by Don Jordan
In London, during the week ending 6 June, deaths from suspected plague rose from seventeen to forty-three. The following week the death toll rose to 112. Panic set in and people began to leave the city.3 Samuel Pepys walked down to the river above London Bridge and took a wherry for Whitehall. At the palace he discovered ‘the court full of waggons and people ready to go out of towne’. The King left for Hampton Court three days later. London’s well-heeled joined the exodus, making for their country estates. Among them, the Earl of Craven closed up his town house in Drury Lane and made for his Berkshire estates. William Craven, a commoner who had washed the taint of trade from his skin by joining the army and affecting the manners of a military gentleman, had been elevated to the peerage by Charles II and made a privy councillor. It is said that after fleeing London, Craven felt so ashamed that he returned to the city, assisted in the relief of the ill and donated land for burials.
Four days after the royal party arrived in Hampton Court, the English fleet, commanded by the Duke of York, scored a considerable victory over the Dutch in the Battle of Lowestoft. The English sank seventeen enemy ships for the loss of one, the worst defeat in Dutch naval history. But James, in an error of judgement, failed to pursue the fleeing Dutch and so missed out on pressing home an advantage. It was to be the key decision in the war.
By July London was in the middle of a heatwave. What should have been a summer of ease turned life in the city into a waking nightmare. The rats carrying the disease flourished in the warm weather, and with them the numbers of fleas, spreading the plague more rapidly to humans. With the disease rampant, people died in huge numbers. Commercial life faltered and the theatres closed. Soon, even Hampton Court was considered unsafe for the royal family. King and court departed for Salisbury, and then on to Oxford, a city connected with royal exodus ever since Charles I had decamped from London at the beginning of the Civil War. For the court of Charles II, Oxford was a congenial setting, providing better facilities for effective rule than Salisbury. Never one to do without his pleasures, Charles was accompanied by his chief mistress, Barbara Palmer, Countess of Castlemaine, as well as his theatre group, the King’s Players, including the young Nell Gwyn, yet to attain her fame and place in English history.
In London, conditions continued to deteriorate. Ships stopped sailing up the Thames. Coal became scarce. Vessels carrying goods out of London were prevented from docking in foreign ports. London became almost a ghost city; few among the remaining population ventured out except to fetch water and food and go to church and pray. Charles had not forgotten the struggling city; he merely preferred not to be near it. At his instructions, a central bureaucracy comprised of the Lord Mayor, the sheriffs and aldermen remained to keep public order.
Having a senior post in the Navy Office while hostilities were still a major concern, Pepys was one of those who stayed. He sent his gold for safekeeping to the house of William Rider in Bethnal Green – Rider’s estate would become a treasure house of gold and valuables from friends and business acquaintances alike – and moved his household from Seething Lane to Greenwich. It says a great deal for the fortitude of the people of London that the administration stayed and carried out the King’s orders and rules to the letter.
The onset of the plague gave a window into the state of practical medicine. Strange theories old and new abounded and quacks of all sorts were on hand to take money from the ill, the worried well and the dying. As the plague spread, so the terrified population became more open to suggestion, their terror driving a desire to believe there was a cure to be bought. Daniel Defoe, who much later carried out journalistic interviews with survivors, described people wearing ‘Charms, Philters, Exorcisms, Amulets and I know not what Preparations’.* On every street, physicians of all degrees and none stuck up their advertising posters: ‘Doctors’ Bills, and Papers of ignorant fellows; quacking and tampering in physic’.4 For both patient and physician these were difficult times. While many thought that quackery was to be deplored, others thought it was every man’s duty, whether an amateur or not, to do what he coidd in extreme circumstances to find a cure. This well-meaning approach led to all sorts of abuses.
The clergy fled in large numbers – as did most members of the Royal College of Physicians, including its president, Sir Edward Alston – leaving the people to their fate. John Graunt was shocked, recording the hope that ‘neither the Physicians of our souls or bodies may hereafter in such great numbers forsake us’.5 Among the doctors who stayed, Nathaniel Hodges was one of the most notable. Born in Kensington, then a village southwest of London, where his father was the vicar, Hodges gained a scholarship to Trinity College, Cambridge, but switched to Oxford, attracted like Wren and others to the experimental philosophy group led by John Wallis. After gaining a degree in medicine he became a member of the College of Physicians in 1659 at the age of thirty. He carried on his medical practice from his home in the parish of Walbrook, a few minutes’ walk north-west of London Bridge, and named after the subterranean, culverted watercourse which rose in Moorfields Commons, outside the walls, and flowed south to the Thames.
When the plague started, Hodges stayed to treat his patients, never flinching in the face of the disease. He saw patients at his house and visited them at their homes, both risky businesses. Hodges did not remain in London for purely altruistic reasons – he wanted to conduct a medical trial on as large a scale as his patient list would allow, and saw the plague as providing an opportunity to test the standard remedies set out by the College of Physicians. While aware of the risks, he also saw that such opportunities to study plague came round only at intervals of ten to twenty years or more. The last great outbreak of plague in London having been in 1636, another chance for a large-scale empirical study might not come around for some time. Hodges was in his mid-thirties and he wanted to make his mark.†
Contemporary pictures exist of the elaborate ways in which ‘plague doctors’ protected themselves from the disease. Since plague was believed to travel in the air, long gowns covered the entire body to the feet, gloves were worn, a wide hat was pulled well down over the head and, most impressively, a mask was worn with a long proboscis shaped more like that of an anteater than a human nose. Inside this comic protuberance the wearer would stuff various herbs and unguents thought to offer protection from becoming infected. Oddly, modern research has shown that plague can, to an extent, travel in the air, borne in water droplets from an infected persons breath.
Hodges wore no fanciful clothes. He took a few simple precautions believed to stop the disease from entering the body; before starting work he ate a ball of herbs and other medicines considered to ward off illness. This was known as an electuary; the dose Hodges took was, he said, as ‘big as a nutmeg’. He was then ready to see his patients. If making a house call, he would ask the family of the patient to burn some disinfectant herbs on hot coals, pop a prophylactic lozenge in his mouth and enter. Hodges was a thorough man with a belief in an empirical approach. He carefully recorded his patients’ symptoms, dividing them into two classes according to severity. Symptoms of the second class included ‘a fever. . . palpitation of the heart, bleeding at nose and a great heat about the précordia’ (or pericardium, the wall of the chest in front of the heart). Pericarditis – inflammation of the pericardium, the sac surrounding the heart – may be caused by bacterial infection. Quite feasibly, Hodges had identified the symptoms of infection. Symptoms of the first class were ‘horror, vomiting, delirium, dizziness, headache and stupefaction’. First-class symptoms indicated death was not far away.6
Anxious to work to a scientific method, Hodges carefully tried the remedies that were available to him at the time. These included such venerable cures as ground unicorn’s horn. The horn proved ineffective. Hodges registered its failure in his records, noting his doubts about whether such a creature actually existed. Some of his patients, he wrote, were sick only of ‘fear’. He himself twice felt he had contracted the plague, but after drinking more sack than
usual he felt well again.
He also tried the ancient and expensive remedy of bezoar stones. Formed in the stomachs of ruminants such as cows and goats, these were thought to have healing properties, particularly if they were a particular earthy yellow in colour. Small quantities of stone were pulverised, made into a paste and washed down by the patient with some liquid. Hodges noted politely that his trials proved bezoar was useless: without having an Inclination to contradict a received Opinion, I have been so convinced by a Multitude of Trials, that the Truth will speak for itself, which manifestly denies its Virtues to be at all equivalent to its value: And I have truly given it in Powder many times to 40 or 50 Grains,‡ without any manner of Effect: and I dare affirm that the Bezoar with which I made these trials was genuine.’7 He did report some remedies as useful, including hartshorn (exactly what its name implied – deer antler, ground and calcinated) and Aristolochia serpentaria, or Virginia snakeroot.
In due course, Hodges published his account of the plague, discounting many of the medical approaches passed down from the Greek physician Galen, 1500 years before. Galen’s theory that the body was regulated by four humours – blood, black bile, yellow bile and phlegm – led physicians to attempt to restore its balance by methods that included sweating, purging and bloodletting, all of which were likely to hasten the patient’s death. The idea that the body needed to be in balance, as first posited by Hippocrates some 300 years BC, was essentially sound. What was disastrous was the subsequent understanding of what balance actually entailed, and how it could be achieved when there were no scientific methods of measuring the physical state of the patient, ineluding body temperature. The seventeenth-century doctor faced one central dilemma: almost all treatments didn’t work.
Hodges took careful note of what happened when various interventions were tried. From this he drew some definite conclusions. ‘Opening the pores’, or sweating the patient, was out. Bloodletting was to be avoided; as Hodges laconically said, ‘I should pass it by as fatal.’ By saying so, he stepped onto contentious ground. Bloodletting was one of the main means by which medicine, as practised in the seventeenth century, sought to restore the patient’s inner balance and so his or her health. It was particularly entwined with astrology, a major influence in seventeenth-century life, including the practice of medicine. The historical centrality of astrology to the intellectual life of the early modern age was overlooked until Keith Thomas’s 1971 work, Religion and the Decline of Magic, broke new ground. A surprising measure of just how integrated astrology was with the practice of medicine is the statistic that of all astrological almanacs published between 1485 and 1700, a third were written by physicians.8
In his rules for bloodletting, the eminent Oxford physician Peter Levens had written in his popular guide to practical medicine, first published in 1587 and republished six times until 1664, that the physician should ‘let no blood, nor open no vein, except the moon be in Aries, Cancer, the first half of Libra, the last part of Scorpio, Sagittarius, Aquarius, or Pisces’.9 Such ideas based on astrology would not be called into question until later in the century. By then the theory that the solar system revolved around the sun, propounded by Nicholas Copernicus in the middle of the preceding century and by others dating back to antiquity, had become more widely accepted. After that, astrology began to lose its validity among the scientifically minded. To its credit, the College of Physicians of London, to which Hodges belonged, put a good deal of effort into stamping out astrology in medicine, trying to identify astrological physicians with a view to having them barred from practice.
The College of Physicians was a body created to regulate the practice of medicine in the monarchical era, long before the civil wars of the seventeenth century.§ This meant neither that its members were all monarchists, nor that they were all Anglicans; during the period immediately before and including the civil wars, the college was predominantly Puritan. In line with the fate of other institutions, its pre-eminent position as the regulating medical body in London declined sharply with the upheavals of the middle of the century. With the return of Charles II, the college hoped its central position would be restored. It was disappointed; two other organisations grew in importance to be recognised by Parliament – the Barber-Surgeons’ Company and the Society of Apothecaries.¶
Most importantly for its own self-view, the College of Physicians was a bastion of traditional medicine learned via Latin at universities, with many of its senior members having been educated not only at Oxford or Cambridge but at the pre-eminent medical schools in Leiden and Padua, where groundbreaking anatomical explorations had been carried out in the previous century. As has been noted by many historians, the primary philosophical debate in the seventeenth century concerned what was known, how it was known and what was the best way to learn more in the future. This debate, between the revealed wisdom of the ancients, or of religion, and of the new thinkers, was carried out in fits and starts. For the medical profession, what was known was steeped in handed-down knowledge closely allied to the status of the universities from which the ancient ideas originated. The comparison has often been made between religion and the university-based received wisdom of medicine.10 The practices of religion and medicine tended to become linked according to an individual’s particular worldview.11
Hodges’ empirical approach to studying the plague indicated a strong inclination to enter the enemy camp, deserting the views of both the college and the universities. He was prepared to take long-held theories instilled through generations of Kuropean university teaching and hold them up to practical scrutiny.
Hodges was not alone in staying in London to fight the plague. To their credit, some other members of the College of Physicians also stayed. A core of other practitioners, very different from the members of the elite of the college who remained in the city, formed a small group who could be seen as representing a changing of the medical ways. They followed the path of Francis Bacon, Paracelsus and others, although the traditionalist old guard lambasted them for being ‘the dross of the earth’.12 In the ferment of thinking in mid-seventeenth century England, the empiricists were often lumped in with ‘enthusiasts’ like Calvinists and other nonconformist religious sects. This was not without reason, for followers of the alchemist Paracelsus were often allied to the more extreme forms of Protestantism.
During the plague outbreak, among the new: groups of empiricists arose those known as Helmontians. Named after the chemist Jan Baptist van H el mont, these physicians believed in creating medicines through the new chemical processes developed largely thanks to alchemy. Among the most eminent was George Thomson, who made close observations of the plague and its victims and administered his own chemically derived medicines. At great personal risk, he carried out a dissection of a plague victim. He was reported to have cured some patients. In all probability, his palliative care in some cases helped his patients recover, for the infection was not always fatal: the survival rate could be 10 per cent or more.
The reasoning behind claims that plague victims might be cured were made clear in the works of Thomson’s fellow Helmontian, Thomas Sydenham. Later to become known as the Tather of English medicine’, Sydenham chose not to stay in London during the plague. In the wide streets and comparatively hygienic environs of St James’s, he and his Pall Mall neighbours would have been relatively safe, had they remained. Nonetheless, Sydenham took to the country. He may have done so for self-preservation, or simply because he realised there was little or nothing he could do to help. At any rate, he later updated his well-regarded textbook on fevers with a chapter on the outbreak. In an age of few definitive remedies, Sydenham – following in the footsteps of Hippocrates – observed that, given a helping hand, the body could often regulate itself and allow illness to subside.
In the case of fevers, Sydenham recommended that his patients should not receive the standard treatments of bleeding, purging and so on, but be given cooling compresses and lotions to help them survive fevers such as
smallpox. Famously, Sydenham said that often he had done best by his patients by doing nothing. Given the degree of medical knowledge available at the time, and the often bizarre and even harmful remedies employed, Sydenham helped patients to rally and, if they could, fight their illnesses with their body’s natural defences. Here he is in characteristic form on scarlet fever:
I hold it, then, sufficient for the patient to abstain wholly from animal food and from fermented liquors; to keep always indoors, and not to keep always in his bed. When the desquamation [peeling off of scaly skin] is complete, and when the symptoms are departing, I consider it proper to purge the patient with some mild laxative, accommodated to his age and strength. By treatment thus simple and natural, this ailment – we can hardly call it more – is dispelled without either trouble or danger: whereas, if, on the other hand, we overtreat the patient by confining him to his bed, or by throwing in cordials, and other superfluous and over-learned medicines, the disease is aggravated, and the sick man dies of his doctor.13
The sick men, women and children of London were not going to die of this doctor. Perhaps Sydenham’s greatest contribution to medicine was the realisation that fever was not itself illness but was a symptom of the body’s reaction to illness, perhaps in an effort to combat infection.
Sydenham’s methods came to be advocated by others – including, perhaps a little surprisingly, Dr Millington, a member of the Royal Society who was also president of the conservative College of Physicians. It had been recognised for some time that certain ailments were just not curable by any methods known to current medical practitioners and that others simply got better. Often, the observed symptoms of disorders followed patterns mimicked by the prescribed treatments: fevers subsided after the patient’s temperature rose or when they were artificially sweated. Gastric ailments subsided following natural diarrhoea or when patients were given emetics, and so on.