James Clark (1788–1870), the son of the butler to the seventh (and last) earl of Findlater, is a good example of upward mobility among the professional classes. Having decided on a medical career, he studied (as would Charles Darwin a few years later, and Conan Doyle after that) in Edinburgh, becoming a member of the Royal College of Surgeons of Edinburgh in 1809.
His first few posts as a newly qualified physician were as a naval doctor: after a year’s training at Haslar Hospital near Portsmouth, he was assigned to various ships (two of which were wrecked) on the North American station, but was put on half-pay at the end of hostilities in 1815. Returning to Edinburgh, he graduated M.D. in 1817, having studied for his dissertation the effect of cold on the living body. (He was much in favour of cold baths.)
His interest in the effect of environment on disease led him to the study of tuberculosis, or ‘consumption’, which was becoming an increasingly frequent cause of illness and death, for which there was no known cure, and for which the main palliative measure (for those who could afford it) was a move to a milder climate, either on the south coast of England, or, ideally, abroad.
Where abroad was the question. In the preface to his Medical Notes on Climate, Diseases, Hospitals, and Medical Schools in France, Italy, and Switzerland (1820) he noted that there had not been adequate research into either the climate or the medical facilities of the places to which British doctors were dispatching their consumptive patients. Having accompanied an invalid across Europe, and made observations on both the weather conditions and the comforts offered to visitors in many towns popular with the British, he first shared his findings with fellow physicians, and then published them so that the public at large should have scientifically based advice.
Clark spent the years 1819–26 in Rome, and had a busy practice among expatriates. Famously, he tended the dying Keats: there appears to be controversy as to whether he actually diagnosed tuberculosis, but he seems to have recognized that, despite his devoted care, nothing could be done to save the poet.
On his return to London, Clark continued to study diseases of the lungs, but he also became attached to the household of Prince Leopold, the widower of Princess Charlotte, accompanying him on summer visits to German spa towns. Probably as a result, in 1835, the year that he published his Treatise on Pulmonary Consumption, he became physician to Leopold’s sister, the duchess of Kent, and to her daughter, Princess Victoria, the heir to the throne.
When Victoria became queen in 1837, Clark was raised to the baronetcy and appointed as the physician-in-ordinary to the royal family. He was a trusted advisor to both the queen and Prince Albert on medical and scientific matters, and took part in many parliamentary and royal commissions on public health. (He introduced Florence Nightingale to the queen, who thus was seen as a sponsor of her health reforms in Britain in the aftermath of the Crimean War.)
Clark also attended Prince Albert on his deathbed. (As with Keats, it has been alleged that he was at fault in not diagnosing the prince’s illness, but neither did Sir William Jenner, an expert in typhoid and typhus diseases.) His last book, written after he had retired, was an appreciative biography of John Conolly, the humane and modernizing superintendent of Hanwell Asylum.
So where, according to Clark, should the British invalid go to improve his or her health? Certainly not to Montpel[l]ier, which for the previous forty-odd years had been ‘the situation almost invariably recommended in cases of consumption … so that its name came to be very commonly applied as a characteristic epithet to places supposed to be particularly healthy.’ (This would presumably explain the large numbers of Montpelier Roads, Streets and even Cottages in watering places such as Tunbridge Wells, Bath and Brighton.) But, as Clark explains, Montpellier was quite unsuitable, ‘and no English Physician thinks of sending such invalids there at present’. He goes on: ‘A stronger instance can scarcely be adduced, of the slow progress of our knowledge in such matters, or of the impropriety of trusting to the information obtained from vague reports of the latitude, &c., …’
Marseilles is another no-no: it’s odd to think that this great seaport, with its sadly terrible reputation, would ever have been thought appropriate for invalids, but in 1820 it was ‘a large handsome city’ of almost 100,000 inhabitants. Its problems were twofold: the patient would not have easy access to the countryside, because of increasing amounts of ‘suburban’ building – villas for the prosperous middle classes; but more crucially, the mistral wind in winter was destructive of health, and indeed the town was notorious for the number of native sufferers from consumption, especially young girls.
Nice (which, by the way, was not in France but was part of the kingdom of Sardinia at this time) is lovely, and protected by its surrounding from the effects of the mistral. However, for some patients, it is actually too warm in winter, its spring climate is problematic because of wide fluctuations in temperature, and – crucially – the invalid is effectively trapped from winter into spring because the land routes though mountain passes are blocked by snow, and escape by sea is inadvisable.
Villa Franca (Villefranche) and Pisa are also found wanting, but as to Rome, ‘I am strongly inclined to think it a preferable situation, for the generality of consumptive patients’. Invalids who went from Rome to Naples in search of greater warmth generally found that haemoptisis (the coughing up of blood) got worse, and was reduced only by returning to Rome. However, the patient must at all cost avoid the ancient and archaeological sites, and the churches (except St Peter’s, which was warm and dry), because they were ‘frequently damp and always cold’. The best residential area was ‘somewhere about the Piazza di Spagna’, where Clark himself lived and Keats of course died. Rome therefore (despite the problem of malaria, which Clark notes) is the best possible place for a winter stay.
However, staying in the warm south in summer is quite a different matter, which Clark emphatically warns against – the night sweats which are a major symptom of tuberculosis are of course made much worse in hot weather. The shores of Lake Como are the only part of Italy where those patients who cannot leave can safely stay, but they are better advised to travel to Switzerland, ideally to Lake Geneva: Lausanne and Geneva itself are the preferred centres.
In the second part of the book, Clark surveys the medical facilities in the cities and towns of Europe through which an English patient might pass. Paris draws his particular attention: he is impressed by the cleanliness of the hospitals, and the work in them of the ‘sisters of charity’ whose nursing skills and dedication had no equivalent in Britain. (The work of the sisters among the French troops in the Crimea was later contrasted with the lack of nursing among the British, thus stimulating Miss Nightingale to her famous task.)
At the Hôpital Necker (founded by Mme de Staël’s mother), Clark was showed the diagnostic instrument invented by a Dr Laennec: he calls it the sthenoscope, and we know it as the stethoscope. This new piece of apparatus was introduced by Clark to Britain as a great advance in thoracic and cardiac diagnosis, though needless to say not all physicians could see the point of it…
In Italy, he was impressed by the medical faculties of the universities of Bologna and Padua, among the most ancient in Europe, but at Turin was horrified – as the sympathetic biographer of Conolly might well be – by the squalor and brutality of the ‘hospital’ in which the insane were confined.
The book was sufficiently successful that in 1829 he produced an extended version (The Influence of Climate in the Prevention and Cure of Chronic Disease, which we have also reissued). The impression given by all his works is of a wise, diligent, thorough, and thoroughly compassionate doctor – and Queen Victoria, to judge from her diary, seems to have seen him in this light too.