by Seth Koven
TAKING NELLIE’S TEMPERATURE
Let me begin with a story about Nellie’s suffering body.
In December 1909, Nellie Dowell recognized the steady advance of her old enemy, rheumatic fever. Her ankles, fingers, jaws and, “chest bones” ached. Her breathing was labored; her mobility impaired. She was no stranger to illness. Not long after leaving Forest Gate Industrial School, fever had wracked her small body and her limbs had jerked involuntarily to the dance of St. Vitus. Her mother Harriet brought her to the Poplar and Stepney Poor Law asylum hospital where she remained five weeks recovering from chorea, a common streptococcal infection.7 (See fig. 4.1.)
Victorian doctors could do little to prevent the chorea’s inevitable sequelae: rheumatic fever and mitral valvular degeneration.8 Widely perceived as a pathological by-product of urban poverty, rheumatic fever struck Nellie in 1901 and returned in 1906 and 1908.9 During the catastrophic attack of 1909–10, she initially responded well to bed rest over the Christmas holidays. However, eight weeks later, her condition worsened and her doctor insisted her survival depended upon rushing her to the great hospital of East London. She “hovered between life and death” and slipped into incoherence and semi-consciousness. Sometimes she raved; but at other times she was as “quiet as a tomb.”10
4.1. “Poplar and Stepney Sick Asylum,” Illustrated London News, December 2, 1871, 299.
At least this last part was how Muriel told the story after Nellie’s death in 1923. Nellie’s hospitalization figures prominently in Muriel’s two typescript biographical fragments, “From Birth to Death” and her published homage to Nellie, “The Salt of the Earth.” London Hospital, East London’s world-renowned voluntary teaching hospital and medical school, is approximately two miles—the distance Muriel specified in her story—from Nellie’s South Bromley home. Its Admission and Discharge register confirmed that she went there. Nellie spent eight days in London Hospital from March 3 to March 11, 1910 when orderlies transported her to the lunatic ward of the Whitechapel Poor Law Infirmary.11 The staff of London Hospital generated an impressive array of documents detailing her past and present condition, her outside and inside, as well as their efforts to treat and represent her disease. They measured the output of her urine and observed its color; they mapped the sounds of her chest and logged the rate and strength of her pulse. Twice daily, Nellie’s nurses took her temperature and recorded it on a graph—with a dotted line indicating “normal” at 98.6 degrees.12 (See fig. 4.2.)
Nothing about Muriel’s accounts of Nellie’s hospitalization prepared me for the seemingly incontestable “facts” of her vital signs. Her body temperature never went above 99 degrees at any point during her hospitalization. She never had a fever (the nurse entered “T. normal” on her chart). Of course, very sick people often don’t have fevers. But none of the other measures of her bodily functions suggests that she was in the throes of a life-and-death crisis when she arrived at London Hospital. In fact, at least one doctor’s note suggests that her condition was improving and that she was not even suffering from an acute case of rheumatic fever at the time of her admission. (When a historian of British medicine, Dr. Fredric Mintz, himself a former cardiologist, reviewed Nellie’s medical file for me, he could not understand why she had been admitted in the first place.) Only on the day before her transfer to the lunatic asylum did she spiral into an acute morbid condition: her body temperature plummeted, she vomited twice and she became “restless.” Muriel’s narratives and Nellie’s London Hospital case records—and the stories about Nellie Dowell and London Hospital, health and disease, the body and interiority they so tersely summarize and enable—form an essential part of my analysis.
4.2. “Temperature and Urine chart” from Dr. F. J. Smith, Medical female patients’ case notes, 1910, RLHLH/M/14/65. (Copyright of The Royal London Hospital Archives.)
Nellie Dowell’s hospital case report is very ordinary. Nothing distinguishes it from hundreds of others filed under the name of her attending physician, F. J. Smith.13 What makes them extraordinary to me is that they are Nellie’s. Much like the significance of an old photograph of people we have never met, the value of Nellie’s medical case report derives from knowing it is hers. Nellie Dowell’s medical case record moves effortlessly across registers as it folds the singular into the general, the idiosyncratic into the exemplary.14 It straightforwardly documents a “case” of rheumatic fever—an abstractable set of physiological measurements (person X evacuated Y urine on Z day) and formulaic observations (“skin moist”) disciplined into categories, charts, and codes ready for London Hospital’s doctors to transform into data for their medico-scientific studies.
Nellie’s London Hospital medical file is so brazenly invasive in reporting the condition of her interiors that my exhilaration at finding it was tempered by discomfort at reading it. Had Nellie Dowell, that perpetually obscured object of my historical sleuthing, come too sharply into focus? Nellie’s letters to Muriel are arguably more private and intimate than her medical records. And yet in reading them, I felt no sense of violating an imagined ethical boundary protecting the defenseless dead’s encounter with the historian. Why? Let me gesture at a key difference. Archives bear the embedded histories of social and institutional relations that enable and haunt their production and preservation. Nellie wrote her letters as an affirmation of self, an act of will; Muriel kept them as tokens of their love. Produced by the hospital, her medical case file chronicled the breaking down of her personhood and makes no apology for its profoundly non-consensual denouement. The hospital kept her file and tens of thousands of others like it for use in medical research.
The tensions between abstraction and embodiment, the impersonal and the too-personal animate my attempt to reconstruct Nellie’s medical crisis in 1910 and explore its historical and methodological significance. Muriel’s stories about Nellie and the supposedly scientific facts of her medical record are densely sedimented sources, which contain the perspectives of many different people. “From Birth to Death” is narrated mostly through Harriet Dowell’s eyes and includes “direct quotations” of Nellie and her mother in Muriel’s improvised Cockney vernacular. Muriel based much of what she wrote about Nellie’s hospitalization on information she could have learned only from Harriet and Nellie themselves. Harriet and Nellie were also her physicians’ chief informants about her past medical history. The medical case report includes notes by various ward nurses as well as five different doctors—the admitting physician, her attending physician, and specialists in vascular, rheumatic, and nervous disorders.15 All of these texts are not only multi-voiced, but in some ways they are also multi-authored, albeit in not quite the same way.
“From Birth to Death” informs us that Nellie’s hospitalization and involuntary confinement left her in a catatonic state for several months. Only after discovering Nellie’s hospital records did I realize that she penned the first of her loving letters to Muriel in November 1910 just as she began slowly to recover from the trauma of her hospitalization. Nellie’s illness and its immediate aftermath allowed Muriel and Nellie physical and emotional proximity that redefined the nature of their relationship. If illness precipitated their intimacy, it also gave Nellie a recurring topic in her letters as well as a language of love with which to address “Dear Miss Lester.”
NARRATING NELLIE
Muriel wrote all three of her stories about Nellie in 1923, sometime after Nellie’s death in late January 1923. By that time, she had become a vocal critic of modern allopathic biomedicine, with its drugs, invasive technologies and body disciplines. She also had assumed a seat on the Poplar Borough council in 1922, which had grabbed headlines across the English-speaking world in 1921 by defying a court order to pay compulsory rates to defray administration costs of metropolitan government. Led by Muriel’s friend George Lansbury, the Poplar Rate Strike of 1921 was part and parcel of the borough council’s adoption of a radical program of economic and social justice. Its planks included equal pay for men and
women; a generous minimum wage for municipal workers; and a call for equalization of “rates” across London to relieve the tax burden of poor districts like Poplar. The government’s decision to send the councilors to prison backfired: their physical sufferings only added a glow of martyrdom to their principled stance. The death of George Lansbury’s daughter-in-law, the Labour councilor Minnie Lansbury, a short time after her release from prison, accentuated awareness of state violence against those seeking justice for workers and the poor at home and abroad. Prison had broken Minnie Lansbury’s body, not her mind or spirit.16 Muriel replaced Minnie Lansbury on the Poplar Council. She headed its Maternity and Child Welfare committee, which demanded extensive publicly funded services for mothers and their children.
Given Muriel’s political commitments in 1923, it is hardly surprising that she cast Nellie’s story as an example of the failure of private philanthropy and institutionalized allopathic medicine to address the root cause of Nellie’s infirmities: her poverty. Nellie’s doctor repeatedly warns her mother to give her daughter something more nourishing than tea and something warmer than a mesh cotton blanket. The doctor grows more frustrated as Mrs. Dowell appears to ignore his pleading. Like so many other well-intentioned outsiders, the doctor perceives Mrs. Dowell through deeply embedded assumptions about working-class mothers’ feckless domestic economy. Muriel shifts to Mrs. Dowell’s perspective and by so doing blasts those who would implicitly blame East London’s poor mothers for failing to care for their children. “But always Mrs. Dowell’s pride forbade her to tell him it was not only rheumatic fever that Nellie was suffering from, but also, and just as acutely, poverty. He might have put two and two together and guessed that, she [Mrs. Dowell] thought.” Muriel characterized such blinkered responses to poverty (the inability to “put two and two together”) as a form of “economic imperialism” that deformed bourgeois perceptions, including her own, of the stark economic choices confronting the poor.17 Elsewhere, she called this “the foolish innocence,” which is subsidized by wealth and ease.18
Deploying tropes of depth and surface, Harriet Dowell critiques modern medicine with its new technologies of interiority such as radiograms and Rontgen rays that purport to reveal truths secreted within the body. “But there people who could look into a locked up box as it were and describe to your face what was going on inside your chest, you couldn’t expec’ them to see the things that were right under their noses.” So too, Nellie’s philanthropic lady friends who run her evening night school and factory girls’ club “didn’t see wot was staring ’em in the face so to speak.”19 They bring Nellie grapes and flowers, rather than milk and woolen blankets. Muriel’s message—as articulated by and through Harriet Dowell—is unmistakable. The poverty of the respectable poor like the Dowells is not legible by their self-presentation. It cannot be read on their surfaces; they do not flamboyantly perform their poverty to elicit charity. Nutritious food and warmth count more than sympathy in the fight against disease. Muriel implicitly argues that only a system of health care that empowers the poor will meet their needs. Health care ought to be a social right, not a philanthropic gift.
Muriel’s account of Nellie’s time in London Hospital demonstrates a surprisingly detailed knowledge of its institutional apparatus and hierarchies. (See fig. 4.3.) “From Birth to Death” explains the circumstances that led to the supreme indignity of Nellie’s confinement in the Poor Law “mad ward” while critiquing London Hospital’s claims to balance care for individuals with managerial efficiency and bureaucratic rationality. As the reader follows Mrs. Dowell’s journey, we see the breakdown in the hospital’s complex circuitry controlling the flow of information and the disposition of bodies. When Harriet Dowell visits Nellie on Wednesday in Gurney Ward, Nellie no longer recognizes her and stares at the ceiling with “unseeing eyes.” (See fig. 4.4.) The kindly Sister in charge of the ward promises to telegraph Mrs. Dowell if Nellie’s condition worsens, but Mrs. Dowell returns on Sunday to an empty bed and understandably fears the worst. “Her head swam, her knees seemed to give way, she swayed where she stood. She felt someone collide with her and heard the matter of fact, stern voice of the nurse, ‘Steady there, Mother. Look where you’re going to please.’” This is a collision not just of bodies, but of incompatible modes of feeling and being. The nurse, “irritated by the interruption of routine which Visiting Day always caused,” demands that Mrs. Dowell not “make a scene.” But make a scene she does. She races from the officious junior nurse (presumably a probationer) to her supervisor, the regular ward nurse, whose “brisk cheery” voice “lacerates the nerves of patients;” to the Porter, who refuses to disclose any information about Nellie because to do so would violate hospital regulations.20
4.3. London Hospital had many ways of gathering information about and representing the bodily interiors of patients like Nellie Dowell. Understanding their psychological needs was not part of the hospital’s brief. Dr. F. J. Smith, Medical female patients case notes, 1910, RLHLH/M/14/65. (Copyright of The Royal London Hospital Archives.)
4.4. This photograph (c. 1923) documented the well-ordered modernity of Gurney Ward and created the false impression that staff members outnumbered patients. According to Muriel, Nellie occupied the bed in the far left corner of the ward during her catastrophic hospitalization in 1910. Gurney Ward, 1923. (Copyright of The Royal London Hospital Archives.)
Only the Sister treats Mrs. Dowell with dignity, but she too has singularly failed to live up to the panoptic demands of London Hospital’s Head Matron Eva Luckes, who expected her Sisters to know “all that goes on in a large ward.”21 Nor did any trace of the egregious breakdown in communication make its way into Luckes’ notes for the week, though she did express unhappiness with one of the nurse probationers on Nellie’s ward, Miss Elsie Marvin, who was “not satisfactory … not thorough.”22 The Sister in charge of Nellie’s ward explains that Nellie had grown so restless and violent that the nurses “had felt themselves unable to cope with her resistance” and transferred her to the “mental ward” of the workhouse.23
Muriel’s word choice is significant: Nellie is not mad, she enacts “resistance”—although precisely what Nellie resists is never clarified. Sister apologizes for the “extraordinary error” of not telegraphing, but Mrs. Dowell cannot be comforted: “The mad ward! My Nellie, gentle as a babe! Oh, if you’d only called me to sit with her.” “Sitting” with Nellie was out of the question within the highly regulated space of the late-Victorian hospital. Nurses positioned family visitors like Mrs. Dowell as sources of “hygienic and moral contamination”—not allies and partners in healing their loved ones.24
Mrs. Dowell finds Nellie in the lunatic ward, broken in body and spirit, “with her forehead pressed against the window panes, gazing out into the world of freedom, counting the bars which emphasized her captivity and with tears streaming down her cheeks.” At this point in “From Birth to Death,” the narrative voice subtly modulates. Where previously the omniscient narrator relied upon the testimony of Mrs. Dowell and Nellie, now the narrator seems to speak from her own direct knowledge. Mrs. Dowell somehow extracts Nellie from the “mad ward,” despite the fact that it is a Sunday and no magistrate is available to sign the necessary papers. No doubt Mrs. Dowell went to heroic lengths to release Nellie from “captivity.” However, the Admission Register of Whitechapel Infirmary contradicts at least one detail of Muriel’s story. Nellie was admitted on Friday morning, March 11, as a “homeless” or “destitute” “mental” patient. She was discharged to her mother on Monday March 14, not Sunday March 13.25 “For months afterwards,” the narrator of “From Birth to Death” explains, “Nellie’s friends feared for her reason. She seemed obsessed by the idea fact that for two days she had been a pauper lunatic. Almost every moment of her incarceration was relived each day. Her memories haunted her.”26
Muriel’s narrative emphasizes the extraordinary power of classification and naming on Nellie’s sense of herself. Called a pauper lunatic, she b
ecomes one. As a seven-year-old who had suffered the trauma of involuntary removal from her mother to a Poor Law orphanage from 1883 until 1888, Nellie had spent a lifetime ensuring that she would never again be subjected to the degradation of the Poor Law. She had stood apart from her friends and fellow workers in London and Wellington, New Zealand when they had gone on strike to protest her ruthless employer’s imposition of unjust wages and work conditions. She had used her exceptional skills as a match factory worker to earn steady wages and secure her economic independence and personal freedom. Keeping her job and supporting herself and her mother mattered more to Nellie than workplace solidarity. Muriel’s narrative emphasizes that Nellie was helpless to prevent the hospital and the Whitechapel Infirmary from reducing her to a condition of abject dependence. The last extant page of “From Birth to Death” literally ends mid-sentence with Nellie “inert and passive” as the Charity Organisation Society denies Mrs. Dowell relief to help pay her rent. In Muriel’s narrative, Nellie and her mother repeatedly encounter institutions and organizations—public and private—intended to succor the poor in their time of need that singularly fail to do so. “From Birth to Death” narrates Nellie’s health crisis of 1910 in a register of moral outrage, which documents the soul-destroying machinery of a not-yet-repealed Poor Law.