The treatment of the mentally disturbed in private mad-houses and public lunatic asylums was often appallingly cruel and intended to be so for the benefit of the patients. As a seventeenth-century physician observed, ‘Maniacs often recover much sooner if they are treated with torture and treatment in hovels instead of with medicaments.’7 It continued to be generally held in the eighteenth century that madmen were best controlled by beating and other methods of coercion, by being flung into baths of cold water and frequently bled and purged. At Manchester Royal Lunatic Asylum, which was opened in 1766, the treatment, so one of its doctors wrote, consisted in repeated bathing, constant dosing with opium and other drugs, ‘bloodletting … vomiting … purgatives … and calomel given until the patient’s mouth was sore’.8 Even the Rev. Francis Willis, an elderly clergyman with an Oxford medical degree who was called in to help look after George III when the king’s mind was affected by porphyria, was a strong believer in the strictest discipline. Considered by some, so Lord Sheffield said, ‘not much better than a mountebank, and not far different from some of those’ that were confined in his mad-house in Lincolnshire, Willis tied his royal patient to his bed, enclosed him in a straitjacket, stuffed handkerchiefs in his mouth to keep him quiet when he was being reprimanded, blistered him when it was considered necessary ‘to divert the morbid humours’ from his head, and doctored him with a formidable variety of medicines. He was given calomel and camphor, digitalis, quinine, and, as an emetic, tartarized antimony which made him so sick that he knelt on his chair fervently praying that he might either be restored to his senses or allowed to die.9
Public sympathy for the king helped to improve the lot of patients at the Bethlehem Royal Hospital in London, more generally known as Bedlam, where, until 1770, visitors were admitted to look at the patients many of whom were chained to cells in galleries like caged animals in a menagerie. ‘You can get a sight of these poor creatures, little windows being let into the doors,’ a visitor wrote after a visit in 1725. ‘On holidays numerous persons of both sexes, but belonging generally to the lower classes, visit this hospital, and amuse themselves watching these unfortunate wretches, who often give them cause for laughter. On leaving this melancholy abode, you are expected by the porter to give him a penny.’10
This hospital existed at the beginning of the fourteenth century as an annexe to the Priory of St Mary Bethlehem, but it probably then cared for patients suffering from general complaints, and, it was not until 1377 that ‘distracted’ patients were looked after, that is to say were kept chained to the wall by leg or ankle and when violent ducked in water. In 1547, when the priory was dissolved, the mayor and corporation bought the site from the king and re-established the hospital as a lunatic asylum. Not until the Bethel Hospital at Norwich was opened at the beginning of the eighteenth century was a new hospital built in England intended solely for the insane.11 And although others soon followed thereafter – Sophie von la Roche was told that there were 300 lunatic asylums in London alone – many insane people were kept locked up at home, like the first Mrs Rochester at Thomfield Hall in Jane Eyre and the ‘madwoman of Cwmgwanon’ who, so the Rev. Francis Kilvert was told, ‘they keep locked up in a bedroom alone, for she will come down amongst them stark naked. She had broken the windows and all the crockery … threatens to wring her daughter-in-law’s neck … Then she will set to and roar till they can hear her down the dingle … nearly half a mile [away].’12 The nurses employed to look after such people were frequently no more tender than Betsy Prig who, so Mrs Gamp tells us in Martin Chuzzlewit, ‘has nussed a many lunacies and well she knows their ways, which putting em right close afore the fire, when fractious, is the certainest and most compoging’.13
By Betsy Prig’s day, however, the treatment of the insane in asylums had become more humane; and it was generally accepted that the mentally deranged were not incurable lunatics possessed by devils but people who were ill, who could be treated and might be cured. There were far more institutions like the Retreat which Louis Simond had visited at York. This was ‘admirably managed, and almost entirely by reason and kindness: it was instituted by Quakers. Most of the patients move about at liberty, without noise and disorder.’14 Commissioners in Lunacy were established as a permanent body in 1828 and were required to visit hospitals and submit reports.15
Much mental illness, so it was supposed, was caused by masturbation which was also held to be a common prelude to self-destruction, so prevalent an occurrence that it was sometimes known as the ‘English disease’. The light-hearted referred to suicide as a joke: in 1755 an advertisement in the Gentleman’s Magazine drew its readers’ attention to a preparation called ‘Stygian Spirit’ which enabled gentlemen who found life intolerable to commit suicide even while in company without upsetting their companions. And some years later the Earl of Pembroke told a friend about a Frenchman who, having spent a long time in Salisbury, contracted the ‘English disease’ and hanged himself ‘à l’anglaise’.16 In his De l’Esprit des Lois (1748) Montesquieu devoted a whole chapter to the English habit of suicide, in which he mentioned the right which English people sometimes exercised of driving a stake through the heart of a suicide unless he could be shown to be insane at the time of his criminal act. The corpse of a London bookseller who killed his child and then shot himself in 1755 was carried off by his friends and buried secretly when a note was found placing the blame upon his creditors rather than upon his own disturbed state of mind. The Lord Mayor ordered that the body should be dug up and reburied at Moorfields crossroads with the customary stake through the heart.17
Despite the claims of doctors and quacks, no effective cure could be found for smallpox which, after the disappearance of plague, became the most feared of all diseases, particularly for children and in industrial towns.18 In one town alone 589 children died between 1769 and 1774; and in London there were 3500 deaths from smallpox in 1796.19 In earlier centuries the victims of the disease had been quite likely to recover, even though they were often scarred for life, many as badly as Mrs Seward whose disfigurement, Pepys thought ‘would make a man weep to see’. In the sixteenth century the young Richard Allington had sadly observed on his death-bed: ‘Maisters, I must needes die, which I assure you I never thought wolde cum to pass by this disease, consyderinge that it is but the small pocke.’20 But since then the severity of the disease and the likelihood of it proving fatal had much increased; and in the eighteenth century the fatality rate rose to one death in every six or seven attacks.21
In certain cases it was shown that the disease might be prevented in children and adults by placing them in contact with a person suffering from it, much in the same way that attempts were made to prevent hydrophobia by plucking a hair from a rabid dog and placing it upon the wound or getting the patient to swallow it. John Evelyn, two of whose own daughters died of smallpox, described such a case in the household of Mrs James Graham of Bagshot:
Her eldest son, was now sick there of the small pox, but in a likely way of recovery; & other of her Children ran about, & among the infected, which she said she let them do on purpose that they might whilst young, passe that fatal dissease, which she fancied they were to undergo one time or other, & that this would be the best: The severity of this cruel dissease so lately in my poore family confirming much of what she affirm’d.22
Experiments with transplanting matter from a mildly affected patient to one in need of protection were first made in Italy and in Constantinople. And in 1721, during a smallpox epidemic in London, Lady Mary Wortley Montagu, whose husband was British ambassador in Constantinople, had her little daughter inoculated in the presence of various physicians. Her son had already been inoculated in Constantinople and had suffered few ill effects. The girl, too, recovered quickly; and the doctors, impressed by the mildness of her attack and by the reports from Constantinople which had been publicized in London by Dr John Woodward, repeated the experiment with almost equal success, first upon some Newgate prisoners, who were promised repri
eves for submitting to it, and then upon charity schoolchildren. There were, however, dangers in this form of inoculation with smallpox. Not only did the induced disease occasionally take a severe course, two or three deaths occurring with every hundred inoculations, but unless the person inoculated was kept isolated the disease was likely to spread. This method of prevention was therefore rarely practised after 1728.23 A subsequent and supposedly improved method, which substituted shallow for deep insertions and usually produced a local rather than a general infection, proved to be scarcely more effective.24 Yet many felt the dangers of inoculation were less to be feared than a severe attack of smallpox, and in certain areas the method continued to be widely practised.
This morning [Parson Woodforde wrote in his journal on 3 November 1776] Dr Thome of Mattishall came to my House and inoculated my two servants, Ben Legate and little Jack Warton. Pray God my people and all others in the Small Pox may do well. Several Houses have got the Small Pox at present in Weston … Nov. 4: My inoculating folks took their salts very well this morning and drank very well of Water Gruel … The inoculated people had for supper Rice Milk, and I am afraid Molly put some eggs in the same … I am astonished at her. Nov. 8:1 paid the Dr. for inoculating our people 10s 6d. I gave him also towards inoculating a poor family: 10s 6d. Ben’s arms look much inflamed … much forwarder than the boy’s … Nov. 12: Dr Thorne told Ben that he might now live as he used to do before Inoculation; [but] that Jack should live low as yet.
These inoculations were successful enough; but in other places they were carried out in a most hurried and haphazard way. A Bath surgeon of long experience wrote:
When the inoculating rage once takes place whole parishes are doomed, without the least attention to age, sex or temperament … with no previous preparation, no after treatment or concern. Are not scores and hundreds seized upon at once, for the incisions, scratchings, puncturings and threadings? … And whether they may or may not receive the infection is just as little known or cared about.25
Yet, despite the dangers, inoculation – or variolation as it is better described – continued to be practised until the end of the eighteenth century when a far more satisfactory method of protection was devised.26
It had long been known that cowherds and milkmaids were for the most part immune from smallpox, but it was generally supposed that contact with the cows protected them rather than the disease of the cows known as cowpox which the animals passed to the persons who milked them through a scratch orlesion on the hands. It was, however, observed that farmworkers who had contracted cowpox did not thereafter suffer from smallpox when that disease visited their villages; and in 1774, during an epidemic of smallpox that swept across Dorset, a farmer near Yeovil allowed two of his men, who had both had cowpox, to nurse the smallpox sufferers. They did so with no ill effects; and, reassured by this, the farmer took some matter from one of his diseased cows and rubbed it into scratches which he made with a darning needle on the arms of his wife and two sons. The farmer was condemned for his inhumanity; but this experiment also was a success. None of his family contracted smallpox; and a local doctor who was told the story sought and received permission to inoculate the two sons with cowpox. No reaction followed; but the doctor does not appear to have tried the experiment on other patients.27
At this time a former pupil of the celebrated surgeon John Hunter was in practice at Berkeley in Gloucestershire. This was Edward Jenner who had been studying the relationship between smallpox and cowpox since a milkmaid had said to him: ‘I cannot take smallpox for I have had cowpox.’ In 1778 Jenner was consulted by a Berkeley woman who, as one who had had cowpox, wanted to know whether she ought to be inoculated against smallpox which had at that time claimed many victims in the district. Jenner inoculated her from a smallpox pustule and observed that there were only the slightest after-effects. He subsequently inoculated several other people who had had cowpox; and they, too, escaped the more serious disease. Finally in 1796, during an outbreak of cowpox on two dairy farms near Berkeley, Jenner was ready to make the vital test.
The more accurately to observe the progress of the infection [he wrote] I selected a healthy boy about eight years old for the purpose of inoculation with the cowpox. The matter was taken from a suppurated sore on the hand of a dairy Maid who was infected by her master’s Cows, and it was inserted on the 14th May 1796 into the arms of the Boy, by means of two superficial incisions, each about three quarters of an inch long … During the whole of [the ninth day after this] he was perceptibly indisposed, and had rather a restless night; but, on the following day, he was perfectly well … On the 1st of July following this Boy was inoculated with Matter immediately taken from a smallpox Pustule. Several punctures and slight incisions were made in both his arms, and the matter was well rubb’d into them, but no disease followed.28
Jenner, however, was a cautious man; and it was not until after he had conducted several more successful experiments that, in 1798, he published his influential Enquiry into the Causes and Effects of the … Disease … Known by the name of Cow Pox. This pamphlet was severely criticized by medical men, attacked by clergymen and journalists and ridiculed by satirists: James Gillray in his The Cow-Pock – or the Wonderful Effects of the New Inoculation portrayed a scene in the Smallpox and Inoculation Hospital at St Paneras where Jenner is seen gashing the arm of a young woman with a knife while a boy holds up a bucket labelled ‘Vaccine Pock hot from ye Cow’. From other patients, cows’ horns and heads sprout grotesquely from noses, ears, foreheads, breeches and petticoats.29
Gradually, however, as several distinguished doctors lent their support to vaccination, the prejudice against it was overcome; and those who objected to being injected with matter from sick animals were comforted to know that the operation was equally successful if the matter came from human beings. In 1808 Isaac Cruikshank produced a caricature in strong contrast to Gillray’s. In it Jenner is seen about to be crowned by a cherub with a laurel wreath; he is holding a vaccination knife, whose blade is inscribed ‘Milk of human Kindness’, while three old-fashioned doctors, practicers of inoculation, run off with much larger and blood-soaked knives, crying: ‘Curse or these Vaccinators we shall all be starved.’ The ground around them is strewn with children dead or dying of smallpox.30
By then, in fact, outbreaks of the disease, thanks to vaccination, were already becoming increasingly less severe. About half the children born in British towns were vaccinated between 1800 and 1870; and in 1853 vaccination of infants within four months of their birth was made compulsory. There was a serious epidemic of smallpox in 1870–72 in which over 40,000 people died, nearly 10,000 of them in London. But in those years the efficacy of vaccination was conclusively shown: in the worst year, 1871, 821,856 children were born in England and Wales; of these nearly 80,000 died before they could be vaccinated, but of the rest almost 94 per cent were successfully treated. After the epidemic was over the number of deaths from the disease rapidly declined.31
The problems of disease in eighteenth-century England were greatly exacerbated by the dreadful housing conditions in which most people lived, by primitive systems of drainage and by inadequate or contaminated water supply. In towns houses were built as quickly as possible, and families flocked into them, often crowding into a single room and having to share what water could be obtained from the communal taps with several other families. They also had to share an outside privy, usually a filthy, overflowing earth closet, with all the inhabitants of a court or row. Those few houses which had water-closets made conditions worse rather than better; for these early water-closets discharged their effluent into brick sewers where in dry weather it remained to stagnate and in wet was carried along with the drain water from the streets to be discharged into a canal or the river from which the water supply of the town was drawn. Nor were the cottages in which many farmworkers lived any better than those of factory hands. Nor were the houses of the rich much healthier than those of the poor; they were more spacious and less
overcrowded to be sure, but their sanitary defects were quite as obnoxious. Even at Windsor Castle, as late as 1861, ‘nothing had been done to improve the drains in connection with the various water closets, sinks, etc.’, so the Lord Chamberlain reported. ‘The noxious effluvia which escapes from the old drains and the numerous cesspools still remaining, is frequently so exceedingly offensive as to render many parts of the castle almost uninhabitable.’ The queen herself had contracted typhoid fever several years before; the Prince Consort is believed to have died of it, though he may also have been suffering from cancer; and their eldest son, the Prince of Wales, became dangerously infected with the disease during a visit to Lord Londesborough’s country house near Scarborough whose noisome drains resulted in the death of his fellow-guest, the Earl of Chesterfield.
While houses remained so unwholesome it could not be a matter of surprise that typhoid and other mysterious fevers, ‘those strange and fatal feavers’ as Samuel Pepys had called them, raged from time to time all over the country. ‘The fever,’ wrote Mrs Gaskell in Mary Barton in 1848 – and she could well have been writing of her great-grandmother’s day – ‘was of a low, putrid typhoid kind; brought on by miserable living, filthy neighbourhood and great depression of mind and body. It is virulent, malignant and highly infectious. But the poor are fatalists with regard to infection, and well for them it is so, for in their crowded dwellings no invalid can be isolated.’ This was in Manchester. In London ‘fever’ featured in the Bills of Mortality as a steady item year after year, seldom falling below 1000 deaths and in 1741, during a general epidemic of typhus, rising to 7500.32 In the countryside ‘fever’ was also a constant menace. ‘Mr du Quesne’s man, Robert, a very old servant, very ill in the Fever that prevails so much in Norfolk now,’ wrote Parson Woodforde in his journal on 28 June 1781. ‘Very bad at Norwich. Fifty three were buried last week there.’ On 1 July he added, ‘Poor Robert England, Mr du Quesne’s old servant died this afternoon in the Fever that rages much.’
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