A guest post by Discover Medical London. Our view of 17th century medicine can be a rather dim one. Still based principally on the teachings and textual interpretation of Hippocrates, Galen and the ‘greats’ of antiquity, it was an academic discipline that, from a modern perspective, often resembles theology more than anything recognisable as early science.
In attempts to restore the four humours – yellow bile, black bile, blood and phlegm – to their natural balance (imbalance being the cause of all illness), the medics of the 1600s stinted at nothing. The liberal administration of enemas, emetics to induce vomiting, purgatives to ‘flush out the system’, poultices and patches to cause wounds or blisters to weep were the day to day craft of the clinical staff of the times. This is attested to in the many books of practice authored by the senior professionals of the age.
Phlebotomy, now associated by most of us with the collection of blood samples, still had its original meaning then: the process of opening the vein. It was principally a means of treatment not diagnosis.
So, when ‘The Black Death’ made one of its regular reappearances in London in 1665 you might expect an orgy of blood-letting to have begun. Well, perhaps.
As the city was awash with what Nathaniel Hodges (1629–1688) described as ‘Chymists and Quacks’ dispensing, as he puts it, ‘Their Medicines [that] were more fatal than the Plague, and added to the Numbers of the Dead’, we can be far from sure what tortures masquerading as treatments were being offered to the populace as a whole by such ‘practitioners’.
Hodges was one of a relatively small number of official physicians to remain in the city throughout the crisis. In his magnificent work Loimologia or an account of the rise and progress of the late plague (1670), it becomes clear that the attitude of the trained medics seems to have been somewhat more reserved and to have become increasingly so as the epidemic ran its course.
Hodges concludes that on key issues concerning the blood ‘I shall dissent from an Opinion both of Ancients and Moderns’ and is clear in his view that ‘Blood could not be drawn from the infected by Phlebotomy, without Loss of Strength, if not of Life’.
Though the noble doctor later invokes the ‘the Authority of the Ancients’ in desisting from ‘Bleeding in a genuine Pestilence’, the reality is, something of a minor medical revolution was going on here: a transition to the kind of observational practice we are familiar with today.
On the issue of buboes, the large blister-like swellings of the lymph nodes chiefly in the armpits, neck and groin that give the bubonic plague its name, Hodges is unequivocal. Buboes should be made to yield forth their pus by the best means possible and at the most propitious time: ‘the greater Quantities of Pus were obtained by Suppuration of their Buboes, the Patient was so much the better for it’, he puts it plainly.
In fact, an inordinate number of means of bringing out the badness in buboes is described by Hodges and his contemporaries, leading us to safely conclude that it was one of the chief means of care for the infected who were lucky enough to receive any kind of medical attention.
Though ‘blister-plasters’ were the most common first line of treatment, should they and their dizzying array of accompanying ointments and medicines fail, the physician would, reluctantly it appears, resort to surgery: ‘we therefore open them by Incision, or to prevent Mortification, by a potential Cautery’. In essence either the ulcer was cut or burnt open to release the pus and then dressed to prevent infection.
That Hodges, a high-status physician, and therefore concerned with internal medicine and cure by remedy, should be so disinclined to recommend a lowly surgical intervention for opening up the bubo, and only then as a last resort, is unsurprising. Given the high likelihood of death resulting from surgery, and what we know today about the bubonic plague, it was also probably very wise clinical counsel.
Hodges caution should not be seen as evidence that the practice of lancing buboes, and even that of extensive blood-letting, was not widespread in plague ravaged London. As the estimable doctor himself remarks, there were others abroad who specialised in this kind of work.
I cannot altogether omit the Mention of those skilful and faithful Surgeons, with due Honour, whose Task in this raging Calamity was very hard and dangerous, how they had the Care of all pestilential Tumours and Ulcers, &c.
Surgeons it seems were not so averse to wielding the knife, it was after all the instrument of their trade.
Nathaniel Hodges completed Loimologia in 1671, and upon its publication the following year was elected a fellow of the Royal College of Physicians. The work was translated from Latin to English in 1720 and served as an inspiration for Daniel Defoe’s famous A journal of the plague year in 1722. It is Defoe’s work as much as the calamity of the event itself that is seen by many as establishing the plague of 1665 as the defining medical catastrophe amongst the many of the 17th century.
As to Hodges himself? Before we become too carried away by his scientific method, he accounted for his remarkable survival from the ravages of the plague year to his copious consumption of that fortified and sweetened Spanish wine, sack!
BUT before I proceed further, Gratitude obliges me to do Justice to the Vertues of Sack, as it deservedly is ranked amongst the principal Antidotes, whether it be drank by it self, or impregnated with Wormwood, Angelica, &c. for I have never yet met with any Thing so agreeable to the Nerves and Spirits in all my Experience.
©Discover Medical London 2015
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