Abstract
Nathaniel Hodges was the son of Thomas Hodges (1605–1672), an influential Anglican preacher and reformer with strong connections in the political life of Carolingian London. Educated at Westminster School, Trinity College Cambridge and Christ Church College, Oxford, Nathaniel established himself as a physician in Walbrook Ward in the City of London. Prominent as one of a handful of medical men who remained in London during the time of the Great Plague of 1665, he wrote the definitive work on the outbreak. His daily precautions against contracting the disease included fortifying himself with Théodore de Mayerne’s antipestilential electuary and the liberal consumption of Sack. Hodges’ approach to the treatment of plague victims was empathetic and based on the traditional Galenic method rather than Paracelsianism although he was pragmatic in the rejection of formulae and simples which he judged from experience to be ineffective. Besieged by financial problems in later life, his practice began to fail in the 1680s and he eventually died in a debtor’s prison.
Background and connections
Nathaniel Hodges was born in Kensington, then an outlying village of London, on 14 September 1629 ‘being Thursday between 7 & 8 of ye clocke in ye Morninge, christened at Richmond ye next Sunday’. 1 His father, Thomas Hodges, was an academic and a committed churchman, educated at Jesus College, Cambridge (BA in 1624, MA in 1627 and DD in 1660). At the time of Nathaniel’s birth, Thomas was Lecturer of St Edmund, King and Martyr in Lombard Street, London. Shortly afterwards the family probably moved to Highgate Chapel in Hornsey, Middlesex where, following the death sometime earlier of Nathaniel’s mother, Thomas the widower married a second time. After several further moves he was eventually appointed, in June 1641, to the long established medieval church of St Mary Abbot, founded in 1262 at Kensington, which living he retained until his death. A growing reputation as a preacher before both the House of Commons and the House of Lords, chaplain to the House of Lords and reformer, he was one of the Westminster Assembly of Divines, a group of 121 clergy and 30 laymen appointed by the Long Parliament of 1643–1649, helping to produce the Westminster Standards that includes the Westminster Confession of Faith.
Further prestigious appointments followed. In 1649, he was Chaplain on 9 March 1649 to royalist officer Henry Rich, 1st Earl of Holland, at his execution for high treason. In 1662, Thomas was installed Dean of Hereford and simultaneously was made Rector of St Peter Cornhill, London. 2 There is a suspicion that the family might have supported a wider range of free thinking than might at first be obvious; owning a collection of perfectionist and mystical literature, it has recently been suggested that Nathaniel, together with a Thomas Hodges (either Nathaniel’s father or possibly his own younger brother), translated the rosicrucian text Themis Aurea, written by Michael Maier (1568–1622).
The family
Nathaniel grew up in a moderately large family, the fourth of six children, five of whom survived their early years. His siblings were Cuthbert (born 1625), Sarah (born 14 May 1627), John (born 17 July 1628), Thomas (born 3 or 4 November 1630) and Rhodia (born October 1632) who died following her christening, a few weeks after she was born.
The godparents of the Hodges clan make interesting reading and clearly indicate the high station and good networking which Thomas Hodges Senior enjoyed. The eldest son was probably named after one of his two godfathers, Sir Cuthbert Hackett (died November 1631). Hackett was a member of the Worshipful Company of Dyers, a trade he received from his very successful father, Thomas Hackett (married in 1540). Elected an Alderman for Portsoken Ward, which lay just outside the city wall near Aldgate in 1616, Hackett quickly rose to the office of Sheriff of London (1616–1617). Established as a successful merchant who transferred to the Worshipful Company of Drapers in 1623, he was a property owner with considerable talent as a politician. Within a year of Cuthbert Hodges’ birth, in 1626 Hackett was elected Lord Mayor of London and was Knighted shortly afterwards, in 1627. Cuthbert Hackett married Joan Woar, daughter of a fellow dyer who, as Lady Hackett, was godmother to Sarah Hodges, Nathaniel’s elder sister. The ill-fated younger sister, Rhodia, who died as a newborn, had Frances Hackett, the wife of Richard Hackett (Cuthbert and Joan’s eldest son) as her godmother. This is a measure of the closeness of the Hodges and Hackett families.
Nathaniel himself counted Sir Abraham Dawes (died c. 1640) as one of his two godfathers. Dawes was a staunch royalist and became one of the wealthiest men in Stuart England, probably mainly by dint of his appointment as a farmer of the customs. In 1604, the government decided to farm out the collection of customs revenue to syndicates of businessmen; each syndicate paid an annual rent to the crown, thus ensuring a steady flow of cash into the royal coffers, in return for keeping the revenues which they collected for themselves. 3 Sir Abraham, who lived in Roehampton/Putney, was acknowledged as one of the most eminent men of his time. 4
Education
Thus, it would seem that Nathaniel’s early life was one with powerful connections but also the subject of much change – the loss of his mother and remarriage by his father, together with several moves associated with his father’s changes of appointment within the church. On the face of it, Nathaniel enjoyed a life of reasonable comfort and privilege in a household that valued academic endeavour and adhered to orthodox protestant religious beliefs. Nathaniel must quickly have shown intellectual promise as he undertook his early education as a King’s Scholar at Westminster School, spending 8 years under the iron hand of Reverend Dr Richard Busby (1606–1695), famous for his extensive and enthusiastic use of corporal punishment; in 1743, the headmaster was satirised by Alexander Pope (1688–1744) – the ghost of Busby comes forward, ‘Dripping with Infant’s blood, and Mother’s tears’ in The Greater Dunciad (IV 142). Nathaniel must have survived the ordeals of a classical education at Westminster as he won a scholarship to Trinity College, Cambridge in 1646. From here he transferred to Oxford, being appointed to a studentship at Christ Church by the parliamentary visitors and gaining BA (1651), MA (1654) and MD (1659). While a student he contributed to a book of poetry issued to celebrate the forging of what was to be an uneasy and short-lived peace with the Dutch at the close of the First Anglo-Dutch War: the Treaty of Westminster was signed on 5 April 1654.
Qualification as a physician took Nathaniel to London where he set up practice at his home in Watling Street in the Ward of Walbrook, situated between Ludgate Hill to the west and Cornhill to the east, adjacent to the modern site of St Paul’s Cathedral. Walbrook is named after the stream passing through the City of London and draining into the Thames at a point just west of the present-day Cannon Hill Railway Bridge. Once in London, on 30 September 1659 Nathaniel became a Candidate of the College of Physicians. He became a Fellow of the College on 2 April 1672, only after an unusually long delay; part of the delay may have been the events that overtook London in the mid-1660s, the Great Plague of 1665 and the Great Fire of 1666.
Arrival of the plague
While Nathaniel was busy establishing, consolidating and building up his medical practice in Walbrook Ward during the early years of the 1660s, events on the continent were building to a crescendo that eventually would threaten England’s peaceful existence in two major ways; the nature of the trade and rivalry with the Dutch was leading inexorably towards war, while plague ravaged its way through Spain, France and Germany until by 1663 it had arrived at the ports dotted along the North and Baltic Seas. 5 Despite King Charles II’s council ordering that all Dutch ships, especially those from plague-ridden Amsterdam, should be detained at Hole Haven near Canvey Island in the mouth of the Thames for 40 days (‘quarantine’) before landing, rather than the usual 30 days (‘triantine’), breaches took place and plague was recorded in Great Yarmouth by the end of 1664. The Bills of Mortality that were to chronicle the progressive devastation of London’s population throughout 1665 recorded occasional early deaths from plague at the close of 1664 and then the rise of the epidemic, particularly in the parish of St Giles-in-the-Fields, in the area of what is now Bloomsbury and Tottenham Court Road. 6
Nathaniel’s first encounter with a plague patient during this epidemic took place during the extreme cold in the ‘Middle of the Christmas Holy-Days’. The young man in question presented a high fever which Hodges treated with unspecified ‘Alixeterial Medicines’ – cure-alls specifically designed to counteract the poisons associated with disease. When, 2 days later, ‘two Risings about the Bigness of a Nutmeg’, black in colour and surrounded by an areole appeared on the boy’s thigh, Hodges diagnosed plague. These marks were called ‘Tokens’ and in his later account of the plague Nathaniel esteemed them ‘sure and speedy Messengers of Death’ although in this particular case his patient recovered! Other symptoms that appeared as the disease progressed included ‘Horror’ (‘involuntary Motions and Twitchings’), ‘grievous Vomitings’ (‘the infected as it were vomit up their Souls’), ‘a great Thirst and Heat’, ‘after Seizure grew delirious, running wildly about the Streets’, suffered from ‘Head-ach, which was so vehement as if the Parts would have flown asunder’, ‘Stupefaction’, ‘Blackness of the Tongue’, ‘Palpitation of the Heart’, sweating ‘as if the whole Constitution was dissolved’, followed by a host of skin lesions including blains, buboes and carbuncles. 7
In the face of the rising epidemic, those who had the means and opportunity fled the capital for the countryside – one commentator calls this exodus a ‘general stampede’. 8 Among the tide of those leaving the city were many members of the clergy, doctors and apothecaries: the very people whose calling involved caring for those left behind. The officers of the College of Physicians left, following hotly in the footsteps of their President. The question arose as to how to stop ‘this cruel Devastation, and save some part of the City at last from the Grave’. The first line of defence was ‘a Monthly fast for Publick Prayers, to deprecate the Anger of Heaven’. Second, the King charged the College of Physicians with writing ‘a general Directory in this Calamitous Exigence’ and to appoint some ‘out of their Number … particularly to attend the infected on all Occasions’. Hodges was one of the chosen, probably by dint of remaining in London of his own volition. They were joined by two further appointees out of the Court of Aldermen and Hodges remarked in grossly understated fashion that ‘this Task was too much for four Persons … for the Disease, like the Hydra’s Heads, was no sooner extinguish’d in one Family, but it broke out in many more with Aggravations’. In all only a handful of trained medical personnel, 9 administrators and apothecaries remained in the capital. Three of these left valuable accounts of the disease; Nathaniel’s contribution, originally published in Latin in 1672, was translated into English by John Quincy (died 1722) and characterised in his Preface as ‘the best Account of the late Visitation’. 10 Indeed, it formed a basic reference text for Daniel Defoe’s (ca 1660–1731) later novel A Journal of the Plague Year (1722). Hodges was also later brought to notice in William Harrison Ainsworth’s (1805–1882) novel Old St Paul’s (serialised in The Sunday Times from January to December 1841); Hodges was invoked to treat the daughter of the grocer (Stephen Bloundel) when she caught the plague.
Treatment and survival
Hodges’ daily routine throughout the year of the ‘Poor’s Plague’ ran like this: after rising early in the morning he took ‘the Quantity of a Nutmeg of the Antipestilential electuary’. This was a formula proposed by Sir Théodore Turquet de Mayerne (1573–1654 or 1655), the Swiss who became physician to James I and his Royal Court, and championed the ideas of Paracelsianism. The electuary comprised the green rind of the walnut, figs and plums macerated in vinegar, Virginia Snakeroot (Aristolochia serpentaria), Contrayerva (rhizome of Dorstenia), Butterbur (Petasites) and White Turmeric (zedoary), sugar, juice from the scale insect Kermes vermilio, syrup of marigold, clove oil and gold leaf.
After attending to family business, Hodges would spend several hours in his surgery where ‘Crowds of Citizens used to be in waiting for me ... all which I endeavoured to dispatch, with all possible care to their various Exigencies’. Having completed his first set of consultations he took breakfast before then embarking on a programme of home visits. As a precaution he ‘burnt some proper Thing’ upon the hot coals when he entered the house of the sick and sucked protective lozenges while he examined his patients. He also took care not to enter the sick rooms if he himself was sweating or out of breath. Arriving home just before Dinner, he drank a glass of Sack – a white fortified wine akin to sherry, imported from Spain or the Canary Islands – ‘to warm the Stomach, refresh the Spirits, and dissipate any beginning Lodgement of the Infection’. He could not praise this drink enough – ‘it deservedly is ranked amongst the principal Antidotes, whether it be drank by it self or impregnated with Wormwood, Angelica etc. for I have never yet met any Thing so agreeable to the Nerves and Spirits in all my Experience’! A careful choice of meats and pickles was accompanied by more wine.
A second surgery was followed by more home visits. At around 9 p.m. he was able to spend time relaxing, ‘drinking to Cheerfulness of my old favourite Liquor, which encouraged Sleep, and an easie Breathing through the Pores all Night’. At any suspicion of a symptom of the disease, Hodges would immediately quaff some more Sack; by the close of the year, although free from plague (he claims to have shown symptoms of plague on two occasions), he must have been in danger of suffering from alcoholism.
Hodges had some caustic remarks for those who peddled fanciful notions about the origins and spread of the plague. Those who espoused ‘Predictions of Astrologers, from the Conjunctions of Stars, and the Appearance of Comets’ and ‘confidently asserted that our Pest was the Issue of those malevolent Influences’ were, to his mind, guilty of breeding a fear among the people that served to ‘propagate and inflame the Contagion, by the strong impressions which it made upon their Minds’, rendering them ‘but an easier Prey to the devouring Enemy’. He concluded that ‘the Mischief was much more in the Predictions of the Star-Gazers than in the Stars themselves’. 11
Hodges searched in vain for the ‘little worms’ described by the Jesuit priest and scholar, Athanasius Kircher (1602–1680), as invading the blood of plague victims in an outbreak of the disease in Rome during 1658. 12 Kircher used an early compound microscope in this, apparently its first application in medicine, and wrote that ‘these worms, propagators of the plague, are so small, so light, so subtle that they elude any grasp of perception and can only be seen under the most powerful microscopes’. Finding their way out of the ‘pores and passages’ of plague victims that were ‘moved by even the faintest breath of air’ and ‘drawn through the breath and through the sweat pores of the body, from which later such fearful symptoms and effects result’. Hodges’ search involved the ‘Help of the best Glasses’. His tongue-in-cheek comment was that ‘perhaps in our cloudy Island, we are not so sharp-sighted as in the serene Air of Italy’!
Hodges believed that the disease ‘first came into this Island by Contagion, and was imported to us from Holland in Packs of Merchandice’, having made its way there ‘from Turkey in Balls of Cotton or Silk; which is a strange Preserver of the pestilential Steams’. Once established here, it arose in different places by ‘a Change or Corruption of the nitrous Spirits in the Air’. These nitrous spirits were exhaled from the bowels of the earth. The logic for this explanation stemmed from observations that ‘corrupt and poysonous vapours from arsenical or other Minerals’ circulated below ground and that plagues often followed hot on the heels of the earthquakes that released these gases. Indeed, he observed that ‘subterraneous Animals, such as Moles, Mice, Serpents, Conies, Foxes, etc. as conscious of approaching Mischief, leave their Burrows, and lie open in the Air; which is also a certain Sign of a Pestilence at Hand’.
In terms of managing the spread of infection, Nathaniel was not short of opinions. The Orders of the Lord Mayor and Aldermen of the City of London, relying on earlier practice, stipulated that in the event of symptoms appearing in any member of a household, the whole house should be sealed for 40 days with watchmen designated to oversee the passing of provisions and maintain the security of the building. The infected houses were marked with a large red cross and the inscription ‘Lord have mercy upon us’. Hodges observed that confining the healthy with the sick in the same household often resulted in the deaths of every member. Neighbours fled, thereby reducing the aid that might have been given to the household, and the nurses who were engaged ostensibly to care for the sick were often guilty of purposefully hastening the spread of the disease and plundering the household goods. In the event of future epidemics, he recommended removing the sick to specially designated apartments situated outside the city.
Nathaniel was scarred by the horror and extent of the disease. He called it the ‘Poor’s Plague’, writing that ‘Death was the sure Midwife to all Children, and Infants passed immediately from the Womb to the Grave’: ‘It was not uncommon to see an Inheritance pass successively to three or four heirs in as many Days’. How to bring relief to those suffering the torments of those deadly symptoms, let alone effect a cure? Hodges was horrified by some of the preparations being touted as cures. He had little respect for the popular antivenins and seemingly magical alexipharmics; oriental bezoar and unicorn horn were quickly discarded from his apothecarial arsenal – eminently practical and pragmatic in his approach, they were tried on patients but rejected once he found them to be ineffectual. He poured scorn on the ‘wicked, wicked Imposters’ and ‘Blowers of the pestilential Flames’ – Quacks ‘of whose Audacity and Ignorance it is impossible to be altogether silent’: ’they were indefatigable in spreading their antidotes; and although equal Strangers to all Learning as well as Physick, they thrust into every Hand some Trash or other under the Disguise of a pompous Title … Their Medicines were more fatal than the Plague’. He was distrustful of antipestilential medicines from abroad, particularly a mineral preparation from France – ‘May it never hereafter be injoined to try Experiments with unknown and foreign Medicines, upon the Lives of even of the meanest Persons!’. Carrying amulets such as walnuts filled with mercury, wax impregnated with arsenic or dried toads (as recommended by Kircher!), all believed to draw out poison by means of an intrinsic magnetic virtue, seemed to Hodges to receive its value only ‘from the Power of Imagination’, rather than from some real property. Similarly, ‘it is strongly to be suspected’ that charms possessed no conceivable medical virtue, their use being promoted only by ‘Jugglers and Persons addicted to infernal Arts’. A ‘professed Enemy’ of smoking tobacco, ‘this American Henbane’, Nathaniel was doubtful about the efficacy ascribed to it in 1646 by Ysbrand van Diemerbroeck (1609–1674), suggesting that ‘the Aptitude of the pestilential Poison’ might be drawn into the lungs that much more easily. 13
The Plague Year saw an attempt by the newly created Society of Chymical Physitians to gain Royal Charter and official recognition for their attempts to rejuvenate prescribing practice on the basis of principles laid down by Paracelsus (1493–1541) and his later disciple, Jan Baptist van Helmont (1580–1644). The group was short-lived but promoted experimentation and iatrochemistry. They published a broadside claiming that ‘Remedies made by Chymical Preparation are of greater Excellence than any other’ and offering them for sale ‘at reasonable Rates, with Directions how to use them in order to Preservation, and in case of Cure’. 14 Neither the College of Physicians nor Hodges was impressed! Nathaniel tarred them with the same brush as the Quacks and referred to them as ‘our pretended Chymists’.
Nathaniel’s approach to treatment was careful and based on approaching the patient as an individual rather than applying universal solutions and dosages. He recommended avoiding the use of bleeding, emetics and purges. He preferred applying medicines which provoked a gentle sweat, and a range of mostly herbal mixtures in the galenical tradition of the day. In spite of his recommendation to avoid antimonial medicines, some of those he commended from the College of Physicians list of approved medicines contained the toxic metal. Others included popular alexipharmic ingredients with a well-established pedigree and history of use, such as Mithridatium and Theriac.
Despite his ‘daily Attendance upon the Infected, to the utmost Hazard of my Life’, Nathaniel Hodges survived the Plague Year and earned the gratitude of the civic authorities, medical fraternity and people of London alike.
The final years
Little is known of Hodges in the post-Plague years although his home and surgery in Watling Street must have been destroyed by the Great Fire of London in 1666. He was appointed a Censor at the Royal College of Physicians in 1682, the year in which he also presented to the College a fire engine and gave the 14th Harveian Oration in 1683.
His Commonplace Book is a large volume consisting of 604 folios numbered in pencil by F Mansfield in 1892. An original numbering system in ink still remains, with up to 1082 sides. The bulk of the volume is divided into titled sections and the pages divided into two columns. Some of the titles have extensive handwritten notes in ink while others lack any entry at all. Most of the notations are medical receipts, some of which are identified either by full title or by original physician author; virtually none relates to cures for the plague. Some correspondence with other physicians is pasted in, as is a handwritten manuscript on the discovery of mineral waters at Shooter’s Hill near Eltham. Folio 67 appears to be a rough numbered index of his book collection, including what might be expected of a medical man (sections on anatomy, surgery, pharmacopoeia, plantae), plus those of an enquiring mind (e.g. epistolae, dictionaries, philology and grammar, philosophy, metaphysics, poetry, theology) together with astrology, ‘controversia’ and manuscripts.
Despite a full and active life of selfless service, Nathaniel’s medical practice began to decline for reasons unknown during the 1680s. ‘Harassed by want of money’ and finding himself frequently in debt, he was awarded two gifts, each of £100, by the Corporation of London.
8
Unfortunately, these were insufficient to mitigate his financial distress and he was committed to a debtor’s gaol. Nathaniel died in Ludgate Prison on 10 January 1688. He was buried at his local parish church, St Stephen’s, Walbrook where he is commemorated by a bust and a plaque, still visible (Figure 1), which provides a fitting testament to a doctor described as one ‘who may be reckoned among the best Observers in any Age of Physick’.
15
Wall-mounted plaque in honour of Nathaniel Hodges in St Stephen’s Church, Walbrook, London.