Jane Austen's England

by Roy Adkins,Lesley Adkins

  As well as seeing private patients, some surgeons held positions in hospitals. Many of these had been established as charities in towns and cities from the early eighteenth century and were funded through public subscriptions to provide free medical care for the deserving poor with injuries and ailments.82 However, any hospital patient too ill to be cured was released, as were those with infectious diseases. When John Byng was in Northampton in 1793, he saw the town’s brand-new hospital for the poor: ‘Their new County Infirmary looks magnificently, let a foreigner travell England, and he must suppose it the land of disease and roguery; “What great building is that? That is an infirmary. What magnificent house is this? This is the county jail.” Every poor man must wish himself in one, or the other.’83

  Surgical operations in hospitals were undertaken either on the wards alongside other patients or in theatres, which were literally places of spectacle for students and visitors.84 In 1771 the surgeon John Aikin wrote about the perils of hospitals and recommended amputation for complicated fractures: ‘Every Surgeon attending a large and crowded hospital, knows the very great difficulty of curing a compound fracture in them. This is so universally acknowledged, that the most humane and judicious of them have been obliged to comply with that dreadful rule of practice, immediate amputation in every compound fracture.’85 Because he had no idea of infection, Aikin thought that the ‘malignancy of hospital air’ was to blame, because he knew that such fractures could heal successfully at home and in rural hospitals.

  Dr John Percival of Manchester gave some advice to Aikin on how to control ‘the noxious effluvia which arise from so many distempered bodies, afflicted perhaps with mortifications, carious bones, malignant ulcers, or putrid fevers’.86 His suggestions included washing hospital wards with vinegar and tar water, fumigating with the steam from boiling vinegar and tar, ventilating the bedclothes of patients who could sit up or walk about, and ‘obliging the sick to conform strictly to the rules of nicety and cleanliness’.87 He also recommended that patients should smoke tobacco:

  If any of them have been accustomed to smoaking, they should be allowed pipes and tobacco, when such an indulgence will not be injurious to them. The patients should have their linen very frequently renewed, and their shirts and sheets should be fumigated with frankincense, before they are used. The dressings of foul ulcers, &c. as soon as they are removed, should be thrown into vessels of vinegar, and carried out of the wards with all convenient expedition.88

  For the poor, there were also charitable hospitals that provided specialist care, such as the lying-in hospitals for pregnant women and a few lock hospitals for venereal disease.89 Eye hospitals were established as a direct result of the contagious ophthalmia brought back from Egypt, and the first one opened in 1805 in London (which is now the Moorfields Eye Hospital). Other specialist institutions included the lunatic asylum and madhouse, which imprisoned those regarded as insane, including sufferers from conditions like epilepsy, post-natal depression and dementia. Whatever their illness, they were often locked away as nobody knew what else to do. As Aikin said in 1771, ‘besides their own sufferings, they are rendered a nuisance and terror to others; and are not only themselves lost to society, but take up the whole time and attention of others’.90

  Private madhouses, some very small, were intended for patients whose families could afford to pay. Pauper lunatics might also be put in these private madhouses if their fees were paid by the parish, but more likely they were confined in poorhouses or workhouses, as described by Holland in Over Stowey:

  The man in the workhouse is chained and lies upon straw, shocking situation – Alas! poor human nature. How many afflictions art thou liable to…Went to the messrs Riches this evening about the madman in the workhouse, both determined to join in sending him to the madhouse in Bristol, be the expense what it will. Eh, says James [Rich], Master Holland I reckon it be a bad business. He is a very bad fellow there is something in it more than madness I count. In short, James thinks…that he is possessed by the Devil or bewitched.91

  It was commonly believed that lunacy was due to evil or to an imbalance in the body’s humours, for which William Ricketts, a surgeon who had run a madhouse at Droitwich in Worcestershire for twenty years, undertook purging:

  When a patient is brought…I generally found depletion necessary, if the Lunatic is violent; I afterwards have him cupped; and the first thing I do is to empty the stomach and bowels by small doses of emetic tartar, or to purge them briskly with calomel…I believe the disease to proceed most frequently from a derangement of the digestive organs…In the majority of females between the ages of fourteen and forty, I think, it arises from a sexual cause.92

  He was also convinced that too much hair was harmful: ‘I conceive in all cases of excessive mania, there is too great a determination of blood to the head, and that the head ought to be kept as cool as possible, the head being loaded with hair, that must increase the heat.’93

  Conditions in madhouses and asylums were often no better than those of prisons, though humane treatment and good intentions were evident, with a gradual shift from confinement towards cure and care. Even so, lunatics were commonly shackled or kept in straitjackets. Some charitable asylums existed, and the most famous institution was Bethlem (‘Bedlam’) Hospital at Moorfields, which accepted lunatics from the entire country. At Newcastle-upon-Tyne a charitable hospital for pauper lunatics was opened in 1767, but the ‘chains, iron bars, and dungeon-like cells, presented to the unhappy inmates all the irritating and melancholy characteristics of a prison…Many of the cells were close, dark, cold holes (less comfortable than cow-houses)’.94 Its physician was Dr John Hall, and he also ran a private madhouse that claimed to offer humane treatment. One advertisement appeared in the Newcastle Courant in May 1774:

  Dr Hall’s Private House for Lunatics, Known by the Name of St LUKE’s HOUSE. DIET, WASHING, and LODGING, for lunatics, at 20l. a year, or 8s. per week, or less where the circumstances of the patient require the expence to be made still more moderate. This house has been universally admired for its healthy, pleasant situation; as also its conveniences for the accommodation of boarders…The greatest care will be taken of all Patients intrusted to him.95

  In 1774 an Act for regulating private madhouses was passed, requiring them to hold a licence and for two doctors to sign a certificate, so as to stop wrongful confinement. In 1808 the County Asylum Act also allowed Justices of the Peace to levy a rate for the establishment of publicly funded asylums for pauper and criminal lunatics, in order to remove them from the workhouses.96 After the General Lunatic Asylum opened in Nottingham in 1812, John Blackner congratulated those responsible, who ‘very early saw the necessity of an asylum for the wandering, half lost, and sometimes wholly neglected maniacs…These humane and praise-worthy gentlemen could not see their fellow creatures, clothed in rags, or half naked, when deprived of their reason, parading the streets, the sport of coxcombs and thoughtless boys, without being painfully struck with the sight.’97 However, few new county lunatic asylums were built over the following decades.

  A House of Commons Select Committee in 1816 revealed the dreadful conditions in licensed madhouses in England. William Ricketts of the Droitwich madhouse gave evidence of the gulf that existed between the rich and the poor, even in lunacy:

  I think about one half [of about eighty-five inmates] are paupers…I have accommodations according to the different classes; according to their pay; patients of a superior class pay, some four guineas a week, some three, some two and a half, some two, some a guinea, and fourteen shillings a week pauper Lunatics, except the town of Birmingham, they pay only ten shillings, and the major part of the pauper Lunatics are from the town of Birmingham…we have different sitting rooms for the different classes…the pauper Lunatics are taken out by my men-servants and work in the garden…Patients of the superior orders amuse themselves at cards; some of them are musical; they have a piano-forte; one lady plays and sings most admirably.98

 
The previous year, 1815, a new Bethlem Hospital (now home to the Imperial War Museum) had opened at St George’s Fields. Conditions were not ideal at this new building, and because Ricketts had seen this new hospital only the month before, the Select Committee cross-examined him: ‘Do you remember that in the old gallery in Bethlem [at Moorfields] many of the patients were chained round a table on the left-hand side, almost in a state of nudity?—Yes, I do. There is nothing of that kind now?—No, they are better covered now. There are several patients in what is called the dirty room.’99 Mrs Elizabeth Forbes, the matron in charge of female patients, was also questioned by the committee:

  Do you consider the patients in the basement story to have suffered from the damp?—They have had bad colds, and have been rather unhealthy this winter.

  Have you lost any patients in that story this winter?—Yes, Four…

  What were the circumstances of the four deaths which have taken place?—It was from cold.

  What were their ages?—None of them were under forty; one was eighty years of age, the other three between forty and fifty.100

  Many elderly people who were treated as lunatics probably had dementia, but most old people were obliged to work for as long as they could, rather than being rewarded with retirement: ‘I met old John French on the road hard at work, tho’ 83,’ William Holland noted in his diary in April 1813.101 State aid for the elderly consisted of relief given by the parish, which all too often meant going to live in the workhouse. In 1795 at Petersfield in Hampshire, Frederick Eden reported: ‘22 persons, (mostly old women and children,) are at present in the work-house: they are, principally, employed in cleansing the streets.’102 Apart from the Chelsea Hospital, which supported some old soldiers (‘Chelsea Pensioners’), and a similar Greenwich Hospital for old naval seamen, the workhouses and some charitable almshouses were the only institutions providing for the elderly.

  Most workhouses were inadequate and badly run, and the poet George Crabbe bitterly condemned them in ‘The Parish Workhouse’ (part of his long poem The Village, published in 1783). He pointed out that people who were comfortably off had no idea of the deprivation and loss of pride, dignity and hope suffered by workhouse inmates. John Byng set down his own compassionate vision of an ideal place for the elderly to live:

  As for the very aged, and helpless, I should revert to that good, old (now neglected,) Custom of Alms Houses…therein I should place 12 of the most pitiable and deserving aged poor, with each their several slips of garden ground; where such as were able might employ themselves: before their doors, a shady walk of trees fronting the south, with some benches, would tempt forth the, not unhappy, lodgers, to bask in a summer’s sun, or to endeavour at a winter’s walk. Is not this a reasonable, a cheap, an heartfelt satisfaction?103

  For elderly paupers, Crabbe wrote, their only escape from the workhouse was death:

  Up yonder hill, behold how sadly slow

  The bier moves winding from the vale below;

  There lie the happy dead, from trouble free,

  And the glad parish pays the frugal [burial] fee.104

  Whatever the cause of death – perhaps illness, childbirth, accident, old age or execution – it was not necessarily a case of resting in peace, particularly for the poor. In some parts of the country, especially those within convenient distance of a medical school, bodies were in danger of being stolen immediately after burial. Anatomists (who were usually surgeons) in the private medical schools and teaching hospitals were always desperate for corpses to dissect in front of students and for their own research. Not enough corpses could be acquired through legitimate means (only a few bodies of executed criminals), and the Government was reluctant to draw up a Bill for the proper provision of bodies, as happened on the Continent. Cadavers were therefore bought from bodysnatchers, and surgeons knew exactly what was happening. It was an abhorrent trade, but one without which medical advances would not have happened.

  Some corpses were stolen from their coffins before burial, but most were robbed from graveyards soon after a funeral when the soil was loose and the body relatively fresh. Graverobbers, or bodysnatchers, chose dark nights, without the light of the moon, and their work was so skilled that graves would look undisturbed. Even where thefts were noticed, records of such crimes seldom survive. Pauper bodies were preferred, as their graves were more shallow. Because of decomposition and the overpowering stench, corpses were useless for the anatomists after a few days.

  Bodies were sometimes shipped in casks to the capital from elsewhere in the country or else were sold to anatomists in places like Bristol and Manchester, but the heart of the trade was London – from October to May, when the private anatomy school classes were running. A satirical piece, published in the Morning Post newspaper at the start of the classes in October 1811, claimed to be the minutes of a general meeting of the guild of bodysnatchers who were worried about their profession:

  ADVERTISEMENT EXTRAORDINARY.

  At a general meeting of the Gentlemen in the resurrection line, vulgarly called ‘body snatchers,’ ‘dead carcase stealers,’ &c. held at their hall the Bonehouse, Rotten-row, in the parish of St. Sepulchre, Gravesend.

  Dick Drybones in the chair,—it was resolved unanimously

  That as anatomy is the end of physic, all those who contribute to the study and improvement of that noble science, are entitled to public support and the most liberal remuneration.

  That of late certain persons not regularly brought up to the profession, have tried to introduce the practice of seizing dead bodies previous to their interment, to the great injury of the industrious members of this right worshipful fraternity.

  That this assembly can view such conduct in no other light than as being illegal, and as a scandalous outrage of the rights and privileges of this community.

  That persons concerned in such practices be forthwith scouted [scorned], unless they chuse to become regular members, paying the usual introductory gallon of gin, as also a forfeit of five shillings, to be spent in bread, cheese, and porter.

  That in consequence of the effect of the Comet on the weather, they have been unable to commence their season in the present year, till the close of October.

  That through the circumstances above stated, they are in such distress, they scarcely know how to keep soul and body together, and consequently feel it incumbent upon them to charge an extra guinea for every subject.105

  The imaginary meeting also urged physicians not to increase the price of physic, or medicines. The logic of this statement was that knowing the harm caused by most medicines, if the amount taken by patients decreased, then the number of deaths would be fewer and the graverobbing business would suffer. These so-called minutes concluded: ‘(Signed) DICK DRYBONES, PAUL PUTRID, MAT MARROWLESS, KIT COFFIN, TOM TOMBSTONE, VALENTINE VAULT, KICKUP RESURGAM, Secretary to the Meeting.’106

  The graverobbing business was actually thriving. In his diary for the years 1811 and 1812, Joseph Naples recorded details of his gang’s activities – taking orders from surgeons, raiding graveyards, delivering corpses and collecting payment. On 7 December 1811, a few weeks after the satirical piece in the Morning Post, Naples noted: ‘At night went out & got 3 at Bunhill Row. 1 St. Thomas’s, 2 Brookes’107 – this meant that he had stolen three bodies from the dissenters’ burial ground at Bunhill Fields or possibly the nearby Quaker burial ground, one of which was taken to St Thomas’s Hospital for dissection, and two were sold to Joshua Brookes.

  A month later, Naples wrote: ‘At 2 A.M. got up, the Party went to Harps, got 4 adults and 1 small [child], took 4 to St.Thomas’s. Came home, went to Mr. Wilson & Brookes. Danl. [Daniel] got paid £8 8 0 from Mr. Wilson, I recd. 9 9 0 from Mr. Brookes. Came over to the borough [Southwark], sold small for £1 10 0, Recd. £4 4 0 for adult. At home all night.’108 James Wilson taught anatomy at the Great Windmill Street Anatomy School, which he had founded, and Joshua Brookes ran another anatomy school on Great Marlborough Street, which he advertised in ne
wspapers across England, as in the Leicester Journal in January 1812:

  THEATRE OF ANATOMY. BLENHEIM-STREET, GREAT MARLBOROUGH-STREET.

  The Spring course of Lectures on Anatomy, Physiology, and Surgery, will be commenced on Monday, the 20th of January, at 2 o’clock,

  By Mr. BROOKES…Spacious apartments thoroughly ventilated, and replete with every convenience, are open all the morning, for the purposes of dissecting and injecting, where Mr. Brookes attends to direct the students, and demonstrates the various parts as they appear on dissection…Gentlemen established in practice desirous of renewing their anatomical knowledge, may be accommodated with an apartment to dissect in privately.109

  Some of the London corpses were even packed up and sent to Edinburgh for dissection in the medical schools there, and on 5 December that same year Naples recorded: ‘packing up for Edinboro, sent 12 to the wharf for the above place, at home all night’.110 This was more than a decade before the infamous Burke and Hare murders would supply the anatomists in Edinburgh with bodies. It was only in 1832 that the Anatomy Act was passed to provide an adequate, legal source of cadavers for dissection.

  TWELVE

  LAST WORDS

  Everybody had a degree of gravity and sorrow; tenderness towards the departed, solicitude for the surviving friends; and, in a reasonable time, curiosity to know where she would be buried.

  Emma, by Jane Austen

  The service for the burial of the dead in the Church of England prayer book contains the line ‘In the midst of life we are in death’,1 and this was the everyday experience of Jane Austen’s contemporaries, especially when sudden, unexplained deaths occurred. In May 1793 Parson Woodforde was shocked to hear bad news from a friend: