Hellish Vic­to­rian hos­pi­tals

Dr Lind­sey Fitzhar­ris de­scribes the hor­rors of theearly the early Vic­to­rian hos­pi­tal, where lice and lethal in­fec­tions flour­ished, the air was filled with the smell of vomit and rot­ting flesh, and all too few of those who went un­der the sur­geon’s knife li

BBC History Magazine - - Contents - Dr Lind­sey Fitzhar­ris is the host of the YouTube se­ries en­ti­tled Un­der the Knife. Her de­but book, The Butcher­ing Art: Joseph Lis­ter’s Quest to Trans­form the Grisly World of Vic­to­rian Medicine, was pub­lished by Allen Lane in Oc­to­ber

From bugs to belly-rip­ping, Lind­sey Fitzhar­ris de­scribes the hor­rors of early 19th- cen­tury ‘ houses of death’

In 1825, visi­tors to St Ge­orge’s Hos­pi­tal in Lon­don dis­cov­ered mush­rooms and mag­gots thriv­ing in the damp, dirty sheets of a pa­tient re­cov­er­ing from a com­pound frac­ture. The af­flicted man, be­liev­ing this to be the norm, had not com­plained about the con­di­tions – and nor did any of his fel­low bed­mates think the squalor es­pe­cially note­wor­thy. Those un­lucky enough to be ad­mit­ted to this and other hos­pi­tals of the era were in­ured to the hor­rors that resided within.

To­day, we think of the hos­pi­tal as an ex­em­plar of san­i­ta­tion. How­ever, late Geor­gian and early Vic­to­rian hos­pi­tals were any­thing but hy­gienic. A hos­pi­tal’s ‘Chief Bug- Catcher’ – whose job it was to rid the mat­tresses of lice – was paid more than its sur­geons at this time. In fact, bed bugs were so com­mon that the ‘Bug De­stroyer’ An­drew Cooke claimed to have cleared up­wards of 20,000 beds of in­sects dur­ing the course of his ca­reer. Hos­pi­tals were breed­ing grounds for in­fec­tion and pro­vided only the most prim­i­tive fa­cil­i­ties for the sick and dy­ing, many of whom were housed on wards with lit­tle ven­ti­la­tion or ac­cess to clean wa­ter. As a re­sult of this squalor, th­ese places be­came known as ‘Houses of Death’.

A num­ber of Lon­don hos­pi­tals in the first half of the 19th cen­tury were re­built or ex­tended in line with the de­mands placed upon them by the city’s grow­ing pop­u­la­tion. For in­stance, St Thomas’s Hos­pi­tal re­ceived a new anatom­i­cal the­atre and mu­seum of spec­i­mens in 1813; and St Bartholomew’s Hos­pi­tal un­der­went sev­eral struc­tural im­prove­ments be­tween 1822 and 1854 that in­creased the num­ber of pa­tients it could re­ceive. Three new teach­ing hos­pi­tals were built in the city, in­clud­ing Univer­sity Col­lege Hos­pi­tal in 1834.

How­ever, most hos­pi­tals re­mained over­crowded, grimy and poorly man­aged. The as­sis­tant sur­geon at St Thomas’s was ex­pected to ex­am­ine more than 200 pa­tients in a sin­gle day. The sick of­ten lan­guished in filth for long pe­ri­ods be­fore they re­ceived med­i­cal at­ten­tion.

The un­san­i­tary con­di­tions cre­ated a dan­ger­ous en­vi­ron­ment for those trapped within a hos­pi­tal’s walls. Preg­nant women who suf­fered vagi­nal tears dur­ing de­liv­ery were es­pe­cially at risk as th­ese wounds pro­vided wel­come open­ings for the bac­te­ria that doc­tors and sur­geons car­ried on them wher­ever they went. In the 1840s, it was es­ti­mated that more than 1,000 moth­ers died each year from puer­peral fever brought on by bac­te­rial in­fec­tions in Eng­land and Wales. Puer­peral fever wasn’t the only cul­prit. Many women also died from pelvic ab­scesses, hem­or­rhag­ing or peri­toni­tis – the lat­ter be­ing

a ter­ri­ble con­di­tion in which the tis­sue that lines the in­ner wall of the ab­domen be­comes in­flamed.

Hos­pi­tals reeked of urine, vomit and other bod­ily flu­ids. The smell was so of­fen­sive that the staff some­times walked around with hand­ker­chiefs pressed to their noses. Sur­geons didn’t ex­actly smell like rose beds, ei­ther. Berkeley Moyni­han – one of the first sur­geons in Eng­land to use rub­ber gloves – re­called how he and his col­leagues used to throw off their own jack­ets when en­ter­ing the op­er­at­ing the­atre and don an­cient frocks that were of­ten stiff with dried blood and pus. They had be­longed to re­tired mem­bers of staff and were worn as badges of honour by their proud suc­ces­sors, as were many other items of sur­gi­cal cloth­ing. As a re­sult, sur­geons car­ried with them the un­mis­tak­able smell of rot­ting flesh, which those in the pro­fes­sion cheer­fully re­ferred to as “good old hos­pi­tal stink”.

As well as the foul smells, fear per­meated the at­mos­phere. The sur­geon John Bell wrote that it was easy to imag­ine the men­tal an­guish of the hos­pi­tal pa­tient await­ing surgery. He would hear reg­u­larly “the cries of those un­der op­er­a­tion which he is prepar­ing to un­dergo”, and see his “fel­low-suf­ferer con­veyed to that scene of trial”, only to be “car­ried back in solem­nity and si­lence to his bed”.

In this pe­riod, it was safer to have surgery at home than it was in a hos­pi­tal, where mor­tal­ity rates were three to five times higher than they were in do­mes­tic set­tings. Those who went un­der the knife did so as a last re­sort, and so were usu­ally mor­tally ill. Few sur­gi­cal pa­tients re­cov­ered without in­ci­dent. Many ei­ther died or fought their way back to only par­tial health. Those un­lucky enough to find them­selves hos­pi­talised would fre­quently fall prey to a host of in­fec­tions, most of which were fa­tal in a pre-an­tibi­otic era.

Past butcheries

The op­er­at­ing the­atre it­self was just as dirty as the sur­geons work­ing in them. It was fre­quently filled to the rafters with med­i­cal stu­dents and cu­ri­ous spec­ta­tors, many of whom had dragged in with them the dirt and grime of ev­ery­day life. The sur­geon John Flint South re­marked that the rush and scuf­fle to get a place in an op­er­at­ing the­atre was not un­like that for a seat in the pit or gallery of a play­house. Peo­ple were packed like her­rings in a bar­rel, with those in the back rows con­stantly jostling for a bet­ter view, shout­ing out “Heads, Heads” when­ever their line of sight was blocked. At times, the floor of a the­atre like this one could be so crowded that the sur­geon couldn’t op­er­ate un­til it had been par­tially cleared.

Most op­er­at­ing the­atres looked more or less the same in this era. They con­sisted of a stage par­tially en­closed by semi­cir­cu­lar stands ris­ing one above an­other to­ward a large sky­light that il­lu­mi­nated the area be­low. On days when swollen clouds blot­ted out the sun, thick can­dles lit the scene. In the mid­dle of the room was a wooden ta­ble stained with the tell­tale signs of past butcheries. Not all pa­tients were laid flat. Be­fore the dawn of anaes­thet­ics in the 1840s, many were sat up­right in an el­e­vated chair. This pre­vented them from brac­ing when the sur­geon’s knife be­gan to dig into their flesh. Un­sur­pris­ingly, they were also re­strained, some­times with leather straps. Un­der­neath their feet, the floor was strewn with saw­dust to soak up the blood. On most days, the screams of those strug­gling un­der the knife min­gled dis­cor­dantly with ev­ery­day noises drift­ing in from the street be­low: chil­dren laugh­ing, peo­ple chat­ting, car­riages rum­bling by.

Pain was not just an un­avoid­able side ef­fect of surgery. Most sur­geons op­er­at­ing in a pre-anaes­thetic era be­lieved it was a vi­tal stim­u­lant nec­es­sary for keep­ing the pa­tient alive. This is why opi­ates and al­co­hol were

On en­ter­ing the op­er­at­ing the­atre, sur­geons donned an­cient frocks that were stiff with dried blood and pus

used spar­ingly, and typ­i­cally ad­min­is­tered shortly be­fore (not dur­ing) a pro­ce­dure, as the loss of con­scious­ness was con­sid­ered to be ex­tremely dan­ger­ous. As a re­sult, sur­geons had to be fast. Very fast. Take, for ex­am­ple, Robert Lis­ton (pic­tured on page 43) – a sur­geon op­er­at­ing in the first half of the 19th cen­tury who was known as the “the fastest knife in the west end”.

At 6ft 2ins, Lis­ton was 8 inches taller than the av­er­age Bri­tish male. He had built his rep­u­ta­tion on brute force and speed at a time when both were cru­cial to the sur­vival of the pa­tient. Those who came to wit­ness an op­er­a­tion might miss it if they looked away even for a mo­ment. It was said of Lis­ton by his col­leagues that when he am­pu­tated, “the gleam of his knife was fol­lowed so in­stan­ta­neously by the sound of saw­ing as to make the two ac­tions ap­pear al­most si­mul­ta­ne­ous”. His left arm was re­port­edly so strong that he could use it as a tourni­quet, while he wielded the knife in his right hand. This was a feat that re­quired im­mense strength and dex­ter­ity, given that pa­tients of­ten strug­gled against the fear and agony of the sur­geon’s as­sault. Lis­ton could re­move a leg in less than 30 sec­onds, and in or­der to keep both hands free, he of­ten clasped the bloody knife be­tween his teeth while work­ing.

Although Lis­ton was all too aware of what awaited his pa­tients on the op­er­at­ing ta­ble, he of­ten down­played the hor­rors for the sake of pro­tect­ing their nerves. Once, he re­moved

the leg of a 12-year-old child named Henry Pace, who had a tu­ber­cu­lar swelling of the right knee. The boy asked the sur­geon whether or not the op­er­a­tion would hurt, and Lis­ton re­sponded: “No more than hav­ing a tooth out.” When the mo­ment came to have his leg re­moved, Pace was brought into the the­atre blind­folded and pinned down by Lis­ton’s as­sis­tants. The boy counted six strokes of the saw be­fore his leg dropped off. Sixty years later, he would re­count the story to med­i­cal stu­dents at Univer­sity Col­lege Lon­don – the hor­ror of the ex­pe­ri­ence, no doubt, fresh in his mind as he sat in the very hos­pi­tal in which he had lost his leg.

Un­avoid­able evil

The pa­tients weren’t the only ones who felt anx­ious be­fore an op­er­a­tion. Sur­geons, too, were ap­pre­hen­sive about cut­ting into liv­ing bodies. The Scot­tish sur­geon Charles Bell was de­scribed by one col­league as hav­ing “the re­luc­tance of one who has to face an un­avoid­able evil”. John Aber­nethy, a sur­geon at St Bartholomew’s Hos­pi­tal, con­fessed to shed­ding tears and be­ing phys­i­cally ill be­fore or after a par­tic­u­larly ter­ri­ble op­er­a­tion. He de­scribed the walk to the op­er­at­ing room as be­ing like “go­ing to a hang­ing”. Many sur­geons, once con­fronted with ex­posed bone, felt daunted by the task of saw­ing through it. Even those who were adept at mak­ing in­ci­sions could lose their nerve when it came to cut­ting off the limb. In 1823, Thomas Al­cock pro­claimed that hu­man­ity “shud­ders at the thought, that men un­skilled in any other tools than the daily use of the knife and fork, should with un­hal­lowed hands pre­sume to op­er­ate upon their suf­fer­ing fel­low crea­tures”. He re­called a spine-chill­ing story about a sur­geon whose saw be­came so tightly wedged in the bone that it wouldn’t budge.

Yet as hor­ri­ble as th­ese hos­pi­tals were, it was not easy to gain en­try to one. Through­out the 19th cen­tury, al­most all the hos­pi­tals in Lon­don ex­cept the Royal Free con­trolled in­pa­tient ad­mis­sion through a sys­tem of tick­et­ing. One could ob­tain a ticket from one of the hos­pi­tal’s ‘sub­scribers’, who had paid an an­nual fee in ex­change change for the right to rec­om­mend pa­tients ts to the hos­pi­tal and vote in n elec­tions of med­i­cal staff. Se­cur­ing ring a ticket re­quired tire­less so­lic­it­ing lic­it­ing on

Some hos­pi­tals only ad­mit­ted pa­tients who brought with them money to cover their al­most in­evitable burial

the part of po­ten­tial pa­tients, who might spend days wait­ing and call­ing on the ser­vants of sub­scribers and beg­ging their way into the hos­pi­tal. Some hos­pi­tals only ad­mit­ted pa­tients who brought with them money to cover their al­most in­evitable burial. Oth­ers, like St Thomas’s in Lon­don, charged dou­ble if the per­son in ques­tion was deemed ‘ foul foul’ by the ad­missi ad­mis­sions of­fi­cer. At a time be­fore germs g and an­ti­sep­sis were fully un­der­stood, reme­dies rem for hos­pi­tal squalor were hard to come b by. The ob­ste­tri­cian James Y Simp­son sug­gested sug­gest an al­most-fa­tal­is­tic ap­proach to the prob­lem. pro If cross-con­tam­i­na­tion could not b be con­trolled, he ar­gued, then hos­pi­tals should sh be pe­ri­od­i­cally de­stroyed a and built anew. An­other sur­geon named n John Eric Erich­sen voiced a sim­i­lar view. “Once a hos­pit hos­pi­tal has be­come in­cur­ably pyemia-stricken [a type of sep­ti­caemia], it is as im­pos­si­ble to dis­in­fect it by any known hy­gienic means, as it would be to dis­in­fect an old cheese of the mag­gots which have been gen­er­ated in it,” he wrote. There was only one so­lu­tion: the whole­sale “de­mo­li­tion of the in­fected fab­ric”.

By the 1860s, the sit­u­a­tion had reached crit­i­cal mass. At a time when surgery couldn’t have been more dan­ger­ous, an un­likely fig­ure stepped for­ward: Joseph Lis­ter, a young, melan­choly sur­geon. By claim­ing that germs were the source of all in­fec­tion – and could be treated with an­ti­sep­tics – he changed the his­tory of medicine for­ever. To­wards the end of the 19th cen­tury, hos­pi­tals ceased to be houses of death and in­stead had be­come houses of heal­ing.

SPE­CIAL EDI­TION You can read more about the his­tory of surgery in our spe­cial edi­tion mag­a­zine,

The Story of Medicine,

avail­able in dig­i­tal for­mat only at his­to­ryex­tra.com/ bbc-his­tory-mag­a­zine/ dig­i­tal- edi­tions

A doc­tor dances a jig in a de­crepit hos­pi­tal. Con­trary to this 1813 etch­ing, one sur­geon con­fessed to shed­ding tears be­fore en­ter­ing the op­er­at­ing the­atre

A sur­geon per­forms an op­er­a­tion in a draw­ing room to re­move a tu­mour from a man’s chest, as de­picted in an 1817 wa­ter­colour

Pa­tients wait­ing at the door of a 19th- cen­tury hos­pi­tal. Al­most all Lon­don hos­pi­tals used a tick­et­ing sys­tem to con­trol ad­mis­sions

The sur­geon Joseph Lis­ter trans­formed medicine by sug­gest­ing that germs were the source of all in­fec­tion

Newspapers in English

Newspapers from UK

© PressReader. All rights reserved.