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Richard Quiller Couch.An Outstanding

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Richard Quiller Couch.An Outstanding HISTORY OF GENERAL PRACTICE Richard Quiller Couch .an outstanding nineteenth century general practitioner D. U. BLOOR, MRCCP, DCH General Practitioner, Stourbridge; Course Organizer, Dudley SUMMARY. The boom in metal mining in the he must think of the community which served them and mid-nineteenth century produced a fearful the availability of medical services. mortality among miners. The history of this The period 1850 to 1870 was one of boom for metal problem is described by the life and work of Mr mining before the rapid decline in the 1870s. Cornwall R. Quiller Couch, a Cornish mine surgeon and and Wales are worthy of study because the structural general practitioner. He was a remarkable man remains have not been so extensively obliterated in these and an outstanding general practitioner. areas as they have in our cities, and the areas were well circumscribed with closely knit communities. There is also much information about mining activities in these areas. Submerged in this unlikely information there are many medical facts, views, and personalities. I am Introduction describing one personality, but to understand his population of Britain doubled between 1815 achievements it is necessary to know the historical back¬ THEand 1871. There was an increase of five million ground. between 1851 and 1871; the birth rate rose from 33-9 to Metal and mine 35-3 per 1,000 and the death rates were 22-7 and 22-4 mining surgeons (Thomson, 1975). Exports and imports trebled. There The metal mines consisted of several shafts and a series were better wages, improved working conditions, and of tunnels called 'adits' which were used for drainage regulation of working hours. Public health measures and access (Bick, 1974). The miners would descend or were being enacted under the driving influence of Snow ascend in one shaft by a series of ladders while the ore and Chadwick (Flinn, 1968), a rudimentary social would be hauled to the surface in another shaft by a welfare service was initiated with the passing of the bucket called a 'kibble'. They worked by candlelight. Poor Law Act of 1834, and an educational service had Gunpowder was used to blast the rock and the ore was started. The grievous abuses of women and children had carted to the shaft bottom by barrow. Ventilation was been alleviated. Living and working conditions were virtually nonexistent and conditions were often made still bad but Britain was booming and had become the worse by the intense heat in the deeper parts of the workshop of the world. tunnel. Foremost in the boom was the mining industry. Coal The power source for all these activities was, even in was required in ever-increasing quantities to produce 1864, the water wheel, which was fed by channels called iron and steel and to feed the trains and ships. But 'leats' from a higher reservoir. There were sometimes metals of all kinds were required, so there was a great several such wheels to cope with drawing the ore, proliferation of copper, lead, tin, silver, and gold pumping out water and working the crushing machinery mines. All this required an ever-increasing transport on the 'dressing' floors. This surface work was system of railways and canals. The population, there¬ invariably done by women and children often in the fore, became more mobile and was massing in "the open exposed to all weathers. were also Midlands, Mersey, and Tyneside. They The proprietors of the mines were called 'mine moving to more desolate places and so we see today the adventurers' and this was apt, for the whole business on the coast of remains of various complexes Cornwall, was risky. They appointed the doctors as mine surgeons the mountain tops of Wales, the moors of Derbyshire, (Parliamentary Papers, 1864) and there was often keen and the Lake District. When a doctor sees these remains competition for the job. It was not unknown for a doctor to shares in a mine to increase his chances of © Journal ofthe Royal College ofGeneral Practitioners, 1978, 28, buy 97-101. appointment. Journal ofthe Royal College ofGeneral Practitioners, February 1978 97 History ofGeneral Practice Occasionally the miners themselves would appoint always an extra at about half a guinea. At some mines their own surgeon. This happened to Mr Richard the 'poundage' system operated at a rate of 4d in the Burford Searle (Medical Directory, 1922) of St Just, pound per month. The doctor was not always obliged to who qualified in 1853 at the age of 21. He had been an see the family; some clubs only required him to hand assistant to a mine surgeon and when he came to leave out medicine. the district the miners went on strike until he agreed to The doctor was invariably appointed to look after the work for them. The same medical family would some¬ miner and his family. The miners' children caused the times look after generations of miners. Evan Davies doctors a lot of anxiety. "Fifty-five deaths in every (Cule, 1973) was one of the first mine surgeons in the hundred in a mining parish are found to be under the Rhondda Valley when mining began in earnest in 1832. age of five years. A large proportion die from debility He was the first in line of a remarkable medical family. within the first year of their existence; and no one who In mid Wales in the 1860s Mr Rowland Rowland has not seen these miserable specimens of humanity can (Power, 1930) and his son looked after the large number have the slightest idea of their diseased appearance; of mines south of the river Rheidol (the Lisburne small, thin, and/shrivelled, with scarcely strength to cry, mines), while his brother Evan Rowland looked after it seems sometifnes almost a crime to attempt to prolong those north of the river (the Goginan mines). their existence" (Couch, 1859). The common diseases The surgeons were responsible for geographical areas were malnutrition, marasmus, scarlet fever, croup rather than individual mines and their work could cover (diphtheria), and typhoid fever. some 30 mines and 2,000 miners. They often employed an unqualified assistant who lived close to the mine, Medical conditions while they themselves lived quite a distance away. Quite The two main problems which the miners presented often other posts were also held, such as union doctor were accidents and respiratory disease. Their occurrence or surgeon to the railways. was so alarming in the early 1860s that a royal commission was set up under the chairmanship of Lord Miners' homes Kinnaird to look at all aspects of mining and particu¬ The- doctor's work involved calling at the mines and larly miners' health (Parliamentary Papers, 1864). visiting the miner's home. Sometimes the mine owners built the homes. The London Lead Company built a The Parliamentary Commission on Mining 1864 new village centre at Nent Head in 1820 for the mine workers at Alston Moor (Raistrick, 1973). It was built in The Commission travelled around the country and held blocks of two and four, but the overmen, doctor, and sessions at each centre of the mine fields. They schoolmaster were placed in semi-detached houses. interviewed the proprietors, the managers of mines The miners would often build their own homes and (called the captains), miners, and the mine surgeons. lease the ground from the owners. "If they are not in Two or three surgeons were interviewed at each session swampy situations, they are as exposed as possible, their and all the questions and answers were recorded. only protection being the undulations of the ground. The Commission explored all the factors that might Many of them have only one floor and only two rooms, have had some influence on the miners' health. Diet, the bedroom and the kitchen. The kitchens have only housing, changing facilities, drinking habits, and earth floors, the doors so dilapidated or so badly made working conditions were all considered. They asked the as to admit every wind that blows, and the rooms are surgeons virtually the same questions. consequently cold and comfortless" (Couch, 1857). There was agreement that miners showed premature These conditions were often made worse by the ageing and died early; their diet, on the whole, was presence of lodgers. The houses built for the Van Mine better than the agricultural worker, and their housing in the 1860s were built on land owned by the Marquis of was universally bad and insanitary. They suffered all Londonderry and one of the conditions of the lease was kinds of accidents and the most devastating were those that lodgers should be taken (Morrison, 1971). due to 'tampering', whereby a bore hole was filled with gunpowder, and a premature explosion resulted in the Financial arrangements loss of hands or eyesight or both. Everyone agreed that the real cause of concern was the incidence of chest The miners were paid on average £3 per month and their diseases and that this Ied to the premature ageing and wages were sometimes a week or two late. There were early death. A large number of surgeons identified the many deductions to be made. Tallow candles and miners' chest affliction, called miners' consumption, as gunpowder were always charged for and the price was peculiar to miners and unrelated to tuberculosis. Others inflated by the adventurers (Hamilton Jenkin, 1972). thought that they were the same or that miners' The adventurers collected 6d a month for the miners' consumption Ied to phthisis. club and this was supposed to be for "visible hurt and sickness". The doctors' club deduction was also about Miners' consumption 6d a month and collected by the owners.
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