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 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
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?
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
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
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
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
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.