extract of picture at Foundling Hospital of Dr Richard Mead

Dr Mead and the Plague: a tale with Covid resonance

Dr Mead of Bloomsbury is best known for his work on smallpox and with the Foundling Hospital https://foundlingmuseum.org.uk/about/our-history/.  My aim here is to remember some of Richard Mead’s other important work in relation to epidemic disease.  

High anxiety in 1720

In 1720 many people thought that the new Hanoverian/Whig regime was already on its last legs:  it had illegally used the Royal Navy to support the war aims of foreign Hannover, and managed to sponsor (by the South Sea Bubble) a banking crisis and a financial scandal reaching all the way to the top.   Ready in the wings was the exiled ‘Old Pretender’ (son of James II, the Catholic King deposed in 1688), who was supported both by foreign powers and many at home (Jacobites) in high places. 

Worse still, 1720 brought the threat of a return of the Plague, which in 1665 (still in living memory) had killed one in four Londoners, having previously spread here from Continental Europe.  A fresh outbreak had reached Marseille, which had close shipping connections with London.  People were right to be scared.

Watercolour of 49 Great Ormond Street
49 Great Ormond Street 1882 by J P Emslie CC BY-SA 4.0

Send for Dr Mead

What best to do?   Two very different individuals stepped forward.  Robert Walpole (ruthless and corrupt) became Britain’s first Prime Minister, stabilised the financial system and suppressed the Jacobites; and Dr Richard Mead (who according to his friend Samuel Johnson “lived more in the broad sunshine of life than almost any man”) was asked by the Government to provide an analysis – to be a one-man SAGE.

Mead was a Physician.  In the 18th Century this meant he had received a solid classical education and followed the medicine of antiquity (Hippocrates, Aristotle and Galen).  In 1714 he inherited the practice of Dr Radcliffe in Bloomsbury Square (who gave his name and money to the Infirmary in Oxford).  Later, Dr Mead permanently transferred his practice and home to a fine town house in Great Ormond Street, on the current site of the famous Hospital https://www.gosh.nhs.uk/about-us/our-history/

By 1720 Dr Mead had a successful practice worth over £6,000 a year (by comparison, an ordained clergyman might earn £60 a year) with Isaac Newton, Walpole, Alexander Pope and the future George II among his patients. He was recognised as a cultured collector of great art and notable books, a charitable man, a loyal friend and a frequent and generous host.  He was in the forefront of a movement to build on the medical principles of the ancients by adopting the most modern developments in physics, chemistry and scientific method.  Anyone notable visiting London would pay a visit to Great Ormond Street for fine hospitality, good conversation and to marvel at Mead’s collections.  There was clearly no better man for the task in hand.  

Contagionists and Anti-Contagionists 

Until the middle of the 19th century, the people and their political leaders mostly thought that epidemic diseases were spread by contagion from person to person, and were carried into a locality by an infected stranger or foreigner.  In times of plague, a stranger was an object of fear.  

Elite physicians and scientists like Mead took a divergent view. Almost to a man they said that such contagion could not be a complete explanation of epidemic disease – some of the infected, despite multiple contacts, did not seem to pass on the plague to anyone.  And some towns would suffer and others be bypassed, without apparent rhyme or reason. 

The majority of physicians went still further and were outright anti-contagionists, believing in accordance with the theories of classical antiquity that air contaminated by seed of poison was the sole cause of epidemics.  The seed might arise or be drawn from the earth, or be caused by bad atmospheric conditions or simply local foul smells.  (Contagionists in contrast thought that the infected put poisonous seed into the air).

Contagionists and anti-contagionists had some things in common:  their explanation for why one person might get the plague, while their neighbour breathing the same air would escape, was based on the common idea (also from classical antiquity) that immunity from infection and general good health were the mark of a robust balance of humours within the body.  Those with a weak constitution in the first place, or who had upset their humoral balance by a licentious or immoderate lifestyle, or by experience of strong emotion or squalid living conditions, would be more likely to succumb.  

In 1720 the anti-contagionist case was fortified by the memory of the Great Plague of 1665.  Ruthless measures had been adopted (the quarantining at anchor of incoming ships from suspect foreign ports or with contagion on board; and the forcible isolation of whole households, including the still-healthy.)  They had failed to prevent the importation and spread of the disease.

The Mead Report

This was entitled A Short Discourse Concerning Pestilential Contagion and the Method to be used to Protect it.  It was widely published in 1720, as opposed to being delivered privately to the Government.   

The report came down decisively on the contagionist side.  Dr Mead recommended an improved regime of quarantine, containment and isolation.  The main improvements centred on a programme for the construction of ‘lazarettos’ (an Italian word for a quarantine station) for three different kinds of use – to isolate the infected, to wash, re-clothe and quarantine still healthy people from suspect ports or infected ships or households, and to quarantine and expose to fresh air soft merchandise (eg imported textiles) from infected ships.  Textiles were thought to absorb poisonous seed from the air and then release the same when brushed or unfolded.

Mead also recommended, with a view to strengthening everybody’s humoral balance, that something should be done to clean up noxious public nuisances (overflowing cess pits, filthy streets, rotting carcasses etc) and to rehouse those in the most squalid conditions.  He thought that no expense should spared to prevent “the greatest of calamities”.  Finally, everyone should help themselves by leading clean and moderate lives and by staying indoors.

Public response and resonance with today

We of planet Covid, transported to 1720/21, would find the ensuing public debate very familiar.  Many critics focused on the complexity of Mead’s underlying theory:  he had addressed the inadequacies of contagion, as a complete explanation of epidemic spread, by adopting the idea that the presence of poisonous seed in the air was a necessary but not a sufficient cause – bad local atmosphere (eg humid or fetid) was needed in addition if epidemics were to spread.  Why then spend large amounts of money on the construction and operation of a system of lazarettos and quarantine, and interrupt trade and interfere with the freedom of healthy people, on the basis of an unproven and complex theory?  Merchants and anti-contagionists were largely in agreement that Dr Mead’s recommendations would do more harm than good, and of course pointed to the failure of quarantine and isolation to prevent the Great Plague of 1665.

It is difficult not to feel sympathy with both sides in this argument.  The 18th century quarantine sceptics were right, up to a point.  We know now that plague bacteria (the ‘poisonous seed’ in question) were spread by infected rats and insects closely associated with trade and towns, and were not transmitted between individuals (unlike Covid, insect bites were to blame); and that bad air adds little to the story.   But the path to that knowledge awaited the development of biochemistry and microbiology beginning in the last quarter of the 19th century.  In the circumstances, Dr Mead was near the mark in his view that local and societal conditions, and trade and the mixing of people, all played a part; and that cleanliness and quarantine could help.  Textiles and people carry fleas and lice, and ships carry rats.

At all events, Dr Mead’s recommendations prevailed at the time.  In 1721 Parliament passed a Quarantine Act largely giving effect to them, replete with characteristic 18th century deterrence and retribution.  A ship’s Captain lying about the plague status of his vessel, or anyone breaking quarantine, would be sentenced to death ‘without benefit of clergy’ (ie, with no remission for a first offence).

Luckily there was no need to execute anyone.  Epidemic plague never did reach Britain, or any other place in Western Europe, after the Marseille outbreak of 1720/21.  The French isolated the port and its hinterland, partly by means a 100 km long wall – a cordon sanitaire.  Probably that did the job, at the cost of an unimaginable mortality rate within the cordon of about one in two.

Other consequences

The Marseille outbreak and Dr Mead’s diagnosis and recommendations nevertheless had an immediate consequence:  Daniel Defoe’s idea for his marvellous novel about the Great Plague of 1665 – A Journal of the Plague Year.  It also had an important remote consequence:  it clothed the idea of transmission of disease between individuals, and the potential benefits of isolation and quarantine, in a lasting respectability that was capable of influencing scientists and policy makers until microbiology brought a more thorough enlightenment in the 1870s and 80s. 

Good old Dr Mead, I say.

REFERENCES

Featured Image at top is an extract from the picture Dr Richard Mead, by Allan Ramsay, 1747.  © Coram in the care of the Foundling Museum.

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