George Vivian Poore

“ It is impossible not to regret the fine old College, with its spacious courtyard and physic garden and its historic associations. But it would seem as if no purely educational establishment81 can flourish in the City of London. The Royal Society, the College of Physicians, and the College of Surgeons have all moved away, and Gresham College alone is left, as if to show the impossibility of flourishing in the richest city of the day. ”

“ Under such conditions as these the sewage problem may well be insoluble. The first and main duty of any sanitary authority should be to exercise a wise control over building. If every house were compelled in the future to have a curtilage bearing a definite proportion to the cubic contents, there would be an end of these towers of Babel, which shut out from us the light and air of heaven; the price of building land would fall; it would be possible to make some calculations as to sewage; and the excessive overcrowding of a city would be prevented. ”

“ London is very largely a city of wealthy and well-to-do people, most of whom must be looked upon as sojourners rather than dwellers in the city. Among such as these, who can command every luxury and necessary of life, including change of air, death-rates ought to be low. It is manifestly unfair to contrast the death-rate of St. George’s, Hanover Square, or Kensington, with the death-rate of a town packed with the wage-earning class.
3. The mobility of the London population is so great that it must vitiate any statistics bearing on the health of the inhabitants. ”

“ In this way medicine and surgery became divorced, and this forcible and arbitrary separation of two branches of the same subject served undoubtedly to hinder the progress of medical knowledge to an enormous extent. Medicine was thus left mainly in the hands of scholars, of men who at that time stood alone in the possession of scholastic learning, while surgery was handed over to men who had little or no scholarship, but who amassed a considerable amount of practical wisdom in the daily struggle with the difficulties of their craft. ”

“ 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. ”

“ If the evil effects of free trade are to be counteracted, it will be by returning the refuse of our towns free of cost to the impoverished agriculturist. If we in England go on as we are going, and if our brethren in the Colonies follow our example, as they are doing, I believe our race must become extinct, and it will be a Chinaman rather than a New Zealander who will sit in contemplation on the ruins of London Bridge. ”

“ 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. ”

“ We have to remember that diseases disappear or become unimportant, and that others become prominent. In our own day we have seen the rise in importance of diphtheria and enteric fever, and just at present we seem to have lost sight of typhus, for a long time the most important of the febrile diseases. “Leprosy,” which was at one time common in London, has practically disappeared. Plague, sweating sickness, and malarial fever have also gone. Whooping-cough was not recognised till the end of the sixteenth century, and could not, therefore, have been as common as it is now. ”

“ 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. ”

“ Another cause of the high death-rate was superstition, which regarded disease as a “visitation” which had to be borne without question or inquiry.
With such an attitude towards epidemics, which by some were regarded as due to an unfortunate conjunction of certain planets, it is not to be wondered at that the epidemics were mismanaged; and it is certainly difficult to imagine any measure better calculated to cause the spread of the plague than that of forbidding those affected to leave their houses, and compelling them to stay indoors and infect the rest of the household. ”

“ A good example is better than any amount of legislation, and a good example set in high places is much needed in this matter, to which there is undoubtedly a moral side.
How to alter the present arrangements in London now the houses have been almost uniformly deprived of their curtilage is very difficult. Under such circumstances “returning were as tedious as go o’er,” but I am myself inclined to think that the best solution of London’s sewage difficulty lies in the direction of cremation—certainly in the direction of decentralisation. ”

“ We must therefore conclude that the death-rate and the disease-rate bear no fixed ratio to each other, especially when we consider that between 2,000 and 3,000 medical men found sufficient work among the population to furnish them with an income. If deaths be few in London, it is clear that second-rate health is by no means exceptional. ”

“ 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? ”

“ Much as we owe to the College of Physicians, we owe even more to the early surgeons, and there is certainly no spot in this city which has a greater interest for us as students of medicine than the hall of the Barbers’ Company in Monkwell Street, a street not far from the General Post Office. ”

“ This population is one mainly of adult males, and since, if they get ill in the City they don’t die in it, the death-rate keeps down, and we like to think it is a wholesome place for a young man to work in. The 50,000 people who have to live night and day on this square mile of ground have not a very cheerful time in this wealthy city, where nature has been most effectually obliterated by the brute force of the almighty dollar. ”

“ Although we have to make many allowances, and take many things into consideration before we can estimate the true value of the London death-rate, it is, of course, undeniable that an enormous improvement in the health of the City has taken place since the beginning of the present century. ”

“ Huge thoroughfares have been driven through London in all directions, but as the ultimate increase in the height of the buildings has been proportionately greater than the increase in the width of the street, locomotion has become more difficult, our traffic has become more in need of police regulations, and it has become an acknowledged rule in the City that if you want to keep an appointment it is dangerous to take a cab, because one can thread one’s way with more certainty on foot. ”

“ The gradual obliteration of open spaces in London is seen not only in public and semi-public spaces, but also in the curtilage of private houses. Before the introduction of our modern system of sewerage and water supply, it was not possible to build houses without adequate curtilage for a well and the bestowal of refuse, and this obvious fact is borne out by a reference to the maps of 1558, 1658, and 1720, which are hung upon the screen. ”

“ 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. ”

“ Not only wheat, but all articles of food and clothing, and also fuel, have of late years been getting steadily cheaper; potatoes and other vegetables are in common use among the masses, and thus we have kept away famine diseases, and also that taint of scurvy, which was undoubtedly a great cause of ill-health in the middle ages. A most important fact36 has been the removal of the in-take of the water companies to a part of the river containing less sewage than that between the bridges. It is not enough to be able to rejoice in a small death-rate. ”

“ Rheumatic fever is one of the common diseases of London, which attacks young adults, and very often cripples them for life. It is a disease of great importance, and appears from the last report of the Registrar-General to have been on the increase since 1858.
Besides the greater liability to premature death which is caused by overcrowding, there are other drawbacks which are scarcely less important. One of these, with which we are well acquainted in London, is an increase in the dirtiness and smokiness of the air, which is mainly due to private fireplaces. ”

“ It was scarcely before the beginning of the eighteenth century that the hospitals of London began to be of any importance in the teaching of medicine. The earliest hospitals in London were leper hospitals, for at one time leprosy abounded in this city. St. James’s Palace is built on the site of a hospital for “maidens that were leprous;” the name Spitalfields reminds us that at one time there was a “spittle” here for lepers. There were other hospitals of a similar kind in Southwark and Kingsland. ”

“ Between 1485 and 1551 there were epidemics of the sweating sickness, a disease different from plague but scarcely less deadly.
We all know what epidemics of plague and sweating sickness did for London, but it may be thought that epidemics are accidental visitations, and are no criterion of the general health of the city. The numbers I have quoted from Henderson will make it impossible for us to believe that old London was at any time healthy, not even after the fire and the rebuilding. ”

“ With land at its present enormous value, it is not to be wondered at, though much to be regretted, that the Company has turned every available inch to account; and the medical antiquary who now goes in search of this, to us, almost sacred edifice, will need to be warned that it is hemmed in and hidden by warehouses. It was in 154097 that Henry VIII. gave a charter to the Barber-Surgeons, and Holbein’s famous picture of this event is the chief treasure of the Barbers’ Hall, which contains many other relics of medical interest. ”

“ Formerly the sanitary arrangements of houses were such that without some garden or back premises they would have been uninhabitable, and a reference to Aggas’s map, or Norden’s map, or Newcourt’s map, will show that in Old London a large proportion of the houses had gardens or back premises large enough to be shown on a map. These maps also show that in Charles II.’s time, just before the plague, the overcrowding of houses in London was much more marked than in the days of Elizabeth. ”

“ CHAUCER’S DOCTOR.
In giving an account of the profession of medicine as seen in London, both in ancient and modern times, one cannot do better than begin with that “Doctour of Phisik” described by Chaucer as setting out from the “Tabard” in Southwark with the other pilgrims bound for the shrine of St. Thomas of Canterbury about the year 1380. Chaucer’s lines have been often quoted, but I make no apology for giving them once more, because the description of the “doctour” bears the stamp of truth and is sufficiently minute to bring the individual before us ”

“ 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 are127 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. ”

“ If the scientific study of medicine should from any cause be checked, there can be no doubt that we should soon again make acquaintance with those pestilences which wrought such fearful havoc in the Middle Ages. ”

“ Some parts of Paris are very much more crowded than any parts of London, and no parts of it have a density of population so slight as Fulham, Hampstead, Wandsworth, Woolwich, or Lewisham. The effect of overcrowding on death-rate is seen very markedly in the city of New York, which has a population of 1,337,000, which has an almost unlimited water-supply, and the sewage of which is discharged direct into the sea. ”

“ Again, many doubtless acquired their first knowledge by practising on animals, and it must be remembered that there are now throughout this country scores of illiterate men who operate with consummate skill on the lower animals. It appears that as early as 1308 the barbers of London were incorporated into a guild, and there appears to have been a gradual separation of them into those which practised surgery and those which practised barbery, and in 1460 the Guild of the Barber-Surgeons was one of the livery companies of the City. ”

“ Until the problem of “What to do with our sewage?” is settled, clearly, we ought to do our best to stop the growth of the evil. Our present system of sewers ought to be closed as far as permission to connect fresh houses is concerned. As it is, the new Council, like the old Board, will have an uncertain quantity of sewage to deal with, for old houses are being everywhere pulled down, and houses of greatly increased capacity erected, and this of course means a proportionate increase in the sewage to be disposed of. ”