Monthly Archives: March 2019

VICTORIAN HOSPITALS: DEADLY INFECTIONS

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Victorian England was a dangerous place to live, especially in the bustling towns and cities. There was a potential accident around every corner, for instance, being run over by a cart or falling from a horse, or being burned or scalded at home when clothing caught fire or a pot of boiling water was knocked over.

In the 1840s, with the increasing amount of building work going on in urban areas, the number of accidents rose. Railways, docks and collieries were also extremely hazardous. In the mills and factories, workers could easily lose a limb or be killed if they became caught up in unfenced machinery. Injuries were also prevalent in manual occupations. A labourer could sustain a crushed hand or finger after carrying (and dropping) a heavy load; the same risk applied to a waggoner unloading goods from a cart.

Anyone injured in a serious accident would be taken to the nearest general hospital for surgical treatment, but that wasn’t necessarily a good thing before the 1880s. That’s because a 35% post-operative death rate was usual at this time. For an operation such as amputation at the thigh, this death rate was as high as 65%. ‘Hospital diseases’ such as hospital gangrene, erysipelas (also known as St Anthony’s Fire) and pyaemia were deadly killers.

The Mellish Ward at The London, 1901

In 1861, 42% of deaths after amputations at Guy’s Hospital in London were a direct result of pyaemia. The name of the disease literally means ‘pus in the blood’, it being a form of blood poisoning caused by the spread of pus-forming bacteria in the bloodstream. The infection could spread rapidly in a hospital ward as miasmatic material could infect one patient while their emanations could infect other patients in the ward. The disease had a very distinct ‘sweet’ smell.

Erysipelas, an infection that caused red patches on the skin, and hospital gangrene were an ever present threat to patients in the 1860s and 1870s. Nathaniel Paine Blaker, a surgeon at the Sussex County Hospital recalled that in the autumn of 1864,

“these diseases raged to such an extent that fourteen or fifteen patients, and also the head nurse, died in the male accident-ward in one week. The disease usually came on suddenly [in] …a patient with a wound…apparently going on well [who] was reported to have a rigor. This was followed by fever (there were no clinical thermo-meters in those days), restlessness, loss of appetite and perhaps vomiting. In a short time the parts round the wound became red, hot and swelled, and in a few hours gangrene commenced in a small spot and spread rapidly…”

A seemingly insignificant event could result in death from pyaemia. On a Saturday night in March 1864, George Milton, a fifty-two-year old domestic servant from Glasgow, ‘had his thumb seized by a drunken man who bent it back till it forced the lower end of the second phalanx through the skin & caused compound dislocation of it’. George was admitted to Glasgow’s Royal Infirmary and the House Surgeon ‘took off [the] lower end of bone of phalanx & replaced it’. By 14 March, erysipelas of the forearm had set in and two weeks later, the unit joint was affected with George’s general health suffering. The whole of his left forearm was put up in a poultice. On 30 March, it was decided to amputate the limb below the elbow joint under the influence of chloroform.  Although George ‘appeared to rally a little after the operation [he] took rigor several times during the day and sank, complaining of stiffness & pain of his joints, his breath [had] a faint odour resembling that in pyaemia’.  George died on 4 April, just over a month after his thumb had been injured.

The surgical building (the Lister Ward) at the Glasgow Royal Infirmary before demolition, 1924. Credit: Wellcome Collection

Given the high death rates after operations (which through word of mouth and newspapers patients would have been aware of), it’s no wonder that hospital registers record a significant number of patients refusing treatment and leaving voluntarily. Frederick Treves, a surgeon at The London recalled the surgical wards in the 1870s:

“The poor had a terror of it, which was not unjustified, and many an hour I spent merely trying to persuade patients to come in for treatment.  Operation results were not encouraging and the general public knew it.  I remember the whole of Talbot [ward] being decimated by hospital gangrene.  Every man died with the exception of two who fled the building.  There was only one sponge in the ward and with that deadly instrument the nurse… washed every wound in the evening using, not only the same sponge, but the same basin and the same water!…Maggots in a wound were regarded as part of the normal fauna of a hospital ward and called for no particular comment.”

Hospitals tried a wide variety of methods to address the increasing mortality rates. They included white-washing walls, removing privies from wards, separating medical and surgical patients, building new wards to allow more cubic space per patient, instigating new ventilation systems, and trying to prevent contaminated air entering the wards. Beds and wards were also disinfected with chemicals such as carbolic acid. 

Wounds had been treated with wine and vinegar acting as antiseptics for centuries and various post-operative and post-accident dressings were used to assist the healing process, including nitric acid, arsenic and tincture of iodine. Unfortunately, no-one yet understood the link between germs and infections, or that the surgical staff themselves could be the source. Surgeons and their assistants operated in blood-spattered street clothes with unsterile wooden-handled instruments, without changing between patients or using face masks or gloves.

Joseph Lister put forward his theory of antisepsis while working as a surgeon at the Glasgow Royal Infirmary. He concurred with Louis Pasteur’s argument that germs were airborne, carried on dust particles, and that they could be removed from the air by filtration, heat or other means. After hearing of the effectiveness of carbolic acid in disinfecting sewage in Carlisle, Lister decided to use the chemical as a filter between the air and open wounds. 

On 12 August 1865, Lister undertook his first trial of carbolic acid on eleven-year-old James Greenlees, whose left leg had been run over by a cart. Lister dressed a compound fracture of the tibia with lint soaked in linseed oil and carbolic acid, and kept the dressing in place for four days. The wound healed perfectly and James walked out of the hospital six weeks later.

In 1867, Lister wrote about his antiseptic methods and the germ theory in the Lancet but most surgeons saw antisepsis simply as a new type of wound dressing which involved carbolic acid, and they only adopted parts of it. Other surgeons, such as George Callender at St Bartholomew’s Hospital, developed their own effective means of combating sepsis which were less time-consuming and cumbersome. Many still believed that infections occurred spontaneously in wounds, not through bacteria.

Use of the Lister carbolic spray in antiseptic surgery, 1882. Credit: Wellcome Collection

By 1871, Lister had introduced the carbolic acid spray and gauze elements to his method. However, it was not widely used until the late 1870s and it did not kill air-borne micro-organisms. Although Lister religiously used his antisepsis techniques, he did not scrub his hands, simply rinsing them in carbolic solution, and he operated in his street clothes. 

Lister’s antiseptic theories were more widely accepted after 1877 when he became Professor of Clinical Surgery at King’s College, London. He continued to adapt his methods, abandoning the cumbersome spray in 1887, and by the 1890s, cleanliness and the germ theory became part and parcel of the practice of asepsis to exclude germs from wards and operating theatres.

The bacteria which caused surgical infections were identified by the 1880s and it was now known that they could be destroyed with antiseptics like carbolic. Hospitals strove for absolute cleanliness to prevent infections and crucially, this included medical and surgical instruments. As early as 1874, Louis Pasteur had suggested placing medical instruments in boiling water and passing them through a flame to sterilise them. In 1881, Robert Koch advocated the heat sterilisation of instruments but this method was not widely used until the 1890s. 

Hugh Lett, a medical student at The London in 1896 described the procedures undertaken before surgery:

“Instruments and ligatures were boiled and placed in a tray of carbolic lotion, and before long on a sterile towel, and handed to the surgeon…Rubber gloves were still unknown, the preparation of the surgeon’s hands [were] therefore formidable; prolonged scrubbing with soap and Lysol, followed by soaking in carbolic lotion, and finally immersion for some minutes in a solution of biniodide of mercury in spirit.  Further, during the operation the surgeon frequently dipped his hands into a solution of carbolic.”

By the 1890s, hospitals were no longer feared by the public. The new antiseptic and aseptic techniques, and a better understanding of how deadly hospital diseases were transmitted, led to a significant reduction in post-operative death rates. 

VICTORIAN FOOD: POISONOUS BATH BUNS

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Buying food today is a straightforward process. Products are made under strict hygiene standards, the ingredients are usually clearly labelled and the origin of the product is named. In Victorian England, it was far more hazardous. The problem was that nothing was as it seemed because almost every kind of food was adulterated in some way.

From bread, pickled fruits and vegetables through to sweets, cakes, cheese and butter – they were all adulterated. This meant that foods were being bulked up with other additives to increase the shopkeepers’ profit margins. Every time the Victorians went shopping, they were being sold adulterated food. Even worse, this could pose serious risks to their health.

Potatoes, ground bones, plaster of Paris, lime and pipe-clay were often added to bread, as was sulphate of copper and alum. Alum was used in the dyeing and tanning industry, and it increased the weight of bread and added whiteness. Although it wasn’t poisonous in itself, it caused severe indigestion and constipation.

‘The Great Lozenge Maker’ from Punch (1858

Even more deadly were the poisons that were routinely added to sweets and other confectionery to make them more colourful and attractive. Chromate of lead created a deep yellow but caused lead poisoning; the more times it was ingested, the more serious the results. Red sulphuret of mercury (vermilion) produced a bright orange-red hue but was known to be a dangerous poison, while green sweets were usually coloured with verdigris (copper acetate) which was a highly poisonous salt.

In 1858, the use of poisons as additives in sweets became headline news. In Bradford, twenty people died and more than 200 others became ill after eating sweets that had been accidentally laced with arsenic during the making process, instead of harmless ‘daft’ (usually plaster of Paris).

A year later, another less well-known poisoning scandal hit the headlines. I wrote briefly about the case of the poisonous Bath buns a few years ago for the British Newspaper Archive blog. But the story is worth re-telling in greater detail. In December 1859, six boys from a boarding school in Clifton, near Bristol bought some Bath buns from the shop of a confectioner named Farr. Within half an hour of eating them, they fell violently ill ‘with a horrible sickness and other symptoms of irritant poison’. The quick thinking of a doctor in using emetics to empty their stomachs meant that five of the boys soon recovered.

A confectioner’s shop in Spalding, Lincolnshire (circa 1907)

But for one of the boys, the poisoning almost proved fatal. He had been greedier than the others and had eaten three of the buns. He remained ‘writhing in agony for a number of hours and fell into a state of collapse’. Luckily, he eventually recovered. The schoolboys were not the only people affected by this batch of Bath buns. A publican called May also bought some for himself and his brother, and they ‘likewise suffered horrid tortures’ for nine hours. When he got better, May complained to the magistrates but as he had not been poisoned outright, there was no case to answer. Had he died, a manslaughter case might have been brought.

Preliminary investigations revealed that Farr regularly coloured the buns with chromate of lead without being aware of its dangers, and at first it was supposed that this time he had carelessly used too much. However, when the buns were analysed by Doctor Frederick Griffin of the Bristol School of Chemistry, it was discovered that the colouring matter was, in fact, yellow sulphide of arsenic in the proportion of six grains to each bun. It turned out that in this instance, the druggist had mistakenly supplied Farr with sulphide of arsenic, a much more deadly poison than the slower-acting chromate of lead. No action was taken against the confectioner or the druggist because the poisoning was accidental.

Doctor Griffin wrote to The Times, arguing that ‘many of the obscure chronic and dyspeptic complaints now so prevalent are due to the systematic adulteration of articles of food with unwholesome or slowly poisonous materials’. This was probably also the reason for the large numbers of adverts in Victorian newspapers offering indigestion remedies.

Dr Jenner’s Absorbent Powder for Indigestion Heartburn and Acidity (Credit: Science Museum, London)

In 1868, the Pharmacy Act was passed, after which only qualified pharmacists and druggists could sell poisons and dangerous drugs. Unfortunately, until 1875, there still remained very little control over the food and drink sold to the public. Although the first Act for Preventing the Adulteration of Articles of Food or Drink was passed in 1860, it had very little effect. In 1872, an amended Adulteration of Food, Drink and Drugs Act came into force, which included the mandatory appointment of public analysts. A second select committee was set up and its findings formed the basis of the Sale of Food and Drugs Act (1875).

Under this legislation, inspectors had the power to sample food and drugs, and to test them for adulteration. There was a further amendment to the Act in 1879, followed by the Margarine Act (1887) and finally, the Food Adulteration Act (1899). From the late 1880s and early 1890s, there were an increasing number of prosecutions for food adulteration, as reported in the local and national newspapers. This was the beginning of the trading standards legislation we take for granted today.

THE VICTORIAN HORSE-DRAWN OMNIBUS

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For the Victorian middle classes living in towns and cities, the preferred method of transport to commute to work or to go shopping was the omnibus (or ‘bus for short).  Inside, there was usually room for five people on each side, and there was straw on the floor to keep the passengers’ feet warm and dry. But this quickly got wet and dirty, and it also harboured fleas. Although the seats were covered in blue velvet, they were definitely not luxurious. The omnibuses were notoriously stuffy and poorly ventilated inside, with no air except when the door was opened. 

Inside the omnibus, passengers were tightly wedged in and there was a painful jolt every time the vehicle stopped. Sitting so close together made omnibuses a magnet for pickpockets and there was also a very serious risk of catching an infectious disease.

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‘Any Gentleman Oblige a Lady?’ from Cassell’s Family Magazine (1885)
 
For these reasons, men preferred to sit on the knifeboard of the omnibus, located on the roof. There were small ledges on which to step to reach the ‘knifeboard’, a raised partition along the middle with seats on each side. It was rare for women to venture up there as it was so difficult to get on and off wearing a cumbersome skirt or crinoline.

If you’re interested in Victorian social history, the memoirs of Molly Hughes (M V Hughes) are well worth seeking out (see Books and Resources). In A London Child of the 1870s (1934), she describes a secret adventure with her brothers in which she went on the mysterious roof of an omnibus for the first time:

‘If I had been asked to a royal ball I couldn’t have been more excited… Dym went up first, then hung down and pointed out the tiny ledges on which I had to put my feet, stretching out his hands to pull me up, while Barnholt fetched up the rear in case I slipped. On the top was what they called the knifeboard…How people stuck on to them I couldn’t imagine. But the boys had other designs: they scrambled down on to the seat in front, by the driver, and got me there too… I was safely tucked in between him and Dym, with Barnholt on his other side.

How powerful the horse looked from this point of view, how jolly to hear the chucklings and whoas, and to see the whip flourished about, but only gently touching the horse. “I never whips old Rosy,” the driver told me. “She’s been with me six years and knows what I want. I use the whip like chatting to her.” …Barnholt, as look-out man, kept calling my attention to things in the shops, and to people doing mysterious jobs in first-floor windows. One room was a nursery, where a boy was riding on a rocking-horse, and in one garden we passed there was a swing with a boy going very high.

We feared to go the whole length of our twopenny ride in case we should be late for tea, so we asked the driver to pull up for us. In my haste to show him how well I could get off by jumping down to Dym in front, I fell right into the muddy street. But no harm was done, and the boys picked me up, and we ran home as fast as we could and slipped in at the back door.’

‘Omnibus Driver’ from Living London (1901)
The knifeboard design was replaced by the ‘garden seat’ omnibus in the 1880s, which had a curved staircase at the rear leading to the top deck. This made it easier for both sexes to access the roof as there was a central gangway, with benches facing the way the passengers were going. There were also ‘decency’ or ‘modesty’ boards on the top deck to give some protection from the weather and to prevent people passing from seeing the ladies’ ankles!

‘London Bridge Station Yard’ from Living London (1901)

 

 

 

VICTORIAN SERVANTS SPEAK OUT

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After a lengthy break, I’m relaunching my A Visitor’s Guide to Victorian England blog on a more responsive platform. Hopefully, it will make the content easier to navigate and search, and be more reader-friendly.

To mark International Women’s Day, this post is about the unsung heroes of Victorian society, without whom the wealthy and middle classes could not manage their daily lives: domestic servants. The rich rarely had issues attracting and retaining staff since working in gentlemen’s service was considered the pinnacle of a servant’s career. However, for smaller households employing just one or two servants, it was a very different matter.

Throughout the second half of the nineteenth century, the newspapers were full of complaints about the ‘servant problem’ – the apparent inability of employers to obtain and keep good servants. Countless opinions were offered as to the cause and the remedy, including that given by Mrs Panton in From Kitchen to Garret: Hints to Young Householders (1888). In her manual, she offered what appears to be common sense advice but it was contrary to the way many mistresses viewed their servants: ‘If we treat our maids just as we treat ourselves we shall find our trouble almost disappear. I invariably leave my maids a good deal to themselves about their work; and once they know what has to be done, I find it is done without my constantly being after them…’

‘Morning Wear’ in Cassell’s Household Guide

Part of the ‘servant problem’ was attributed to the increasingly wide range of employment opportunities for working-class girls who had traditionally gone into domestic service. Jobs in shops and factories were more attractive because of the fixed working hours, whereas servants were at the beck and call of their mistresses at all hours of the day. After 1880, working-class girls were educated for longer and to a higher standard. The most intelligent could now aspire to enter the professions of teaching and nursing, while clerical work offered further opportunities away from domestic service.

This increase in literacy among servants led many to air their grievances by writing to their local newspapers; this was one of the few ways they could express themselves publicly. While researching my book Servants’ Stories, I came across an exchange of letters on the British Newspaper Archive. They were sent to the Western Mail in November and December 1892. The first letter was a request from ‘A Servant’ of Swansea for ‘protection against tyrannous mistresses’:

Will you insert a servant’s complaints of the way in which the majority of that much-abused class are treated? No one seems to heed our long hours or our holidays, which are (like angels’ visits) few and far between. There seems no other class working at a greater disadvantage. For instance, no servant can expect a situation who had not got a good reference and a long one from where she last lived. It often happens she has been living with unprincipled people, who think not half so much of their servants as they do of their dumb animals. What is it to them if the girl does not get a situation? She has offended them in some way or other. Perhaps she had had more than her share of work, bad food, and other things too numerous to mention, and she has spoken too plainly to please them. That, of course, is considered impertinent, for, according to many mistresses’ opinion, a servant is a being made expressly for them, and she has no rights whatever, and she is told she need not expect a character. What are servants to do under these circumstances? They may be out of a situation for months – perhaps something worse. Do the mistresses think we have no spirit, and that we must bear quietly the petty tyranny they have it in their power to use in a hundred ways? My two last situations have happened to be places where it is impossible for servants to live, I being the sixth servant in three months, and yet we have nothing and no one to warn us of places of this sort. I think it is a serious matter that our character (I may say our livelihood) is at the mercy of such people. Why cannot something be done to benefit servants as well as other working classes? Servants ought to know what kind of places they are going into, as well as the character of the people they are to live with.

Maid of all work (Living London)

In the days that followed, other maids wrote to the Western Mail listing their own problems with their employers. ‘A Poor Servant in Pembrokeshire’ added:

I am only grieved to say that we servants are worse treated than pet animals. They are studied with fresh air every day, but we do not need it once a week even. Are we allowed sufficient time to eat the food we get, which would not be often given to their pets? When we enter into an engagement with a lady we are asked if we can obtain a good character. Should there be a little spot, “Oh you won’t suit me.” Should the lady’s character be inquired into as closely as the servant’s, I wonder which would prove the most just. You are asked if you are honest. Is it needed where everything is locked. You are expected to be clean. Can you be clean in some ‘houses’ where you have a piece of soap locked from you?

Lack of trust between mistress and maid was a constant source of frustration and anger. Employers also wrote in to have their say during this discussion. ‘A Mistress’ of Park-place, Cardiff commented:

I do not doubt that among servants, like every other class, there are some who are badly treated, but … what of the gross carelessness and wicked wastefulness of servants, and what of their growing antipathy to doing the ordinary work of a household? Servants, nowadays, are not to be compared to the honest and industrious worker of a few years ago, and their grievances are entirely of their own making.

This letter provoked an impassioned reply from to ‘A Servant’ of Newport:

I have heard many say that modern servants are not like the old-fashioned ones, but mistresses of the present day are very different from what they were then. Mistresses used to respect their servants and were looked up to in return, but such mistresses now are few and far between. There are so many ‘ladies’ who have been domestics themselves that we cannot expect them to make good mistresses. I should think that to have a good place we should have a kind mistress. This is the chief thing; then the girl would find it a pleasure to be industrious.

‘In a Servants’ Registry Office’ (Living London)

A butler with 17 years’ experience wrote:

I respectfully contend that servants are far more honest now than they were years ago, when many of them had little or no wages more than their food. No, servants are not what they were years ago. They, like other branches of the community, have improved with the times, and are still improving. But why is it they meet with so little encouragement from their employers? Hundreds of societies are formed, recreation-rooms built, and everything conceivable is done for the improvement of the clerk, artisan, mechanic, &c. Mistresses subscribe liberally to any of these, but no helping hand is held out to the poor being who is unlucky enough to bear the insignificant designation of “servant”… I am happy to say from experience that there are some few mistresses who take an interest in their servants, and do all they possibly can to encourage them to be thrifty &c, and improve themselves, not only by giving them good advice, but with kind, substantial help. But while employers continue to treat servants as machines, expecting all and giving as little as possible in return (for it is not solely a question of wages), there will be a difficulty in obtaining good servants.

Finally, came the hopes of ‘A Cardiff Girl’:

Would you kindly allow me a small space in your valuable paper to refer to the proposed servants’ union. I am sorry to see that such a few girls of this town have taken the matter up. Why do not some of them come forward with pluck and energy and stand out one with the other until they get a union like the shop assistants and have a half-holiday once a week, with some part of the day on Sunday, instead of being penned in like prisoners once a fortnight? I am sure we deserve it, I sincerely hope, now the girls have made a stir that it will not result in a failure like the last.

Unfortunately, the various servants’ trade unions had little effect on improving the working conditions of those in domestic service. It was difficult to recruit members because the contract between servant and employer was a private one, and maids ran the risk of being blacklisted if they were discovered to be members of a union.

This exchange of letters in the Western Mail continued for weeks, indicating the depth of feeling on both sides. The ‘servant problem’ continued well into the twentieth century when a trend developed of maids becoming ‘daily helps’ or char-women, which meant they had fixed hours and were able to return home at the end of the day.