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.

Bleeding

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.

Cholera in Belfast in 1832 and 1848/49 by Nigel Farrell

On the 28th of February, 1832 at around midnight, Bernard Murtagh, a 34 year old cooper who resided in a lodging house on Quay Lane Belfast, a narrow street near the River Lagan, became violently ill. Described as a man of irregular habits he had been suffering from diarrhoea for two or three days previously but had not complained of any other symptoms when he went to bed following his usual supper of stirabout and milk. Around midnight his condition worsened and towards morning was accompanied with intense cramps and vomiting, the fluid (from both ends) described as whitish and like milk or meal and water. He was seen by Surgeon McBurney the following morning and was found to be in a state of extreme weakness and collapse, extremely cold and without a perceptible pulse at the wrist. A mustard emetic was administered around midday after which he appeared to revive a little. However, this proved only to be a temporary respite and he died between 7 and 8 p.m. that evening some nineteen hours after becoming ill.

High Street Belfast c.1831. A water cart can be seen to the right of the picture

Source: Ulster Museum IC/High St/831

Murtaugh had become the first recognised victim in Ireland to have died from what was then perceived as a new a frightening disease from the East, Asiatic cholera, though in truth it was new only to the West. Cholera, notable for its severity, rapidity and high mortality had been endemic in India in for some time before spreading throughout Asia after 1817 and Europe after 1829. Its signature symptoms, violent vomiting and diarrhoea resembling rice husks were usually accompanied by agonising cramps, muscular spasms, a weakened pulse, low temperature, and a blue tinge to the nails and skin. They were caused by infection with a microorganism, vibrio cholerae, usually following the ingestion of water contaminated by the excreta of another cholera sufferer, particularly in places where infected sewage was able to seep into the public water supply. In the towns and cities of nineteenth century Ireland where sanitary practices and sewage systems were often rudimentary at best this particular method of dissemination was a common and deadly hazard.

In Ireland alone around 40% of those who contracted cholera between 1832 and 33 would die as a consequence and in some areas mortality rates were as high as 76%. In a second outbreak during 1848/49 mortality rates were even higher, with the disease finding easy prey in the form of a population severely weakened by Famine and its associated illnesses. Belfast’s mortality rate at just 16% was however, much more favourable than anywhere else in the country and was significantly lower than Dublin or Cork who experienced rates in excess of 40%.

A Court For King Cholera. This famous cartoon depicts conditions conducive to the spread of cholera.

Source: Wellcome Images

Nineteenth century Belfast was Irelands only industrialised town and outwardly appeared successful and prosperous. Described by one commentator as looking as if it ‘had money in its pocket and roast beef for dinner’. However, while industrialisation had created opportunity, it also created serious social issues particularly in the provision of housing, water supply and sanitation. Housing for the labouring poor was laid out in a grid pattern of confined and insanitary courts, lanes and alleys, commonly consisting of two story buildings occupied by two or more families. Few houses were provided with piped water and over 7,000 houses were supplied from public fountains, by water carts, or from pumps sunk by landlords. Sewers were often constructed to deposit their effluent directly into the town’s main watercourses and high tides and flooding regularly carried effluvia back onto the streets and into the homes of those who lived in their vicinity, making sanitary conditions and their likelihood of contracting serious illnesses inherently worse.

When cholera came however, Belfast appears to have been as well, if not better prepared to combat the disease than most. The initial response was the remit of the Police Commissioners and of an ad hoc and hastily formed Board of Health. Working closely together, a systematic programme of street cleaning and of whitewashing and fumigating houses was instigated. Temporary hospital accommodation was provided in the grounds of the towns Fever Hospital with Dr Henry McCormac placed in charge. McCormac combined a strict isolation policy with treatments which included bloodletting and the administration of calomel (mercury), opiates and dilute sulphuric acid. Though mortality in the hospital was much higher (22%) than for the rest of the town there does appear to have been less resistance in Belfast to the idea of going to hospital than was the case elsewhere. In Dublin for example, opposition was such that carriages carrying the sick to hospital were occasionally set upon, the patients ‘rescued’ and the carriages thrown in the Liffey.

Cholera Localities Belfast 1832

Source: A.G. Malcolm ‘The Sanitary State of Belfast with Suggestions for its Improvement’

http://www.tara.tcd.ie

By the end of the first epidemic over 400 people had died in Belfast and cholera, as did on-going preventative public health provision, passed quickly from public consciousness. Thus, when cholera returned to Ireland in 1848 practically nothing had changed in the way it was fought. However, during this second epidemic, the efforts of Belfast’s new Board of Guardians, the physician and sanitary reformer Dr Andrew Malcolm and additional sanitary powers granted to the new Town Corporation by town improvement legislation arguably prevented a much higher death toll than was experienced elsewhere. The Guardians, for example acted in defiance of the Poor Law Commissioners when they opened the Belfast Workhouse in 1841 with ten beds for the reception of the sick, rapidly increasing this to 100. The Corporation introduced new housing regulations and were granted additional sanitary powers, giving them more authority to require landlords and property owners to remove nuisances and pave streets. However, by 1848 Dr Malcolm reported that there continued to be a ‘lamentable deficiency’ with regard to the removal of offensive remains. As fears of choleras immanent arrival grew the influential Malcolm rose to the fore to guide the municipal authorities. A Sanitary Committee headed by Malcolm and specifically aimed at dealing with cholera in the first instance was formed in 1848. The Committee published and distributed reports, magistrate’s orders were issued for the removal of nuisances, poor families were provided with straw bedding, houses were whitewashed and new sewers were constructed in some parts of the town.

Despite the preparations however, fatalities were almost treble those of 1832. Though Belfast now had two hospitals capable of receiving cholera patients the willingness of the sick to be admitted had declined decidedly. The Committee of the General Hospital attributed the reluctance to ‘prejudices or perhaps the state of apathy and hopelessness which accompanies this severe malady’ and commented that it was a ‘matter of regret, that that the advantages of the hospital were not more generally or duly appreciated by the poor’. By the end of the epidemic 3,538 cases and 1,163 deaths had been recorded but mortality at 33% was again lower than that of other sizable Irish towns. However, in Belfast’s worst affected areas, poverty and deficiencies in sanitation and hygiene had clearly been instrumental in the spread of the disease. And while the town’s municipal authorities had effected much civic enhancement, major sanitary improvements had not been instigated in the areas of the town where they were most required. Nevertheless, some lasting lessons had been learned and when cholera returned again in 1853 and 1866 mortality rates were almost insignificant by comparison.

Nigel Farrell is a third year PhD student based at the University of Ulster Coleraine and is researching cholera and the development of public health in Belfast between 1832 and 1878. The above post is based on his winning entry to the History of Medicine in Ireland Prize competition.