Georgian London - Filed under 'Sick London'

February 12, 2010

Burking and Body-Snatching: The Deadly Side of Medicine in Georgian London

Some time ago I noted in a blog post about Bart's Hospital that the hospital's methods of obtaining bodies for anatomical study would bear further scrutiny, ideally as a PhD thesis (not by me, I hasten to add). Last weekend, an article appeared in the Guardian regarding Don Shelton's latest paper in the Journal of the Royal Society of Medicine, where he posits that surgeons William Hunter and William Smellie had women at their full-term of pregnancy murdered or 'burked' to provide bodies to further their obstetric studies. He's right in that the numbers don't add up, and that it is rare for a woman to die at full-term but without having begun labour, which seems to be their favoured choice of subject. However, whilst he has made a valuable study and some very salient points, I stall at his inference of murder. If you care what I think (and why should you?), this is why I don't agree.

There is no argument that both Smellie and Hunter were unscrupulous when it came to acquiring subjects for study, or for Hunter's medical 'museum' of freakery. Hunter in particular behaved appallingly over the corpses of various subjects he had his eye on, bribing family and friends to bring the body to him after the final illness, whatever the wishes of the person in question. Most famously, he paid the friends of Irish giant Charles Byrne five hundred pounds to supply him with Byrne's body, despite the fact that Byrne hated Hunter and specifically requested that he be buried at sea to avoid the anatomist's knife <this is an error on my part - it was actually John Hunter, William's younger brother who did this>. Being utterly ruthless and sanctioning murder are not the same. At one point, Hunter noted against Smellie's study of twins in utero that Dr MacKenzie, Smellie's assistant had procured and dissected the body without Smellie's knowledge 'was the cause of a separation between them, as the leading steps to such discovery could not be kept secret'. This indicated that the woman had been obtained by methods not sanctioned by Smellie and that he did not want to be associated with such methods. Hunter and Smellie were rivals medically, and both were aware that the whole business of procuring subjects would not bear scrutiny in polite society, but it doesn't mean they were turning a blind eye to the possible murdering of pregnant women.

Shelton examines the mechanisms of burial and arrives, quite rightly, at the conclusion that most 'resurrected' bodies were obtained from the poorhouses, either pre or post burial. He also asserts that people in a paupers' cemetery were placed in large pits and left uncovered until the pit was full. Nowhere in any of my studies have I found this to be true. Yes, destitute people were placed in communal graves in burial grounds throughout the city, but they were placed there with a bit of dignity and covered over with earth, even if others were later to be added to the grave. They were also prayed over by the incumbent. The pragmatism displayed by Georgian Londoners in the face of death and illness is not the same as being callous or unfeeling.

The rarity of death in women at full-term is a fact that cannot be argued with. However, in this we are largely influenced by modern statistics and the success of modern obstetric medicine, but pre-eclampsia is a dangerous condition still common now, affecting up to ten percent of pregnancies. Characterized by very high blood pressure, pain in the chest, damage to vital organs through raised blood protein levels, seizures and possible cerebral haemmorhages, there was no effective treatment for this condition in the 18thC. Sufferers describe the attendant pains of pre-eclampsia as unbearable, and medicate accordingly which may have resulted in overdose. If untreated, pre-eclampsia can prove fatal to both mother and child, and in Georgian London, would have meant many more mothers died when heavily pregnant, but without loss or damage to the body that would prevent an anatomist making a detailed study of the gravid uterus.

My last point is upon Shelton's light treatment of the 'resurrectionists'. Obtaining corpses for anatomical study wasn't an obvious career choice, granted. It would require a strong stomach, both morally and literally and a network of connections with like-minded individuals. Nevertheless, it was a job, perhaps coupled with another part-time occupation, but one taken seriously by those who engaged in it. They would know the poorhouses and those who supervised, they'd watch to see who came and went. Scoliotic, palsied, deformed or otherwise 'freakish' subjects were all required, as well as pregnant women. No doubt palms were heavily greased for word of a death. I don't believe for a moment that resurrectionists simply disinterred corpses 'randomly'. Most were probably never even buried. Vultures may be abhorrent creatures, but they let nature do the killing.

From the study of Smellie and Hunter's extant works, it appears they obtained 32 full term corpses in 13 years. I believe this number of women were available through natural death, but their bodies were obtained through fairly creepy and suspect supply chains, rather than murder. The woman pregnant with twins was clearly too much for MacKenzie to resist, and I am sure there were indeed murders associated with the study of anatomy, but I disagree with the condemnation of Smellie and Hunter as serial-killers and the sensationalism is both unpleasant and inaccurate. The inference that the men also worked on women rendered unconscious but still alive has no basis in fact whatsoever.<to further clarify this point: women were not 'anatomized' whilst still alive, although there are cases where C-sections were undertaken with little hope of the mother's survival. This does not make the operating doctor a monster.> Smellie and Hunter were at the top of the medical tree, doing valuable work. Associated with them were a large number of 'worker bees', from the artist Jan van Rymsdyk, who produced the astonishing images in the gallery to the poorhouse supervisor who shuffled the bodies out of the back door, to the grave-digger who after dark disinterred a body he had only just covered over. For my money, Rymsdyk is the scary one: he sat with these bodies for hours, studying them in minute detail and there is an adoring beauty to his renderings of these unfortunate women and their children: the sitting posture of the gravid woman, with her knees covered by a blanket, but her internal organs displayed by the neat flaying of the anatomist, and the baby curled snugly inside her, a stray wisp of its hair escaping the womb. There is a liveliness and humanity to the drawings that eludes the photographer's lens in post-mortem photography.

It is too easy to look back at history and attribute cruelty and inhumanity to people who lived in a time when death was a closer companion than it is now. As I hope this blog has shown, the 18thC is an interesting enough place to spend time even without sensationalism.

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November 3, 2009

John Keats: Apothecary, Surgeon's Pupil, Poet-

The airwaves are abuzz with Bright Star, Jane Campion's biopic of John Keats (1795-1821). Of all the Romantic poets he is the 'real' Londoner and as such I find his life interesting; more interesting than his poetry anyway.

John Keats' short and painful life began at the Hoop and Swan by Moorgate where he was the eldest of three boys and a girl. His father Thomas was a barman who came to manage or even own the pub (now Keats and the Globe for some reason, being nowhere near The Globe). When Keats was seven he was sent to a school in Enfield, North London. Nine months after he started at the school, John's father came to visit him and on the way home was thrown from his horse. Thomas Keats's skull was fractured and he died. John's mother, Frances, remarried almost instantly but it wasn't a success and she was forced to move in with her mother in north London. She died in March 1810, leaving her fourteen year old son in the charge of Thomas Hammond, an apothecary. He shared Hammond's lodgings, giving him a sense of continuity and an interest in medicine that would lead John to become a student at Guy's Hospital when he was 18. He would study there for 5 years, as a dresser (attending in theatre and dressing the patients' wounds after surgery). In 1816 Keats took his apothecary exams, and passed. He was an avid letter writer (although his handwriting was often more 'doctor' than 'poet'), rapidly developing a friendship with Leigh Hunt, Ben Haydon and others. He frequently left off 'spouting Shakespeare' to go and attend a surgery. In that year, Hunt helped him achieve publication with his first poem, and the following year, a collection of his poems were put before the public, to little success.

During a Scottish summer holiday in 1818 with his friend Charles Brown, Keats developed a cold so severe he could not continue and for the first time began to drop weight. When he came home, it was to the reality of his brother Tom's full-blown tuberculosis. Keats nursed Tom, but was probably succumbing to the early stages of TB himself. Their other brother George had left for America (although he would later return to borrow money from John, who was broke anyway and complained that 'He ought not to have asked,'). Tom died late in 1818 and by that time Keats had started his own slow decline. He had also started to take laudanum, claiming it eased the tightness in his chest, but it soon became a habit, and one he and Brown fell out over more than once. The two friends moved to Hampstead, where he met the elusive Miss Fanny Brawne, who would inspire so much of his work. Keats knew himself to be extreme in nature, and it is almost amusing he chose someone so practical and down-to-earth as Fanny to fall in love with. She was an incorrigible flirt and not just with John, which tore him up. He wrote her cruel and often spiteful notes, then others full of contrition. She seems to have taken them all in her stride and they developed a close relationship which would lead to an engagement. The convention of the day insisted John raise enough money to provide her with at least somewhere to live before they married, but he wished to devote himself to poetry, and so had to make some money out of writing. These hopes were almost dashed in 1819 with the publication of Endymion. It was savaged by the critics and Keats was heartbroken. Byron sniped at Keats as a 'Cockney' and a 'dirty little blackguard', but he was genuinely sorry for his fellow poet's mauling at the hands of the critics.

'Tis strange the mind, that very fiery particle,

Should let itself be snuffed out by an Article.

Keats' odd appearance was perhaps one of the factors that drove his unbalanced character. He was of short stature, perhaps no more than five feet tall, and delicately built. He was painfully aware of a mismatch between his mind and his body. He perceived himself as unattractive to women and regarded them with suspicion, perhaps always imagining them to be laughing behind their hands at him. Severn's appalling duck-faced, fuzzy-headed portrait remains one of the most popular images of John. Much better are the various sketches featured in the gallery, by various artists. His life mask shows a fine sensitive face with remarkable eyelashes and a beautiful, if slightly top-heavy mouth (emphasised in the silhouette). The touching image of him asleep as he was dying, also by Severn, conveys both the heartbreak of a friend, and the character of the patient.

Joseph Severn was to become Keats' greatest friend, and also his nursemaid, but through an odd series of events. Towards the end of winter in 1820, Keats returned from the City to Brown's house, thoroughly chilled. He was sent to bed by Brown, who brought him up a glass of spirits. Keats coughed once, but blood hit the sheet. He ordered Brown to bring him the candle in order to see the colour of the blood. His surgical training allowed him to recognize it as arterial blood, meaning his lungs were compromised. 'That drop of blood is my death warrant,' he told his friend. Later that night, he had his first serious lung haemorrhage, his mouth filling with blood. Brown later remembered the calm with which Keats wiped his chin and remarked, 'This is unfortunate.'

This period was one of his most productive, and with Leigh Hunt's support he began to think that it may be possible to support himself, and a wife through writing. John had run through three doctors, who seemed to have no idea what to do with him. He was bled, starved, fattened and opiated. He fretted for Fanny's company and began to suffer palpitations. Finally, the doctors recommended a warm climate. Joseph Severn, a promising young artist with an award for travel from the Royal Academy was singled out as a good friend for John, and he became a regular visitor, along with Coleridge. John was living with the Hunts, but found the noise and the children distressing. An odd incident drove all matters to a head: a letter from Fanny was opened by mistake. Keats had a tantrum then began to cry, walking the streets in a distracted state. He passed the house where his brother had died, then made his way to the Brawne house, where he collapsed. Mrs Brawne took him in and she and her daughter nursed John for a month. His lungs became more congested and he began to produce blood on a regular basis. Rome was settled upon as the place for him to convalesce, and Jospeh Severn as the companion. Fanny gave John paper that he might write to her and a large marble she used to cool her fingers when sewing. It would rarely leave his reach for the rest of his life.

John and Joseph Severn left England on the 17th of September 1820. As the distance from Fanny grew, John's spirits sank. Severn did not know how to help him, but listened when the poet talked. They employed an English doctor, who encouraged a robust diet and walking. When Keats continued to decline, the doctor confirmed what John already knew: that he was dying. Keats became set upon suicide by laudanum, determined not to suffer the loss of dignity his brother Tom had undergone. Severn confiscated Keats' supply of the drug and John punished him with descriptions of the incontinence, vomiting and raving that was to come. Severn was a stoic and ignored his friend, nursing him as his health plummeted early in 1821. Their friendship was a rare one. Keats became frightened of the dark, so Severn rigged up a system whereby one faltering candle would light the wick of the next, an invention Keats named 'the fairy lamplighter'. The sketch at the head of the gallery was drawn on 28th of January 1821 in the light of one of those candles.

Keats became resigned to his fate and encouraged Severn in his nursing: 'Now you must be firm for it will not last long.' A letter arrived from Fanny, but he would not open it, only asking for it to be placed in his coffin with his lock of her hair. On the 23rd of February, his lungs began 'to boil'. He asked Severn to lift him up and hold him, resolving to die easily, and soon. So he and Severn sat, hand in hand for the next seven hours, until John Keats died. The Police visited the house the following day (as was the law in Italy for consumptive deaths) and ordered all destroyed. Severn saved some things for himself, but Keats was buried in the Protestant cemetery as they had agreed. Severn wrote to Brown to tell him the news:

I am broken down from four nights' watching, and no sleep since, and my poor Keats gone. Three days since, the body was opened; the lungs were completely gone. The Doctors could not conceive by what means he had lived these two months. I followed his poor body to the grave on Monday...

The news took a month to reach London, where it was published in The Times on March 23rd, 1821.

At Rome on the 23rd of Feb., of a decline, John Keats, the poet, aged 25.

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November 2, 2009

Th'Infernal Gout-

Gout is an extremely unpleasant disease, usually manifesting itself in the large joint of the big toe and causing agony to the sufferer. Too much uric acid in the blood causes urates (spiky little crystals of difficult-to-dislodge poison) to accumulate in the joints and mimics a painful arthritic attack. Over time, it can lead to large swellings on the joints which then break through the skin.

Uric acid is a byproduct of purine breakdown. Certain foods, such a lobster, crab, foie gras, champagne and port contain high levels of purine, leading gout to be termed the 'Rich Man's Disease'. Thomas Sydenham, the gifted doctor who introduced a holistic approach to English medicine recorded in his papers in 1683 that:

Gouty patients are, generally, either old men, or men who have so worn themselves out in youth as to have brought on a premature old age - of such dissolute habits none being more common than the premature and excessive indulgence in venery, and the like exhausting passions.

Of course, many other, more complex conditions were diagnosed as 'the gout'. The light diet and abstention from alcohol prescribed by Sydenham and his like-minded colleagues would have helped, but once got, gout is difficult to get rid of. Queen Anne, Isaac Newton and many others are famous sufferers. Samuel Johnson is also have thought to have suffered from gout, but let's be honest, there wasn't anything he didn't suffer from and it could have been any one of many underlying diseases, or simply degenerative arthritis. Gout is also a side effect of kidney failure and/or liver disease. It was likely that many deaths attributed to gout, including that of John Milton (8th Movember, 1674) were actually result of renal failure, with gout as the most obvious symptom. Dropsy, or grotesque swelling of the body, often accompanied gout-like pain.

All fortified wine was known to exacerbate gout, although there is always an opportunist ready to market their wares as 'medicinal'. One wine merchant sent a bottle of sherry to arch-snob Lord Chesterfield, with a note extolling the ability of his wine to 'cure the gout'. Lord Chesterfield, sharp as ever, replied:

Sir, I have tried your sherry and frankly prefer the gout.

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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.

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October 26, 2009

'Monstrous Twins-'

Physical abnormality is a difficult and emotive subject, and the late seventeenth century saw the emergence of the first glimmers of understanding about genetic disorders. There were many who still believe the sperm was delivered to the mother as a tiny homunculus, which she then nurtured and brought into the world. Any abnormalities were of course, the mother's fault.

There was a new school of thought: that material for a child was inherited from both parents. Such new ideas paved the way for new medical journals, and new ways of addressing patients. Emphasis was placed on the medical practitioner having seen and examined each case, and descriptions were more accurate than they had been before.

Of particular interest were conjoined and parasitic twins (a twin not fully formed and utterly dependent on the other, rather than 'Siamese' twins). Other than in the poorest countries of the modern world, every effort is made to separate or disengage twins joined at birth and efforts were made, even in the 17thC to separate twins who did not share organs, but the majority would struggle through life as they were. London appears to have drawn them in. The following note appears in the Statues on Slavery.

Sir Thomas Graham bought a monster in the Indies, which was a man of that country,

which had a perfect shape of a child growing out of his breast; as an excres-

ency, all but the head. This man he brought hither (i.e. to England) and

exposed to the sight of the people for profit.

In the same year, in Genoa, James Pero was born, displaying a similar parasitic twin called Matthew, which you can see in the gallery. He appeared on show in London in 1714, prompting Sir Hans Sloane to commission his portrait (now in the British Museum). Another witness to James Pero's show was James Paris du Plessis. Paris was not a physician (he was a servant and for some time worked for Samuel Pepys), but he was fascinated by medical anomalies, and by the end of his life had amassed a large library of associated matter. Written circa 1731, his History of Prodigies detailed the lusus naturae or natural freaks he had seen on his travels in service. There is no hint of kindness in his tales, but there is little of cruelty either, he is simply an observer, although on occasion he is rather more 'hands on' than perhaps he should've been: fascinated by the 'Yorkshire hermaphrodite' and noted 'its viril Herge did erect by Provocation'.

Every so often, something truly grotesque appears (don't read this if you have a delicate constitution):

December, 1748

Two months ago, J.H. a poor

woman belonging to this town,

was delivered of a monstrous child,

which, besides the usual form and parts

of a female, had adhering to, or rather

contained in it, as in its capsula, a rude

and imperfect substance, whose shape

is somewhat conical; at the birth it re-

sembled a large cyst, or bag, extending

itself from the fundament quite down

to the toes of the child; its size was e-

qual to that of a bullock's heart, was co-

ver'd with a thin membrane, in which

was contained a limpid fluid. A few

days after the birth, the membrane

burthing, discovered to view an irregular

mass of flesh, perfectly human, with a

smooth skin of a florid colour: In its

inside are solid substances, which feel

like bones; and on its external surface

are visible a distinct hand and foot; on

the former are five fingers and a thumb,

on the latter four toes, with the great

toe in the middle. There was no other

visible distinction of either parts or sex

in this substance, for part of it is still

lodg'd in the body of the child, and

possesses all that cavity form'd by the

ossa innominata (the pubic bone), reaching upwards half

the length of the spina dorsi (the spine), in order to

the lodgment of which, the rectum of

the child gives way, and discharges its

excrements very regularly at the left

groin. But the uncommon bulk, in

equality, and feel of the parts, I appre

hend there are distinct extremeties, and

a head still conceal'd from view; the

whole bulk, if extract'd, would be near

ly equal to that of the child---It re

ceives fluids, and increases in bulk, tho'

whether it enjoys an animal or vegeta

ble life is uncertain. I saw the child

yesterday, which feed heartily; many

hundreds beside myself have likewise

seen it; and 'tis allow'd to be one of of

the most surprising instances of the kind

ever seen of heard of.

Such phaenomena, as they are re-

markable displays of divine almighty

power, so they are undoubtedly visible

proofs of God's displeasure against sin,*

in that, contrary to the established laws

of nature, he sometimes permits such

uncommon lusus naturae (freaks of nature) to exist among

the human species; for in general har-

mony and proportion are the beauty of

his works.

* The parent of the child has been remarkably vile, and her offspring is spurious.

The freakishness of this entire entry is only compounded by the equal vileness of the 'constant reader' who submitted it.

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October 23, 2009

Touching for the King's Evil-

Scrofula, or the King's Evil is a nasty and disfiguring disease caused by the rod-shaped bacteria you can see in the gallery. It can be a complication of tuberculosis, but in small children is usually a hideous lymphatic infection: the nodes of the neck and face swell and eventually the skin becomes attached to the swelling, hardens and bursts, causing an open wound or sinus.

To have a child suffering from scrofula must be very distressing. In 1702, Samuel Johnson's parents brought their son from Staffordshire to be touched by Queen Anne in the hopes of curing him. 'Touching for the King's Evil' was a tradition with its roots in the Middle Ages, when monarchs were deemed to be the chosen representative of God. Their touch was supposed magical and many children and adults were presented to Kings and Queens to be 'cured'. They came away with a 'touchpiece', a little metal token of the event (Samuel Johnson kept his about his person for the rest of his life).

The advertisement in the gallery, from the London Gazette of the 20th of April 1668, gives notice that Charles IInd will finish touching for the summer at the date printed. Although this might indicate Charles didn't want this duty to interfere with his summer plans (or be in a crowded room with the afflicted), it is estimated he 'touched' over 90,000 people for the Evil during his reign. He was well aware of the power of the ceremony, and how it was valued by the people who took part. Not everyone was convinced by the tradition though, and William IIIrd refused to 'touch', with one exception, when a man begged him. William laid his hand on the man's head saying, 'God give you better health and more sense.'

Queen Anne was by far the busiest monarch as far as touching was concerned, and she reinstated it as a ceremony immediately. Most monarchs laid their hand on the head of the afflicted and wished them better health (this touching of the forehead is all I can find in the early prints). Queen Anne apparently laid her bare hands on the sores themselves, making her fairly brave if you ask me. George Ist stopped the ceremony immediately, condemning it as superstitious and touching for the King's Evil ended in Britain (it continued in France until 1825).

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October 20, 2009

A Genuine Court-Plaister.

This little packet (16cm long) contains a Georgian sticking plaster, dating from around 1780. It was made from silk or cotton, isinglass (a sticky substance made from the swimbladders of fish, namely sturgeon) and glycerine. Supplied in various sizes, it could be used as a piece, or cut to fit the damaged area. It was then slightly moistened and applied and quite literally, stuck.

Survivals like this little packet, complete with its dried out plaister are very rare, and it is intriguing to see the form in which it would have been purchased originally. How it could have been 'faked', I have no idea, and presumably, the very fact it came from London rendered it superior to provincial sticking plasters.

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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.

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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.

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September 27, 2009

Suffer the Little Children

The Armory vs. Delamirie blog of yesterday leads onto two further posts: one on the reality of life as a 'climbing boy' in Georgian London, and one on the life of Paul de Lamerie. The children get to go first.

So how did a child end up as a sweep, or an apprentice maid? To be born very poor in London was no joke. At the bottom of the working ladder there was a reasonably sized population of piecemeal workers living in lodgings, often situated around the Holborn 'rookeries' (old Tudor courtyards surviving the fire, but too rickety and infested for anyone else to want to live there). The men took casual labour, and the women made cheap cotton lace, ran errands or sorted rags, often turning to prostitution when things got very tough. Gin gave cheap recourse to temporary insensibility, but it didn't prevent pregnancy. These people didn't need the added burden of children. Neither did the unwed serving girl who ended up pregnant with her lover's, or her master's child. I'm not a fan of the theory that all Georgian gentlemen molested the servants, but Samuel Pepys's constant pestering of the beleaguered Mercer shows it took strength of character to prevent wandering hands. A look through the Old Bailey records of the time reveals too many incidences of infanticide committed by unmarried women. Typically: servant girl takes to her bed, pleading fever. Gets up two days later and visits outside privy. Returns to work. Household suspicious. Investigates privy (!). Finds dead baby in mire. I am sure only a small proportion of these cases came to court, and would depend upon the bond of affection between servant and household. How many prostitutes came to term in poor lodgings and ditched the baby without detection?

In an attempt to both understand and prevent poor parents doing away with, or mistreating their children, Thomas Coram set up the Foundling Hospital in Brunswick Square, opening in 1741. Coram was a sea captain, who returned to London and became distressed by the state of the children of the poor. William Hogarth painted a series of pictures for the hospital. He also set up a wet-nurse system near his house at Chiswick and acted as 'Inspector of Nurses'. He was supposed examine the quality of their character and dwelling, but I imagine this job had some perquisites. George Frederick Handel donated an organ to the hospital and gave performances to benefit the charity. Originally, a basket hung outside the gate of the hospital in which babies might be placed anonymously, with a token from their former life (it was intended for newborns, of less than two months). The capacity of 400 was soon reached, and in desperation Coram introduced an interview system, where mothers had to present themselves and explain their situation. At the end of the interview, they were presented with a small painted ball. A white ball meant their child had been accepted. A red ball meant they had made the waiting list. A black ball meant no, giving rise to the modern meaning of 'black-balled.'

Children taken into the Foundling Hospital were sent out to Hogarth's Chiswick until they were four or five, when they returned to Brunswick Square where in theory, they received the rudiments of an education before they were 'apprenticed', at fourteen for the boys and sixteen for the girls. The reality of the Foundling Hospital, noble though its aims were, was that it hired out the children as day labour. A fact testified to by illustrations and cartoons of the time (such as the one in the gallery below, with the sweep leaving the hospital for his day's labour). Of the fifteen thousand children presented to the hospital in its first four years, less than a third survived to adolescence. A shameful statistic, and one Coram was disillusioned by. Poor families who managed to keep hold of their children fared little better, and it was not uncommon for people in desperate straits, or poorhouses to sell children into the service of the 'master-sweeps'.

Master-sweeps were rough men who patrolled the streets of London with their climbing boys and sometimes climbing girls, waiting to be accosted by housekeepers and footmen. Reliance on coal fires for heat and cooking meant London was a smoky place, full of labyrinthine chimneys connecting rooms and even different houses. Soot collected on brick ledges and double-backs. A lot of soot meant fire, and no one in London liked the word fire. The extendable brushes still used today would not make it around the corners of Georgian London's chimneys. Only small children were agile enough to scramble up and brush the soot down, with a hand-held brush. After pushing the child up the chimney, the master-sweep would gain the roof and wait for the child to reach the top of the chimney, thus proving they had done the job properly. Often, the fireplace and chimney were still hot, particularly in kitchens where a constant fire was necessary.

It is necessary to avoid sentimentality when researching the lot of these children, but it is hard not to be affected by the tales of their woes. In 1817, the account of the death of Thomas Pitts was recounted before a Parliamentary Committee, in an attempt by humanitarians to have something done about the lot of the climbing children.

'On Monday morning, 29 March 1813, a chimney sweeper of the name of Griggs attended to sweep a small chimney in the brewhouse of Messrs Calvert and Co. in Upper Thames Street; he was accompanied by one of his boys, a lad of about eight years of age, of the name of Thomas Pitt.'

The fire was still lit at the brewhouse, so Griggs extinguished it and sent the boy down from the top. Inside the chimney was an iron pipe, perhaps carrying hot water. It remained scalding hot, and Thomas Pitt became lodged against it immediately. When ordered to come out, he apparently responded with a pathetic cry of, 'I cannot come up, master, I must die here.’ The alarm was raised and a bricklayer working nearby came and broke the boy out of the chimney, but he was dead. The report of the surgeon attending was thus:

'On inspecting the body, various burns appeared; the fleshy part of the legs and a great part of the feet more particularly were injured; those parts too by which climbing boys most effectually ascend or descend chimneys, viz. the elbows and knees, seemed burnt to the bone; from which it must be evident that the unhappy sufferer made some attempts to return as soon as the horrors of his situation became apparent.'

Should any of these boys survive to adolescence, they were prone to the serious malady 'soot-warts'. For decades it was believed to be a venereal disease resulting from sooty love-making, probably because it arrived at the same time as puberty. It was Percivall Pott, in 1775, who recognised it as the first occupational cancer in his treatise Chirurgical observations Relative to the Cataract, the Polypus of the Nose, the Cancer of the Scrotum. Pott's treatise is not for the faint-hearted or for anyone in possession of a scrotum, so I content myself with the following extract.

'The fate of these people seems singularly hard; in their early infancy, they are most frequently treated with great brutality, and almost starved with cold and hunger; they are thrust up narrow, and sometimes hot chimnies, where they are bruised, burned, and almost suffocated; and when they get to puberty, become peculiarly liable to a most noisome, painful, and fatal disease.'

Just in case you thought the girls got away with it, they didn't. There were a few incidences of climbing girls, but mostly they were put out to do 'a woman's work'. This included helping midwives such as Elizabeth Browrigg. Brownrigg was a respected midwife in Fetter Lane. She took girls from the Foundling Hospital and used them as maids to help her during births. A girl named Mary Jones ran back to the Foundling Hospital in 1765, crying cruelty. The hospital investigated and warned James Brownrigg to keep his wife under stricter control. The neighbours complained again, but nothing was done. By the 4th of August 1767, the Browrigg's had murdered a girl in their care.

Mary Clifford was fifteen, and came to the Foundling Hospital as the result of a broken home. Upon the death of her mother, her father had married another woman, also Mary. Four years later, he left her. Unable to support a young girl, Mary had left her with the Foundling Hospital and 'gone into Cambridgeshire'. Mary Clifford was put into service with Elizabeth Brownrigg with another girl, Mary Mitchell, who was to testify at the Brownrigg's trial for Clifford's murder.

Mary Clifford had the misfortune to be a bed-wetter, giving Brownrigg an excuse to shave her head, strip her naked, make her work naked, and beat her while she hung from a hook, naked. They then locked her up for the weekends when they went to Hertfordshire, without food or water. Brownrigg and her son, John, were clearly unrestrained sexual sadists. Georgian courts refrain from discussing sexual abuse (although they delight in the minute mechanics of sodomy), but the full transcript of the case in the Old Bailey records dwells repeatedly upon Mary's near-constant nakedness and the injuries inflicted upon her whilst naked, inferring sexual intention on the part of both Brownrigg and her son. She was beaten, chained, and starved. James Brownrigg, the husband, sometimes attempted to restrain his wife, by hiding her whips and sticks, but he wasn't very good at it. John Brownrigg sounds a disgusting little article in late adolescence, who liked administering beatings to a naked girl who was quite possibly of slow wit.

In midsummer 1767 Mrs Clifford returned to London and sought out her step-daughter in Fetter Lane. She was turned from the door, John Brownrigg telling her that Mary did not want to see her. The real reason was that he and his mother had beat Mary into insensibility. However, before we condemn Georgian London as a hell-hole without mercy, we see the testimony of William Clipson, apprentice baker to Mr Deacon next door. Clipson was upstairs in his master's house and happened to look into the Brownrigg's yard. There he saw Mary Clifford, lying in the filth with the Brownrigg's pig, and crawled out of a sky-light in order to get a proper look at her.

'I spoke to her two or three times, but could get no answer; I tossed down two or three pieces of mortar, and the third piece fell upon her head; then she looked up in my face, I saw her eyes black, and her face very much swelled;...I went down and told my mistress what I had seen, and what a shocking condition the girl was in; then a watchmaker's wife, that lives opposite to us, went and found out the girl's mother-in-law (he means step-mother), and she came to our house; we told her what I had seen, and what a condition the girl was in; she cried...'

The parish overseers and a Constable were called to the house. The Brownriggs denied the girl was within the house, but the neighbours, Mrs Clifford refused to leave until she was produced. In the end, James Brownrigg was threatened with Newgate, and they produced both Mitchell, and Mary Clifford. Mrs Clifford was distressed by the state of her step-daughter.

'She was in a sad condition indeed, her face was swelled as big as two, her mouth was so swelled she could not shut it, and she was cut all under her throat, as if it had been with a cane, she could not speak; all her shoulders had sores all in one....I suppose they were cut by whips or sticks...her head was cut, she had a great many wounds upon it, and cuts all about her back and her legs; when I pulled her shoes and stockings off at the workhouse, I found her legs cut cross and cross, as if done with a thin end of a whip, and her back worse than her legs, and a very bad wound upon one of her hips.'

Mary Clifford died later that day. Elizabeth Brownrigg was found guilty and hanged at Tyburn the Monday following her trial. James and John Brownrigg spent six months in Newgate and were bound over for seven years. Such was the public approbation for John Brownrigg that he shortened his name to Brown and moved further west, somewhere near Oxford Circus.

The feral desperation of abject poverty is nowhere more depressing, and well-illustrated than in Georgian London, nor the cruelties it allowed those who came to be in a position to mete them out. It also draws a clear distinction between people who mistreated children because of their own poor state, and people who abused children because it was in their nature to do so. Such niceties of distinction are still with us today. Tyburn is not.