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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