Richard Mead, Thomas Guy, the South Sea Bubble and the founding of Guy's Hospital

Introduction

Several of London's major hospitals were founded in the first half of the 18th century. The Westminster Hospital was built in Petty France in 1719, St George's at Hyde Park Corner in 1732, the Royal London at Moorfields in 1740 and the Middlesex Hospital in Windmill Street, Soho in 1745. Guy's Hospital, founded in 1721, was a product of this voluntary hospital movement, in which charity hospitals, supported by individual contributions, but not by the State, were established in response to a range of scientific, social and humanitarian motives, some of them at a time of austerity following the war against France.

Early 18th-century London

The reign of Queen Anne, the last Stuart monarch, ended in 1714, leaving England in a strong political position, united with Scotland and dominant over France. A grateful nation gave Blenheim Palace, Vanbrugh's masterpiece, to Marlborough in recognition of his victories in Europe and national confidence was echoed in another great Vanbrugh creation, Castle Howard, built at the turn of the century for the 3rd Earl of Carlisle. George I came to the throne in September 1714, a middle-aged German almost unable to speak English. The Jacobite rising of 1715 fizzled out and the Whig government set itself to solve, among other matters, the problem of the country's war debt of almost £50 million.

In 1710 the Tory government had granted a charter to a company trading in the south seas and had arranged for it to take over one-third of the national debt. The South Sea Company's wealth gradually expanded, and in 1720 directors of the company suggested to the government that they might absorb the whole national debt, with the possibility of clearing it in 25 years. Bribery and corruption within Parliament were rife at this time, and it is said that over £1 million was spent on bribes to ministers, MPs and courtiers to secure these arrangements. The Bank of England competed for a share of the action, but was out-bid by the South Sea Company.

Robert Walpole fiercely opposed the scheme, but the South Sea Bill was passed on 2 April 1720, opening the way for furious speculation and, before long, financial ruin for the gullible investors who poured their savings into the enterprise. The South Sea Bubble expanded and expanded and then burst, leaving thousands ruined.¹ There were resignations from government, the Postmaster General took his own life by poisoning, and the directors of the company were arrested. Walpole steadied the ship of state by introducing a scheme guaranteeing much of the South Sea capital by the Bank of England, re-structuring the national debt and emerging as Britain's first Prime Minister.

Early 18th-century medicine

At the start of the 18th century, formal regulation of medicine was over 150 years away and the medical tribes – the surgeons, physicians and apothecaries – went about their business with few rules and even fewer effective cures. Their professional boundaries were re-drawn by the Rose case of 1704, in which an apothecary, William Rose, was initially found guilty, and then acquitted by the House of Lords, for diagnosing and prescribing, as well as dispensing (and charging very high fees). This judgment laid the foundations for the development of the general practitioner because thereafter apothecaries were able to diagnose and prescribe remedies, as well as prepare them.^2,3

Along with St Bartholomew's, St Thomas' Hospital was one of a very few hospitals which had developed from ancient institutions, generally with their origins in religious foundations. The history of St Thomas' can be traced back to the 12th century and, of particular interest in relation to Thomas Guy's profession, the first translation of the Bible into English took place at St Thomas' in 1533. At the beginning of the 18th century, St Thomas' occupied a site on the north side of St Thomas Street, close to the south end of London Bridge. The land on which Mr Guy was to build his hospital lay directly across St Thomas Street and was bounded, in part, by Great Maze Pond, the George Yard and Snowsfields, named after the appearance given to the area by large numbers of animal hides stretched out for bleaching. The site was surrounded by inns, most famously the Tabard, from which Chaucer's pilgrims set out on their travels to Canterbury, and the George, where Shakespeare drank and may well have seen some of his plays performed.

Dr Richard Mead

Dr Richard Mead was one of London's most brilliant physicians at the beginning of the 18th century and was elected to the staff of St Thomas' Hospital in 1703.⁴ His father was a controversial, dissenting cleric. Richard was born on 11 August 1673 in Stepney, in the east end of London. He was educated privately in England and travelled extensively in Europe, where he attended the Dutch universities of Utrecht and Leiden, graduating MD in Padua, Italy in 1695. He came to national attention when he was called to attend the dying Queen Anne in July 1714. The Royal Physician, Dr John Radcliffe, London's leading medical figure, was indisposed with gout and, because he had a high opinion of Mead, suggested that he be called instead. Mead recognized that the Queen was at death's door and urged that this news be communicated urgently to the Court at Hanover. The Queen died quickly, as Mead predicted. The message was delivered expeditiously so that, in accordance with the Act of Settlement of 1701, Prince George, Elector of Brunswick-Luneberg was proclaimed George I of England.

Mead achieved further prominence when called on to provide advice to the Lords Justices in 1719 when England was, once again, threatened with the plague. He clearly had a considerable insight into the mode of transmission of plague and other contagious diseases. He was a strong proponent of the concept of quarantine, which was used both in England and France to limit the spread of the disease. Mead's ‘Short discourse concerning pestilence, contagion and the methods to be used to prevent it’ became a best-seller.⁵

Mead's salary at St Thomas' was £20 a year and he was required to visit poor patients on three days each week. He was an astute clinician who understood the dangers of precipitate abdominal paracentesis and demonstrated that pneumonia was most frequently the cause of death in measles. He took a great interest in the postmortem examinations performed on his patients. In 1714 Mead resigned his consultancy at St Thomas' and moved into Radcliffe's house in Bloomsbury Square. He became a fellow of the Royal College of Physicians, where he was elected President in 1744, but declined to accept the office ( Figure 1).

Figure 1.

Richard Mead, 1740. From a portrait by Allan Ramsay, courtesy of the National Portrait Gallery, London

Mead had a wide circle of friends within and outside medicine, and counted among them Herman Boerhaave, whom he had met in Leiden and was probably the greatest physician of the 18th century, Jonathan Swift, Alexander Pope, Sir Hans Sloane, Sir Isaac Newton, William Cheselden (the St Thomas' surgeon) and, of most importance for the people of south-east London, the philanthropist, Thomas Guy. Mead and Guy both became governors of St Thomas' Hospital and developed a close friendship which was probably the most important factor leading to the foundation of Guy's.

Thomas Guy

Thomas Guy was born in either 1644 or 1645 in Pritchard's Alley, off Fair Street in Horsleydown, a parish close to the site of the present-day Tower Bridge, which has now been absorbed into the parish of Bermondsey.^6,7 His father was a Thames lighterman and collier who became a successful barge-builder before moving to Tamworth in Shropshire, and then returning to London where Thomas was bound as an apprentice to John Clarke, bookseller and bookbinder, in Mercer's Hall porch in Cheapside in the City of London. He must have had a close experience of both the Black Death of 1665 and the Great Fire of London in 1666. Guy set up in business in 1668 in a shop on the corner of Lombard Street and Cornhill where he both sold and published books, principally the Bible and the Book of Common Prayer. The Bibles printed by Oxford University Press were too large and those printed by the King's Printer of too poor quality for widespread use, and an illegal trade in the importation of Bibles printed in Holland had sprung up. Guy's belief that a Bible should be available at a low price to every household in the land, along with the chance to make a great deal of money, led him to become involved in this scheme. In 1678, together with his business partner Peter Parker, Guy secured the appointment of Printer and Bookseller to Oxford University Press, and in 1684 Guy and Parker were formally appointed as University printers by the Vice Chancellor (Dr John Fell) and Delegates of the Oxford University Press. Over the 14 years of Guy's work for the Press, during which time he and Clarke published a variety of other books including the classics, dictionaries and histories, he amassed a considerable fortune and also attained his ambition of providing well-printed copies of the Bible at a cost accessible to the lowliest citizens ( Figure 2).

Figure 2.

Thomas Guy, 1706. From a portrait by John Vanderbank

Guy went on to become a dealer in government securities and in ‘Seamen's tickets’, documents given to royal naval seamen instead of money at a time of national insolvency. It was, however, Guy's investment in the South Sea Company which led to a multiplication of his fortunes because, unlike many of those who were ruined by the collapse of their stocks during the South Sea Bubble crisis, Guy sold at the top of the market and records in his personal ledger between April and June 1720 indicate that he sold a little over £50,000 worth of South Sea stock for over £250,000 (approaching £400 million at today's prices).⁸ At the end of 1720 the unmarried Thomas Guy, aged 76, was extremely wealthy, with a fortune sufficient to build Blenheim Palace or a dozen of Hawksmoor's City churches.

By 1677 Guy had begun his philanthropic career, extending Tamworth Grammar School, funding the building of Almshouses, and providing a new Town Hall for Tamworth, where he had spent his boyhood. Described as the town's ‘Incomparable Benefactor’ he became Member of Parliament for Tamworth, representing his constituency between 1695 and 1710 during a series of parliaments. His relationship with Tamworth ended in acrimony when Guy, who always seems to have been a controversial figure, had a major disagreement with the Town's burgesses, who he regarded as ungrateful for his extensive benefactions.

In 1704 he became a Governor of St Thomas' Hospital, where his first gift was to provide funding for three new hospital wards. In 1708 he provided £100 per annum for the support of the poor in the hospital and had begun discussing, with his friend Dr Richard Mead, how best to assist patients who were discharged from hospital but were unfit for employment and unable to enjoy convalescence before returning to work.

Mr Guy's Hospital

Guy did not keep a diary and few of his letters remain. It seems likely that his ideas for helping the ‘incurables’ who were discharged from St Thomas' Hospital were formed before his friendship with Mead began when they were Governors of St Thomas'. Guy was involved in the ‘passing-out’ system at St Thomas', and would have witnessed the discharge of patients who could no longer be helped medically or who did not have sufficient means to support themselves outside the hospital. Nonetheless, there are many reasons for believing that Mead's advice was instrumental in persuading Guy to found his new hospital across the road from St Thomas'. A painting by CW Cope, which used to hang in the Dining Room of the Treasurer's House at Guy's, shows Guy discussing the plans and costs of the new hospital with Richard Mead and the architect (Figure 3). In his discussion of Mead's Harveian Oration of 1723, Sir Walter Langdon-Brown commented that it was, indeed, Mead who ‘persuaded Guy to use his wealth to found the hospital to which, for more than a century, Mead's own hospital was close neighbour’.⁹ It seems likely that Mead's advice to Guy provided the practical solution to the problems of the indigent poor of which Guy had been aware for some time.

Figure 3.

Dr Mead, Mr Guy and Mr Stear by CW Cope. Reproduced with kind permission of the Guy's and St Thomas' Charity

Guy's last will and testament was clear about the purpose of his endowment, which was to build a hospital able ‘to receive and entertain therein 400 poor persons or upwards, labouring under any distempers or disorders, thought capable of relief by physic or surgery but who, by reason of the small hopes there may be of their cure, or the length of time for which that purpose may be required or thought necessary, are or may be adjudged or called incurable and as such not proper objects to be received into or continued in the present hospital of St Thomas’… My mind is that they receive and entertain lunatics, adjudged or called aforesaid incurable, not exceeding 20 in number at one time.'

Guy had made his decision to establish the hospital in 1721, but died before it was completed, on 27 December 1724, containing 12 wards with 435 beds ( Figure 4). He was buried in considerable style, with a funeral procession of 40 coaches, each drawn by six black horses. There is an interesting controversy about the dates at which the hospital opened and admitted its first patients. The generally-accepted date of the opening of Guy's has always been 1725, but Cameron⁶ points out that the dates given by Wilks and Bettany,⁷ do not take into account the adoption of the reformed Gregorian Calendar in England in 1752. The correct date, according to Cameron, is January 1726, and the bicentenary of Guy's, celebrated in 1925, may have been a year too soon.

Figure 4.

Guy's Hospital for Incurables 1725 by Thomas Bowles

Guy's will was so complex, and the sums of money involved were so enormous, that an Act of Parliament was required to enact it and a governing body of 60 people was appointed to implement his wishes. Although the cost of Guy's Hospital is generally reported to have been in the region of £30,000–40,000, this was only a fraction of Guy's enormous fortune, and under the terms of his bequest, building continued for several years, with the front square, containing his statue, completed in the early 1740s. The chapel was not built until 1774 and a new ‘lunatick house’ was finished in 1797, for the occupation of female lunatics only.

The earliest pupils were accepted in what was to become Guy's Medical School in 1734, when Joseph Warner, one of the first medical students, reported that ‘Each surgeon was permitted to receive four pupils and four dressers at a time, inclusive of apprentices, and that every pupil required to complete a certificate signifying that he had served 5 years “with diligence and sobriety”’.

The arrangements for the care of patients were clear, if cursory: ‘Each surgeon sees the whole number of his patients once a week, when he presents out those who are cured, and gives directions for the rest. Particular bad cases are seen every day if necessary because, by a rotation, one surgeon at least visits the hospital every day. On Saturday the physicians and surgeons all meet and go in pairs to visit all their patients. The hours of business are from 11.00–1.00. There is no house surgeon.’¹⁰

The absence of resident medical staff made the task of the Resident Apothecary a particularly onerous one because ‘The visits of the physicians and surgeons, fine gentlemen in wigs, ruffles, knee britches and coats of many colours, were neither long nor frequent. It is hard to see how their work of treating the patients was conducted or how they kept count of those allotted to their care, scattered as they were indiscriminately in every ward of the hospital. A surgical operation was a rare and spectacular happening, which excited everyone's interest, and no doubt the victim was accorded special care and consideration. But, for the most, the hospital was content to provide a refuge, neither very restful nor very clean, which offered to “poor, sick persons” food, bed and medicine, all of which were likely to be wanting in their poverty-stricken homes in the great city.’⁶

Guy's and St Thomas' worked closely together as the twinned ‘Borough Hospitals’, until, as a result of an acrimonious dispute over the appointment of Sir Astley Cooper's successor as senior surgeon in 1825 they separated, to re-merge as the United Medical and Dental Schools in 1982.

Meanwhile, Richard Mead's medical career continued to flourish. His early publications on poisoning, plague and the influence of the sun and moon on human illness were followed by discourses on scurvy, smallpox, measles and anatomy.¹¹ As well as his high-profile medical practice, Mead was a great collector and patron of the arts, amassing a huge library which included a second-folio Shakespeare that had been owned by Charles I and was reputed to have been read by him the night before his execution. His collection of anatomical texts was matchless, and included the original works of Vesalius, now in the British Museum, and 14th- and 15th-century works of the earliest anatomists. His paintings included works by Rembrandt, Reubens, Titian, Holbein and Canaletto, among many other great masters, including Holbein's portrait of Erasmus which had been presented to Sir Thomas More. He kept all these treasures in his large house in Great Ormond Street.

He died on 17 February 1754, at the age of 81, and is commemorated not only by a large monument in Westminster Abbey but also by Mead Ward, the intensive care unit at the present-day St Thomas' Hospital, which moved from Southwark to Lambeth at the end of the 19th century.

Footnotes

DECLARATIONS —

Competing interests None declared

Funding None

Ethical approval Not applicable

Guarantor RJ

Contributorship RJ is the sole contributor