VICTORIAN HOSPITALS: DEADLY INFECTIONS

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

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.

DUST, DOG DIRT AND DUNG IN VICTORIAN ENGLAND

I wasn’t sure about the concept of the BBC’s 24 Hours in the Past at first. Watching celebrities complain about the frankly unpleasant nineteenth century tasks they had to undertake didn’t sound very appealing. However, I was impressed by how realistic the scenes in the first episode were. Filmed at the wonderful Black Country Living Museum, episode 1 was set in a dust-yard where dust and other rubbish was sifted through to collect bones, rags and pieces of metal. 

‘Removing Street Refuse’ from Living London (circa 1901)

The street was covered with horse manure and the celebrities were expected to clean it up while looking out for valuable ‘pure’ which was mixed in. Zoe Lucker, quickly getting fed up with her shovel, got stuck in and used her bare hands to pick up the manure.

While this is shocking to the modern eye, for the lower working-classes it was simply a fact of life. ‘Pure-finders’ spent every working day picking up dog excrement to sell on for a premium to leather-dressers and tanners (it was used to soften the animal skins before the actual tanning could take place).

Upper-class Victorians who happened to witness this daily task were equally as shocked. An American, John Henry Sherburne, who visited England in 1847, wrote that on passing through the great thoroughfares of Liverpool, ‘the most disgusting sight’ to him ‘was seeing women and young girls employed in scraping up street manure with their naked hands, and placing it in baskets, or their aprons’. He concluded, ‘These scenes are so common, as not to be noticed by the citizens’.

‘Sorting a Dust-heap at a County Council Depot’ from Living London (circa 1901)

The dust-yard was the Victorian version of today’s recycling factories. No landfill for them! Nothing was thrown away because every single thing had a value and could be re-used in different forms. Rags were sold to paper makers after washing; bones were used to make knife handles and ornaments, and the grease from them was a component of the soap-making process; coal and cinders were needed for brickmaking; while horse manure mixed with night-soil (human excrement) and hops made an excellent fertiliser.

This first episode of 24 Hours in the Past illustrated the back-breaking manual labour our working-class ancestors had to carry out on a daily basis for a pittance; they lived a stark hand to mouth existence – when there was no work, there was no pay and no food. We take so much for granted today and this episode was a timely reminder of that.

‘A Crossing Sweeper’ from Living London (circa 1901)

REVIEW OF ‘LIFE IN THE VICTORIAN ASYLUM’ BY MARK STEVENS

My Victorian England blog has been shamefully neglected of late because most of my time has been taken up with my forthcoming book, ‘Servants’ Stories’. Now that I have a bit more breathing space, I can start to blog again.

Let’s start with a review of Mark Stevens’ thoroughly absorbing book ‘Life in the Victorian Asylum‘. This is very late as the book was published in October last year, but better late than never! Regular readers of this blog will know that this is a subject I’m fascinated with.

‘Life in the Victorian Asylum’ is the companion to Mark’s highly successful first book, ‘Broadmoor Revealed‘ which dealt with the treatment of the criminally insane and focused on some of the most interesting case histories. This new book is more general and as the title suggests, it describes daily life for the asylum patient.

The book is separated into two distinct parts. The first part is written in the style of a handbook for Victorian asylum patients and the reader is addressed as if he or she was a new inmate. Walking them through step by step, the information includes what they could expect during the admission process and how a diagnosis was made; what the accommodation and the daily routine was like; the treatment for mental illness and general healthcare; and how patients were discharged after recovery.

If you have an ancestor who was admitted to an asylum, this section of the book will give you a detailed overview of daily life for him or her inside the institution.  The sad thing about the handbook is that, in reality, even if the process had been fully explained to asylum patients, their fragile mental state would probably have meant they would not have understood it.

The second part of the book is written as a straight history of Victorian asylums with special reference to Moulsford Asylum (Fair Mile Hospital) in Berkshire, which was the inspiration for the book. Mark Stevens is an archivist at Berkshire Record Office where he looks after the archives of both Fair Mile Hospital and Broadmoor so there are plenty of fascinating examples and case histories from the archives throughout the book.

The book provides a tantalising snapshot of a world behind the locked doors of the asylum and shatters a few myths about the purpose of such institutions and the treatment for patients within them. So often portrayed as dark, forbidding places from which there was no escape, Mark Stevens offers a different point of view about lunatic asylums. What really comes across is that the staff of Victorian asylums were extremely compassionate in the way they treated their patients with the aim of achieving recovery for as many as possible.

If you haven’t already read ‘Life in the Victorian Asylum‘, I would highly recommend it. It’s available from Pen & Sword Books and Amazon.

‘Needlework in Bethlem’ from ‘Lunatic London’ in Living London, 1900

A VISIT TO ST LUKE’S HOSPITAL FOR LUNATICS, 1900

There were some very moving stories in last week’s episode 1 of ITV’s Secrets from the Asylum with three celebrities uncovering the records of their ancestors who all became patients in lunatic asylums. Aside from some slight over-reactions from the participants, the programme did succeed in showing how people with senile dementia, post-natal depression and general paralysis of the insane (the last stage of syphilis) were treated in Victorian times.

The concluding episode airs on Wednesday and I will be interested to see which other mental conditions are covered. To tie in with this and with Kate Tyte’s excellent recent guest post on this blog, I’d like to share part of an article from Living London about a journalist’s visit to St Luke’s Hospital for Lunatics in 1900.

He described “grimy, forbidding St Luke’s” as essentially “the twin sister of Bethlem; not so comfortable, perhaps, not with such fine grounds, but broadly a replica of the famous cure house. It receives the same class of patients, has pretty much the same rules, and has the same system of wards.”

Both St Luke’s and Bethlem looked after patients who were generally from the educated and professional classes, and art, music and literature was actively encouraged. At St Luke’s in a room housing the worst female cases were “two attendants of neat, nurse-like appearance. In one corner a woman is to be seen standing like a pillar; in another a lunatic is in the attitude of prayer – outwardly, a rapt devotee; and close by a poor deluded creature is kneeling before a box of paints, some of which she has been sucking.”

The journalist described the contrast of a middle-aged woman “sitting in listless vacuity, her head drooping, her hands clasped in her lap, fit model for Melancholia” with another in the middle of the room “striding to and fro with regular steps over a fixed course – so many forward, so many back – muttering unintelligibly and raising her arms aloft with machine-like regularity.”

 He went on to note, “How truly painful it is to study the faces of the patients in this and other rooms! The knitted brow of acute melancholia, the grotesque indications of delusion – here perplexity, misery and fear, there dignity and exaltation – the fixed look of weariness indicative of the reaction that follows acute mania, are all present, with many other characteristic expressions.”

On red-letter days such as St Luke’s Day and on festival days like Christmas, there were frequent dramatic and musical entertainments, occasional dances, billiards and other games, as well as ample reading facilities. According to the journalist, “Everything possible is done to rouse and amuse patients, and that in this the officials succeed is attested by the high percentage of cures – a percentage which, happily, increases every year.”

Lunatic patients at Bethlem and St Luke’s were the lucky ones; they were of a more superior class to those housed in county lunatic asylums and their mental conditions were such that there was always hope they would be cured and discharged.

Pauper lunatics were not so lucky. They were admitted to the workhouse to the ‘mental’ wards, which had padded rooms where the most violent cases were housed for their own safety. The journalist described the newest of these rooms as being “about three feet wide and seven feet high, and lined throughout – top, bottom, sides, and door – with perfectly smooth padded rubber, more yielding than a pneumatic tyre inflated for a lady’s weight.”

If the mental state of pauper lunatics was too serious to be treated in the workhouse, they were transferred to a county lunatic asylum. Although conditions in these institutions had improved by 1900, they were frequently overcrowded and understaffed, and their patients were too often deemed to be ‘hopeless cases’. These were the men and women who were destined to die in the asylum. Then, as now, mental illness was a tragedy not just for the patients, but for their families too.

VICTORIAN LUNATIC ASYLUMS: HOW TO GET ADMITTED

It’s been a while since I blogged but I’m starting back with a great guest post from Kate Tyte, an archivist, writer and expert on mental health history. Writing about Victorian lunatic asylums, she offers excellent advice about how to get admitted to one and, more importantly, how to get out again:

Any visitor to mid-Victorian England would find the healthcare landscape very different from today’s. There were no state-funded hospitals, but in 1846 each county was required to open an asylum to care for the mentally ill.

The modern, mid-Victorian asylum was an optimistic place. Doctors had cast aside the superstitions and barbaric treatment of previous centuries. They felt certain that a pleasant therapeutic environment, free from chains, straitjackets and other ‘mechanical restrains’, would soon cure most of their patients. They would apply the new ‘moral method’ of treating lunatics. Rest, work and rewards for good behaviour would soon coax their patients back to health.

A Victorian Lunatic Asylum, circa 1900 (Copyright Michelle Higgs)

Visitors to Victorian England who want to get admitted to an asylum will need to:

•    Have depression, manic-depression, psychosis, or epilepsy
•    Get classified as an ‘idiot’ or ‘imbecile’ – in other words, have a developmental disorder or learning disability, such as Down’s syndrome
•    Be an elderly person with dementia
•    Be an alcoholic or drug addict
•    Contract syphilis. Wait until it infects your brain and nervous system, giving you delusions of grandeur, psychosis, and gradually paralyses you
•    Contract ‘puerperal fever’ in childbirth, from poor hygiene. This can lead to temporary insanity. The good news is you’ll probably recover within 6 months, and be able to go home again

The Asylum for Criminal Lunatics, Broadmoor (courtesy of Wellcome Images)

Once you’re inside, you can enjoy some of these wonderful activities:

•    Look at the view – most asylums were in the countryside as a lovely view was thought essential to recovery
•    Do some therapeutic gardening – asylums were largely self-sufficient communities where staff and patients worked together to produce most of their own food
•    Learn new craft skills – asylums had workshops including upholsterers, tinsmiths, cobblers, tailors and bakeries so there’s plenty of scope for hipster hobbies!
•    Sew your own clothes. Female patients at Broadmoor in 1864 hand-sewed an astonishing amount of clothes and household linens, including 1138 shirts, 197 dresses and 270 bath towels!
•    Catch up on some reading – asylum wards were well-furnished with libraries
•    Become a card sharp – in the days before television, patients spent a lot of time playing cards
•    Have a knees-up around the old Joanna – the women’s wards were sometimes furnished with pianos
•    Join a band – or a sports team, choir, or amateur dramatic troupe. For the exhibitionists in asylums, there was plenty of scope for showing off their skills to others. Boules and cricket were the preferred sports, but football was usually banned for being too violent
•    Enjoy some seriously hip entertainment. Troupes of actors, magicians, singers, bands and vaudeville acts played on the asylum circuit. Variety shows with sentimental and comic songs were popular, as were short one-act farces. You’d pay a fortune for that kind of entertainment in London’s trendy East-End bars nowadays!
•    Indulge in some carb-loading. A typical asylum patient had bread and butter for breakfast, a dinner of 4oz of meat, 12oz of potatoes, fruit pie or suet pudding, unlimited bread, and ¾ pint of beer. Four times a week, some of their potatoes were swapped for seasonal vegetables. Tea was bread and butter again. You wouldn’t get your five a day, but you certainly wouldn’t be hungry!

Somerset County Asylum Patients at a Dance (courtesy of Wellcome Images)

When you’ve seen enough and want to leave, you’ll need to convince the superintendent that you’re perfectly sane and not likely to relapse. Work hard, do what you’re told, and engage in rational conversation, and you could be released within a year! Just don’t mention that you’re from the twenty-first century…

Thanks, Kate! I’m sure it would be fascinating to visit a Victorian lunatic asylum but I think I’d prefer to do it as a day visitor… For more details on Victorian asylums, mental health history and musings on other historical subjects, visit Kate’s excellent blog at Kate Tyte Writes.

VICTORIAN HOSPITALS: THE OUT-PATIENTS’ DEPARTMENT

In the UK, we often take the NHS for granted. Everyone, regardless of background or income, can receive medical or surgical treatment if they need it without having to worry about whether they can afford it.

Imagine, then, how different it was if you lived in Victorian England. Back then, it was your social class which determined the type of healthcare you could get. The wealthy upper classes paid for private medical treatment at home or, later in the nineteenth century, in a practitioner’s consulting room. The middle classes might also pay for their treatment, perhaps at one of the increasing number of specialist hospitals, or through a general practitioner or dispensing chemist.  

‘Awaiting Their Turn: In the Out-Patients’ Department at St Bartholomew’s Hospital drawn by Frank Craig (The Graphic, 3 August 1907)
Workers earning a regular and sufficient income could make weekly contributions to a ‘sick club’ or other providential scheme, but the benefits rarely extended to their wives or families. The working classes who were just above the poverty line were eligible for free treatment from charitable general hospitals or dispensaries.  The abject poor who were receiving poor relief were refused admission to these hospitals and their only option was to seek treatment at the workhouse infirmary.
 
The out-patients’ department of a Victorian general hospital was very like today’s accident and emergency departments where most cases could be treated and sent home. More serious cases were admitted as in-patients. 

‘Notes at a London Hospital: Saturday Night’ (The Graphic, 27 December 1879)


When a reporter for Living London (1900) visited one of these out-patients’ departments, he described the waiting room: “The pale consumptive jostles a sturdy labourer whose bandaged head furnishes an illustration of the momentum of falling bodies; patients with rasping coughs and panting breath; patients on crutches; patients in splints, with limbs swathed in bandages; men and women, old and young, strong and feeble, are here mingled into an indiscriminate assembly.” 

Inside one of the consulting rooms, round the sides were “a number of electric lamps fitted with bull’s-eyes. At one of these a clinical assistant is examining, with the aid of a reflector fastened to his forehead, a patient’s throat, while at another a student is exploring an obstructed ear.” In the medical department “stethoscopes abound and coughs prevail; in the surgical, bandages, dressings and antiseptics are in evidence”. In the eye department, the air was “filled with a droning sound of “E, T, B, D, L, N” as the patients read aloud the letters of the test types through the trial glasses, and students, working out ‘refractions’, are seen in dark closets, throwing from their ophthalmoscopes bright, dancing spots of light on to the eyes of their patients.” 

‘Extracting a Metal Fragment at the Ophthalmic Hospital’ (Supplement to The Sphere, 16 November 1901)

Those who had been seen by a doctor emerged from the consulting room with a prescription card which they took to the dispensary. Unlike today, bottles were not supplied free of charge so patients brought their own jars as receptacles for their medicine, or bought one from an itinerant bottle-seller outside the hospital. As well as medicines, out-patients could be prescribed surgical appliances such as crutches, artificial eyes or limbs, spectacles or a truss for supporting a hernia (a common complaint amongst labourers).  


‘Notes at a London Hospital: La Queue at the Dispensary’ (The Graphic, 27 December 1879)

 

Victorian general hospitals were staffed with highly dedicated and skilled doctors, surgeons and nurses, but they were overstretched and had to work within the constraints of a limited budget. While there is a clear parallel with today’s hospitals, large numbers of the Victorian population, particularly women and children, frequently went without medical treatment simply because they weren’t entitled to it and couldn’t afford it. Thankfully, those days are long gone and today’s NHS is a more fair and just system of healthcare.