The “Doctor” in time of Pestilence.

By William E. A. Axon, f.r.s.l.

“I do not feel in me those sordid and unchristian desires of my profession; I do not secretly implore and wish for Plagues, rejoice at Famines, revolve Ephemerides and Almanacks in expectation of malignant Aspects, fatal Conjunctions, and Eclipses.”—Sir Thomas Browne’s “Religio Medici,” pt. ii., sec. ix.

 

Of the great epidemics which have from time to time devastated Europe, Great Britain has had its full share. Between 664 and 1665 there were many visitations, resulting in heavy mortality, to which the general name of plague or pestilence has been given, although they were not always identical in form. Often the dread sisters Famine and Pestilence went hand in hand in the domains of merrie England in the good old times.

The Statute of Labourers declares, no doubt with perfect truth, that “a great part of the people, principally of artisans and labourers,” died in the pestilence known as the Black Death of 1349, which had important consequences, socially and politically. There were many subsequent outbreaks, though they fortunately did not attain to the enormous proportions of the great mortality. We have from the graphic hand of Chaucer a life-like portrait of a medical man of the fourteenth century who had gained his money in the time of pestilence.

At the end of the fifteenth and middle of the sixteenth century, we have as alternating with bubo plague, the Sudor Anglicanus. Its appearance coincided with the invasion by which Richard III. lost his crown, and his rival became Henry VII. Dr. Thomas Forrester, who was in London during the outbreak of 1485, gives instances of suddenness with which the “sweat” became fatal. “We saw two prestys standing togeder and speaking togeder, and we saw both of them die suddenly.” The symptoms were sweating, bad odour, redness, thirst, headache, “and some had black spots as it appeared in our frere Alban, a noble leech, on whose soul God have mercy.” Forrester complains of the quacks who put letters on poles and on church doors, promising to help the people in their need. He lays stress upon astrological causes, but does not overlook the defective sanitation which gave the plague some of its firm hold. The Sudor Anglicanus returned in 1508, 1517, 1528, and 1551. The last visitation was the occasion of a treatise by the worthy Cambridge founder, to whom Gonville and Caius College owes so much.

“The Boke of Jhon Caius aganst the sweatyng Sickness” is an interesting document. It opens with a long autobiographical passage as to his previous literary labours, which have ranged from medicine to theology. At first he wrote in English, but afterwards in Latin and Greek. The reason for this change is stated. “Sence yt that tyme diverse other thynges I have written, but with the entente never more to write in the Englishe tongue partly because the cōmodite of that which is so written, passeth not the compasse of Englande, but remaineth enclosed within the seas, and partly because I thought that labours so taken should be halfe lost among them which set not by learnyng. Thirdly, for that I thought it best to auoide the judgment of the multitude from whom in maters of lernyng a man shal be forced to dissente, in disprouyng that which they most approue, and approuyng that which they most disalowe. Fourthly for that the common settyng furthe and printīg of every foolishe thyng in englishe, both of phisicke vnperfectly and other matters vndiscretly diminishe the grace of thynges learned set furth in thesame. But chiefely because I would geve none example or comfort to my countrie men (whō I would to be now, as here tofore they have been, comparable in learnyng to men of other countries) to stande onely in the Englishe tongue, but to leaue the simplicitie of the same, and to procede further in many and diuerse knowledges both in tongues and sciences at home and in uniuersities, to the adornyng of the cōmon welthe, better service of their kyng, and great pleasure and commodite of their own selues, to what kind of life so euer they should applie them.” But his resolution not to write again in the vulgar tongue was broken by considerations of utility, for he saw that it could not be very serviceable to ordinary English people to give them advice as to the treatment of the sweating sickness in a language which they did not understand. In his account of this dire malady, he lays stress upon errors and excess of diet as a strongly co-operating cause. “They which had thys sweat sore with perille or death, were either men of welthe, ease and welfare, or of the poorer sorte such as wer idls persones, good ale drinkers, and Tauerne haunters. For these, by ye great welfare of the one sorte, and large drinkyng of thother, heped up in their bodies moche evill matter: by their ease and idlenes, coulde not waste and consume it.” Against the infection of bad air he recommends avoiding carrion “kepyng Canelles cleane” and other general sanitary precautions. He suggests that the midsummer bonfires were intended for purging the air, “and not onely for vigils.” Rosewater and other perfumes are to be used, and he thinks it would be well to clear the house of its rushes and dust. It is to be feared that the rushes which served instead of carpets, even in great houses, were not renewed very frequently. The handkerchief was to be perfumed, and the patient was to have in his mouth “a pece either of setwel, or of the rote of enula campana wel steped before in vinegre rosate, a mace, or berie of Juniper.”

Dr. Caius, like Dr. Forrester, did not omit to warn his readers that even with the aid of his book a medical man was still necessary, and in doing so he gives us a glimpse of the quack doctors of the sixteenth century. “Therefore seke you out a good Phisicien, and knowen to haue skille, and at the leaste be so good to your bodies, as you are to your hosen or shoes for the wel-making or mending wherof, I doubt not but you wil diligently searche out who is knowē to be the best hosier or shoemaker in the place where you dwelle: and flie the unlearned as a pestilence to the comune wealth. As simple women, carpenters, pewterers, brasiers, sope ball sellers, pulters, hostellers, painters, apotecaries (otherwise then for their drogges), auaunters thēselves to come from Pole, Constantiple, Italie, Almaine, Spaine, Fraunce, Grece, and Turkie, Inde, Egipt or Jury: from ye seruice of Emperoures, kinges, and quienes, promisīg helpe of al diseases, yea vncurable, with one or two drinckes, by waters sixe monethes in continualle distillinge, by Aurum potabile, or quintessence, by drynckes of great and hygh prices as though thei were made of the sūne, moone, or sterres, by blessynges, and Blowinges, Hipocriticalle prayenges, and foolysh smokynges of shirts, smockes, and kerchieffes, wyth such other theire phantasies and mockeries, meaninge nothng els, but to abuse your light belieue, and scorne you behind your backes with their medicines, so filthie, that I am ashamed to name theim, for your single wit and simple belief, in trusting thē most which you know not at al, and vnderstad least: like to them which thinke farre foules have faire fethers, although thei be never so euil fauoured & foule: as though there could not be so conning an Englishman, as a foolish running stranger (of others I speak not) or so perfect helth by honest learning, as by deceiptfull ignorance.”

Dr. Caius laid stress upon exercise as an aid to health, but some popular games he thought “rather a laming of legges than an exercise.” We need not follow him in the details of the treatment he recommends if in spite of the adoption of his preventive regime, the sweating sickness should come.

In 1561 there was issued “A newe booke conteyninge an exortacion to the sicke.” The tract ends with the following parody on the nostrums current for the cure of the pestilence: “Take a pond of good hard penaunce, and washe it wel with the water of your eyes, and let it ly a good whyle at youre hert. Take also of the best fyne fayth, hope, charyte yt you can get, a like quantite of al mixed together, your soule even full, and use this confection every day in your lyfe, whiles the plages of God reigneth. Then, take both your handes ful of good workes commaunded of God, and kepe them close in a clene conscience from the duste of vayne glory, and ever as you are able and se necessite so to use them. This medicine was found wryten in an olde byble boke, and it hath been practised and proved true of mani, both men and women” (Collier’s Bib. Account, i. 74).

The wealthy, on an outbreak of the plague, fled from the infected city, as we may learn from Boccaccio, and from Miles Coverdale’s translation of Osiander’s sermon, “How and whether a Christian man ought to flye the horrible plage of the pestilence,” which appeared in 1537.

During the plague of London, in 1603, the physicians are asserted by Dekker to have “hid their synodical heads,” but this is at all events not wholly true. Thomas Lodge, the poet, was also a graduate in medicine, and in his “Treatise on the Plague”—not the only one published in relation to this epidemic—we are told of his experiences of the plague-stricken city. He gives some good advice in relation to the sanitary measures to be taken for the prevention of the plague.

The nature of the regulations devised in the Tudor times to ward off infection may be gathered from the rules laid down at Chester in November, 1574, when

“the right Worshipful Sir John Sauage, Knight, maior of the City of Chester had consideracion of the present state of the said cite somewhat visited with what is called the plage, and divisinge the best meanes and orderlie waies he can, with [the advice] of his Bretheren the alderman, Justices of peace within the citie aforesaid (through the goodness of God) to avoid the same hath with such advice, sett forth ordained and appointed (amongst other) the points, articles, clauses, and orders folowing, which he willeth and commandeth all persons to observe and kepe, upon the severall pains theirin contayned:

“Imprimis. That no person nor persons who are or shalbe visited with the said sickness, or any other who shall be of there company, shall go abrode out of there houses without license of the alderman of the ward such persons inhabite, And that every person soe licensed to beare openlie in their hands ... three quarters long ... ense ... shall goe abrode out of the ... upon paine that eny person doynge the contrary to be furthwith expulsed out of the said citie.

“2. Item if any person doe company with any persons visited, they alsoe to beare ... upon like payne.

“3. Item that none of them soe visited doe goe abroad in any part or place within the citie in the night season, upon like payne.

“4. Item that the accustomed due watche to be kepte every night, within the said citie, by the inhabitants thereof.

“5. Item the same watchman to apprehend and take up all night walkers and such suspect as shalbe founde within and to bring them to the Justice of peace, of that ... the gaile of the Northgate, that further order may be taken with them as shall appear....

“6. Item that no swine be kept, within the said citie nor any other place, then ... side prively nor openlie after the xiiith daie of this present moneth, upon paine of fyne and imprisonment of every person doing the contrary.

“7. Item that no donge, muck or filth, at any tyme, hearafter be caste within the walls of the said citie, upon paine of ffyne and imprisonment at his worships direction.

“8. Item that no kind or sort of ... or any wares from other place be brought in packs into the said citie of Chester, untill the same be ffirste opened and eired without the libities of the said citie, upon pain last recited.

“9. Item that papers or writing containing this sence Lord haue mercie upon us, to be fixed upon euery house, dore post, or other open place, to the street of the house so infected.

“10. Item that no person of the said citie doe suffer any their doggs to goe abrode out of their houses or dwellings, upon paine that euery such dogge so founde abrode shalbe presently killed. And the owners thereof ponished at his worships pleasure.”

It has always been found easier to make laws than to have them enforced, and we find certain inhabitants complaining of the disobedience of infected persons in the following petition:—

“To the right worshipful Sir John Savage, knight, maior of the Citie of Chester, the aldermen, sheriffs, and common counsaile of the same.

“In most humble wise complayninge sheweth unto your worships, your Orators, the persons whose name are subscribed inhabiting in a certain lane within the same citie called Pepper Street, That where yt haue pleased God to infect divers persons of the same Street with the plage, and where also for the avoidinge of further infection your worships have taken order that all such so infected should observe certaine good necessarye orders by your worships made and provided. But so it is, right worships, that none of the said persons infected do observe any of the orders by your worships in that case taken, to the greate danger and perill, not only of your Orators and their famelyes being in number twenty, but also of the reste of the said citie, who by the sufferance of God and of his gracious goodness are clere and safe from any infection of the said deceas: In consideration whereof your Orators moste humbly beseche your worships for God’s sake, and as your worships intend it your Orators should, by the sufferance of God, avoide the dangers of the said deceas with their family, and also for the better safty of the citie to take such directions with the said infected persons that they may clearly be avoided from thens to some other convenient for the time untill God shall restore them to their former health. And in this doing your Orators shall daily pray, &c.”

During the visitation of the plague at Manchester in 1645, when the place suffered severely, the authorities not only provided “cabins” at Collyhurst for the reception of those whom the disease attacked, but engaged the services of “Doctor Smith,” who received £4 “for his charges to London and a free guift,” and £39 “for part of his wages for his service in the time of the visitation.” Thos. Minshull, the apothecary, was paid £6 2s. 6d. for “stuffe for ye town’s service.” Some “bottles and stuffe” were unused at the end of the plague, and these were sold to “Mr. Smith, Phissition,” for £1.

The story of English pestilence closes with the Great Plague of London in 1665. It began about the west end of the city, Hampstead, Highgate, and Acton sharing the infection, and gradually worked eastward by way of Holborn. Out of an estimated population of 460,000 there died 97,306 persons, of whom 68,596 perished of pestilence. One week witnessed 8,297 deaths, and it has been seriously argued that the official figures very much underrate the truth, and that in this week of highest mortality the deaths really amounted to 12,000. “Almost all other diseases turned to the plague.” Many of the clergy fled, and the places of some were occupied by the ejected Nonconformists. The complaint of absenteeism was also brought against the physicians, but there were certainly some who stayed in the infected and desolate city. “But Lord!” says Pepys, “what a sad time it is to all: no boats upon the river, and grass grown all up and down Whitehall Court, and nobody but poor wretches in the street.” William Boghurst, who was an apothecary, and Nathaniel Hodges, who was a physician, each wrote full accounts of the plague.

Hodges was the son of a vicar of Kensington, where he was born in 1629. He was a King’s scholar at Westminster, and was educated both at Cambridge and Oxford, taking his M.D. degree at the latter university in 1659. When the great plague broke out he remained at his house in Walbrook, and gave advice to all who sought it. There was unfortunately no lack of patients. Hodges’ writings give us a minute account of the “doctor in the time of pestilence.” The first doubtful appearances of the plague were noticed by Dr. Hodges amongst some of those who sought his counsel at the Christmas of 1664-5, in May and June there were some that could not be mistaken, and in August and September he was overwhelmed with work. He was an early riser, and after taking a dose of anti-pestilential electuary, he attended to any private business that needed immediate decision, and then went to his consulting room, and for three hours received a succession of patients, some already ill of the plague, others only infected by fear. Having disposed of these anxious inquirers, the doctor breakfasted, and then began his round of visits to patients who were unable to see him at home. Disinfectants were burnt on hot coals as he entered their houses, and he also took a lozenge. Returning home, he dined off roast meat and pickles, prefaced and followed by sack and other wine. A second round of visits did not terminate until eight or nine in the evening. He was an enemy of tobacco, but his dislike of the Indian weed did not extend to sack, which he seems to have drunk plentifully, especially perhaps on the two occasions when he thought he had himself caught the plague. These proved to be false alarms. Amongst the drugs he tried and found useless were “unicorn’s horn” and dried toads. The Corporation of London testified a due sense of Hodges’ services by a stipend and the position of physician to the city. His “Loimologia” is an important contribution to the literature of epidemics.

Hodges, who had thus been a witness of the Carnival of Death in the metropolis of England, may well have pondered on the words of one of his illustrious contemporaries, Sir Thomas Browne, who says:—“I have not those strait ligaments, or narrow obligations to the world as to dote on life, or be convulst and tremble at the name of Death. Not that I am insensible of the dread and horrour thereof; or by raking into the bowels of the deceased, continual sight of anatomies, skeletons, or cadaverous reliques, like vespilloes or grave makers, I am become stupid, or have forgot the apprehension of mortality: but that, marshalling all the horrors and contemplating the extremities thereof, I find not anything therein able to daunt the courage of a man, much less a well resolved Christian.... For a Pagan there may be some motive to be in love with life; but for a Christian to be amazed at Death, I see not how he can escape this dilemma, that he is too sensible of this life, or hopeless of the life to come.”