by Seth Koven
4.5. London Hospital was a grand private voluntary hospital serving East London’s impoverished and diverse population. “The London Hospital from Whitechapel Road,” E. W. Morris, A History of the London Hospital (London, 1910), 234.
Muriel’s stories about Nellie’s hospitalization offer an alternative to the self-congratulatory way in which officers of London Hospital characterized their institution. E. W. Morris, London Hospital’s longtime Secretary and Governor, published his History of the London Hospital at the time of Nellie’s hospitalization in 1910. (See fig. 4.5.) He affectionately chronicled its past and present achievements with an eye to stimulating philanthropic bequests. He paid homage to London Hospital’s modernity as both an instrument of bureaucratic rationality and a caring institution that refused to reduce patients like Nellie to mere “cases.” Morris introduced readers to the Hospital through the gratefully adoring eyes of one of its impoverished patients “coaxed back to health and happiness” whose “love” for the Hospital “is often mingled with a tenderness most touching.” He celebrated the well-oiled modern machinery of the hospital with its up-to-date systems of communication, its dazzling therapeutic technologies such as Finsen lamps and Tyrnauer baths, and its efficiency in delivering 1,200 hot dinners across eight acres of buildings. Morris extolled the “very full and careful notes … of every case treated.” “Classified and bound,” these individual case reports formed “one of the most useful medical and surgical reference libraries in the world.”27 They also document how hospital staff represented patients—including Nellie—in fulfilling their scientific and therapeutic mandates.
Much like Nellie’s body temperature, her “case” file is disconcertingly cool compared to the heat of Muriel’s rhetoric. It presents Nellie as stable and in relatively good health at the time of her admission and for the first six days in hospital. Far from hovering near death, Nellie’s doctor observed “she has been better since in Hospital.” Her once disabling pain had dissipated; her digestion and appetite were good, her urine normal. Over and over again, doctors and nurses commented on the normality of her inward and outward signs. With utter detachment, the file preserves her doctors’ evaluation of the condition of her body surfaces and orifices. Her teeth are dirty and she has two stumps in the back of her mouth; her tongue is “pink little furred;” her menstrual cycle (“catamenia”) is “always regular” but she has “slight leucorrhoea” or vaginal discharge “present” during the doctor’s physical examination. Only the report of the vascular specialist indicated conspicuous evidence of the long-term effects of rheumatic fever on her heart valves.28
The ideology of London Hospital permeated all its record keeping. In Nellie’s medical case file, she almost becomes the disease that afflicts her. She is “case no. 624, Gurney Ward, S [single]; 30 (she was nearly 34).” She presented as a classic case of rheumatic fever but she is “becoming,” her doctor notes, “Rheumatoid Arthritis type.” “Chorea when aet 12; sore throat at times. 9 yrs ago—1st attack ankles; 3 yrs ago and last year—2nd and 3rd attacks. Ankles, knees, fingers. Treated at home. 6 weeks in bed last time. 4th and present attack: 11 wks ago—in ankles, ‘chest bones’, knees, fingers, jaws, much better now.” Her P(resent) C(ondition): Knees and elbows only stiff; skin moist, Fingers wasted; Pulse, reg[ular], small.” Her case file demonstrates the Hospital’s aspiration to reduce disease—and hence Nellie as its bearer—to its scientific management. Nellie is quite literally all—and only—a diseased body.
And yet there are many moments when the case file cannot quite contain Nellie who spills out and beyond its carefully ordered pages. Nowhere is this more apparent than in the reports filed by the specialist in neurological and mental disorders. He initially described Nellie as a “somewhat nervous woman; lies quietly in bed and appears to be comfortable.” The word “nervous” appears in the notes of nearly each of the nurses and doctors who observed her; it was also the word Muriel herself used to describe Nellie as a child. On her seventh day in hospital, her doctor added an ominous new entry: “Pt very noisy now. Suffers from delusions.” The specialist in Mental Diseases decided she had become of “unsound mind”: “morose, suspicious, & delirious.” Invariably, these words signaled a patient’s removal from London Hospital to the Lunatic Ward of the Whitechapel Infirmary.29
Why was Nellie sent to the lunatic ward? It is tempting to retrospectively diagnose her condition by offering a pharmacological explanation for Nellie’s apparent change in behavior. She did receive a potent cocktail of different kinds of painkillers and narcotics including morphine; tincture of belladonna; tincture of opium; as well as a narcotic sedative and depressant, hyoscine, used at the turn of the century to relieve rheumatic pain and hysteria in women. Any one of these drugs might have induced the kind of behavior Muriel and her doctors described. She may have become disoriented by the experience of being in a hospital ward, so different from her slum flat on Brunswick Road.
We might also explain Nellie’s transfer as an outcome of the indifference of London Hospital staff except that surviving evidence strongly contradicts such a claim. Her physician, F. J. Smith—a prominent Harley St. doctor and graduate of Christ’s, Balliol, and London Hospital’s own medical school—was renowned for his work on diseases of the chest and forensic medicine as well as his passionate commitment to serving the needs of his poor patients as individuals. Smith and other medical men used their unpaid affiliations with leading research hospitals to establish lucrative private practices and collect data for publications, but by 1910 he was already a wealthy man and highly respected clinician.30 If the drugs administered to her triggered Nellie’s removal to the lunatic asylum, it was also a function of how the hospital allocated its scarce resources and managed its patients’ bodies. Within the medico-administrative logic of London Hospital, which tabulated the precise number of articles washed each week—55,061 for the week ending March 8, 1910—restless patients simply demanded too much time and attention from busy ward nurses and orderlies.31 (See fig. 4.6.) They needed to be sent away.
4.6. Matron Eva Luckes’s careful weekly accounting of every piece of laundry in the entire hospital reflected the institution’s commitment to economies of scale and accountability. Eva Luckes, Ward Notes, March 3–8, 1910, Matron’s Log Book, LH/N/6/13. (Copyright of The Royal London Hospital Archives.)
Nellie’s doctors and nurses at London Hospital were capable of distinguishing a delirium induced by fever or temporary incoherence caused by drugs from severe mental illness; but they lacked the resources to care for patients suffering from any of these conditions. The Hospital had no mental disorders ward. Nellie entered the Hospital as a case of rheumatic fever. She exited it—against her will but perhaps also because she exercised her will—when the medical staff described her as a case of mental disorder.
Nellie’s removal to the Whitechapel Lunatic Asylum was much more than a shift from one therapeutic-disciplinary institution to another. It meant her reclassification from a charity patient at a private voluntary hospital to an involuntary inmate as a pauper lunatic ward of the state.32 Poor Law infirmaries and asylums emerged from the 1860s onwards out of sheer necessity. Crusading medical journalists like Dr. Ernest Hart (Samuel and Henrietta Barnett’s brother-in-law) had shamed workhouse officials by publicizing egregious cases in which sick paupers had died because they had failed to receive medical attention.33 These institutions remained notoriously underfunded and understaffed even as they emerged as the de facto system of hospitals for most poor people in England. Admission to the lunatic ward was itself a complicated process, which must have left little time for medical staff to provide care for their patients. The admitting Poor Law medical doctor interviewed each patient, assessed her physical and mental condition, and communicated directly with a nurse from the medical ward who had recommended transfer.
The certification forms of the Whitechapel lunatic ward tersely summarize the results of these interviews. They chronicle the 23-year-old Jewish man who was
absolutely certain he was going to marry Baron Rothschild’s daughter and the Indian immigrant who claimed that he was a Bengal prince, come to Britain to demand that Queen Victoria (dead for several years) return his kingdom to him.34 They constitute a remarkable archive not just of profound mental illness but collective cultural fantasies and reparative longings of the outcast poor. Admission to the Whitechapel lunatic ward generally required speaking with family members—clearly something that did not happen in Nellie’s case. Perhaps this explains why the form certifying Nellie’s admission as a lunatic has not been preserved. The staff at London Hospital and the Whitechapel Infirmary may well have decided it was best to destroy the records chronicling the consequences of Nellie’s “captivity.”
Nellie’s physical collapse in March 1910 marked the end of her two decades as an independent wage-earning factory worker. It left her economically insecure and vulnerable. It required her to rethink who she had once been even as it also allowed her to imagine in altogether new ways who she might become. For all their profound differences in tone and intent, “From Birth to Death” and Nellie’s medical case file can both be read as narratives of exhaustion. Just as Nellie’s doctors noted her “wasted” left hand, so too she was spent, used up. In an almost shockingly literal way, Nellie, the factory hand, had lost full use of her hand. Much like a piece of obsolete equipment, she had imparted a minute fraction of the total value of her hand into each of the millions of matches she had stuffed into matchboxes—exactly one hundred fifty at a time—twelve hours a day for twenty years for her employers, R. Bell and Company. Her value dispersed into commodities, she retained none for herself. Nellie could no longer support and understand herself through the labor she had performed so well for so long. She grasped an opportunity to redefine who she was by deepening her ties with Muriel and her ambitious schemes in Bromley-by-Bow.
“YOU DON’T LOOK NEAR SO WELL REALLY”
In the summer of 1916, Muriel suffered a debilitating breakdown of body, mind, and spirit. Her breathing was jerky, her heart missed beats and then raced furiously. It was an unpropitious time for her to be laid up at the Grange, her parents’ lovely Loughton home. Kingsley Hall, the Christian revolutionary people’s house and community center that she, Doris, and Nellie had founded in wartime Bow in February 1915, was still in its infancy. Hostile neighbors suspected that the Hall’s pacifist-feminist residents loved their German enemies better than their countrymen. Who would tend to Muriel’s evening clubs and classes, the women’s suffrage kitchen serving cheap nutritious meals, her public ministry, and her various antiwar campaigns? For eight tedious months, she consigned herself to her doctors’ care in the expectation that swallowing their medicines and obeying their orders would cure her. The family doctor, no doubt intent to curtail her activities in Bow, prescribed rest at home in Loughton supplemented by long solitary walks—“four hours if possible”—in Epping Forest.35 An expensive masseuse came twice weekly to relax her tense muscles and nerves. Nothing worked and she fretfully contemplated a circumscribed life of semi-invalidism. If Nellie’s “wasted” hand signaled her exhaustion as useable manual labor in the industrial workplace, Muriel, it seems, had likewise depleted her psychological and physical reserves. Much like “riding the rims” of a bicycle with flat tires, she had “liv[ed] on my nerves” and worn them jagged and raw.36
It dawned on her one afternoon in 1917—or so she claimed—that “there could be no respite from my struggle until I had somehow discovered how to harness my own puny, unreliable spirit to the Eternal Spirit.” She came to see her illness as rooted in her disharmony with God’s love, in her cultivation of pride, scorn and anger rather than opening herself to God’s re-creative spirit.37 The spiritual technology she devised for healing herself she called her “Prayer of Relaxation.” It required a full hour each day of complete solitude and uninterrupted silence.
Muriel’s Prayer eclectically combined physiology and psychology with Christian prayer, yoga-inspired meditative practices, and autosuggestive techniques.
I stretched myself out on my back concentrated on the nerve plexus at the back of the waist. Then I relaxed my muscles. This was no easy task, for I certainly had been seriously ill. I loosened my finger muscles and spread out my hand as though it were the model for an artist; made the whole arm relaxed, loosened, so that when it was raised, it fell heavy and inert … then the same with the toes and the feet … and the face muscles … I would listen to my own breathing, noticing it, how regular it had become, and as I listened it became slower … now the artificial stimulus [of daily life] was withdrawn and the nerves were recovering their tone. The tiredness was gradually transformed into deep restfulness, until I could say to myself, not in words, but in my mind, “With every breath I draw, I am breathing in the very breath of God.” These life-giving exercises I continued indefinitely until my whole being seemed to be enveloped by a great sense of peace….38
What precipitated Muriel’s breakdown? Why did she find her way out of allopathic medicine with its biomedical “cures” for “disease” to the power of God’s restorative Spirit with its promise of transformative “healing” in the name of “health”?39
Muriel is my chief informant about her own breakdown. In a typescript account of her illness, which Muriel entitled “1916-Very Early a/c of finding the Prayer of Relaxation,” she linked her collapse to Bow and Kingsley Hall.40 She began to feel “funny,” she recalled, eighteen months after the Hall’s founding in February 1915. In the margins, she made this connection even more explicit. “I was just over 33. Work at K.[ingsley] H.[all] kept expanding. Trustees, lawyers, accountants & banking accounts and a lot of voluntary help and public life—were all new to me and I became pale and wan looking.”41 Muriel recycled an explanation that had served well several generations of high-strung public men in Victorian Britain like the great Free Trade Liberal John Bright; she had worked too hard doing “men’s” work for the public good.42 The cause of her affliction was her affliction: selfless overwork.
No sources survive showing Muriel through the eyes of her doctors and nurses, friends and family members, with one important exception. Nellie had a great deal to say about Muriel’s body and health. It was among her favorite topics. Her letters indicate that Muriel battled various health woes almost continuously from 1910 until her breakdown in 1916–17. Muriel’s collapse had been long in coming and fulfilled Nellie’s worst fears about her “closest friend on earth.” On Valentine’s Day 1912, Nellie enjoined Muriel to “ly on your back & scribble it [a letter to Nellie] & then I shall know you are resting your back.”43 Six months later, Muriel’s back troubles still worried Nellie. Directly addressing Muriel and then responding to her own question, she “wondered if you were all quite well … how is your back I hope it is better.”44 In an undated letter probably written in December 1912 as Muriel and her brother Kingsley escaped the London damp and cold, Nellie seemed to endorse one of Muriel’s favored explanations for her ill health: “don’t work to[o] hard you are losing all your flesh you don’t look near so well really.” Nellie believed that Muriel’s labors “tramping” around “dirty old Bow” weakened her. If dirt is matter out of order, Muriel, by virtue of her ladylike cleanliness, was a body out of place in Bow. It was also where Nellie most wanted her to be.45
Muriel refused to see herself as that familiar fin-de-siècle figure of degeneration, the morbid hysterical feminist spinster.46 She must have known that she fit the bill down to its particulars. She was a feminist; she was unmarried; she was highly educated; she suffered from “nerves;” and she spent her time in the insalubrious slums of London rather than its perfumed drawing rooms. The political battle to control such women, their bodies as well as their representation, was waged at fever pitch in the decade before World War I. Through hunger strikes and public marches, feminists strategically used their bodies as weapons in their citizenship campaigns. The militant suffragette Emily Wilding Davison famously sacrificed hers for “The Cause” by t
hrowing herself to her death under the King’s horse during the Epsom Derby of 1913. Their critics as well as the British state likewise recognized feminists’ bodies as sites for articulating and enacting their own gender and social politics. Anti-suffrage artists depicted them as anorectic unwomanly witches and lunatics while the state violated their bodily insides through forced feedings in prison.47
Muriel retrospectively tried her best to foreclose such interpretations of her breakdown by advancing her own. Mind, body, and spirit were intertwined just as nerves and the heart muscle were physiologically connected. Her illness, she insisted, stemmed from her failure to keep them in proper balance.48 She eschewed allopathic medicine’s diagnostic-disease model to which London Hospital subjected Nellie. Nellie’s symptoms and case history, supplemented by clinical observations and test results, authorized medical staff to diagnose, name, and treat her disease. The structure of the hospital and the absence of a mental ward materialized its separation of mental from physical illness. Healing mind and spirit had no place in its delivery of up-to-the-minute allopathic medical services to the London poor.
The span 1916–17 undoubtedly marked a period of acute crisis in Muriel’s life, a slough of despond worthy of a modern pilgrim’s impeded progress. However, her own testimony—published and unpublished—suggests that neither her breakdown nor her ideas about the healing power of God’s love simply “dawn[ed]” on her in February 1917. As with so much of Muriel’s writing about turning points in her life, she produced many versions of this story, each with different details, each suggesting slightly different chronologies.
The origins of Muriel’s shift from allopathic medicine toward spiritual healing can be traced to the previous decade. Her Prayer of Relaxation eclectically drew upon early twentieth-century transnational conversations about spirituality, the body, health, and disease. During the interwar years, Muriel importantly contributed to these exchanges as a celebrated lay preacher, pacifist lecturer, and social worker. Before and during the war, she remained an eavesdropper—listening, observing, and borrowing from others as she saw fit.