Chapter VII: Health, Disease and Sanitation125 (1)

When I mentioned to a friend that I intended to devote one of the chapters of this book to the consideration of sanitation in the Middle Ages, he hinted that as there was no such thing this would partake somewhat of the character of the famous chapter on Snakes in the _History of Ireland_. In this opinion I hope to prove that he is wrong.

There are many conflicting accounts of the general sanitary condition of a walled town in the Middle Ages, but although some have painted the condition of early London in a very unfavourable light, there is sufficient evidence on the other side to induce us, in taking a general survey of so large a subject, to be careful not to use too dark colours for our picture. Probably the town was healthier in ordinary times than the country, because the regulations were stricter, but in time of pestilence it was doubtless worse, from the confined space and the want of fresh air, caused by the closeness of buildings.

We do not hear much of the health of London between the periods of pestilence, but occasional information shows how great was the mortality among infants. The vast disproportion between the births and deaths made the influx of immigrants from the country necessary to keep up the population.

As a sign that the general conditions of life were unhealthier then than now, we may note that the expectancy of life in the Middle Ages was much shorter than at present. It is said that as large a number of persons died at forty years of age as now live to seventy. Queen Elizabeth was the first of the twenty-three sovereigns of England after the Conquest who attained the age of seventy, although Edward I indeed lived to his sixty-ninth year.

Dr. Jessopp gives a vivid picture of the frightful condition of town populations. He writes: 'The sediment of the town population in the Middle Ages was a dense slough of stagnant misery, squalor, famine, loathsome disease and dull despair, such as the worst slums of London, Paris or Liverpool know nothing of.'[126]

Dr. Charles Creighton, in his monumental work on epidemics,[127] takes the view that we must receive with some scepticism the extremely unsatisfactory accounts of the condition of old London. He points out that, while Erasmus gives a most repulsive description of the state of the houses, his contemporary and friend, Sir Thomas More, takes a much more flattering view. Dr. Creighton says: 'Some part of the rather unfair opinion as to the foulness of English life in former times may be traced to a well-known letter by Erasmus to the physician of Cardinal Wolsey. There are grounds for believing that Erasmus must have judged from somewhat unfavourable instances.' Dr. Creighton further points out that William Harrison (_Description of England_) gives proof enough that the filthy floors described by Erasmus had no existence two generations later, even among the poorer classes.

Fitz-Stephen was quite satisfied with the salubrity of the city, and he becomes enthusiastic over the gardens and clear springs which abounded on all sides, and made the walks of those who took the air in the summer evenings so agreeable. In fine, he says: 'The city is delightful indeed when it has a good governor.'

Sir Thomas More at a later period saw so little amiss that he was content to consider London as a fair sample of what he would wish the capital of Utopia to be. We know, at all events, that whatever its faults it was in advance of foreign cities. It has been said that the English word 'comfort' cannot be translated, and a curious confirmation of this is found in the fact that in the old French contemporary account of Wat Tyler's Rebellion the word is introduced in a French context, as if there was no equivalent in that language.

Dr. J. W. Tripe, in 1881, took as the subject of his inaugural address on assuming the presidential chair of the Society of Medical Officers of Health: 'The Sanitary Condition and Laws of Mediæval London.' Referring to this, a writer in the _Medical Times and Gazette_ says: 'His description of the streets and houses of Old London, and of the habits of our forefathers, though most graphic, was not new ... but few, we think, have any idea of the antiquity of Sanitary, Nuisance Removal and River Conservancy Acts, and Dr. Tripe has therefore done well to again set forth the accounts of them that have been exhumed from the records of the city. Rude as they may seem to modern notions, they ought to have sufficed for the prevention of the epidemics which from time to time decimated the population, if they had not, like so many more recent enactments, been in advance of the age, and consequently remained for the most part dead letters.'[128]

Before entering into particulars as to means taken for the protection of the city from disease, and as to those upon whom the duty was laid of carrying them out, it will be necessary to make a few remarks upon the healing art in the Middle Ages.

It may be presumed that at all times large numbers suffered from illnesses and required medical aid, yet little has come down to us relating to the treatment adopted by the doctors. Unfortunately the medical men of the Middle Ages do not appear to have trusted to themselves or to their own practical knowledge. Instead they put their whole trust in the little they knew of Greek practice which they learnt from the Arabs. So that, even when writing on cases that came under their own observation, they give but slight information respecting the clinical treatment they adopted, and were afraid to express an opinion without the authority of a great name.

Dr. Norman Moore says: 'The basis of medicine is the patient.'[129] This being so, as the patient always exists the medicine man must always have been required.

Those whose duty it was to combat disease among the Saxons seem to have been of little account, if we are to judge from the Rev. Oswald Cockayn's collection of _Leechdoms, Wort-cunning and Star Craft of Early England_, published in the Master of the Rolls' Series (1864); and Dr. J.F.Payne's _Fitzpatrick Lectures on the History of Medicine_, 1903.

The Saxon leech received a professional education, and was often learned although he did not advance knowledge. He seems to have placed more reliance upon charms and magic than upon any sensible treatment. He compounded recipes of the most incongruous character, and paid special attention to the use of herbs, but few instances of cures performed by him are recorded.

It is not until after the Conquest that we are able to find the first signs of the noble profession of to-day.

It is said that mediæval medicine first began to emerge from obscurity in the thirteenth and fourteenth centuries. The Jews and the clergy were among the first to practise medicine. A noted Jewish physician is recorded by William of Newburgh as practising at King's Lynn at the end of the twelfth century, but shortly afterwards the Jews were driven out of the country, and we hear no more of them except of an occasional physician who managed to escape the general outlawry of his nation. The clergy also in course of time largely gave over their noble attempts to heal their fellow-citizens, and a medical profession was gradually formed.

John of Salisbury (d. 1180), the friend and counsellor of Thomas à Becket, who is called by Bishop Stubbs 'the central figure of English learning for thirty years,' and may therefore be considered to some extent as an authority on the subject, had a very poor opinion of the medical profession of his day, and rated its members roundly for their ignorance and incompetence. He affirmed that they had two maxims which they never violated--'Never mind the poor; never refuse money from the rich.'

There was no school of anatomy or surgery throughout England in the age of Chaucer and Wyclyf, but the medical schools of Salerno, Naples and Montpellier were attended by Englishmen. St. Luke is usually considered as the patron saint of the medical profession, but in the Middle Ages he was to a great extent dispossessed by St. Cosmas and St. Damian,[130] two brothers, who practised as physicians in Cilicia, and were martyred in the early part of the fourth century. These were the patron saints of the Company of Barber Surgeons, but the Fellowship of Surgeons, whose history has been written by Mr. D'Arcy Power,[131] kept St. Luke's Day as well as that of St. Cosmas and St. Damian.

Chaucer found room for the 'Doctor of Physick' in his wonderful gallery of mediæval portraits, and a very vivid picture he gives of the studies and practice of this worthy. It is drawn with the poet's tolerant humour, but he ends by saying that the doctor loved his gold, and all accounts appear to corroborate this opinion.

'With us ther was a Doctour of Phisik,
In all this world ne was ther noon hym lik,
To speke of phisik and surgerye;
For he was grounded in astronomye.
He kepte his pacient a ful greet deel
In hourés, by his magyk natureel.
Wel koude he fortunen the ascendent
Of his ymáges for his pacient.
He knew the cause of everich maladye,
Were it of hoot or cold, or moyste or drye,
And where they engendred and of what humour;
He was a verray parfit practisour.
The cause y-knowe and of his harm the roote,
Anon he yaf the siké man his boote [remedy].
Ful redy hadde he his apothecaries
To sende him droggés and his letuaries,
For ech of hem made oother for to wynne.
Hir frendshipe was nat newè to begynne.
Wel knew he the oldé Esculapius
And Deyscorides and eek Rufus,
Olde Ypocras, Haly and Galyen,
Serapion, Razis and Avycen,
Averrois, Damascien and Constantyn,
Bernard and Gatésden and Gilbertyn.
Of his dieté mesurable was he,
For it was of no superfluitee,
But of greet norissyng and digestible.
His studie was but litel on the Bible.
In sangwyn and in pers he clad was al,
Lynéd with taffata and with sendal.
And yet he was but esy of dispence,
He kepté that he wan in pestilence.
For gold in phisik is a cordial,
Therefore he lovéde gold in special.'

Chaucer here shows great learning and knowledge of the history of medicine. He gives a full list of the Greek and Arab authorities, and also of the men living nearer to his own day. Bernard was Bernardus, Gordonius the professor of medicine at Montpellier in Chaucer's time, Gilbertyn was Gilbertus Anglicus and Gatesden was John of Gaddesden.[132]

Gilbertus Anglicus, author of a _Compendium Medicinæ_ (about 1290), is said to have been the first English practical writer on medicine, but as Gilbert quotes a Master Richard, there may have been a still earlier English writer on the subject. The book contains the first description of leprosy written by a European. Little is known of the particulars of his life, but he is said to have been Chancellor at Montpellier. He travelled in the East at the time of the Crusades, probably during the Third Crusade in which Richard I. took part.

John of Gaddesden (1280-1361) was a Doctor of Physick of Oxford, graduating from Merton College, Oxford, who subsequently obtained a large practice in London. He was in priest's orders and held a stall in St. Paul's Cathedral. His famous medical treatise, entitled _Rosa Anglica_, was written about the year 1305. It treats of fevers and injuries of all parts of the body, and soon became a medical text-book throughout Europe. In this book there is an account of his special treatment of smallpox. He wrote: 'Let scarlet red be taken, and let him who is suffering smallpox be entirely wrapped in it or in some other red cloth; I did thus when the son of the illustrious King of England suffered from smallpox, I took care that everything about his couch should be red, and his cure was perfectly effected, for he was restored to health without a trace of the disease.'[133] Gaddesden was court physician to Edward II. and Edward III., and seems to have taken advantage of his position to exact high fees. He recommended his contemporaries to make arrangements about payment before undertaking a case.

The clergy were forbidden by Pope Innocent III. (1215) to undertake any operation involving the shedding of blood, and subsequently they were forbidden to practise surgery in any form. From this cause the practice of surgery largely came into the hands of the barbers.

We shall see later how the profession was divided between the military surgeon and the barber surgeon, but here we have only to deal with the physician.

We learn from Riley's _Memorials_ (p. 464) that Roger Clerk, of Wandsworth, was placed in the pillory in May 1382 for pretending to be a physician. He was brought before the Mayor and aldermen, and charged with deceit and falsehood by Roger atte Hacche: 'Whereas no physician or surgeon should intermeddle with any medicines or cures within the liberty of the city aforesaid, but those who are experienced in the said arts, and approved therein, the said Roger Clerk knew nothing of either of the arts aforesaid, being neither experienced nor approved therein, nor understood anything of letters.'

He pretended to heal Roger atte Hacche's wife Johanna of her bodily infirmities by making her wear an old parchment leaf of a book rolled up in a piece of cloth of gold. This being of no avail, Clerk was adjudged to be led 'through the middle of the city with trumpets and pipes, he riding on a horse without a saddle, the said parchment and a whetstone, for his lies, being hung about his neck.'

This man evidently was an impostor, and was properly punished for obtaining money under false pretences, but many of the recipes adopted by the recognised physicians would probably be as ineffectual as the charm of Roger Clerk. John de Gaddesden made a disgusting plaster of dung, headless crickets and beetles, which was rubbed over the sick parts to cure the stone, and we are told in the _Rosa Anglica_ that 'in three days the pain had disappeared.'

It was very long before the doctors gave up the making of extraordinary plasters and decoctions. Apparently they had the assistance of laymen on occasions. Dr. Furnivall has printed in his edition of Vicary's _Anatomie of the Bodie of Man_ (1888) a series of ten recipes by Henry VIII., and his physicians, Dr. Augustyne, Dr. Butts and Dr. Cromer, taken at random from Sloane MS. 1047 (British Museum). Among these are 'the Kinges Majesties owne plastre,' 'a black plastre devised by the Kinges Hieghness,' 'a plastre devised by the Kinges Majestie at Grenewich, and made at Westminstre, to take awaye inflammacions, and cease payne, and heale excoriations,' 'a decoccioun devised by the Kinges Majestie,' and 'a cataplasme made ungtment-lyke of the Kinges Majesties devise, made at Westminster.'

A conjoint Faculty of Medicine and Surgery was founded in 1423. On the 15th of May 1423 the Mayor and aldermen were petitioned for this purpose. 'The petition prays that all physicians and surgeons practising in London may be considered as a single body of men, governed by a Rector of Medicine, with the assistance of two surveyors of the Faculty of Physic and two masters of the Craft of Surgery. There was to be a common place of meeting, consisting of at least three separate houses, one fitted with desks for examinations and disputations in philosophy and medicine, as well as for the delivery of lectures. The second house was for the use of the physicians, and the third for the convenience of the surgeons.'[134]

The petition was granted, and on the 28th May 1423 Master Gilbert Kymer was sworn before the Mayor and aldermen as Rector of the Faculty of Medicine. Dr. Kymer was a graduate of the University of Oxford, and physician to the household of Humphry, Duke of Gloucester, and also an ecclesiastic. Dr. John Somerset and Dr. Thomas Southwell were sworn on 27th September to act as Supervisors of Physic. The former was also a graduate of Oxford University and a physician to Duke Humphry. Of the latter's history Mr. Power could find nothing. There is no record 'of the swearing in of a Rector of Medicine after 27th September 1424, nor is there any other indication of the continued existence of a conjoint college after 1425.'[135]

Dr. Kymer went to the west of England in 1428, and became Dean of Salisbury in 1449. He continued, however, to practise medicine, 'for in June 1455 he was summoned to Windsor to attend Henry VI. in the fit of imbecility which attacked him after the first Battle of St. Albans.'[136] Little is known of the action of the physicians from 1427 until the College of Physicians was founded by Linacre in 1518.

_Surgeons._--Barbers were of old humble practitioners in the art of surgery and performed minor operations such as bleeding, tooth-drawing, and cauterization. They largely assisted the clergy, in whose hands the practice of surgery and medicine was almost wholly confined. The action of the Popes, already alluded to, in forbidding the clergy to interfere in any matter connected with the shedding of blood as incompatible with the holy office caused the clergy to devote themselves specially to medicine, and the duties of the barbers were thereby largely extended.

Mr. D'Arcy Power has drawn attention to a matter which is of the greatest interest in the history of the profession, viz., that two types of surgeons flourished side by side in London during the Middle Ages--the military surgeons who formed the aristocracy of the profession, and the barber surgeons. As early as the Third Crusade (1189-1192) military surgeons 'were in attendance upon the kings and nobles, often in a purely personal capacity, but in the thirteenth century they had formal gradations of rank and were known as "the Royal Surgeon," the "Common Surgeon," etc.'[137]

In 1308 Richard le Barber, the first master of the Barbers' Guild, who dwelt opposite the Church of Allhallows the Less, in Upper Thames Street, was sworn at Guildhall, and in 1310 barbers were appointed to keep strict watch at the city gates, so that no lepers should enter the city.

John Arderne was an early surgeon of mark who is worthy of special notice as one of the first English writers on surgery. He had an extensive experience in the treatment of wounds, and it is supposed that at one time he was attached to the English forces during the French wars in the capacity of field surgeon. He was born in 1307, and practised at Newark from 1349 to 1370, when at the age of sixty-three years he settled in London.[138]

He was specially famous for his treatment of fistula, and he made his great reputation by curing Sir Adam Everyngham of this complaint after his case had been pronounced incurable by the chief doctors in France. Arderne had many distinguished patients and received very large fees. In his works he entered very fully into the history of his cases, and his mode of treatment, and when describing 'ye mannere of ye leche' he throws a remarkable light upon the professional ethics and habits of his time. He was by no means reticent as to the best means of getting over his patients and making them pay well. The surgeon is told to 'beware of scarse askings,' and as an example, Arderne says that, if he had to do with 'a worthy man and a great,' he charged 100 marks or £40 for a cure, 'with robez and feez of an hundred shillyns terme of lyfe, by year.' 'Of lesse men' he would take £40 or 40 marks without feez, but he adds 'never in alle my lyf toke I lesse than an hundred shillyns for cure of that sekeness.'

He counsels doctors to be careful in estimating the length of time of a cure, in fact to suggest double the time he expects. If the patient wonders at the rapidity of cure and asks, 'Why that he putte hym so long a tyme of curyng, sithe that he helyd hym by the halfe? Answere he, that it was for that the pacient was stony-herted and suffred wele sharpe thingis, and that he was of gode complexion, and hadde able fleshe to hale, and feyne he other causes pleasable to the pacient for pacientez of syche wordez are proude and delited.'

Arderne's instructions for the guidance of doctors are very sensible, and they help us to form a correct estimate of the manners of the public who were patients. Dr. Poore, after giving an analysis of the surgeon's work, writes: 'It is evident that John of Arderne was a consummate man of the world, and knew all the tricks of his trade. His fees seem to have been enormous, and indeed he is only one out of many examples among our early professional forerunners who made very large professional incomes.'[139]

Mr. Anderson, the biographer of Arderne, remarks that although he called himself 'Chirurgus inter Medicos,' 'there is nothing to show that he possessed a master's degree, or any formal license for the exercise of his calling.' Mr. Anderson adds, however, 'his writings prove that he was a man of clerkly attainments, with a good knowledge of Latin and French, and well read in the available literature of his profession, quoting freely from the works of the mediæval surgeons, the Arabs, and even from the Greeks.'

Mr. Anderson notes that there are no less than twenty-two manuscripts of the works of Arderne in the British Museum, both in the original Latin and in early English translations, 'some repeating or overlapping others in matter.' His book _Da curâ Oculi_ is dated from London in 1377.

It was not until the next century that a surgeon of equal distinction had arisen in England.

There must have been many incompetent practitioners in London in the fourteenth century, an instance of which evil we find in Riley's _Memorials_. John le Spicer of Cornhill in 1354 attended Thomas de Shene, who suffered from a serious wound in the jaw. Certain surgeons sworn before the Mayor found that the 'enormous and horrible hurt on the right side of the jaw of Thomas de Shene' was incurable, but they held that if John le Spicer had been expert in his craft, or had called in counsel and assistance to his aid, the injury might have been cured.[140]

When the charter was granted to the Barbers' Company in the next century it is expressly stated in the preamble (1462) that through 'the ignorance, negligence and stupidity' of various barbers and other practitioners in surgery many of the King's lieges had 'gone the way of all flesh.'

Mr. D'Arcy Power states that 'a Guild of Surgeons, distinct from the Guild of Barbers, existed in London from time immemorial. The guild was always a small body, probably never more than twenty in number, and sometimes dwindling to less than a dozen. It existed and remained unincorporated at a time when many of the other guilds either vanished or were converted into companies. The earliest notice of the Surgeons' Guild occurs in 1369.'[141] This information is obtained from Letter Book G, translated from the Latin by Riley.

'On Monday next, after the Feast of the Purification of the Blessed Virgin Mary [2nd February 1369], Master John Dunheued, Master John Hyndstoke, and Nicholas Kyldesby, surgeons, were admitted in full husting, before Simon de Mordone [Mayor] and the Aldermen, and sworn, as Master Surgeons of the city of London, that they would well and faithfully serve the people, in undertaking their cures, would take reasonably from them, would faithfully follow their calling, and would present to the said Mayor and Aldermen the defaults of others undertaking cures, so often as should be necessary; and that they would be ready, at all times, when they should be warned, to attend the maimed or wounded, and other persons; and would give truthful information to the officers of the city aforesaid, as to such maimed, wounded and others, whether they be in peril of death or not. And also faithfully to do all things touching their calling.'[142]

There is a similar ordinance dated April 1390 in which Master John Hynstok, Master Geoffrey Grace, Master John Brademore, and Master Henry Suttone, surgeons, were admitted and sworn before the Mayor.[143] Mr. Power points out that this ordinance is specially interesting, because the inspecting master surgeons are sworn 'faithfully to follow their calling, and faithful scrutiny to make of others, both men and _women_, undertaking cures, or practising the art of surgery; and to present their defaults, as well in their practice as in their medicine, to the aforesaid Mayor and aldermen, so often as need shall be.'[144]

Mr. Power says: 'The officers thus put under an obligation to perform certain public duties were the masters or aldermen of the Surgeons' Guild, and it is certain that they took so wide a view of their duties as to harass the members of the Barbers' Guild who meddled with surgery. Thus in 1410 certain 'good and honest folk, barbers of the city, appeared by their counsel in the private chamber of the aldermen and sheriffs, and demanded that they should for ever peaceably enjoy their privileges, without scrutiny of any person of other craft or trade than barbers, and this neither in shaving, cupping, bleeding, nor any other thing in any way pertaining to barbery, or to such practice of surgery as is now used, or in future to be used, within the craft of the said barbers.'[145]

In 1417 there is in the city records special reference to the wardens of the faculty or craft of surgeons. Security was given by a surgeon to the Chamberlain of the city to ensure due care of his patients. John Severelle Love, surgeon, undertook to pay £20 sterling to the Chamberlain if he 'should take any man under his care, as to whom risk of maiming, or of his life might ensue, and within four days should not warn the wardens of the craft of surgery thereof.' Half of this sum was to go to the city, and the other half to the faculty of surgeons.[146]

We now arrive at the time when another great surgeon arose. This was Thomas Morestede, surgeon to Henry V. and Henry VI., and probably previously to Henry IV., who, Mr. Power says, made the first serious attempt to convert surgery into a profession. When Henry V. in the spring of 1415 entered on his campaign in France, which ended with the victory at Agincourt on the 25th October, the medical arrangements of the army were very complete. 'The agreement, dated 29th April 1415, is to the effect that Nicholas Colnet was to accompany the King for a year as physician to the forces in Guienne and France. He was to be attended by three archers as a guard, each archer receiving sixpence a day, whilst Colnet drew twelvepence for his own pay. Thomas Morstede, the surgeon, had also three archers assigned to him for protection, and he too received twelve pence a day, in addition to the usual allowance of one hundred marks a quarter--the pay, it is stated, for thirty men-at-arms, with a share of the plunder. Morestede was directed further to take with him twelve of his own craft, each subordinate surgeon to receive the pay of an archer--sixpence a day.... The scale of pay here granted is very liberal. The ordinary day's wage of a labourer at this time was one penny. Each archer and each surgeon was considered to be worth the wages of six day labourers, and the two chiefs double their assistants.... Yet in spite of these attractions the service was a perilous one, even though it only lasted a few months. Morestede engaged William Bredewardyne to act under him, but he had such difficulty in securing the services of the twelve assistants that he prayed the King 'to grant his letters of Privy Seal directed to your Chancellor of England, to cause him to deliver to your suppliant letters of commission under your great seal, by force of which he should have power to press twelve persons of his craft, such as he should choose to accompany him, and to serve your most gracious sovereign lord during your campaign.'[147] Morstede became a rich and influential London citizen, and served as sheriff in 1436. He died in 1450, and was buried in the Church of St. Olave Upwell, Old Jewry, where he had built 'a fair new aisle.'[148]

Dr. Furnivall printed in his edition of Thomas Vicary's _Anatomie of the Bodie of Man_ (Early Text Society, 1888, p. 236), a paper from a manuscript in the British Museum (Royal M.S., 7 F., xiv., art. 24) containing a statement of the pay of navy surgeons in the reign of Henry VIII. _The Henry Grace de Dieu_ carried two surgeons at 23s. 4d. a month; also _The Mary Rose_ and _The Great Gally_, with two surgeons each at the same pay, and nineteen other vessels each with one surgeon at 10s. a month.

To return to the Fellowship of Surgeons, Mr. Power tells us that in 1435 the surgeons, then seventeen in number, became an established body, with a code of laws and regulations which still exist in a small vellum volume now preserved in Barbers' Hall. In 1462 they obtained a charter of incorporation, and in 1492 were given a grant of arms. In 1493 the guild 'was living on friendly terms with the Barbers' Company, for in this year the two guilds entered into a "composition," dated 12th May, and signed by representatives of both bodies. This composition recognised the independence of the two fellowships "of surgeons enfranchised within the city of London," and "of barber-surgeons and surgeon-barbers enfranchised in the said city." It was agreed that neither body should admit any one except a regular apprentice to practise surgery without the consent and knowledge of the other, and to ensure this being carried into effect every stranger seeking a license to practise in London was to be presented to the Mayor by the four wardens of the two guilds.'[149] The end of the Fellowship of Surgeons came in 1540, when it was united by Act of Parliament (32 Henry VIII.) with the Company of Barbers. The granting of the charter on this occasion was the cause of Holbein's famous picture being painted. This picture still decorates the Barbers' Hall in Monkwell Street.

Allusion has already been made to the Barbers' Company--to its first master in 1308, and to its incorporation by royal charter in 1462 by Edward IV. In 1376 the gild elected two masters, and at this time the members were sharply divided between the barbers proper and the barbers exercising the faculty of surgery.

In 1390 four masters were sworn in in one year, but these were really only master and wardens, as stated by Mr. Young in his most valuable and exhaustive account of the Barber Surgeons' Company.[150]

The relative positions of the city companies has frequently changed, thus at one time the Barber Surgeons were entitled to the seventeenth place, but in 1516 they only ranked as the twenty-eighth. In 1537 the Barber Surgeons formed the most numerous company in London, the number of freemen being 185. The next in order of numbers was the Skinners with 151, then the Haberdashers with 120, the Leathersellers with 113, and the Fishmongers with 109. The rest of the companies numbered less than 100, the Bowyers being the lowest with 19.[151] In 1745 the surgeons, who had long chafed under the inconveniences caused by official connection with the barbers, seceded and formed the Surgeons' Company, under the title of 'The Masters, Governors and Commonalty of the Art and Science of Surgery,' which was established by Act of Parliament. The Surgeons found a temporary home at Stationers' Hall until 1751, when the premises known as Surgeons' Hall, in the Old Bailey, were ready for occupation.

The company came to a premature end in 1796, and it was not until 1800 that the Royal College of Surgeons was established.

HOSPITALS

_St. Bartholomew's Hospital._--We are justly proud of the hospitals of the twentieth century, but one of them stands out from the rest on account of its early foundation, and its enormous influence on the growth of professional feeling. In following the incidents in the history of St. Bartholomew's Hospital, we cannot doubt but that this is one of the noblest institutions in London. The hospital was founded by Rahere in 1123, and refounded in 1546. We have little history of the earlier period, but the documents relating to the refoundation evidently echo the sentiments formed during the earlier period.

Dr. Norman Moore in his paper on the Progress of Medicine at St. Bartholomew's Hospital (1888), writes: 'We are in the very middle of the sacred land of medicine, and many of the great events in the history of medicine are connected with the particular region in which our hospital is, or have occurred in our hospital itself.'

Rahere while building the hospital continued his labours by founding the priory, of which all that now remains is the Church of St. Bartholomew the Great. This consists of the choir and transept of the church of the priory, and a part of the site of the close is marked by the present Bartholomew Close. The hospital and the priory were independent but connected. The relations between the two were revised by Richard de Ely, Bishop of London in 1197; by Eustace de Fauconberg, Bishop of London in 1224: and by Simon of Sudbury, Bishop of London in 1373, and the two foundations were finally separated on the dissolution of the priory in 1537.

There is in the British Museum (Cotton MS. Vespasian, Bk. ix.), a Life of Rahere written by one who had known those who knew the founder. The manuscript is a copy of an earlier one written in the reign of Henry II., within fifty years of the foundation of the

hospital. This work, which is of great value, is described by Dr. Norman Moore, and analysed in Mr. Morrant Baker's _Two Foundations of St. Bartholomew's Hospital_, A.D. 1123 _and_ A.D. 1546[152]

Rahere has been described as the King's minstrel or jester, but there is no authority for this. The writer of his life says that he was a frequenter of the palace, and of noblemen's houses, and made himself so agreeable as to be highly esteemed as the leader of tumultuous pleasures. He was, however, converted to a better state of life, but probably, as is the wont of those who write about conversions, the author rather darkens the picture of the courtier's early follies. Rahere determined to go to Rome, and after visiting the shrines of St. Peter and St. Paul, he was taken ill with a grievous sickness. He feared that God was angry with him for his sins, and he vowed that if God would give him health so that he might return to his own country, 'he would make an hospital in recreation of poor men, and to them so there gathered, necessaries minister after his power.'

In the night he saw a vision which filled him with dread. He seemed to be borne up on high by a beast having four feet and two wings, and set down in a high place. From this great height he looked into a deep pit, and he feared to slide down into it. Then appeared to him a certain man of great beauty and majesty, who fastened his eye upon him and said, 'O man, what and how much service shouldest thou give to him, that in so great peril hath brought help to thee?' Rahere answered: 'Whatsoever might be of heart and of might, diligently should I give, in recompense to my deliverer.' So the kingly man spoke again: 'I am Bartholomew, the Apostle of Jesus Christ, that came to succour thee in thine anguish, and to open to thee the secret mysteries of Heaven. Know me truly, by the will and commandment of the Holy Trinity, and the common favour of the celestial Court and Council, to have chosen a place in the suburbs of London, at Smithfield, where in my name thou shalt found a church, and it shall be the house of God.... My part shall be to provide necessaries, direct, build and end this work; and this place to me accept with evident tokens and signs, protect and defend continually it under my wings; and therefore of this work know me the master, and thyself only the minister; use diligently thy service, and I shall show my lordship.'

Rahere when he got back to London made overtures to the citizens for the purpose of obtaining the land he required for building, and the authorities were favourable to his scheme, but they could not settle the matter until Henry I. had been consulted, because the place at Smithfield was within the King's market. When the petitioner applied to the King his plea was acceded to, and he was given authority to execute his purpose.

It is not quite clear where all the money came from for the carrying out so vast an undertaking, but Rahere had a winning way, and from the King downwards he appears to have obtained liberal help. Before he could build he had to drain the land, which was nothing but a marsh, and when he went there the only sign of civilisation about was a gibbet. The hospital, which from the first was a hospital for the sick, and not a mere almshouse, had a master, eight brethren and four sisters.

The first master was Alfun, an old man who had previously built the Church of St. Giles, Cripplegate, and Rahere was the first prior.

Alfun was also styled hospitaler or proctor of the poor, and the writer of the manuscript Life of Rahere tells how it was the custom of Alfun to go about begging for provisions and other necessaries for the poor men that lay in the hospital, he also looked after the welfare of those who were employed in building the church. Rahere had many troubles in his later life, and a large number of envious enemies spoke evil of him and did him injuries. There was a plot against his life, which failed on account of the confession of a penitent conspirator. He had, however, a good friend in the King, who helped him and confirmed his previous grant by a charter which gave full liberty and great privileges to the priory and hospital. When, therefore, Rahere died, after having been prior for twenty-two years and six months, he left his great establishment in a prosperous condition.

Dr. Norman Moore points out that in the Life of Rahere there is an account of the admission of the first patients of which we have any record. This was a man named Adwyne, who came up to London from Dunwich, in Suffolk, in the reign of Henry II. There are many records of people who were supposed to be healed by praying at Rahere's tomb, but this man is described as having been admitted into the hospital, and therefore a genuine patient. He was discharged cured, but although his condition is described no details of his treatment are given. Dr. Moore supposes that by long lying in bed Adwyne's muscles had become anaemic and enfeebled. He was encouraged 'to move his limbs a little, and he found that he was able to move them much more than he expected; he began to make small objects, commencing with cutting and carving, and so at last was able to work again, and to follow the craft of a carpenter.'[153]

John Mirfield, a canon of St. Bartholomew's Priory, wrote a general treatise on medicine, entitled _Breviarium Bartholomei_, about the year 1380, when Richard Sutton was master of the hospital. This book is of considerable interest, both as an early medical treatise written at a time when this form of literature was not general, and for its connection with the hospital. Dr. Moore gives a full description of the contents, and adds: 'The picture is complete of the medical and surgical practice in St. Bartholomew's Hospital in the reign of Richard II.'[154]

London was doubtless well able to supply the hospital with patients, and the dismounted knights in the jousts at Smithfield must have found it convenient to have their wounds attended to at once. It is recorded that when Wat Tyler fell from his horse, half dead from his wounds, he was dragged within the hospital gate, and died in what is now the open space between the church and the outer wall of the great hall. The body was then laid in the master's chamber. Walworth, however, had the body brought out and beheaded, the head being sent to London Bridge to replace that of Archbishop Sudbury.

By a composition, dated 1373, the master of the hospital was ordered to be presented to the Prior of St. Bartholomew's Priory after election, and previous to presentation to the bishop. The last master was John Brereton, who subscribed to the King's supremacy in 1534. The last prior, Robert Fuller, surrendered the priory to the King in 1540.

About the year 1423 the famous Richard Whittington repaired the hospital at his own expense. Little more than a century after this it was refounded by Henry VIII., but with very little pecuniary help from the King.

In 1538 the Mayor, aldermen and commonalty of the City of London petitioned Henry VIII. that they might from thenceforth have the order, rule, disposition and governance of St. Mary's Spital, St. Bartholomew's Spital, and St. Thomas's Spital, and the new Abbey at Tower Hill, with the rents and revenues appertaining to the same, for the only relief of the poor, sick and needy persons. In 1544 the King confirmed by letters patent the grant and establishment of St. Bartholomew's Hospital to the master and chaplains, but in 1546 a deed of covenant between Henry VIII. and the Mayor, commonalty and citizens of London respecting the hospital was sealed, by which they came under the rule of the city. It is stated in the deed that 'his Highness of his bountiful goodness and charitable mind was moved with great pity for and towards the relief, aid, succour and help of the poor, aged, sick, low and impotent people.' Additional letters patent were issued in 1547.[155]

In 1552 was published _The Ordre of the Hospital of S. Bartholomewes in West Smythfielde, in London_, with this text on the title, 'I Epist. John, ij. chap. He that sayeth he walketh in the lyght, and hateth his brother, came never as zeal in the lyght. But he that loveth his brother, he dwelleth in the lyght.'

We have already seen how the later years of Rahere's life were darkened by the attacks of enemies, and a curious revival of similar slanders appears to have occurred when the hospital was refounded, and so virulent were the slanders that it appears to have been thought that a reply from the governing body was needed, and such a reply is found in the Preface to the _Ordre_[156]--this commences as follows: 'The wickednes of reporte at thys Daie, good reader, is growen to such ranckenes, that nothing almost is able to defend it selfe against the venyme thereof, but that, either with open slander or privie whisperyng, it shalbe so undermyned, that it shall neither have the good successe, which otherwyse it myght, ne the thankes whiche for the worthines it ought.'

Henry VIII. being dead the governing body appear to have felt it possible to tell the truth as to the little he had done in endowing the hospital. In fact, both Henry VIII. and Edward VI. have gained credit as founders, when they really did little more than give buildings for public purposes that were of no use to themselves and then leave others to find the money to support them.

The writer of the Preface says that the slanderers ought to repent and praise both the deed and the doers so as to wipe away the slander: 'But forasmuch as it is doubtful whether thei wil do as thei maie, and of conscience are bounden, and the slaundre is so wide spred, that a narowe remedy cannot amend it: It is thought good to the Lord Mayour of thys Citie of London, as chief patrone and governour of this Hospitall, in the name of the Citie, to publishe at this present the officiers and ordres by hym appoincted, and tyme to tyme practysed and used by twelve of the citizeins the moste aunciente in their courses, as at large in the processe shal appiar, partly for the staye and redresse of such slaundre, and partly for that it myght be an open witnesse and knowledge unto all men howe thynges are administered there and by whom. Wherein if any man judge more to be set forth in woorde, than in diede is folowed there be meanes to resolve him.'

The case in abstract is as follows: For the relief of the sore and sick of the City of London Henry VIII. was pleased to erect a hospital in West Smithfield for a hundred sore and diseased. He endowed it with 500 marks a year, on condition that the citizens found another 500 marks. The citizens soon discovered that the King's endowment was far under what at first they had hoped. The 500 marks rent was to come from houses in great decay, and some 'rotten ruinous,' so that to make them again worth the wonted revenue was no small charge, and after paying certain pensions, etc., there only remained towards succouring the hundred poor sufficient for the charge of three or four harlots then lying in childbed. The citizens therefore, to relieve their own poor and others coming daily out of all quarters of the realm, spent above their covenant of 500 marks yearly not much less than £1000, which enabled them to receive the number agreed upon. In spite of this, certain busy bodies more ready to espy occasion to blame others than skilful to redress things blameworthy indeed, rounded into the ears of the preachers their tender consciences. These preachers took upon them to make known these slanders, so that the good citizens for their five years' loathsome work done for Christ's sake received only open detraction and the poor a greater hindrance.

During these five years (1547-1552) 800 sick folk were healed in the hospital and 92 died. The Preface writer ends by saying that if any man spieth aught in the Ordre worthy to be reformed he will find those at the hospital glad and willing to reform it, and the city wish, if by any means it is possible, to raise the number of those receiving the benefits of the hospital from 100 to 1000.

The number of distinct paid officers is given as seven, in this order--(1) The Hospitaller, (2) the Renter Clerk, (3) the Butlers, (4) the Porter, (5) the Matron, (6) the Sisters (twelve), (7) the Beadles (eight). 'There are also as in a kynde by themselves iii. chirurgeons in the wages of the Hospitall, gevyng daily attendaunce upon the cures of the poore.'

The charges in this little book of orders are of great interest, and will well repay careful perusal. The surgeons are charged to the uttermost of their knowledge to help cure the diseases of the poor without favouring those with good friends; they are not to admit the incurables, so as to keep out those who are curable; when they dress any diseased person they are to advise him to sin no more and be thankful unto God; they are to receive no gift from anyone, and never to burden the house with any sick person, for the curing of which person they have received any money. In conclusion, they are to report any wrongdoing to the almoners.

The nurses of the present day would be surprised at the stringency of the instructions in the charge to the sisters. Mr. Morrant Baker specially refers to one command: 'And so muche as in you shall lie, ye shall avoyde and shonne the conversacion and company of all men,' and adds, 'An order which, I have no doubt, was as implicitly obeyed then as any similar command would be now.'

At the end of the charges is 'A daily service for the poore,' and 'A thankesgeving unto Almyghtie God to be said by the poore that are cured in the hospital, at ye time of their delivery from thence, upon their knies in the hall before the hospitaler, and twoo masters of this house, at the least. And this the hospitaler shal charge them to learne without the booke, before they be delivered.'

Thomas Vicary, serjeant surgeon to the King, and the foremost surgeon of his time, was first appointed Governor of St. Bartholomew's on the 29th of September 1548, and in January 1552 he was made governor for life. He was the first medical officer of the hospital. Dr. Norman Moore describes his position as 'intermediate between that of the master of older times and that of the surgeons subsequently appointed. For some years he seems to have had both medical and general charge of the hospital.'[157]

At this time he had long held a distinguished position, although not originally a trained surgeon, and at first in small practice at Maidstone. In 1525 he was junior of the three wardens of the Barber Surgeons' Company. In 1528 he was upper warden and one of the surgeons to Henry VIII. On 29th April 1530 he was granted the office of serjeant surgeon to the King 'as soon as Marcellus de la More shall die, or resign or forfeit his post,' and in the same year he became master of the Barber Surgeons' Company. La More died, or disappeared from England at some time after Easter 1535, when he received his last payment. Vicary received his first quarter's salary as serjeant surgeon on the 20th September 1535, and filled this distinguished office under Henry VIII., Edward VI., Mary and Elizabeth. The serjeant surgeons were originally military surgeons, whose first duty was to attend the King upon the battlefield. John Ranby was the last to perform this duty when he attended George II. at the Battle of Dettingen in 1743.[158]

In 1541 Vicary was appointed first master of the Amalgamated Company of Barbers and Surgeons, and in 1548 he is said to have published for the first time his _Anatomie of Man's Body_. This work was reprinted in 1577 by the four surgeons of St. Bartholomew's of that time--William Clowes, Wil. Beton, Richard Story and Edward Bayly, who dedicated it to the president and governors. The book is one of great interest, but Dr. Payne has lately proved that it is not an original work, but merely a _rechauffé_ of an anatomical treatise of the fourteenth century, from which the greater portion has been transcribed word for word.[159]

The first physician of St. Bartholomew's was Dr. Roderigo Lopus, a Portuguese Jew, who was appointed about 1567.

_St. Thomas's Hospital._--This hospital is almost of as great antiquity as St. Bartholomew's. The original hospital belonged to the canons of the Priory of St. Mary Overy, and was situated on the west side of the road running south from London Bridge. In 1207 the hospital was destroyed in the fire which devastated the borough of Southwark, but a temporary building was erected on the old site (now occupied by the Bridge House Hotel and the London and Westminster Bank). Peter de Rupibus, Bishop of Winchester, projected a new hospital on a more suitable site on the east side of the road, and appealed for funds for this purpose by means of a charter of indulgence, 1228: 'Behold at Southwark an ancient hospital built of old to entertain the poor, has been entirely reduced to cinders and ashes by a lamentable fire; moreover, the place wherein the old hospital has been founded was less appropriate for entertainment and habitation, both by reason of the straitness of the place and by reason of the lack of water and many other conveniences; according to the advice of us, and of wise men, it is transferred and transplanted to another more commodious site, where the air is more pure and calm, and the supply of water more plentiful.'

The new hospital was dedicated to St. Thomas (à Becket) the Martyr, and became independent of St. Mary's Priory. It was frequently referred to as Becket's Spital.

The third building was erected about 1507, and in 1535, a short time before the dissolution of the religious houses, the custos or master, the brethren and the three lay sisters, had the charge of forty beds for poor and infirm people, who were to be supplied with food and firing.