BLOOD, BANDAGES AND BODIES
On 2 February 1685 King Charles II woke up feeling unwell. His doctors opened a vein and drew a pint of blood. Witnessing no improvement, they cupped another eight ounces of the sovereign’s blood and forced him to swallow antimony – the toxic metal made Charles vomit.
The king was then given a series of enemas. His hair was shaved and his scalp blistered with a hot iron to drive down the bad humours, and pigeon droppings were applied to the soles of his feet to attract the falling humours.
Another 10 ounces of blood was drawn and doctors administered forty drops of ooze from ‘the skull of a man that was never buried’. Finally, crushed stones from the intestines of a goat were forced down the royal throat. On 6 February the king died.
Charles probably died from a stroke. The doctor’s treatments – which seem to us more like torture – may well have hastened his departure.
But the king’s physicians regarded themselves as beyond reproach; they were the leading medics of their time, men of classical learning, whose curative traditions were passed on from the ‘Father of Medicine’ himself: Hippocrates.
A SENSE OF HUMOURS
For nearly 2000 years, British medicine was ruled by the ancient Greek principle of the humours.
This is a theory that the human body is composed of four elements: blood, yellow bile, black bile and phlegm. The key to health was balancing these factors; imbalance led to sickness and sick people were, literally, dis-eased.
So someone with too much ‘blood’ became sanguine, others were phlegmatic, bilious, choleric or jaundiced (from the Latin for yellow). These words have lost their medical meanings but are still used in modern English.
Health was restored by draining the excessive humour. The most popular treatment was bleeding; removing blood by cutting a vein, cupping or attaching leeches – treatments that were still used by doctors as late as the 19th century.
Other methods included enemas and purges. Patients frequently died in a blitz of blood and vomit.
The word ‘medieval’ evokes images of poverty, pestilence, darkness and disease. For most people these misfortunes were constant companions.
Some misfortunes, however, were inflicted by medieval physicians. Medicine was tied to ideas that were over 1000 years old and doctors disdained practical cures. A gentleman physician did not touch a person; his job was to talk to patients. His training involved learning Latin, debating philosophy and swishing about in purple robes – not tackling the dirty diseases of daily life.
Astrology was at the heart of medicine. Physicians consulted the heavens to calculate the best day to cure a headache (3 April) or treat blindness (11 April) – the planets determined the outcome.
The word ‘disaster’ comes from ‘bad star’ in Greek. So when the plague struck England in 1348, medical professors blamed ‘the conjunction of Mars and Jupiter causing great pestilence in the air’.
While medics had their heads in the stars, the Black Death scythed its way through England. Some doctors promoted remedies such as shaving a chicken’s backside and strapping it to a plague sore, bloodletting (providing, of course, that the patient’s horoscope was right), eating arsenic (highly poisonous) and drinking ten-year old treacle.
In desperation, towns hired plague doctors. These were second-rate physicians or con-men, recognisable by their ‘protective suit’: a heavy overcoat, mask with glass-eyes, and a nose cone or beak stuffed with herbs and flowers to filter the miasma or bad air ‘carrying’ the pestilence.
The plague doctors perished alongside the 1.5 million people – nearly half the population of England – who died in the Black Death.
ELF AND SAFETY
Medieval man was profoundly superstitious. The world of bad spirits, divine providence and supernatural beings was as real for him as the ground he walked on.
Bald’s Leechbook is a 9th century English medical textbook. It details a cure for ‘elfsickness’, a disease inflicted by invisible sprites who would shoot tiny arrows into their victims causing them to waste away or freeze. Evil elves were blamed for all kinds of maladies, including hiccoughs and the elf-stroke – a paralytic seizure, the origin of the word stroke.
Christianity offered salvation from these bad spirits. Healing shrines and pilgrimages flourished and saints and martyrs were invoked for health. Each organ and complaint has its own saint; St. Vitus for chorea (epilepsy and seizures) and St Anthony for erysipelas (skin disease).
One cure for demonic possession was trepanning. This involved drilling into the skull to allow the evil spirits to escape. Prehistoric Britons used flint tools to do this. Some people subjected to trepanning survived, and skulls have been found with bone grown back around the hole.
Scrofula was another ailment caused by evil spirits. Medieval people believed that the sovereign – whose body was considered divine – could cure this growth on the neck. The monarch would place their hands on the victim in a ritual known as ‘touching for the king’s evil’.
The writer and wit Dr Samuel Johnson suffered from scrofula. In 1712 he received the royal touch from Queen Anne. The ceremony proved ineffective and Johnson’s growth was removed by surgery.
SHOCK AND GORE
While doctors quacked away at the star charts and Hippocratic humours, the real medical heroes were the surgeons. Looked down on by the gentleman doctors, they were the craftsmen you called on when you needed a tooth pulled, a boil lanced or a broken bone set.
In the middle ages, the man with the sharpest knife and finest cutting skills was the barber. He could cut off your hair and your warts at one visit. In 1540, the London Company of Barber Surgeons was formed. Their charter specified that no surgeon could cut hair or shave and that no barber could practice surgery, but both could extract teeth. Barbers received higher pay than surgeons.
Surgery was brutal. An evening out at a public operating theatre became ghoulish entertainment, where audiences thrilled and chilled to the blood and screams. With no anaesthetic, operations were so gory that relatives and bystanders often fainted. Even the surgeon’s assistants – whose job it was to hold the patient down – sometimes fled the operating theatre.
The celebrity bone cutter in early 1800s London was Robert Liston. Known as ‘the fastest knife in the West End’, he could remove a limb in 28 seconds and then hold the severed stump up in the air to show the crowd. One patient, who needed a bladder stone removed, ran from Liston’s operating table and locked himself in the toilet. His fear was understandable, as the operation involved inserting a rod in the penis and pushing the stone out. Liston dragged him back to the table and operated.
In December 1846 he performed the first surgery in Europe using modern anaesthesia. Ether had been pioneered in Boston before Liston brought it to the operating theatre at University College Hospital.
The fear of surgery meant that people would live with ailments rather than be cut while conscious.One of Liston’s patients had a tumour on his scrotum so large that he pushed it around in a wheelbarrow. The introduction of ether meant people who had been too frightened to undergo surgery came forward for operations.
In 1783, John Hunter set up his anatomy school and exhibition in London’s Leicester Square. The Scot studied anatomy alongside his brother, performing dissections and analysing the progress of disease. Hunter also worked as a dental doctor, transplanting teeth from poor people to wealthy clients.
Hunter’s London exhibition included a collection of live animals. When they died their skeletons were turned into anatomical specimens. He collected and displayed some 14,000 exhibits, many of them human.
One exhibit Hunter was determined to have was the skeleton of the giant Charles Byrne. The 7’ 7” Irishman had travelled to England, where his height turned him into a celebrity. When Byrne’s health waned, Hunter asked him to donate his body. The giant refused, but after Byrne’s death Hunter bribed the undertaker to hand over the body. Today the skeleton, with much of Hunter’s surviving collection, is in the Hunterian Museum at the Royal College of Surgeons in London.
Hunter developed several innovative surgical procedures; he also advanced the science of anatomy and is regarded as ‘the father of scientific surgery’.
Before 1832, the only legally available bodies for anatomical study in Britain were criminals condemned to death and dissection. Medical schools could never secure the 500 corpses they needed each year, so anatomists like Hunter made deals in the dark underworld of London’s grave robbers.
The resurectionists’ trade was so lucrative that body snatchers would run the risk of fines and imprisonment. To protect their relatives and friends, the bereaved would watch over a grave after burial. Cemeteries built watch towers, tombs were encircled with iron bars called mortsafes and bodies interred in iron coffins.
In the 1820s, Burke and Hare brought a new dimension to the trade by murdering people and selling their victims’ fresh corpses for medical dissection.
Their macabre activities resulted in the 1832 Anatomy Act that permitted unclaimed bodies and those donated by relatives to be used for the study of anatomy. This law brought an end to body snatching.
Plants have been part of medicine since the Stone Age. Archaeologists have found evidence of Neolithic surgical amputations and have speculated that they must have used pain-killing plants such as the hallucinogenic Datura (Thorn Apple) during the operation, and cleaned wounds using antiseptic herbs like sage.
During the Middle Ages monasteries provided hospitals for the sick. The monks cultivated cures in their physic gardens: coriander was used to reduce a fever, stomach pains were treated with wormwood and mint, lung problems were medicated with liquorice and comfrey, and horehound syrups were prescribed for colds and coughs.
In 1649 Nicholas Culpeper published a book of natural medicine. He wrote The Complete Herbal in English so it could be read by ordinary people and his cures used local plants that were available to everyone.
Culpeper apprenticed as a London apothecary and set up practice among the poor, often charging no fee for his herbal remedies. Apothecaries frequently diagnosed illnesses and prescribed medication, but they charged less money than physicians, infuriating the medical establishment.
A colourful figure with strong opinions, Culpeper died at age 38 from tuberculosis compounded by intensive smoking of tobacco, an activity he had promoted as a cure for coughs.
The 18th century writer, Lady Mary Wortley Montagu suffered from smallpox as a child. She survived, but lost her eyelashes and was scarred for life.
When her husband was made ambassador to Turkey, she insisted on travelling with him. The maverick Lady Mary defied contemporary notions of behaviour, disguising herself as a local woman and venturing into the harems and houses of Constantinople. Here she discovered that the women were vaccinating their children against smallpox. Wortley arranged for her son to be inoculated.
When she returned to England in 1721 a smallpox epidemic broke out – killing 30% of its victims. Lady Mary convinced several female members of the royal family to be inoculated, but doctors did not want their authority usurped by ‘a few ignorant women’ and they denounced her as ‘illiterate’ and ‘unthinking’.
Posterity has shown that had the medical establishment not objected to a woman ‘interfering’ in medicine, many lives would have been saved in the 80 year period before Jenner developed the vaccination for smallpox.
On a July morning in 1865 a scream rang out around Dr James Barry’s house. For the past month the curtains had been kept drawn in his bedroom on London’s Cavendish Square, and now the Inspector General of Military Hospitals was dead.
The charwoman, sent to prepare his corpse, pulled up his nightshirt to uncover a secret the doctor had managed to hide for most of his life: James Barry was actually a woman.
Barry was one of the most highly respected surgeons of his day. He had risen from hospital assistant to top-ranking doctor in the British Army – serving in garrisons from South Africa to Jamaica.
But James Barry was actually born Margaret Ann Bulkley. Brought up by a liberal family who believed in women’s rights and education, his family decided that Margaret would train as a doctor. This was a time when women were not permitted to enter university, so in 1809 Margaret assumed her uncle’s name, James Barry, and enrolled in Edinburgh as a medical student.
Following graduation he joined the army. By 1845 Barry was principal medical officer in the West Indies. When the Crimean War broke out he demanded to be sent to the front line.
Right until the end, Barry had done everything to prevent the secret from being discovered, even requesting that no post-mortem be carried out on his corpse. But at the last the truth was, literally, uncovered.
The Victorian pioneer, Elizabeth Garrett was determined to become a physician. Her requests to study at medical school were denied so she enrolled as a nursing student, attending classes intended for male doctors – but was thrown out after complaints from fellow students.
Garrett discovered that the Society of Apothecaries did not specifically forbid women from taking their examinations. In 1865 she passed and gained a certificate enabling her to become a doctor. The society immediately changed its rules to prevent women from joining the profession this way.
In 1870, Garrett became visiting physician to the East London Hospital. Still determined to gain a doctor’s degree, she taught herself French and graduated from the University of Paris. The British Medical Register refused to recognise her qualification.
In 1872, Garrett founded the New Hospital for Women in London, with an entirely female staff. Renamed after its founder, it is now part of University College Hospital. Garrett’s determination paved the way for other females, and in 1876 an act was passed permitting women to enter the medical profession.
Florence Nightingale is regarded as the founder of modern nursing. She came to prominence while serving during the Crimean War, where she organised the treatment of wounded soldiers. There was no knowledge of germ theory at that time, but her instinctive understanding of hygiene led to her demanding clean wards and nutritious food for patients. Her innovations reduced the death rate from infections by more than half. In 1860, Nightingale laid the foundation of her profession with the establishment of her nursing school at St Thomas’ Hospital in London.
As science swept away medieval superstition and antiquated ideas, many British doctors were at the forefront of medical advancements.
WILLIAM HARVEY was the model Enlightenment physician. At the beginning of his anatomy lectures he would read out his manifesto: the human body can only be understood by observation. In 1628 he published De Motu Cordis. This book contains the first accurate account of the circulation of the blood and action of the heart. Modern medicine would be impossible without this discovery.
EDWARD JENNER was a rural Gloucestershire doctor whose discovery is said to have ‘saved more lives than the work of any other human’. Jenner realised that the relatively harmless cowpox infection milkmaids caught from cattle protected the farm girls from life-threatening smallpox. In 1796, Jenner tested his hypothesis by inoculating Phipps, the eight year old son of his gardener. He scraped pus from a cowpox on a milkmaid and used it to inoculate the boy, who contracted a mild fever.
He later injected Phipps with a small amount of smallpox. No disease followed. He repeated the experiment; again there was no sign of infection. He had developed the medical science of vaccination (from vacca, Latin for cow).
ALEXANDER FLEMING was a research doctor at St Mary’s Hospital Medical School in London. In 1928, while studying influenza, Fleming noticed that mould had developed accidentally on a set of culture dishes used to grow the staphylococcus germ.
The mould created a bacteria-free circle around itself. Fleming named the substance penicillin. In the 1940s this research was developed into the first drug that could successfully combat serious infections.
Before penicillin, a bee sting that became infected could kill you. The discovery was ranked as the most important of the 20th century and is estimated to have saved some 200 million lives.
Places of interest to visit:
WELLCOME COLLECTION – LONDON
Displays an unusual mixture of medical artefacts and original artworks exploring ‘ideas about the connections between medicine, life and art’. wellcomecollection.org
HUNTERIAN COLLECTION – LONDON
In 1799 the government purchased the collection of John Hunter which is displayed in the Royal College of Surgeons. The museum displays thousands of anatomical specimens, including the skeleton of the ‘Irish giant’ Charles Byrne, and many surgical instruments. www.hunterianmuseum.org
THE THACKRAY MEDICAL MUSEUM – LEEDS
Located in a former workhouse built to accommodate 784 paupers, highlights include reproduction Victorian slum streets, surgery before anaesthesia and an interactive children’s gallery looking at how the human body works; as well as the skeleton of Mary Bateman, the ‘Yorkshire Witch’, who was executed for fraud and murder in 1809. www.thackraymedicalmuseum.co.uk
THE FLORENCE NIGHTINGALE MUSEUM
The museum is located at St Thomas’ Hospital London. Open to the public seven days a week the museum tells the story of the lady with the lamp’, from her Victorian childhood to her experiences in the Crimean, through to her years as an ardent campaigner for health reform. www.florencenightingale.co.uk
ROYAL COLLEGE OF SURGEONS OF EDINBURGH
The College was founded in 1505. The collection includes ‘natural and artificial curiosities’ medical instruments, anatomical samples and a digital dissection theatre. The newly renovated Surgeons’ Hall Museums are open to the public. www.museum.rcsed.ac.uk