Friday, 11 April 2014

Treating Measles in late Seventeenth-Century London and Dublin by Elizabethanne Boran

This month, Elizabethanne Boran, librarian at the Edward Worth Library, Dublin, writes on treating measles in late seventeenth-century London and Dublin, with particular focus on the works of John Pechey (1654-1718), many of which were collected by the Irish physician Edward Worth (1678-1733). 

A keen collector of medical works

Title page of  John Pechey's Collections of Acute Diseases (1691)
‘These Measles began very early, as they use to do, to wit, at the beginning of January, 1670/1 and increasing daily, came to their height at the Vernal Æquinox, i.e. the Tenth of March: afterwards they gradually decreas’d. and were totally extinguish’d the following July’. Thus begins John Pechey’s account of an outbreak of measles in his Collection of Acute Diseases (London, 1691), a book collected by the early eighteenth-century Dublin physician, Edward Worth (1676-1733). Worth was a keen collector of all kinds of medical and scientific works and was particularly interested in infectious diseases. As the Worth Library’s online exhibition on infectious diseases demonstrates, his main areas of concern were plague, smallpox, syphilis, and tuberculosis, not to mention all kinds of fevers, but he was also avidly interested in books on other infectious (and non-infectious) diseases.

John Pechey

Perhaps it was for this reason that Worth was drawn to the works of John Pechey (1654-1718), for he collected no less than seven books by this popular author: Pechey’s Collection of Acute Diseases (London, 1691) had quickly been followed by his Collections of Chronical Diseases (London, 1692). Three years later Pechey’s Storehouse of physical practice was on the market and in the next two years he produced a book a year: Treatise of Women’s Diseases (London, 1696) and Treatise of Children’s Diseases (London, 1697). All of these books were collected by Edward Worth who joined to them a 1700 edition of Pechey’s Promptuarium praxeos medicae (which had been a Latin translation of the Storehouse), and, finally, in 1707, Pechey’s Compleat Herbal of Physical Plants. Though these books didn’t not represent the entire output of Pechey (which includes a host of pamphlets on the virtues of his famous medical concoctions), it is clear that Worth was drawn to Pechey’s understanding of disease, which was, in turn, heavily dependent on the works of the great English physician, Thomas Sydenham (1624-1689), whose works were translated and published by Pechey.

Portrait of Thomas Sydenham

A fractious relationsip with medical authorities

Pechey was the son of William Pechey, a Sussex ‘Practitioner in Physick and Surgery’, whose influence his son publicly acknowledged in the fifth part of his Collection of Acute Diseases. Judging by this dedication, Pechey had a fractious relationship with medical authorities. Initially his education had been unremarkable: he had taken a BA and MA from the University of Oxford in 1675 and 1678 respectively and in late 1684 he had successfully taken the Royal College of Physicians licentiate examination. Three years later he, and a number of other licentiates, set up practice at the Golden Angel and Crown in King’s Street, London and it was there his trouble started. His and his colleagues’ decision to advertise their medical services with the admirable promise that ‘the sick may have advice for nothing’ was met with less than enthusiasm by the medical authorities, who were appalled at Pechey’s approach. Legal battles ensued and it was in this context that Pechey issued the first edition of his Collections of Acute Diseases, which was published in London in 1686. In effect, Pechey had simply translated Thomas Sydenham’s works on smallpox and measles into English, no doubt in an effort to demonstrate how mainstream his medical teaching was. This was by no means plariarism: Pechey undoubtedly had the support of Sydenham in translating his work and he was himself keen to give credit where credit was due. Indeed he informs the reader that he had ‘chiefly collected from Dr Sydenham, because I have found by Experience, that his Methods in Acute Diseases have been most successful in practice. The Chapter of a Peripneumony was taken from Willis. The Chapter of Women’s Diseases, from Riverius and from Mauriceau, The Chapter of an Apoplexy, Lethardy, Coma and Carus; likewise from Riverius.’ It is revealing that works by all these authors were likewise collected by Worth.

The 'English Hippocrates'

The choice of Sydenham was a shrewd one – as the numerous editions of Pechey’s English translation of Sydenham’s complete works testify. But if Pechey hoped to win approval by translating Sydenham’s works his hopes were dashed for Sydenham’s own relationship with the Royal College of Physicians was problematic. It is at first sight surprising that so eminent a physician, one who was regarded as the ‘English Hippocrates’ due to his emphasis on clinical experience, was never made a Fellow of the College. However, it was precisely Sydenham’s advocacy of experience over theoretical medicine that threatened the status of the members of the College. Sydenham might have avoided publishing his most radical attacks on the medical establishment but there was sufficient criticism of them in his famous Methodus to ensure that they were less than attracted to the likely social implications of his health regime.

Bleeding a patient

'These Men blame me for Englishing their Mysteries'

 So Pechey’s advocacy of Sydenham, though it fitted in perfectly with his own medical philosophy, was unlikely to endear him to the Royal College of Physicians who were already incensed by Pechey’s propensity for advertising his medical wares. Not only this, but, as Pechey explains to the reader in Worth’s 1691 edition of the Collection of Acute Diseases, the very method of his popularizing of Sydenham was criticised: ‘These Men blame me for Englishing their Mysteries, though they know that Hippocrates and Galen and Celsus, and many others wrote in their Mother-Tongue.’ That didn’t stop him for, as his preface to his father makes clear, his publications represented not only an opportunity for financial gain but more importantly were part of a crusade to defend the importance of practice and experience over theory, and, at the same time, to democratize medical knowledge by making the works of eminent doctors available in English to non medical readers. In this Pechey seems to have been following his medical hero, Sydenham, for the latter never joined the ranks of fashionable doctors and was more than happy to treat poor patients.


Therefore, much of Pechey’s description and suggestions for treating measles comes directly from Thomas Sydenham. Certainly both men would have concurred that ‘the Patient be kept in his bed onely two or three days after the eruption, that the bloud may gently breath out, according to its own genius, through the pores of the skin, the inflam’d Particles that are easily separable which offend her; and that he have no more cloaths nor fire, than he is wont to have when he is well’. Though Sydenham in general opposed the treatment of bleeding in cases of fever and smallpox, he admitted that in some cases of measles the standard practice of bleeding should be implemented. Edward Worth’s collection of medical books demonstrate that this early eighteenth-century Dublin physician was a keen follower of the Pechey-Sydenham approach to infectious disease.
Elizabethanne Boran is librarian at the Edward Worth Library, Dublin. She may be contacted at elizabethanne "dot" boran "at" hse "dot" ie.