London (Ancient And Modern) From The Sanitary And Medical Point Of View — Ditto: The Pharmacopoeias; The Rise Of The Medical Schools; Hospitals Built By Public Benevolence; Modern Medical Schools And Examinations; London As A Place Of Study

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.

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