March 20, 2010

A Morning Walk in the Metropolis

London is and always has been a tale of two cities: London and Westminster, the river and the shore, town and country, rich and poor. The contrasts can be remarkable. If Tiger Woods were to stand at the east end of pristine, polished Threadneedle Street where millions are traded every day and hit a golf towards Whitechapel, that ball would fly over at least one boarded-up pub, a handful of derelict buildings, a trendy club, local authority flats, 26 Big Issue sellers and some corner shops where all the biscuits are out of date.

Two hundred years ago, poverty and sickness were an ever-present spectre for many families and particularly the day-labourers, who supported wives and families from one sunrise to the next with the strength of their backs. They skirted the abyss, never more than a few days away from losing their footing. This morning I was flicking through a facsimile of an old miscellany from the British Library. Lots of it is random and undated, but one letter, originally submitted to the Gentleman's Magazine in 1780 really got under my skin. In December of 1780, Mr Lettsom left his front door with the intention of taking a morning walk. He was 'accosted' by a tall, thin man who was 'a picture of distress'. Lettsom enquired as to the man's situation and informed that the man's name was Foy, and that he had recently recovered from a sickness. He sought work, to support his family in Little Greenwich, Aldersgate Street.

Lettsom handed over some money, and Mr Foy burst into tears and went on to try and find work. Lettsom set out on his walk, but was troubled by the idea of the man and his family. His steps turned towards Aldersgate Street and without much trouble, he discovered Foy's 'miserable habitation': 'a little chamber furnished with one bedstead; an old box was the only article that answered the purpose of a chair'. However, it wasn't the furniture that shocked Lettsom, but the occupants: in the bed was a woman suffering from a putrid fever, her lips and gums black. At her feet was a girl of around five years old, naked apart from a poultice bound to the blisters on her back, held on by strings across her chest. Beneath the arm of the mother lay a naked boy of toddling age. On the floor was a girl of about twelve, covering herself with a petticoat, moaning that she would 'die of thirst'. All were fevered, apart from a four year old girl in a 'fragment of petticoat', who stood barefoot near them, providing water. The twelve year old, no doubt relieved to see another adult, begged Lettsom to look at 'her mother's side', where a huge 'mortification', or skin infection spread from her thigh to stomach, 'and nothing to stop its progress had been applied'.

Mr Lettsom 'procured medical assistance immediately' and paid a neighbour to nurse the family. Not long afterwards, he had 'the pleasure the conclude this relation of their unspeakable distress by communicating their total delivery from it'.

This is a tale of London itself, the ever-present gulf and how it is often breached by small acts of kindness rarely remembered. For Lettsom, the incident bore one crucial lesson and one that is a relevant today as it was in 1780:

I..experienced how greatly the sight of real misery exceeds the description of it.

October 30, 2009

Debunking Bedlam

On Wednesday I made a brief mention of the number of private Madhouses* in Hackney, Hoxton and Bethnal Green. I'll do a separate post on those another time, but today I just want to tackle the thorny subject of Bethlem Hospital (in its Georgian incarnation), and the treatment of the insane in Georgian London.

Bethlem Hospital, nicknamed Bedlam from its earliest times, is the oldest hospital in the world to deal specifically with mental disturbance. It has lived in four places since it took in its first mentally ill patients in 1357: in an old priory where Liverpool Street Station is now, Moorfields and Southwark and now Beckenham. I am most concerned with the Moorfields site, the first of three later purpose-built hospitals. Whilst the priory with its individual cells had originally been useful for confining inmates separately, it was over subscribed and in a poor state of repair. The new building, designed by Robert Hooke, was built at the Southern edge of Moorfields. It was a huge, grand building (that would later prove structurally unsound) and included the Caius Gabriel Cibber sculptures of 'Raving and Melancholy Madness' (now in the V&A). These sculptures signified the distinction made at the time between insanity (incurables) and depression (curables). Those born with severe mental deficiency, but largely passive natures were classed as idiots*. Samuel Johnson and Fanny Burney had a conversation about madness (mainly Johnson's fear of it) and how he believed it to come about through disconnected thinking, and how she believed it to be the result of a breakdown when life was very cruel and burdensome. 'Moral insanity' which one hears bandied about so much was a blanket term and it didn't mean 'you are a bad person and it has sent you mad', it means 'you have syphilis, or have lost your mind because of vile experiences as a street prostitute, or through drug abuse, and are therefore insane, and this is an acceptable euphemism'.

Very briefly, the care an afflicted person could expect to receive depended then, as now, on how much money they had. Bedlam was for poor people, which is why large numbers of official documents pertain to it. If you had a relative or spouse who became mentally ill, or was born an idiot (they managed to marry remarkably often if they had a large amount of land or money) you could have them nursed at home. If they became violent, you could have them cared for in an private madhouse. If you had nothing and were likely to end up on the street or in the workhouse, you went to Bedlam. The criminally insane such as Margaret Nicholson, who attempted to stab George IIIrd were also confined there. The engravings of the new hospital show it was built on no mean scale, and looks far more like a sanctuary than a prison. Hooke's plans show a distinct care for space, light and recreational areas for the patients.

From its opening in 1676, tours of the new building could be had for a penny a time. That people came and poked the insane with sticks is unlikely, but they did come to watch the 'ravers', particular favourites being the compulsive masturbators of both sexes. In no way do I condone making a spectacle of mental illness, but if asylums were open for visiting today people would go and gawp, so to condemn the Georgians as cruel is hypocritical considering the number of websites and magazines devoted to the bizarre and unfortunate of every kind. It should also be noted that one cannot take too much notice of Mr Hogarth's paintings and engravings on such subjects. He was a notorious joker (note how the Rake is depicted in the posture and appearance of Cibber's 'Raving Madness') In 1770, the visits were stopped, being considered inhumane.

In 1774 the Madhouses Act was passed in an attempt to improve the lot of those consigned to these institutions. It was largely unsuccessful, but excellent private houses did exist (and terrible ones, to be posted on some time in the near future), and the Monro family of doctors did take action to improve care at Bedlam in over a century of medical attendance there. Although many of their ideas were antiquated, they were concerned with exchanging shackles for straight-jackets, fitting cork or india-rubber flooring to cells, recreational activities, good diet and exercise for those who could take it. It is unclear how many patients were there at a time, but the numbers indicate above two hundred, plus around 80 criminally insane prisoners who were kept separately. Exceptionally violent or criminally insane patients were still kept fettered and in some cases wearing only blanket tunics and if they continued to soil bedding were given only straw to sleep upon. Almost every patient had a carer, but men were sometimes put in charge of female patients and there were accusations of abuse.

It cannot be assumed that everyone in Bedlam was an incoherent lunatic*. There were inmates who were both lucid and persuasive, such as James Tilly Matthews, admitted in 1797, who is believed to be the first fully documented case of paranoid schizophrenia. Tilly Matthews was a Welsh tea merchant who became obsessed with the idea that a gang of espionage 'experts' had set up a magnetic 'Air Loom' at London Wall, and were brainwashing the citizens of London, including major politicians. He spoke of threatening and harming these 'infected' persons. John Haslam, Bethlem's resident apothecary studied Tilly Matthews and made drawings of this loom (in the gallery). As a patient, Tilly Matthews was charming, but he was kept in an institution for the rest of his life.

In 1799, the building began to subside, and it was decided that it should be moved to Southwark. It took until 1815 to happen and the old hospital was demolished. With the turn of the 18th century, care for the mentally ill entered a new phase, much more like the care we see today and attitudes towards the afflicted changed rapidly. Bedlam is perhaps the worst example of early psychiatric care (we will never know the worst abuses in the private madhouses), and it was rapidly outpaced by the new-fangled St Luke's, under the charge of William Battie, which opened opposite it in 1751. However, it has retained its original purpose into the present day, and continues to provide care under very difficult circumstances.

*All these were the accepted terms in the period, although they are now antiquated and in many cases, inappropriate.

Click here to download:

Debunking_Bedlam.zip (1687 KB)

October 15, 2009

The King's Physician, the Theatre Royal and London's first STD clinic-

Time for the 'human interest' story of the week: venereal disease. For the past twenty five years the world has been obsessed with HIV: a nasty disease, and a very clever one that gives you a decade of appearing normal and infecting other people before it kills you with the common cold. Syphilis or 'the pox'* was the big concern in Georgian London. It is a corkscrew-shaped bacteria, preferring a warm, damp environment such as the crotch. There are three stages of symptoms ranging from unthinkable sores in special locations, to white, fungal-type blooms, to the final stage where it corkscrews into your bones and brain, leaving you grossly deformed and insane. The first Britons to contract syphilis were the Crusaders but it became widespread when England's naval capability provided international 'travel'.

By the Elizabethan period syphilis was the new leprosy and by the end of her reign Elizabeth had put into place a system of local relief to help people disabled by the disease. Elizabeth's measures to care for the poor continued throughout the 17thC but as the population became increasingly urban, diseases began to concentrate upon the towns. Syphilis was no different. Of course, the natural reaction was to blame the whore you caught it from, which is a bit like putting your 'hand' in the fire and then blaming her because it's still hot. The law-makers of the time were aware of the women who ended up literally sitting in the streets after becoming so sick they could not support themselves by any means, but it was a thorny subject. Their solution was the 'foul' wards in hospitals, but it was unsatisfactory, both for patients and carers. Traditional remedies were the poisons arsenic and mercury, either applied directly to the affected parts, or administered in a manner of unappealing ways. No matter how unpleasant, these cures did not work, and only the natural remission of the disease between stages lead physicians to declare one third of their patients 'cur'd'.

William Bromfield was a doctor In Holborn. His father was a Doctor of Medicine at Oxford and his maternal grandfather had instructed Isaac Newton in anatomy and been William IIIrd's private physician. In 1744 he was elected Demonstrator of Anatomy at Barber-Surgeon's Hall (a better job than it sounds) and 1755, he became Vice-Surgeon to The Prince of Wales. In 1746, Bromfield began to rustle up a committee to raise money for a hospital concerned only with venereal disease, to be advised by doctors from St George's Hospital (where, co-incidentally, Bromfield had just been elected Surgeon). He was concerned at both the implications of housing the infected with other patients and the moral implications of housing prostitutes and men of 'low moral character' both with each other. Hospital boards had started putting patients of 'low character' in yellow outfits, giving rise to the name 'canaries' for those afflicted with venereal disease, but that was soon recognized as inhuman and stopped.

It is interesting to note that as early as the 17thC, a clear distinction was drawn between prostitutes and 'lewd women'. Historians often lump them together but prostitutes were recognized as a necessary part of society, and of male life. The average age of a first marriage during the 18thC remained fairly steady at around 26. If we take 16 as the beginning of sexual maturity that leaves a decade of abject frustration, or recourse to whores. It is likely all but the shyest or most devout men would've made some arrangement with one, or a few of London's estimated fifty thousand prostitutes.

Bromfield's charitable society was well-patronized, and on the 31st of January 1747, the original London Lock Hospital opened in the fine setting of Grosvenor Place near Hyde Park Corner (it is the building on the bottom left extreme of the map image, just behind what are now the gardens of Buckingham Palace). The engraving in the gallery is a bit hazy, but the large signs on the front read 'London Lock Hospital. Voluntary Contributions.' A Lock Hospital was the old name for a lazar house, thought to come from the French word for rags: loques, and soon there were more opening across London, utilizing old lazar and workhouses. Of course, you had to have a bit of God in your 'cure', so there was a zealot chaplain (Wesleyan Martin Madan), but the care given out was of a high standard, whilst all the time acknowledging that a true cure was not possible. Bromfield was nothing if not resourceful when it came to getting money out of his rich clients for his needy poor: he rehashed at least one old play, The City Match, by Jasper Maine and it was performed at the Theatre Royal in 1755 specifically to raise money for a separate hospital chapel (which gave its name to Chapel Street, SW1). William's brother Thomas was the 'visiting apothecary', charged with dispensing the drugs they did have available. They also established an 'asylum' in Knightsbridge for women who did not want to go back to prostitution.

Many people see Georgian London as a very inhospitable place to be poor or sick, and whilst there is some truth to this, it is necessary to see that the hospital was acutely aware that almost half the prostitutes they helped had been raised in local workhouses, and saw no alternative to their way of life. The London Lock Hospital was pioneering in providing healthcare and help for a hitherto marginalized section of society. The Hospital treated men as well, but it appears with rather less sympathy. Bromfield died in 1792, popular with his clients, but less so with the rest of the medical population, who weren't impressed with his championing of the venereally afflicted. His hospital and asylum eventually moved to the Harrow Road where they had better facilities, but by then it was the Victorian period and a solution to prostitution and its attendant problems had been found: Tasmania.

* The pox usually refers to syphilis, rather than smallpox.

Click here to download:

The_Kings_Physician_the_Theatr.zip (1294 KB)

October 1, 2009

Bart's

The Strype image of Bart's shows its mammoth scale in way that is difficult to grasp in the modern hospital (unless you are completely lost and trying to find pathology). Officially, Barts has had at least four hundred beds for centuries (being founded as a poor-house in 1123 by the minstrel Rahere, entertainer to Henry I), but its main purpose as a hospital was to provide care for out-patients in the City and surrounds. During the 18C, the hospital had its heyday, being the focus of extensive patronage from the Hardwick family amongst others, providing funds for additional building by James Gibbs. Inspired by Wren, Gibbs went on to create such architectural splendours as the Radcliffe Camera in Oxford and St Martin-in-the-Fields Church in Trafalgar Square, but the Great Hall at Bart's is no mean achievement. The boards on the walls contain the names of patrons through the ages. The main entrance to the hospital contains two enormous murals by William Hogarth. Hogarth was outraged by the fact the trustees were going to use foreign artists to decorate the hospital, and so offered to work for nothing. The results are magnificent and reflect the period of Hogarth's career when he embraced paint as his natural medium.

One of the leading figures at Bart's during the 18C, and indeed, in the field of medicine was Percivall Pott, writer of the treatise on the unfortunate chimney-sweeps and their diseased scrotums. He taught, but excelled as a surgeon after his appointment in 1749. On one occasion, visiting a patient in Kent Street, Southwark, he fell from his horse and sustained a serious compound fracture of the lower leg. He entreated no one to move him, and managed to negotiate the purchase of a door from a nearby building site. Having sent for a band of chair-men (sedan chair carriers), he got them to strap their poles to the door and using it as a stretcher they carried him home to his house in Watling Street, by the east end of St Paul's. He declined amputation and instead had the leg splinted, monitoring his own condition carefully. Both leg and Potts survived.

Another famous physician at Bart's was Anthony Agnew, who assembled a vast library, known as the Bibliotheca Askeviana. It was sold after his death in 1775, with the sale lasting from the 13th of February to the 7th of March, by far the biggest literary sale of the century. Askew was a great friend of Hogarth, no doubt going some way to explaining the presence of Hogarth's art in the hospital.

Perhaps the most famous of the all the Bart's surgeons was John Abernethy. Although he was a rather alarming figure in the operating theatre, he was a charismatic speaker and an eccentric character. As the resident surgeon at Bart's, he treated the patients as they came, but was also at liberty to take paid consultations. Many sought his advice, which was delivered bluntly. A lady came to him complaining of low spirits, to which his advice was, 'Buy a skipping-rope'. Another had pain in her arm when she raised her arm above her head, to which he replied, 'What a fool you must be to hold it up then'. When the Duke of Wellington arrived out of hours in Abernethy's parlour, Abernethy enquired as to how he had managed to get into the room. 'By the door,' the Duke said. 'Then I recommend you make your exit by the same way,' Abernethy told him.

Abernethy was surgeon during a tricky time in medical education. In earlier times and up to the Augustan period the Bart's students would leave boxes outside the gate where paupers could leave a body they were too poor to bury. Later, when London was a little more prosperous, it was criminals who provided anatomical subjects. Deaths from execution in which the guilty party was condemned to dissection post mortem were declining, leading to a shortage of bodies for the students to practice upon. Grave-robbing began proliferated in the poorer parts of London. Neither Abernethy or many of his contemporaries were against purchasing corpses, particularly interesting ones (Ireland being particularly well-known for producing both dwarves and giants for some reason). Bart's had no trouble procuring subjects for study during Abernethy's tenure, and his methods would bear further investigation.

Bart's prospered during the Victorian period, becoming respected throughout the world. It is particularly famous for being the venue of the first encounter between Holmes and Watson (see the plaque in the image gallery). It survived the Blitz, although the image in the gallery shows it did sustain some shell damage still visible in the walls as you wander around. In the mid-90s there was an attempt to close Bart's, sparking a massive campaign (including a donation from Tokyo Sherlock Holmes enthusiasts). The A&E department did close, but it is scheduled to become a cancer and cardiac centre by 2010, which is apt. At present, Bart's is something of a building site but it has a remarkable atmosphere: chaotic and friendly, and timeless. People have shuffled about here in various stages of decrepitude for almost a millennium, and for some reason that makes it a very comforting place to be poorly.

Click here to download:

Barts.zip (3187 KB)