InsideHistoryDigital

I S S U E N O . 1
V O L U M E N O . 1
INSIDE
HISTORY
M E D I C I N E A N D S U R G E R Y
T H E A R T
O F
A N A T O M Y
*FLORENCE NIGHTINGALE* MEDICINE AND THE "FREAK SHOWS: A TROUBLED RELATIONSHIP * HOUSES OF DEATH *
*DR LINDSEY FITZHARRIS AND THE BUTCHERING ART *HILDEGARD OF BINGEN AND ABBESS EUPHEMIA: CHAMPIONS OF
MENTAL AND PHYSICAL HEALTH IN THE MIDDLE AGES *GALEN * Major Jonathan Letterman * PLAGUE DOCTORS*

D I T O R E
Kevern
Nick
O N T R I B U T O R S
C
Lindsey Fitzharris
Dr
John Woolf
Dr
Wyatt
Louise
Kirby
Dominic
Kevern
Nick
Nightingale
Florence
Museum
Heath NHS Trust
Barts
Museums
is very easy to take for granted the amazing health care we
It
fortunate enough to receive today. Now we are fighting
are
did not happen overnight. In fact, the advances in
This
and Surgery has taken thousands of years to get to
Medicine
point. There was a great deal of trial and error but also
this
work of significant individuals who made it their lives
the
to advance the world of medicine. This magazine is
work
that incredible story.
about
Lindsey Fitzharris explores the "Houses of Death", as they
Dr
referred to in the Victorian period. Today we would
were
call them "Hospitals". However, they have not always
simply
the most hygienic of places. It was only when Joseph
been
developed antisepsis that the modern hospital truly
Lister
a place of healing.
became
Art of Anatomy highlights the beautiful gruesomeness of
The
human body and the relationship between anatomist
the
artists. Whilst not for the faint of heart (yes, it comes with
and
warning) it reminds us of the lengths the early anatomists
a
to not only to showcase their work but also to allow us
went
understand the complex nature of the human body.
to
was often seen by some as a form of entertainment in
Surgery
such as the Old Operating Theatre in London.
places
the surgeons at work and hearing the screams of
Witnessing
patient was macabre enough but for those who couldn't
the
that, the freak show offered many medical curiosities.
afford
on Chang and Eng, Dr John Woolf explores how the
Focusing
show and the medical world formed a mutually
freak
relationship to help us to understand the many
beneficial
recent Ebola epidemic in West Africa saw many doctors
The
protective suits in order to help those affected by the
wearing
In many respects, those similar suits were also used by
virus.
plague doctors in the 17th Century. Both are just as eerie
the
bring about a sense of dread. We take a closer look at the
and
doctors to see just what they really did.
Plague
is, of course, a lot more we have included in our first
There
of INSIDE HISTORY as we aim to take you closer to the
issue
A NOTE
BY THE
EDITOR
OUR FIRST THEMED ISSUE
EXPLORES MEDICINE AND SURGERY.
IT'S NOT FOR THE FAINT OF HEART
cancers, surviving operations and treated by doctors with a
wealth of medical knowledge.
inflictions suffered by these individuals.
I T H T H A N K S T O :
W
Operating Theatre
Old
past one theme at a time. I hope you enjoy the journey.
Wellcome Collection
@inside__history insidehistorymag @InsideHistoryMag

06 Galen: The Godfather of Medicine
of Bingen and Abbess
Hildegard
Champions of Mental and
Euphemia:
Nightingale: The Legend and
Florence
Legacy
the
of Death: Walking the Wards of a
Houses
Hospital
Victorian
and Freak Shows: A Troubled
Medicine
Relationship
14
18
22
36
Quarantine! The Village of Eyam
Magazine that takes you closer to
The
past one theme at a time
the
I N S I D E H I S T O R Y
14
I S S U E 0 1 / M E D I C I N E A N D S U R G E R Y
10
C O N T E N T S
10
Physical Health in the Middle Ages
26
32
36
44
22
44
The History of the Plague Doctors
Major Jonathan Letterman
The Art of Anatomy
insidehistorymag
@inside__history
06
INSIDE
HISTORY

26

GALEN: THE
GODFATHER
OF MEDICINE
The checking for a pulse is the first thing you should do
when a collapsed body lays before you. It might seem
obvious to us today but like all discoveries, someone had
to figure it out in the first place. Nowadays this simple
diagnostic procedure helps us to check for the vital sign of
life. One of the reasons for this is the work of Claudius
Galen.
Born in Pergamon, he would travel to Egypt to study
medicine before eventually finding his way to Rome where
he would go on to become the most celebrated physician
in the Roman Empire.
Like many before him, he was greatly influenced by the
work of Hippocrates and strongly advocated the
importance of the theory of the humours. The humours of
blood, black bile, yellow bile and phlegm were believed to
be imperative in health. The four would need to be
balanced in order to be healthy. If one or more
counterbalanced it could result in disease. It was for this
reason why simple operations such as blood-letting were
undertaken. If too much blood was diagnosed then
relieving this in the form of letting would bring the
balance back to normal. This theory would go on to
dominate the medical landscape for nearly 1300 years.
Galen would put this, and other theories, to work including
the first attempt in the western world to understand how
our bodies worked through dissection. With the dissection
of humans banned for religious reasons, Galen instead
dissected animals including monkeys and pigs in order to
understand how the body functioned. It was through
these dissections that Galen discovered the function of the
arteries and how they carried blood.
Whilst many of his discoveries went unchallenged until
the renaissance many would eventually use his work to
discover more about the human body. Although Galen
knew what the arteries did it would not be until William

Harvey's discovery of the circulation in 1628 until a more
complete picture of how blood travelled around the body
was discovered.
Whilst more of his theories would eventually become
challenged, Galen still remains an important part of the
history of Medicine.
Restricted to animal dissection his anatomical knowledge
could only ever go so far but Galen did have some
opportunities to see many wounds during his time as a
physician for gladiatorial combat. It was a position he held
for four years in his hometown of Pergamon.
Here he put the four humours theory into practice and in
doing so focused on the diet and hygiene of the gladiators.
He would also treat fractures and trauma wounds. During
his time the gladiators only five died as a result of his
treatments. His predecessor saw sixty die. For Galen, it was
a massive success.
Whilst many of his
theories would
eventually become
challenged, Galen still
remains an important
part of the history of
Medicine.
Galen's theories would eventually become dismissed as
the renaissance continued but it would be wrong to
discredit him entirely. His theories on diet and hygiene still
hold today as does his detection of the pulse.
Others used his work not with the intention to discredit
him but for the same reason that he held the ideas of
Hippocrates so dear. For Galen, it was about proving
theories to be right or wrong. He tried them and for him,
they worked. His quest for knowledge during a time of
anatomical restriction laid the foundations for others to
take his work even further and although he was ultimately
proven wrong on a number of issues, he had inspired the
medical renaissance for the better.
It is for this reason that Galen is often seen as the
Godfather of Medicine. A man who helped many during
his time but also hugely significant to those who aimed to
understand the human body even further.

HILDEGARD OF BINGEN AND
ABBESS EUPHEMIA:
CHAMPIONS OF MENTAL
AND PHYSICAL HEALTH IN
THE MIDDLE AGES
Words: LOUISE WYATT
Images: Wellcome collection/CREative commons
LOUISE WYATT IS CURRENTLY A PRACTISING
DISTRICT NURSE SISTER IN BRISTOL, COMBINING
BOTH HER PROFESSIONAL CAREER AND HER
WRITING. INTERESTED IN HISTORY FROM AN EARLY
AGE, LOUISE HAS, TO DATE, WRITTEN THREE LOCAL
HISTORY BOOKS AND A HISTORY OF NURSING IS
HER FIRST FORAY INTO MORE GENERAL HISTORY.

One of the most outstanding figures of the later
Middle Ages has to be that of Hildegard of Bingen;
visionary, scientist, philosopher, theologian,
composer and physician. Born in 1098 in
Bremersheim, Rhineland (Western Germany), the
tenth child to a noble family, Hildegard was
destined for the religious life. A sickly child of eight
years old, her parents offered her as an oblate to
the Benedictine monastery of Disibodenberg
where she was under the care of Jutta, a religious
and reclusive noblewoman who took charge of the
education of other noble-born girls. Jutta
eventually became prioress of Disibodenberg and
on her death, Hildegard was offered the position.
Hildegard had spent thirty years at Disibodenberg;
however, she refused the offer of prioress and
founded her own monastery in St Rupertsberg in
1150 with twenty nuns. Sadly, the remains of the
monastery were destroyed in 1857 to make way for
a new railway track.
In her book Heroines of the Medieval World, Sharon
Bennett-Connolly notes it was whilst at St
Rupertsberg that Hildegard wrote her two
medicinal treatises – Causea et Curea and Physica.
It is also interesting to note from Heroines of the
Medieval World, that Hildegard – although taught
to read and write – was not proficient in Latin and
had secretaries to correct her in later life.
Hildegard became a religious, moral and political
advisor to at least half of Europe during the later
Middle Ages, a high acclaim at that time for a
woman. Her medieval hymn chant compositions
can still be bought today but amazingly, her
scientific knowledge was used as reference until
the sixteenth century and still provides a basis for
naturopathic healing today.
Both Causea et Curea and Physica were the only
writings of Hildegard de Bingen that were not
linked or prompted by her visionary work. Both
tomes are written from her original monastic
experiences of hands-on care in both the herbal
gardens and the infirmary and then by
observations of the same, whilst also being
Abbess. Coupled with theoretical knowledge from
the monastic libraries (and noting Hildeberg’s
supreme literary genius with other works such as
Scivias and her music compositions), Causea et
Curea is focused on exploration of the human body,
disease, unbalance and its connection to the
natural world.
Hildegard wrote and
taught about the ‘green’
health of the natural
world influencing the
physical health. This is
still recognised today,
850 plus years after
Hildegard wrote about
it.
Physica deals with the scientific and medicinal
properties of plants, stones, fish and animals. An
early faith healer, spiritual advisor, herbal
practitioner … all these variables stand at the basis
of what we know today. It is the early foundations
of Holistic Health, something relevant and still with
us in today’s nurse training at all levels.
Hildegard wrote and taught about the ‘green’
health of the natural world influencing the physical
health. This is still recognised today, 850 plus years
after Hildegard wrote about it. In fact, the term
‘green care’ is still being used in studies:

‘A new study has been published by Natural England which
reviews the benefits and outcomes of approaches to green
care for mental ill-health.’ www.gov.uk, 2016
‘Around 30 per cent of all people with a long-term physical
health condition also have a mental health problem, most
commonly depression/anxiety’
www.kingsfund.org, 2012
It seems we are still studying and connecting what
Hildegard knew and taught all those years ago.
Nearer to home, we find similar traits of Hildegard
in Euphemia de Walliers (1213-1257) who became
the Abbess of Wherwell in Dorset from 1226 until
her death. It is noted in some sources she was the
‘pioneer of modern hospital design’. Further
investigation shows that Abbess Euphemia did
indeed restructure Wherwell Abbey to cater for
more hygienic areas to care for the sick and needy –
it is worth noting this is 600 years before Florence
Nightingale bought the connection of sanitation
and health to the public eye.
In the fourteenth century, the chartulary of the
nuns of Wherwell Abbey was composed
(sometimes spelt cartulary, these are medieval
manuscripts containing transcripts of original
documents relating to all things connected to an
ecclesiastical building). This shows us how, again,
the connection with green care and health was
recognised:
‘She also, with maternal piety and careful
forethought, built, for the use of both sick and
sound, a new and large firmery away from the main
buildings, and in conjunction with it a dorter and
other necessary offices. Beneath the firmery she
constructed a watercourse, through which a
stream flowed with sufficient force to carry off all
refuse that might corrupt the air … Moreover she
built there a place set apart for the refreshment of
the soul, namely a chapel of the Blessed Virgin,
which was erected outside the cloister behind the
firmery. With the chapel she enclosed a large space,
which was adorned on the north side with pleasant
vines and trees. On the other side, by the river bank
… a space being left in the centre where the nuns
are able from time to time to enjoy the pure air. In
these and in other numberless ways, the blessed
mother Euphemia provided for the worship of God
and the welfare of the sisters’
Both of these powerful and respected women
highlighted nursing within other aspects of their
domain. They were highly intellectual but nursing,
closely linked to medical knowledge, was a
combination of studying nature, observing
remedies, studying the teachings of Hippocrates,
understanding models before their time – such as
the importance of hygiene and mental health –
whilst retaining their faith. In 2012, The King’s Fund
noted that around 30% of all people with a longterm
physical health condition also had underlying
mental health issues, namely depression/anxiety.
In 2016, Natural England published a study that
reviewed the benefits of green care for mental
health - note the term ‘green care’, still being used
over 800 years after Abbess Euphemia!
Louise Wyatt is the Author
of A HISTORY OF NURSING
published by Amberley
books.
RRP: £14.99

A POCKET FULL OF POSIES:
THE ROLE OF THE PLAGUE
DOCTOR
Words: DOMINIC KIRBY
Images: Wellcome collection
DOMINIC KIRBY IS A HISTORY AND POLITICS
TEACHER AT A SCHOOL IN LINCOLNSHIRE. HE IS
CURRENTLY WRITING A BIOGRAPHY OF THE
ELIZABETHAN POLITICIAN AND ADMIRAL, LORD
HOWARD OF EFFINGHAM. A STRONG ADVOCATE
OF LEARNING OUTSIDE THE CLASSROOM, DOMINIC
IS A KEEN SUPPORTER OF THE CHALKE VALLEY
HISTORY FESTIVAL.
YOU CAN FOLLOW HIM ON TWITTER AT
@HISTORY_CHAP

Of all the images we have of the plague, that of the
plague doctor is perhaps the most familiar – and
certainly one of the most chilling. The sight of a
solitary figure wearing a beak-like mask, slowly
making its way from infected house to infected
house must have been a disturbing sight to witness
in the streets of any plague-ridden city or town.
Indeed, not only is the figure of the plague doctor
synonymous with the plague, it has become a
personification of death itself.
The French physician Charles de Lorme is credited
with inventing the familiar ‘beak doctor’ costume in
1619 or 1620, in order to minimise the risk of
contracting the dreaded disease himself. Lorme
had need of protection. As the personal physician
to the Medici family, he practiced medicine in
Florence, Milan and Naples, three of the worstaffected
cities in seventeenth-century Europe.
Lorme wrote of his outfit’s distinctive mask thus:
“nose half a foot long, shaped like a beak, filled with
perfume with only two holes, one on each side near
the nostrils, but that can suffice to breathe and to
carry along with the air one breathes the
impression of the drugs enclosed further along in
the beak.”
The drugs he refers to in the beak of the mask were
strong-smelling herbs, spices and dried flowers (the
posies referred to in the seemingly innocent
nursery rhyme) which supposedly prevented the
inhalation of miasma – the bad air which for
centuries was thought to be one of the key causes
of the plague.
For every high-profile plague doctor like Lorme
there were thousands of untrained and
inexperienced pseudo-physicians, known as
empirics, who valiantly tried in vain to ease the
suffering of their family, friends and neighbours
afflicted by one of the worst diseases in human
history. Many of them died while doing so. Lacking
even the most basic scientific knowledge and
understanding of the real cause, transmission and
spread of the plague, the methods plague doctors
used to treat their patients ranged from the
sensible to the ludicrous.
The first thing to do was to isolate the patient and
fumigate their house. There are numerous
accounts of whole families being locked in their
homes, the healthy with the sick, such was the
desperation to prevent the plague from spreading.
If the patient or their family could afford one, a

doctor would be summoned. It’s easy to forget the
seventeenth century was a world without free
healthcare.
One of the most common forms of treatment for the
plague was the ancient practice of ‘bleeding’ the patient,
which involved draining some of their supposedly badblood
from their veins or applying leeches to prescribed
parts of the body in order to rebalance the ‘four
humours’ in the patient’s body. Plague doctors might
also lance and drain the buboes, the infected blisters
around the lymph glands from which the term bubonic
plague is derived, which may have given some degree of
pain relief to the sufferer.
Other more bizarre
treatments for the
plague involved placing
or rubbing various
approved items – a frog,
I
a chicken (preferably
plucked) or a snake
(chopped up) on the
buboes.
If any or all of the above methods failed, and they almost
always did, the only thing left to do was to send for a
priest – who in many communities was often the ‘doctor’
anyway – to pray for the patient to have a painless death
and, in Catholic countries, salvation for their soul after
death.
Although as historians with the benefit of hindsight we
can look back at how the plague was treated with
derision or condemnation, we must keep in mind that
many plague doctors simply did what they thought was
best for their patients, during one of the most traumatic
events in European history.

QUARA
Photo: Flickr/Dun.can/Attribution 4.0 International (CC BY 4.0)
EYAM: THE

NTINE!
In 1666, the village of Eyam in
Derbyshire would fight the plague
without the use of a plague doctor.
In doing so, the village would
become famous for a selfless act
that would go on to save the lives
of thousands of people in the
surrounding area.
It all began with a package from
London waiting to be opened...
PLAGUE VILLAGE

George Viccars opened the delivery within
moments of its arrival from London in 1665. The
package contained a bale of cloth for the local
tailor, Alexander Hadfield. For the Derbyshire village
of Eyam, this event was nothing out of the ordinary.
Viccars opened the parcel and went to work
hanging the damp cloth by the fire. Little did he
realise at that moment that there was something
extra hidden and incubating within that particular
cloth. The heat of the fire had awoken plaguecarrying
fleas that laid dormant. Now they were
beginning to warm from their slumber with a new
area to infect.
William Mompesson's wife, Catherine, recorded in
her diary: "It might be difficult to predict the
outcome because of the resentment as to William's
role in the parish, but considering that the Revd
Stanley was now stood at his side, perhaps he
would gain the support necessary to carry the day."
The villagers reluctantly agreed to remain. They
knew that for many within the village it was
effectively a death sentence
Days later, Viccars became the first victim of the
plague. His two stepsons, Edward and Johnathan
Cooper soon followed as the endemic began to
take hold of the village. Soon, the whole village
would make a dramatic decision that that would
cost the lives of many in Eyam.
The devastating effects of the plague would soon
be felt across the village of Eyam. In this small area
of Derbyshire, grief would turn into panic. Between
September to December, 42 villagers had died.
Many families were on the verge of fleeing the
village in order to rebuild their lives in nearby
towns. If they did, there was a great likelihood that
they could unwittingly spread the disease to those
areas.
William Mompesson had only been in the village for
a couple of years. As the new village rector, he was
far from popular among his parishioners. There was
tension in the air from the moment he had arrived.
The previous rector, Thomas Stanley, was ousted
after he refused to acknowledge the 1662 Act of
Uniformity, which made it compulsory to use the
Book of Common Prayer, introduced by Charles II,
in religious services.
With Stanley living in exile just outside the village,
Mompesson knew that if he could get the former
rector to support his plan then the rest of the
village would follow. The plan was simple. In order
to prevent the plague from spreading to the nearby
towns, the village and those who resided within
should be quarantined.
Persuading the villagers would be difficult. On the
24th June 1666, he told the parishioners that no one
would be allowed to leave or enter Eyam. The Earl
of Derbyshire had offered to send food and supplies
if the villagers agreed to stay. Mompesson told his
congregation that he would also stay and would do
everything in his power to alleviate their suffering
The village was
now in lockdown.
No one was to
leave.

The fleas carrying the plague that laid in dormant
soon woke up again during the summer of 1666.
That particular summer, it was remarkably hotter in
Eyam that the previous year, It was the perfect
conditions for the fleas to continue spreading their
pestilence.
By August, the death toll in Eyam was rising.
reaching a peak of up to six deaths a day. Seven of
those deaths all came from the same family. In the
space of eight days in August, Elizabeth Hancock
had buried her seven children and her husband
close to her family farm.
In total, 260 villagers from 76 families would die in
Eyam. However, the actions of Mompesson and the
inhabitants of Eyam no doubt saved thousands of
lives in the surrounding areas by their actions.
William Mompesson would survive the plague and
would eventually move to a new parish in Eakring,
Nottinghamshire. He would remarry in 1670 to
Elizabeth Newby. The thoughts of Eyam would
always remain with him until his passing in 1709.
Today, the village is known as "The Plague Village."
The village itself has become a place of historical
importance with plaques around the houses
recalling the victims.
The church of St Lawrence still stands. The stainglassed
windows tell the story of the village's
courage during that time. It is a legacy that
continues to live on.
PLAGUE FACTS
It was known as the "Black Death"
during the 14th Century, causing
an estimated 50 million deaths
There are three forms of plague
infection: bubonic, septicaemic and
pneumonic. Bubonic, characterised
by painful swollen lymph nodes or
'buboes', is the most common form
The burying of the dead was an all too common
experience for the villagers. Marshall Howe, would
not only bury his own family but also many
villagers. Howe was inflected during the early
outbreak in 1665 yet he had survived. Believing
himself to be immune he took on the post of
burying the dead.
Catherine Mompasson was busy tending to the sick
to make their forthcoming deaths more tolerable. It
was inevitable that she would eventually succumb
to the disease herself. On the 23rd August,
Catherine died at the age of 27.
Plague still is endemic in many
countries. The three most endemic
countries are Madagascar, the
Democratic Republic of Congo and
Peru
From 2010 to 2015 there were
3248 cases reported worldwide,
including 584 deaths.

MAJOR JONATHAN
LETTERMAN: THE FATHER
OF BATTLEFIELD MEDICINE
Words: NIck Kevern
Images: Wellcome collection/wikimedia commons

When the Springfield Musket arrived on the scene
in 1861 it had become the weapon that effectively
changed warfare. Accurate to more than 500 yards,
the Springfield would get its first real outing during
the American Civil War with devastating
consequences.
Whist the technology had advanced, the tactics
operated in the battlefield had yet to catch up.
Lining up in traditional formations, the armies of
the Union and the Confederacy would charge each
other head-on in the same manner as armies had
fought for years prior. It provided the Springfield
Musket with plenty of targets and it duly delivered
resulting in massive casualties as the 0.58 calibre
bullets, weighing nine pounds, penetrated the
enemy. More than a third of any unit would fall
victim to the Springfield once the whistle was
blown. Back in 1861, the Springfield was a weapon
of mass destruction.
Yet, the advance in technological warfare was not
the only thing to be concerned about. Those who
had survived the onslaught of the Springfield
would be transferred from the battlefield to the
camps. Here, thousands of men would suffer as
dysentery, scurvy, typhoid fever, pneumonia,
smallpox, tuberculosis, measles, and malaria took
hold. It is believed that 60% of Union soldiers would
die from non-battle injury disease.
"It provided the Springfield
Musket with plenty of
targets and it duly
delivered resulting in
massive casualties as the
0.58 calibre bullets,
weighing nine pounds,
penetrated the enemy."
For those who depended on medical care from
either battle wounds or disease, there was another
concern. In 1860, the U.S Army had 100 doctors for
every 16,000 soldiers. With the country now divided
and the escalation of the war taking hold, it was
virtually impossible to maintain that ratio. At its
peak, the Union had two million soldiers with only
10,000 surgeons operating.
Jonathan Letterman was one of those surgeons. His
army career was already well established before the
first shots were fired at Fort Sumter. 11 months later,
he was promoted to the rank of Major and named
medical director of the Union Army. The soldiers
may not have known it yet but Letterman was
about to change their lives.
Using his experience from his pre Civil War service,
Letterman started to make sweeping changes. He
began with the soldiers themselves and in
particular, their diet. From the preparation of food
and the handling of waste, soldiers were given
larger and more nutritious rations prepared in
more hygienic conditions. The camps became
cleaner with the men well-fed and rested. In
improvement in morale was clear but more
importantly for Letterman, there was a reduction in
the disease rate by nearly one third.
Jonathan Letterman (second left) with staff .
Credit: Wikmedia Commons
The conditions and wellbeing of the soldiers were
only the first part of his plan. Letterman saw the
devastation on the battlefield at first hand
witnessing the deaths of thousands of men. Many
would die on the battlefield from wounds and thirst
as there was little that could be done to remove
them to safety. The wounded were often left to
their own devices depending on comrades to
remove them. In some cases, it could take up to
one week to remove the wounded from the
battlefield as was the case at the Second Manassas.
For this reason, Letterman established the first
Ambulance Corps.

"With over 23,000
casualties, the newly
established Corp was able
to remove the wounded
within 24 hours and in
doing so, saved hundreds
of lives in the process."
Men were trained to act as stretcher-bearers and to
operate wagons to pick up the wounded quickly
and efficiently. If necessary, the Ambulance Corps
were trained to use triage on the battlefield. The
success of Letterman’s Ambulance Corps was
witnessed at the Battle of Antietam in September
1862. With over 23,000 casualties, the newly
established Corp was able to remove the wounded
within 24 hours and in doing so, saved hundreds of
lives in the process.
The immediate treatment on the battlefield was a
game-changer but Letterman had also instigated
further changes for the care of the soldiers after the
battle. His evacuation system comprised of three
core areas. A Field Dressing Station located on the
battlefield for triage, dressings and
tourniquets. Those who required surgery would be
moved to the Field Hospital before transferring to a
larger Hospital away from the battlefield for longerterm
treatment and recuperation. Having an
organised system from the battlefield to recovery
not only saved the lives of the men within his own
care but also later, the Union Army as in March 1864
the system was adopted by the whole Union Army.
Since the Civil War, almost 4 million American have
served in their country. Of these, more than
600,000 have died with over 1.3 million returning
home injured. Many would have experienced the
services that Letterman and his team had
pioneered in the 19th century. Technology may
have advanced even further but the concept of
what Letterman introduced in still used to this day.
It is for this reason that is referred to as,
"THE FATHER OF
BATTLEFIELD MEDICINE"
American Civil War veteran, with an amputated leg at the hip. Credit: Wellcome Collection. CC BY 4.0

Society of Civil War Surgeons
Preserving Civil War Medical History
The Society of Civil War Surgeons was formed in 1980 by six medical reenactors who recognized a need
to open communication among those with this specialty. Today, the Society boasts more than 215 members
throughout the United States, as well as in Canada, Denmark, England, and Italy. It is the largest organization
dedicated to Civil War era medicine.
Incorporated in the State of Ohio in 1990 as a non-profit educational corporation and recognized by the
Internal Revenue Service as a tax-exempt group, the Society is organized solely to educate the general public about
medicine during the American Civil War era (Mexican War through the Indian Wars). The Society covers all
aspects of medicine and the care of the sick and wounded. This is accomplished through research, publications, and
living history exhibitions and lectures during Civil War reenactments.
The Society has been represented at most of the larger anniversary reenactment events since the 1980s.
Members have appeared in many big screen productions on the Civil War, as well as numerous conventions,
association meetings, and on the Arts & Entertainment channel’s Civil War Journal. Members have served as
advisors to several television productions.
The Journal of Civil War Medicine, published quarterly, reprints original articles by actual participants, peer
reviewed articles written specifically for the journal, and articles from other publications for which reprint
permission has been obtained.
The Society hosts an annual conference with lectures and presentations by members and nationally
recognized Civil War experts. Conventions have been held in Richmond and Williamsburg, VA., Chattanooga,
Knoxville, and Nashville, TN., Louisville, KY., and Harper’s Ferry, WV among others. The 2020 conference will
be held March 27th-29th in Lexington, VA. In 2021, we will host our meeting in the St. Louis, MO area.
Society members are available for presentations to Civil War roundtables, historical societies, medical
societies, and other organizations. Some members are also available to set up living history displays.
For more information on the Society, or if you want to join the Society, visit our website at
www.civilwarsurgeons.org; e-mail a request to socwsurgeons3560@gmail.com, or write to: Peter J. D’Onofrio,
Ph.D.,President; 539 Bristol Drive, S.W.; Reynoldsburg, OH 43068.

FLORENCE
NIGHTINGALE
THE LEGEND AND
THE LEGACY
"When I am no longer even
a memory, just a name, I
hope my voice may
perpetuate the great work
of my life"
Florence Nightingale

To many, Florence Nightingale is known throughout the
world as the “Lady with the Lamp” who organised the
nursing of the wounded soldiers during the Crimean War.
Oil paintings of Florence holding her lamp would circulate
the country as she became more than a nurse but a
beacon of hope for the military. The lamp that she held
whilst on her nightly rounds had transformed into a halo
of selflessness. It was an image that has remained with us
to this very day.
This is the legend that was created, however, Nightingale
was much more than the “Lady with the Lamp”. Her
influence transcends the Crimean War and can still be felt
in today’s modern medical world. Whilst her image has
become iconic, the lamp can also be seen as a metaphor
as someone who shone a light towards the changing of
victorian hospitals, midwifery and social change.
Her upbringing suggested that nursing should not have
been Florence’s calling in life. Born in Florence, Italy, she
was the daughter of William and Frances Nightingale. As a
well connected and well off upper-middle-class family,
Florence was expected to be obedient and follow her class
distinctions. For her, it was expected that she should marry
but Florence had other ideas.
Her Christian faith had always been a driving force
throughout her life and she believed that she heard God’s
voice calling to her just before her 17th Birthday. The call to
help others was clear to her and nursing, in particular,
became her chosen profession. There was, of course, an
issue with this decision. Nursing in the 19th Century was
seen as a job for the working classes. From her uppermiddle-class
background, it was seen by her parents as an
embarrassing move that defied convention.
They tried to dissuade her in the best way that they could.
They prevented Florence to train as a nurse in Salisbury.
Despite this, she continued to study in secret before her
battle with her family took a toll on her own health.
Increasingly depressed and suffering from nervous
collapses, she eventually got what she wanted. The
Nightingales still didn’t want their daughter in a rough
victorian hospital filled with diseases and drunkenness.
Instead, they sent her to Kaiserswerth, a religious
community in Germany.
It was here where Florence Nightingale learned her trade.
Observing amputations, learning how to dress wounds
and how to care for the sick and dying. For her, God’s
calling had started to come true. She later wrote: ”Now I
know what it is to love life.”
Upon on returning home the news of the Crimean War
was featured on every newspaper front page. The
conditions of the base hospitals at Scutari had quickly
become horrific.

"It is of appalling horror! These poor
fellows suffer with unshrinking
heroism, and die or are cut up without
complaint. We are steeped up to our
necks in blood!"
Florence Nightingale
Sidney Herbert, the secretary of state for war, had a crisis
on his hands. More soldiers were dying from disease than
from enemy action. To make matters worse, the press was
having a field day reporting about it. Florence had
previously written to Herbert to let her go to the Crimea.
Now he had decided to take her up on her offer.
Nightingale and her carefully selected team of 38 nurses
set sail for Scutari.
The horror of Scutari was no fantasy made up by eager
journalists embellishing their stories. It was very real to
Florence and her team. The overcrowding and the
shortness of supplies. The soldiers were dirty and
undernourished. To make matters worse, there was also an
issue with the sewage. Florence quickly realised that the
hospitals in the Crimea were poorly managed.
Working without rest, she aimed to change these
conditions. Nightingale bombarded Sidney Herbert with
letters asking for more supplies and used her own money,
and that generously donated by the British public, to buy
scrubbing brushes, blankets, bedpans and operating
tables. A deep clean of Scutari was now made possible.
If cleanliness is next to godliness then Nightingale was the
Angel that God sent to do his bidding. The wards were
cleansed, effectively managed and the sewage was taken
care off by Dr John Sutherland. The disease rate began to
drop.
The care that the soldiers received went above and
beyond what they had previously experienced. Routinely
checking on the soldiers in the dark of night with her
fanoos, she became known as the "Lady with the Lamp."
Little did she know it at the time but the newspapers back
home were celebrating her efforts. Fame awaited her
when she returned to Britain. Whilst she hated that fame,
she knew that she now had some something more
valuable. Nightingale could use that newfound fame to
help shape health and reform not only for the soldiers but
also the everyday man, woman and child.

The Crimea had left its mark on Florence. Contracting
"Crimean Fever" her health was never the same. Despite
that though, she continued to use her influence to change
the health care in Britain.
She studied the design of hospitals with many architects
and doctors asking for her advice. Florence believed that
hospitals needed separate wings connected by corridors. It
was known as the "Pavillion Style." The first newly built
hospital to adopt her suggestions was the military hospital
at the Woolwich barracks in east London. Soon others
would follow including the rebuilt St Thomas' Hospital.
Money was raised by the public to train even more nurses.
The Nightingale nurses would eventually lead the
reformation of nursing under Florence's image.
Nightingale would also write about nursing. Notes on
Nursing would become a best seller. Many families owned
their own copy studying the advice of the "Lady with the
Lamp" in order to help and nurse their own families. She
would become a prolific writer writing some 200 books,
pamphlets and articles.
It is with this that her legacy lives on. From hospital
layouts to the nursing practices that we receive today. All
of which were the product of Florence Nightingale.
"If a patient is
cold, if a patient
is feverish, if a
patient is faint, if
he is sick after
taking food, if he
has a bed-sore, it
is generally the
fault not of the
disease...but of
the nursing."
Florence Nightingale

HOUSES OF DEATH: WALKING
THE WARDS OF A VICTORIAN
HOSPITAL
Words: Dr Lindsey Fitzharris
Images: Wellcome collection
DR. LINDSEY FITZHARRIS IS A BESTSELLING AUTHOR,
AND MEDICAL HISTORIAN WITH A DOCTORATE
FROM THE UNIVERSITY OF OXFORD. HER DEBUT
BOOK, THE BUTCHERING ART, WON THE PEN/E.O.
WILSON AWARD FOR LITERARY SCIENCE IN THE
UNITED STATES; AND WAS SHORTLISTED FOR BOTH
THE WELLCOME BOOK PRIZE AND THE WOLFSON
HISTORY PRIZE IN THE UNITED KINGDOM. SHE IS THE
CREATOR OF THE POPULAR BLOG,
THE CHIRURGEON'S APPRENTICE, AS WELL AS THE
HOST OF THE YOUTUBE SERIES, UNDER THE KNIFE.

Today, we think of the hospital as an exemplar of
sanitation. However, during the first half of the
nineteenth century, hospitals were anything but
hygienic. They were breeding grounds for infection
and provided only the most primitive facilities for
the sick and dying, many of whom were housed on
wards with little ventilation or access to clean
water. As a result of this squalor, hospitals became
known as "Houses of Death.”
The best that can be said about Victorian hospitals
is that they were a slight improvement over their
Georgian predecessors. That's hardly a ringing
endorsement when one considers that a hospital's
"Chief Bug-Catcher" (whose job it was to rid the
mattresses of lice) was paid more than its surgeons
in the eighteenth century. In fact, bed bugs were so
common that the "Bug Destroyer" Andrew Cooke
(see image above) claimed to have cleared upwards
of 20,000 beds of insects during the course of his
career. [1]
In spite of token efforts to make them cleaner, most
hospitals remained overcrowded, grimy, and poorly
managed. The assistant surgeon at St. Thomas's
Hospital in London was expected to examine over
200 patients in a single day. The sick often
languished in filth for long periods before they
received medical attention, because most hospitals
were disastrously understaffed. In 1825, visitors to
St. George's Hospital discovered mushrooms and
wriggling maggots thriving in the damp, soiled
sheets of a patient with a compound fracture. The
afflicted man, believing this to be the norm, had
not complained about the conditions, nor had any
of his fellow convalescents thought the squalor
especially noteworthy. [2]
Worst of all was the fact that a sickening odor
permeated every hospital ward. The air was thick
with the stench of piss, shit, and vomit. The smell
was so offensive that the staff sometimes walked
around with handkerchiefs pressed to their noses.
Doctors didn't exactly smell like rose beds, either.
Berkeley Moynihan (one of the first surgeons in
England to use rubber gloves) recalled how he and
his colleagues used to throw off their own jackets
when entering the operating theater and don
ancient frocks that were often stiff with dried blood
and pus. They had belonged to retired members of
staff and were worn as badges of honor by their
proud successors, as were many items of surgical
clothing.
The operating theaters within these hospitals were
just as dirty as the surgeons working in them. In

A lecture at the Hunterian Anatomy School, Great Windmill Street, London. . Credit: Wellcome Collection. CC BY

the early decades of the nineteenth century, it was safer
to have surgery at home than it was in a hospital, where
mortality rates were three to five times higher than they
were in domestic settings. Those who went under the
knife did so as a last resort, and so were usually mortally
ill. Very few surgical patients recovered without incident.
Many either died or fought their way back to only partial
health. Those unlucky enough to find themselves
hospitalized during this period would frequently fall prey
to a host of infections, most of which were fatal in a preantibiotic
era.
In addition to the foul smells, fear permeated the
atmosphere of the Victorian hospital. The surgeon John
Bell wrote that it was easy to imagine the mental
anguish of the hospital patient awaiting surgery. He
would hear regularly “the cries of those under operation
which he is preparing to undergo,” and see his “fellowsufferer
conveyed to that scene of trial,” only to be
“carried back in solemnity and silence to his bed.” Lastly,
he was subjected to the sound of their dying groans as
they suffered the final throes of what was almost
certainly their end.[3]
As horrible as these hospitals were, it was not easy
gaining entry to one. Throughout the nineteenth
century, almost all the hospitals in London except the
Royal Free controlled inpatient admission through a
system of ticketing. One could obtain a ticket from one
of the hospital’s “subscribers,” who had paid an annual
fee in exchange for the right to recommend patients to
the hospital and vote in elections of medical staff.
Securing a ticket required tireless soliciting on the part
of potential patients, who might spend days waiting and
calling on the servants of subscribers and begging their
way into the hospital. Some hospitals only admitted
patients who brought with them money to cover their
almost inevitable burial. Others, like St. Thomas’ in
London, charged double if the person in question was
deemed “foul” by the admissions officer.[4]
Some hospitals only
admitted patients who
brought with them
money to cover their
almost inevitable
burial.
Before germs and antisepsis were fully understood,
remedies for hospital squalor were hard to come by.
The obstetrician James Y. Simpson suggested an
almost-fatalistic approach to the problem. If crosscontamination
could not be controlled, he argued,
then hospitals should be periodically destroyed and
built anew. Another surgeon voiced a similar view.
“Once a hospital has become incurably pyemiastricken,
it is impossible to disinfect it by any known
hygienic means, as it would to disinfect an old
cheese of the maggots which have been generated
in it,” he wrote. There was only one solution: the
wholesale “demolition of the infected fabric.”[5]
It wasn’t until a young surgeon named Joseph Lister
developed the concept of antisepsis in the 1860s that
hospitals became places of healing rather than
places of death.
1. Adrian Teal, The Gin Lane Gazette (London:
Unbound, 2014).
2. F. B. Smith, The People's Health 1830-1910 (London:
Croom Helm, 1979), 262.
3. John Bell, The Principles of Surgery, Vol. III (1808),
293.
4. Elisabeth Bennion, Antique Medical Instruments
(Berkeley: University of California Press, 1979), 13.
5. John Eric Erichsen, On Hospitalism and the Causes
of Death after Operations (London: Longmans,
Green, and Co., 1874), 98.
Dr Lindsey FItzharris is the
award winning author of
THE BUTCHERING ART:
JOSEPH LISTER'S QUEST
TO TRANSFORM THE
GRISLY WORLD OF
VICTORIAN MEDICINE
RRP: £9.99
@DrLindseyFitz
Joseph Lister, 1st Baron Lister. Lithograph.
Credit: Wellcome Collection. CC BY

might be a rather gruesome subject matter but
It
have long been fascinated with the human
artists
This fascination exploded during the
body.
period. It was during this time that the
Renaissance
aimed to show the world the fine lines
artist
art and reality. In their never-ending quest
between
perfection, artists were focusing on the human
for
in order to make their work more real.
body
the most famous of the era, Leonardo Da
Perhaps
was one such artist who ventured into the
Vinci,
of anatomy in order to create his perfect
world
He had previously studied the human
masterpieces.
during his artistic apprenticeship with
body
but Da Vinci's interest in the subject went
Verrocchio
Da Vinci, a particular interest in any subject
For
was difficult to extinguish once the flame
matter
begun to burn. He would help with
had
then draw, in detail, what he saw. His
dissections
despite being over 500 years old, remain a
sketches,
standard in the world of anatomical
gold
natural curiosity and a desire to represent the
A
form as perfectly as possible through art led
human
Vinci on a highly secretive personal journey. He
Da
his drawings and work on anatomy to
wanted
become a published treatise. If he had
eventually
so, he would have transformed medical
done
of the body even before Vesalius released
knowledge
groundbreaking work, De Humani Corporis
his
work would reside among his personal papers
his
their significance lost to the world until their
with
THE ART OF
ANATOMY
Words: Nick Kevern
Images: Wellcome Collection/Rijksmuseum/Wikimedia Commons
further.
illustration.
Image Credit:
Studies of Embryos by Leonardo da Vinci (Pen over red chalk 1510-1513)
Wikimedia Commons
Fabrica, in 1543. However, following his death in 1519,

Last Supper and The Mona Lisa may be what he
The
remembered for most today, but Da Vinci also
is
that not only could anatomical drawings be
showed
to the advancement of medical
beneficial
process was taken even further by Andreas
The
who would have been unaware of Da Vinci's
Vesalius
was about to challenge the very ideals that
Vesalius
gone unchallenged for nearly 1300 years. The
had
world and anatomy, in particular, was still in
medical
grip of Galen's ideas. In 1543, Vesalius would turn
the
medical world upside down by not only
the
the work of Galen but producing a work
disproving
showed people the human form in ways that
that
had never seen before.
they
Humani Corporis Fabrica (On the Fabric of the
De
Body) was, like many anatomical books, a
Human
effort. Unlike Leonardo Da Vinci,
collaborative
talents did not lay in the world of art but in
Vesalius
art of dissection. Artists would be hired to
the
striking images. The final product would
produce
of more 600 pages of text and beautifully
consist
plates. The plates transcended to work of
detailed
Vinci. Here, the artists involved gave the
Da
work more artistic meaning.
anatomical
of the most iconic illustrations within the
One
is that of a skeleton leaning on a plinth
Fabrica
examining a skull. The skeleton itself is
whilst
structured anatomically, yet this image
perfectly
further. Here, the Fabrica itself is wonderfully
goes
up. The Skeleton, that appears to be a part
summed
the learning process, is also assessing our own
of
mortality.
on the plinth itself is a message that
Engraved
from Latin as: "Everything else is mortal
transcribes
genius lives on." It would suggest that even the
but
involved in this masterpiece of anatomical
artists
acknowledged just how important the work of
work
was.
Vesalius
many believe it to be the work of Jan Van
were,
a Flemish artist who worked with the Titan
Calcar,
collaboration between artist and anatomist
The
the world the gruesome beauty of the
showed
body. It would go on to inspire the work of
human
Harvey and open the door for many artists to
William
anatomical art began to flourish, so to did the
Whilst
of other artists who did not venture down that
work
avenue. The surgeon's guild of Amsterdam
particular
go on to commission a young artist
would
discovery 400 years later.
knowledge, but also be considered works of art in
their own right.
In 1543, Vesalius would turn
the medical world upside
down by not only disproving
the work of Galen but
producing a work that
showed people the human
form in ways that they had
never seen before.
anatomical masterpieces.
Whilst we do not know for sure who the exact artists
Vesalius, De humani corporis fabrica, 1543. Credit: Wellcome Collection. CC BY
studio.
explore even further.
who would later go on to be considered a master.

Vesalius, De humani corporis fabrica, 1543. Credit: Wellcome Collection. CC BY

the age of 26, Rembrandt was commissioned to
At
the piece entitled "The Anatomy Lesson of
produce
Nicolaes Tulp". It shows that the theme of
Dr.
could also be used without showing the
anatomy
scene shows a traditional anatomical lesson. Dr.
The
is showing his engaged audience the muscles
Tulp
tendons of the left arm of Aris Kindt. Kindt was
and
to death following his conviction for armed
hanged
Many convicts sentenced to death would
robbery.
feature on an anatomists table. The
usually
students are peering into a book whilst
captivated
seeing the dissection taking place in front of
also
this work, Anatomy and the interest in the
With
had moved away from scientific textbooks
subject
had become a part of the global and artist
but
with the subject.
fascination
Anatomy Act of 1832 would see a further
The
within the artist world. Prior to the act,
explosion
was an illegal trade in corpses as anatomists
there
more bodies for dissection. The age of
demanded
bodysnatcher was a profitable one and even led
the
murder.
to
years before the act became law, Burke and
Four
were selling corpses to Dr Robert Knox for his
Hare
anatomical lessons in Edinburgh. Not all of the
own
provided were those from natural deaths.
corpses
and Hare would go on to murder 16 victims in
Burke
to maintain a steady supply of bodies for the
order
1832 Anatomy art would eventually bring this
The
activity to an end. It would also bring more
illegal
to those that specialised in anatomical
freedom
With the work largely on the fringes of
illustrations.
law, many went uncredited for their work in
the
to protect themselves. Now, they were free to
order
more credit for their work. No longer seen as an
take
activity, a mass of anatomical books hit the
illegal
market with each displaying wonderfully
general
plates.
painted
such book would go on to dominate our
One
of the human body. Gray's Anatomy
knowledge
expand on the work of Vesalius whose work
would
published in Latin. Henry Gray would write the
was
accessible and inexpensive anatomy textbook
most
is still used by medical students to this day.
that
in 1858 and illustrated by Henry Vandyke
Released
the work was the product of the newfound
Carter,
Credit:;The Anatomy Lesson of Dr. Nicolaes Tulp/ Rembrandt / Rijksmuseum
internals of the human body.
lessons of Dr Knox.
them. It is wholly possible that this book is work of
Vesalius.
freedoms of the 1832 Anatomy Act.

Bourgery & Jacob, "Traite complet de l'anatomie de l'homme". Credit: Wellcome Collection. CC BY

today's artistical-world the use of anatomy and
In
interest in the subject still continues. Damien
our
has continued the trend producing some of the
Hirst
expensive works of art for any living artist.
most
diamond-encrusted skulls to large sculptures,
From
is prepared to remind us all of our own mortality
he
the same way that his predecessors have in the
in
past.
past renaissance masters such as Leonardo Da
From
to modern artists such as Hirst, the art of
Vinci
holds a mirror to our never-ending
anatomy
with the human body. It reminds us of all
fascination
our complexities, our strengths and reminds
about
that underneath our own skin, we are all the
us
work of Da Vinci, Vesalius and the many others
The
us to understand the complex nature of our
helped
They were prepared to challenge ideas that
bodies.
gone unchallenged for 1300 years. Because of
had
the advances in modern-day medicine has
this,
at an accelerated pace. They challenged a
advanced
world that still saw the dissection of man
scientific
only as barbaric but a challenge to God. Over
not
art of anatomy is more than just the images that
The
produced by artists. It reminds us that in order
were
advance further medically, the need for
to
is absolute. Art is more than a pencil
collaboration
"From diamondencrusted
skulls to large
sculptures, Hirst is
prepared to remind us all
of our own mortality in
the same way that his
predecessors have in the
past."
same.
time that attitude has changed.
drawing or a painting, it can also be a scalpel to.

JOHN WOOLF IS A RESEARCHER, WRITER AND
DR
SPECIALISING IN NINETEENTH-CENTURY
HISTORIAN
HISTORY. HE WORKS ACROSS T.V, RADIO
CULTURAL
FILM. AND
HAS CO-WRITTEN AN AUDIBLE-COMMISSIONED
HE
STEPHEN FRY'S VICTORIAN SECRETS,
BOOK,
OCTOBER 2018) AND HIS NEW BOOK,
(PUBLISHED
WONDERS IS PUBLISHED BY MICHAEL O'MARA
THE
2019) IN THE U.K and PEGASUS IN THE USA
(MAY
2019)
(NOVEMBER
MEDICINE AND FREAK
SHOWS: A TROUBLED
RELATIONSHIP
Words: Dr John Woolf
Images: Wellcome collection

On 24 November 1829 over thirty surgeons and
physicians crowded into the Egyptian Hall in
Piccadilly, London. There was Astley Cooper and
Anthony Carlisle, previous Presidents of the Royal
College of Surgeons (RCS), and Honoratus Leigh
Thomas the current President. There was also a
cohort from the Royal College of Physicians: Francis
Hawkins, Charles Locock and Henry Halford, the
President of the College. These learned gentlemen
had come to pay homage to the exceptional bodies
of Chang and Eng The Siamese Twins, eighteen
years old and joined below the breastbone by a
band of flesh 2in thick and 4in long.
They were giving a private performance in an
exhibition space dubbed the Home of Mystery,
marked with hieroglyphics and fronted by the giant
statues of the Egyptian Gods Isis and Osiris. The
surgeons and physicians watched in amazement as
the twins performed acrobatics with somersaults
and backflips. They even played a form of
badminton with each brother holding a miniature
racket and hitting the shuttlecock to and fro. On
account of their connecting ligament the twins
stood a mere 4–5in apart, so this fast-paced hitting
of the shuttlecock was a spectacle of agility,
harmony and speed.
"The surgeons and
physicians watched in
amazement as the
twins performed
acrobatics with
somersaults and
backflips."
After the show, the surgeons and physicians were
at liberty to poke, prod and inspect the twins. The
surgeons made straight for the connecting
ligament which contained the mystery of their
body, and they fondled the flesh while musing on
the possibility of surgical separation. Not being able
to comprehend fully the nature of the twins’
abnormality made the groping so enthralling: the
enigma of their exceptional physiology engendered
excitement and debate.
The medical gentlemen subsequently signed a
statement testifying to the integrity of Chang and
Eng’s performance, praising the ‘remarkable and
interesting youths’, the reliability of the
performance, ‘in no respect deceptive’, and
emphasising the respectability of the show,
‘nothing whatever, offensive to delicacy’. (1) This
statement was published on the first page of the
twins’ exhibition pamphlet, which was sold when
the public poured into their freak show. A personal
statement by Joshua Brookes, a leading London
anatomist, was included on the first page:
"Having seen and examined the two Siamese
Youths, Chang and Eng, I have great pleasure in
affirming they constitute a most extraordinary
Lusus Natuare; the first instance I have ever seen of
a living double child; they being totally devoid of
deception, afford a very interesting spectacle, and
are highly deserving of public patronage. " (2)
Chang and Eng the Siamese twins, aged eighteen,
with badminton rackets. Coloured engraving by JLB,
1829. Credit: Wellcome Collection.
A reciprocal relationship between medicine and
freakery had been established. On the one hand,
the managers of Chang and Eng benefited from
these medical endorsements. At the time, medicine
was slowly modernizing and becoming more
professional, gaining social respectability and
cultural authority, so these attributes were
transferred onto Chang and Eng’s freak show. The
display of deformity was often associated with lowclass
itinerant fairs, so this backing from medicine

Chang and Eng, conjoined twins, seated. Photograph, c. 1860. Credit: Wellcome Collection.

helped elevate the twins’ show. Indeed, from the
1840s the freak show would become a respectable
family affair attracting everyone from Queen
Victoria to working-class men, women and
children.
On the other hand, medicine benefited from
associating with Chang and Eng. The public were
still sceptical of surgeons, so the medical
endorsements were an exercise in public relations:
surgeons were associating with the popular freak
show and demonstrating an ability to view and
inspect, not steal and dissect, the exceptional body
(important when surgeons were renowned for
relying on the dreaded body snatchers). And a
relationship with the freak show meant access to
the ‘freak’ body. There was a long tradition of
surgeons getting their hands on the corpses of
freak performers: the cadavers of the so-called Irish
Giant Charles Byrne and the Sicilian Fairy Caroline
Crachami found their way to the RCS, while the
managers of Chang and Eng carried embalming
fluid to preserve their corpses in case of sudden
death. (3)
Such was the friendliness between the medics and
the managers that the surgeon George Bolton, a
member of the RCS, could examine the twins
intimately during their seven-month stay in
London. Bolton delivered a report to his colleagues
in April 1830, relaying how he had tested the
sensitivity of the twins’ connecting band by poking
it with a pin; he fed Chang an asparagus and sniffed
the twins’ urine to decipher their ‘sanguineous
communication’; and he even examined the twins’
genitals, which they particularly resented.
Nonetheless, Bolton could praise their ‘owners’
(merchants who had effectively purchased the
twins) for ‘the liberal manner in which they have
uniformly afforded the means of investigating so
curious an object of philosophical inquiry’.(4) The
medical world and the freak show were happily
united.
But fast forward towards the end of the century.
Chang and Eng had transitioned from freak
performers to American farmers, fathers and
slaveowners in the South (they had 21 children
between them and were committed slaveowners).
They continued to tour intermittently, displaying
their offspring to gawping crowds, but the twins
remained more concerned about their plantations
in North Carolina than they did about their freak
show careers. In 1874 the twins died aged sixty-two
and, despite protestations from the family, the men
of science finally got their sweaty palms on the
corpses: Chang and Eng were dissected and their
conjoined livers were displayed at the Mütter
Museum in Philadelphia, where they can still be
seen today.
Medicine was increasingly colonising and
controlling the ‘freak’ body. Indeed, Joseph Merrick,
famously known as The Elephant Man, was taken
from the freak show and contained within the
London Hospital from 1884 until his dying days,
under the careful watch of the eminent surgeon
Frederick Treves. He condemned the freak show
and Merrick’s London manager but, paradoxically,
the surgeon became the showman: Treves
exhibited Merrick at the Pathological Society of
London; he controlled who saw, photographed and
examined Merrick; and he capitalised on his
association with The Elephant Man. When Merrick
died in 1890, his body was handed over to Treves
who dissected Merrick and arranged his skeleton
for display in the Pathological Museum which,
according to a contemporary surgeon, was ‘little
better than a freak-museum’. (5)
By the twentieth century, the rise of eugenics and
social Darwinism led to a medical condemnation of
freak shows which, it was increasingly believed,
peddled physical deformity that threatened the
nation’s health. The enigma of exceptional bodies
was uncovered by the discovery of the endocrine
system, ductless glands that regulate growth and
secondary sexual functions; the X-Ray further
exposed the inner realities of outward deformities.
(6)
Science was pathologizing the freak, killing the
onstage mystique that had once been an essential
part of the freak’s appeal. And freak performers
increasingly went from the circuses and music halls
to the laboratories and asylums as science gave the
freak show a kiss of death.
However, with shows like Embarrassing Bodies and
documentaries peddling unusual bodies, the
relationship between medicine and freakery
lingers. Reality TV and programmes like The
Undateables continue to rely on spectacle,
titillation and voyeurism. Science might have
marginalised the freak show in popular culture but
remnants remain.
The show, as they say,
must go on.

John Woolf is the Author
Dr
THE WONDERS: LIFTING
of
CURTAIN ON THE
THE
SHOW, CIRCUS AND
FREAK
AGE published
VICTORIAN
Michael O'Mara books.
by
Chang and Eng the Siamese twins. Coloured etching. Credit: Wellcome Collection.
Notes:
(1) [James W. Hale], An Historical and Descriptive Account of the
Siamese Twin Brothers, from Actual Observations, Together with
Full Length Portraits, the Only Correct Ones, Permitted to be
Taken by Their Protectors (London: W. Turner, 1830), p. 3.
(2) Ibid.
(3) Cynthia Wu, Chang and Eng Reconnected: The Original
Siamese Twins in American Culture (Philadelphia: Temple
University Press, 2012), p. 36.
(4) George Buckley Bolton, ‘Statement of the Principle
Circumstances Respecting the United Siamese Twins Now
Exhibiting in London’, Philosophical Transactions of the Royal
Society of London, 120 (1830), 177-186.
RRP: £20.00
(5) John Bland-Sutton, The Story of a Surgeon (London: Methuen,
1930), p. 8.
@drjohnwoolf
(6) Robert Bogdan, Freak Show: Presenting Human Oddities for
Amusement and Profit (Chicago: University of Chicago Press,
1988), pp. 62-7.

FINAL THOUGHTS
Content and Advertising:
As an Independent magazine, we are completely
funded by our readers. There are many advantages
to our independence. For example, you may have
noticed a lack of advertising when compared to
other titles. We have made the decision to donate
our advertising space to companies or non-profit
organisations whom we believe our readers would
genuinely be interested in.
We also have complete editorial control of our
magazine in terms of design and content. We
value our independence and for that reason, we
would like to thank everyone involved in the
making of this first issue of INSIDE HISTORY.
From editorial, design, content and most
importantly of all, those who believed in the
project and donated their hard-earned money in
order to hold the copy that is in your hands.
Their names might be unfamiliar, you might even
pass them on the street with no knowledge of who
they are, but to us, they are the reason why we
exist.
In an era of clickbait based articles, we hope to
continue to provide our readers with high-quality
historical content as the magazine continues to
grow.
Dr Lindsey Fitzharris, Dr John Woolf, Louise Wyatt,
Dominic Tiley, Daniel Gathercole, Meera Pain,
Monica Walker, Charlie Simpson, Kate Jarman,
Catherine Starling, Peter D'Onofrio.
Issue supporters via CrowdfunderUK.
Dr Lindsey Fitzharris, Claire Miles, Vicky Pearson
Amy McKibben Cormier, Helen Jones, Mark
Clough, Michael Woolf, Stephen Pitt, Monica
Seggos, Sue Nieland, Rebecca Sayers, Jamie
Richardson, Alexander Nirenberg, Rebecca Frost,
Julia McShane, Rob Walmsley, Trish Howard, Daniel
Kevern, Steven Dawes, Carol Thomson, Sam
Fisher, Håvard Graudo, Peter Dillon, Peter J.
D'Onofrio, Ph, D, Allyson Dyar, Simon Jackson,
Cathy Kennedy, Francis McNulty, Cat Irving, Helen
Lang, Debbie Kilroy, Robin Bristow, Clare O'Brien,
Amanda Walsh, Patrick Monaghan, Kirsty Walton,
Barbara Clayton, Katie Mayers, Stephanie Horton,
Arron Kevern, Claudia Glazzard, Olivier Lefebvre,
Emma Looney, Jamie Abbott, Glenn Dietz, Karl
Bengtsson, David Kavanagh, Anke De Cock,
Richard Kirkup, Christopher W Grimes, Emma
Powell, Hanna Stokes, Dr John Woolf, Carl Schalck,
Carina Kramer, Ray Clough, John Frewin,
Samantha Trousdale, George Towers, Emma
Angus, Stacey Treloar, Brooke Schumacher, Keri
Cronin, Anthony Sinnott, Kate Clough, Aleksandra
Kapis-Facchini, Yosuke Yamazaki, Thomas
Kidman, Caroline McKee, Paul Davies, John
Albiston.
NEXT ISSUE:
CRIME AND THE UNDERWORLD