was introduced by other similar institutions.

 

Minute books recording Mead’s involvement in the establishment of the Foundling Hospital, and its attempts to provide state-of-the-art medical care to the children, are on display in the exhibition The Generous Georgian: Dr Richard Mead, alongside various other items exploring Mead’s role at the Hospital and his position as an eminent physician, collector and patron of Georgian London.

 

My next post will explore the experiments of Sir William Watson, a Foundling Hospital physician, into different methods of inoculation carried out at the Foundling Hospital’s infirmaries.

A Duel over Smallpox

On 10 June 1719 Dr Richard Mead and Dr John Woodward allegedly came to blows outside Gresham College in central London. This was the, perhaps rather surprising, culmination of a pamphlet war over Mead’s advocacy of the use of purgatives in the treatment of smallpox.

I met with Dr Mead to discuss this extraordinary incident and the events leading up to it.

First of all, what exactly was your suggested treatment for smallpox?

Well, having been several Years one of the Physicians to St. Thomas’s Hospital, in the year of our Lord 1708 I observed that some of my Patients recovered from a very malignant sort of Small Pox, even beyond Expectation, by a Looseness seizing them on the ninth or tenth Day of the Disease.

Hence, I took the Hint to try what Good might be done by opening the Body with a gentle Purge on the Decline of the Distemper. The Success was in a great Measure answerable to my Wishes: for by this Method I recovered many who were in the most imminent Danger.

John Friend (1675–1728), Oil on canvas, studio of Michael Dahl, c. 1725, © Royal College of Physicians

John Freind (1675–1728), Oil on canvas, studio of Michael Dahl, c. 1725, © Royal College of Physicians

Did you then publicise these findings?

I communicated this Method of Practice to various of my Peers, including Dr John Freind. He and several Physicians likewise, both in Town and Country, were in Agreement about its salutary Effects, and he included a Letter I had written about it in his 1717 Commentary on Fevers, Commentarium novem de febribus.

How was your letter received?

There never are wanting Men of so invidious a turn of Mind that their principal Pleasure consists in blackening the Reputation and decrying the Productions of others; as if what they strip their Neighbours of was to be added to their own Characters. Thus, Dr Freind’s Book had no sooner appeared in Public, but some of this Ilk flew to arms, as if to save the Common-wealth, attacking my Mode of Treatment.

Was there a ring-leader for this disagreeable faction?

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

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

In front of this Band stood forth Dr John Woodward, physic Professor at Gresham College, a Man equally ill-bred, vain, and ill-natured, who, after being for some time Apprentice to a Linen-Draper, took it into his Head to make a Collection of Shells and Fossils, in order to pass upon the World for a Philosopher. Thence having got Admission into a Physician’s Family, at length by dint of Interest obtained a Doctor’s Degree.

This man publish’d a Book entitled, The State of Physic and Diseases, wherein he took great Liberties with Dr Freind, and those in the same Sentiment with him, but pointed his Arrows most particularly at me. These were neither Arguments nor Experiments, of which he had none, but bare-faced Calumny and Raillery, which he poured forth in Abundance.

I understand that this war of words eventually led to what has been called a duel. I have here Woodward’s own account of the fight in a statement he sent to the Weekly Journal for 20 January 1719:

“I had by this time drove Mead from the street quite through the gateway, almost to the middle of the College yard; when making another pass, my right foot was stopped by some accident, so that I fell down on my breast.  In an instant I felt Dr Mead’s whole weight upon me…. after that [he] gave me very abusive language, and bid me ask for my life.”

Is this a fair description of what happened?

The Arrogance and Vanity of the Man is beyond Belief. I am aware of this libellous Account and can utterly refute it. I was passing by Gresham College in my Carriage and paused momentarily in order to water my Horses. I stepped out of the Carriage for a Breath of fresh Air and was suddenly confronted by Dr Woodward who drew his Sword and forced me to respond to his Assault. Naturally I swiftly gained the upper Hand and demanded an Apology. His preposterous Account is merely an Attempt to safeguard his Reputation, what there is of it.

How do you look back on this altercation?

‘Tis much against my will that I revive the Remembrance of that Libel, which already is well-nigh sunk into Oblivion. However, I hope I have demonstrated how little Foundation Dr Woodward had for his personal Reflections and Brawling.

 

The alleged duel is commemorated in a plate of a book by John Ward (c.1679 – 1758), The lives of the professors of Gresham College (1740), in which two small figures battle it out in the bottom right-hand corner of a depiction of the College building. The book, and many other artefacts and works relating to Mead’s battle against smallpox, can be seen in The Generous Georgian: Dr Richard Mead, at the Foundling Museum until 4 January 2015.

 

The next post will look into smallpox at the Foundling Hospital and how the Governors were pioneers in their introduction of the practice of inoculation.

 

This ‘interview’ draws on Mead’s writings to answer a series of questions posed in an imaginary conversation.

Inoculating ‘The Speckled Monster’

Textured watercolour illustration from a Japanese work on smallpox entitled Toshin seiyo [The essentials of smallpox], ca. 1720 © Wellcome Library, London

Textured watercolour illustration from a Japanese work on smallpox entitled Toshin seiyo [The essentials of smallpox], ca. 1720 © Wellcome Library, London

The practice of inoculation had been common in China, India, and Turkey for hundreds of years but did not spread to Europe until the eighteenth century. In the case of smallpox, it involves infecting a patient with a tiny amount of fluid from a pustule by placing it in a small incision or puncture wound, usually on the upper arm. This then hopefully produces a mild case of the disease, providing immunity from further infection. However, the inoculated persons would be as contagious as if they had caught it naturally, so this danger was not reduced. In the case of smallpox, inoculation can also be called variolation after the Latin for pustule: variola.

The first written account of variolation describes a Buddhist nun practicing between 1022 and 1063 AD. She would grind up scabs taken from a smallpox-sufferer into a powder, and then blow it into the nostrils of someone not yet immune. By the 1700s, this method of variolation was common practice in China, India, and Turkey. It was not risk-free: up to 2% of people died after variolation. However, compared with the danger of contracting the disease naturally, inoculation was well worth it, decreasing the total number of smallpox fatalities ten-fold.

Lady Mary Wortley Montagu with her son, Edward Wortley Montagu, and attendants, attributed to Jean Baptiste Vanmour, oil on canvas, circa 1717 © National Portrait Gallery, London

ady Mary Wortley Montagu with her son, Edward Wortley Montagu, and attendants, attributed to Jean Baptiste Vanmour, oil on canvas, circa 1717
© National Portrait Gallery, London

Lady Mary Wortley Montagu, wife of the British Ambassador in Constantinople, came across the practice in 1717 when she witnessed local women performing inoculations at seasonal ‘smallpox parties’ by spreading matter from smallpox scabs into a scratch in the skin. Lady Mary had caught smallpox herself at 26 and was left with many pitted scars on her face and no eyelashes. She wore veils and heavy make-up to cover the scars. Her only brother had also caught it but did not survive.

She was determined that her own children should be safe. She had her son inoculated while still in Turkey, and during a smallpox epidemic in London in 1721 had her three-year old daughter inoculated by Charles Maitland, a physician who had been at the embassy in Turkey. The event was highly publicised in order to spread the word about the practice, and was attended by other medical men as well as various ‘persons of distinction’. At this point inoculation was still controversial, but it was gradually becoming an accepted form of preventive medicine.

Caroline Wilhelmina of Brandenburg-Ansbach by Jacopo Amigoni, oil on canvas, 1735 © National Portrait Gallery, London

Caroline Wilhelmina of Brandenburg-Ansbach by Jacopo Amigoni, oil on canvas, 1735
© National Portrait Gallery, London

One prominent supporter was Caroline of Ansbach, the Princess of Wales. She had caught smallpox shortly after her marriage to the future George II and was keen to protect her children, though she had reservations. To put her mind at rest she requested a monitored trial.

Dr Mead was a keen supporter of the method, and along with Maitland and Sir Hans Sloane conducted a trial in Newgate Prison.

Six convicted criminals were told that they would be released without charge if they underwent the trial. Five developed symptoms and then recovered; the sixth had lied about never having had smallpox and so was already immune. Mead tested the Chinese method of inhaling smallpox matter on another prisoner which, understandably, ‘gave great uneasiness to the poor woman’. All the prisoners were then released. To make sure that it had worked they sent one of the prisoners to Hertford where there was a particularly deadly outbreak of the disease. The, now ex-prisoner, nursed an infected patient and even shared a bed with them but did not suffer a relapse.

Newgate Prison, Inner Court, 18th century, from a contemporary print © Wellcome Library, London

Newgate Prison, Inner Court, 18th century, from a contemporary print © Wellcome Library, London

The Newgate trial had been a success but the Princess promoted another trial before she was ready to have her own children inoculated. Six ‘charity-children’ from St. James’s Parish were inoculated. Five came down with symptoms and then recovered. Again, the sixth had in fact had it before. Caroline was then happy for the ‘royal inoculations’ to go ahead.

Some aristocratic families followed suit, despite some highly publicised cases of inoculation being fatal, and the practice became more generally accepted. However, this was still a method of personal prevention rather than a public health strategy, and the end of smallpox was still a long way off.

 

Find out more about Mead’s role in inoculating against smallpox in eighteenth-century London by visiting The Generous Georgian: Dr Richard Mead, which runs at the Founding Museum until 4 January 2015.

 

My next post will be an interview with Dr Mead himself, where I ask him about the circumstances of the alleged duel he fought over smallpox.

The Speckled Monster: Smallpox

Smallpox used to be one of the most devastating diseases in existence, killing at least a third of those it infected.

The head of Ramesses V, showing lesions caused by smallpox. Click on the image for a close-up view

The head of Ramesses V, showing lesions caused by smallpox. Click for a close-up

The origin of the disease is uncertain, but it is believed to have originated thousands of years ago in Africa, then spreading to India and China. The earliest physical evidence of smallpox is the pustular rash on the mummified body of Pharaoh Ramesses V of Egypt, who died in 1157 BC.

Called ‘smallpox’ by the English to distinguish it from the ‘Great Pox’, syphilis, it was also known as the ‘speckled monster’ because of the painful rash that spread over the skin of sufferers.

The first symptoms of the disease appear two weeks after infection. During this incubation period, sufferers look and feel healthy and are not contagious. Then follows a sudden onset of flu-like symptoms including fever, headaches, back pain and sometimes vomiting, diarrhoea or both. A few days later, flat, red spots appear on the skin. Within a day or two, many of these lesions turn into small blisters filled with clear fluid, which then turn into pus. Scabs begin to form eight to nine days later and eventually fall off, leaving deep, pitted scars.

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

Those that survive carry the legacy of smallpox for life. It can leave the sufferer blind and almost all are disfigured by scars. The ravaged, pock-marked faces of survivors would have been a familiar sight for Dr Richard Mead.

Due to the growing use of dissection as part of medical training, most doctors in eighteenth-century Britain had some practical knowledge of the human body. However, successfully treating disease was rather more hit and miss. Smallpox was easily identifiable by the distinctive rash it produced, but once it was diagnosed there was little that could be done.

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

Doctors and apothecaries would prescribe an array of potions, powders and elixirs. These could include what was referred to as animal materia medica. Sir Hans Sloane, a contemporary physician and friend of Mead, regularly prescribed woodlice, crabs’ eyes and oil of scorpion. This was not uncommon at the time, and such treatments were not excluded from the Royal College of Physician’s Pharmacopoeia until 1788.

Many treatments, such as bleeding or purging, or the use of laxatives or medicines to provoke vomiting, in fact tended to make patients worse.

The Generous Georgian: Dr Richard Mead includes a number of objects which shed light on Mead’s battles with smallpox, from his A discourse on the small pox and measles of 1748 to a portrait of Mead’s fierce rival the Gresham Professor of Physic, John Woodward.

My next post will look at inoculation, and the active role that Dr Mead played in it becoming an accepted and beneficial practice in England.

Inside Mead’s Library

The nucleus of Mead’s library was formed during his grand tour of Italy in 1695. The small number of books that he brought back with him eventually grew to an extensive library of great renown.

49 Great Ormond Street

49 Great Ormond Street

Having moved to 49 Great Ormond Street after the death of the renowned physician Sir John Radcliffe, its previous occupant, Mead decided to build a library in the garden to house his growing book collection, to which was added Radcliffe’s collection of over two hundred volumes.

Mead employed for this the architect James Gibbs, who also designed the Radcliffe Camera in Oxford and Trafalgar Square’s St. Martin in the Fields. His library was built between 1732 and 1734 and became a prime destination for scholars, as well as for visitors just wanting to see the building and Mead’s collection of curiosities.

William Macmichael (1783-1839), one of Mead’s biographers, wrote

“Mead threw open his library and art gallery to the humble student, the unrecommended foreigner, and the poor enquirer, who derived as much pleasure from them as their owner did.”

Aesculapius holding a staff encircled by a snake. Drawing by G.B. Cipriani © Wellcome Library, London

Aesculapius holding a staff encircled by a snake. Drawing by G.B. Cipriani © Wellcome Library, London

Above the grand fireplace at the far end of the library hung Giovanni Paolo Panini’s Prayer to Aesculapius on the Isola Tiberina; a painting that Mead commissioned especially for his library. The painting depicts a prayer at the shrine to Aesculapius, the ancient Greek god of healing, in the city of Rome during a deadly plague epidemic. Mead also had a statue of the god to the right of the fireplace. This centrepiece recalled Mead’s work on contagion and prevention of the plague, as well as setting the tone for Mead’s erudite collection. He also had busts of Pope, Shakespeare and Milton on display.

Mead was not only a scholar; over his career he became a powerful patron in his own right. At least thirty-five books were dedicated to him, all of course displayed in his own library. He had a fine collection of medical books, but it was nothing compared to his collection of literature and the classics. Mead had one hundred and forty-six incunabula (books, pamphlets, or broadsides printed in Europe before 1501) including the works of Aristotle, Hippocrates, Terence, Horace, Livy, Ptolemy, Strabo and Pliny.

Front cover of the Shakespeare Folio, Royal Collection Trust / © Her Majesty Queen Elizabeth II 2014

Front cover of the Shakespeare Folio, Royal Collection Trust / © Her Majesty Queen Elizabeth II 2014

One notable book in Mead’s collection was a second folio of Shakespeare’s Comedies, Histories and Tragedies published in 1632, which had belonged to King Charles I. He supposedly read this folio while imprisoned at Carisbrooke Castle on the Isle of Wight before his trial and eventual execution. On the fly-leaf he wrote ‘Dum Spiro Spero’ (While I Breathe, I Hope). Mead bought the folio from the Herbert family, descendants of Sir Thomas Herbert, the Master of the King’s Bedchamber, to whom Charles presented it before his death. The book is now in the Queen’s library at Windsor.

Charles's inscription

Charles’s inscription

The only novel in the library was Henry Fielding’s Tom Jones – the full title being The History of Tom Jones, a Foundling. The book was first published in 1749 and perhaps reflects Mead’s commitment to the Foundling Hospital.

His library grew to over 10,000 books and, along with his collection of paintings, sculpture and other artworks, took 56 days to auction at his death.

49 Great Ormond Street, as well as its library, were transformed in 1852 into a new children’s hospital, now the Great Ormond Street Hospital. At first the original buildings were preserved, and what had been Mead’s library became the first hospital ward.

An engraving showing the ward in all its glory, retaining the highly decorated ceiling and panelling from its days as a library. At the front of the picture to the left are Dr Jenner and Dr West tending to patients.

An engraving showing the ward in all its glory, retaining the highly decorated ceiling and panelling from its days as a library. At the front of the picture to the left are Dr Jenner and Dr West tending to patients.

By 1870 the hospital buildings had become cramped and over-crowded, and so in 1871 they were demolished to make way for a new and purpose-built hospital. So it is no longer possible to visit Mead’s house and library. However, I’m sure he would have approved of the organisation that now occupies the site.

 

Key items from Mead’s life and collection have been reunited for the exhibition, The Generous Georgian: Dr Richard Mead, including a number of Mead’s own publications and works from his renowned art collection. The importance of Aesculapius to Mead, as a symbol of learning and medicine, is present in Ramsay’s magnificent portrait, in the form of a statue of Aesculapius’ daughter Hygieia, a goddess of health.

 

My next post will explore the scourge of smallpox in the eighteenth century and Mead’s role in its treatment.

Georgian Quacks: Doctors or Charlatans?

Ben Jonson in his play Volpone describes the Quack as a ‘turdy-facy, nasty-paty, lousy fartical rogue’.

This gives a pretty good idea of the popular opinion of quacks. However, the boundary between respected physicians and quack doctors is more blurred than you might believe. The term ‘quack’ is in fact a shortened version of early modern Dutch quacksalver; someone who cures with home remedies (1543; Dutch kwakzalver).

Doctor Humbug, an itinerant medicine vendor selling his wares from a stage with the aid of an assistant. Coloured etching, 1799 © Wellcome Library, London

Doctor Humbug, an itinerant medicine vendor selling his wares from a stage with the aid of an assistant. Coloured etching, 1799 © Wellcome Library, London

This said, a ‘quack’ is a far more insulting term than this suggests; indeed, it was more a term of abuse than anything else. It generally indicates a certain genre of medical operator; someone who claims to have miraculous cures and promotes them as ostentatiously as possible. ‘Cure-all’ medicines were frequently advertised in markets, with the quack-creator crying out their virtues from a stage.

A tooth-drawer holding up a tooth he has just extracted on stage to try and sell his skills. Etching after J. Steen © Wellcome Library, London

A tooth-drawer holding up a tooth he has just extracted on stage to try and sell his skills. Etching after J. Steen © Wellcome Library, London

Many of these people had no qualifications and would entirely fabricate their expertise. In his treatise on poisons Mead wrote that “mathematical learning will be the distinguishing mark of a physician from a quack”. However, this was not always the case.  Many so-called quacks did in fact have some kind of formal medical qualification. Academic honours could legitimately be bought from universities. Mead himself was awarded his medical degree from Padua after only a few months of being there. He then proceeded to set up his practice in his father’s house in Stepney without a licence. This is rather ironic seeing as he later became one of the members of the Royal College of Physicians tasked with checking that all physicians in London had the proper licences.

Much is made of the disgusting or even dangerous ingredients in the wonder-cures peddled by quacks. This was often the case, but quack remedies frequently had much in common with medicines given by respected physicians. Mercury was often prescribed for venereal diseases or skin problems, and all sorts of animal powders were mixed up into medicines. Mead contributed a recipe for snail water to the Pharmacopoeia Pauperum in 1718. The recipe:

Take Garden-Snails cleansed and bruised 6 gallons, Earthworms washed and bruised, 3 Gallons Of common Wormwood, Ground-Ivy, and Carduus, each one Pound and half, Penniroyal, Juniper-berries, Fennelseeds, Aniseeds, each half a Pound, Cloves and Cubebs bruised, each 3 Ounces, Spirit of Wine and Spring-water, of each 8 Gallons. Digest them together for the space of 24 Hours, and then draw it off in a common Alembick.L0030155 R. Bradley, A philosophical account of the works of nature...

This concoction was intended to cure venereal disease. Many leading physicians attached their names to cures. Even if they didn’t profit from the sales, it meant that they became household names. Mead also had his name attached to a rabies powder, his ‘Pulvis Antylisus’[1], and his friend Dr Hans Sloane promoted medicinal chocolate.

There were also plenty of quack, or simply incompetent, surgeons who would carry out questionable procedures and then leave town before people had the chance to take their bandages off. Handel lived with declining vision for the last decade of his life following failed cataract surgery by an oculist called the ‘Chevalier’ John Taylor. He underwent a procedure known as ‘couching’, in which a needle was poked into the eye and the cataract-clouded lens was pushed into the rear, out of the field of vision. The lyrics to the aria ‘Total eclipse’ from Samson where Samson laments his lost eyesight[2], were written as Handel began to go blind.  Today, operations in which cataracts are removed and the lens replaced are among ophthalmology’s most successful procedures.

An operator treating the carbuncled nose of an obese patient with “Perkins’s tractors”. Coloured aquatint after J. Gillray, 1801 © Wellcome Library, London

An operator treating the carbuncled nose of an obese patient with “Perkins’s tractors”. Coloured aquatint after J. Gillray, 1801
© Wellcome Library, London

Regular doctors tended to treat patients face-to-face with lots of contact time whereas quacks sought custom from the anonymous consumer through advertising and sales of ready-made medicines. Mead dedicated a lot of his time to seeing his wealthy patients. However, he also used to spend afternoons in coffee-houses where he would write prescriptions for apothecaries who would come to him for advice on their patients.

Many people thought that all medical men were as bad as each other. This correspondent in the Tory Tatler of Friday 8 December 1710 certainly did:

Death as an apothecary’s assistant making up medicines in a jar. Watercolour by T. Rowlandson or one of his followers © Wellcome Library, London

Death as an apothecary’s assistant making up medicines in a jar. Watercolour by T. Rowlandson or one of his followers
© Wellcome Library, London

Poor Health must needs be in a fine Condition, when so many Physicians, Quacks, Surgeons, and Apothecaries are her sworn Enemies, and whole Magazines of Pills and Drugs lie in wait for her Destructions. It is indeed often ask’d, what Disease a Man died of, Fever, Pleurisie, or the like; but properly speaking, the Question should be, not what Distemper, but what Doctor did he die of: Distempers seize Men, but the Physicians execute ‘em… For my part, I never hear an Apothecary’s Mortar ringing, but I think the Bell’s a tolling; nor read a Doctor’s Prescription, but I take it for a Passport into the next World.

While this might be a slight exaggeration, before the advent of modern medicine and diagnostic technology it must be said that medical practitioners were only sporadically effective in curing their patients.

 

I will be giving a short talk on entitled Quacks: medical charlatans of eighteenth-century London at the Foundling Museum Sunday 2 November, followed by a concert performance by flautist Michael Liu and harpist Rebecca Royce.

My next blog post will expore the contents of Mead’s impressive library and the beautiful building which housed it.

 

 


[1] Recipe: Let the patient be blooded at the arm nine or ten ounces. Take of the herb, called in Latin Lichen cinereus terrestris, in English, Ash-coloured ground liverwort, cleaned, dried, and powdered, half an ounce. Of black pepper powdered, two drachms. Mix these well together, and divide the powder into four doses, one of which must be taken every morning, fasting, for four mornings successively, in half a pint of cow’s milk warm. After these four doses are taken, the patient must go into the cold bath, or a cold spring or river, every morning fasting, for a month: he must be dipt all over, but not stay in (with his head above water) longer than half a minute, if the water be very cold. After this he must go in three times a week or a fortnight longer.

[2] Total eclipse! No sun, no moon! All dark amidst the blaze of noon! Oh, glorious light! No cheering ray To glad my eyes with welcome day! Why thus depriv’d Thy prime decree? Sun, moon, and stars are dark to me!

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.