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 SOME TALES FROM THE ARCHIVES Hospitals protect patients' morals
Hospitals protect patients' morals 'Resolved that a distinction be made in the sort of meals served up for the Superior & Inferior Patients ... with respect to the food of the Inferior Patients it be such as is suitable to their habits of life ... ' 'No Female, except the Mother, Wife, Daughter or Sister, shall visit any Male Patient; and no Male, except the Father, Husband, Son or Brother, shall visit a Female Patient, except by special permission' The social attitudes of the past can make an interesting study, and the history of hospitals is no exception. Mixed wards are still a comparatively new phenomenon but in previous centuries whole hospitals, especially psychiatric hospitals, were designed to keep the sexes apart at all times. Both the Warneford and Littlemore Hospitals were built in such a way as to ensure that male and female patients never met, and the nurses and attendants were always of the same sex as their patients. Even in 1950 the Matron of the Watlington Hospital was not prepared to employ a male domestic assistant without the express permission of the House Committee, even though the appointments were entirely in her hands. The Warneford took very great care: Samuel Warneford is reported as saying 'a wall is not enough to separate the sexes - there should be two walls and an interval of ground between'. When a proposal for changing the use of part of the garden was put forward in 1834 the Rev Vaughan Thomas, of the Committee of Management, recorded his dismay that now the men would 'have access to the walls of the Women's airing court, and that the men instead of being kept away from the females, and at the greatest possible distance, are brought close to the females, with nothing but a low wall between them'. Elsewhere he records that the low wall in question was in some parts 'not more than 6 feet 6 inches high, and easily to be scaled'. When the chapel was built at the Warneford mixed services took place and the Annual Report for 1850 says that 'the United attendance of the male and female patients ... has not been attended with any of the consequences which were once apprehended'. This was hardly surprising, as the men and women entered by different doors and did not even see each other as there was a screen down the centre of the chapel. Segregation remained strict for many years. It was not until 1925 that a female (qualified) nurse took over the male side of the hospital as Matron; the unqualified head male attendant was pensioned off. Even as late as 1944 a report states that 'the sexes were judiciously mixed' as an experiment at the Christmas dinner. A report on the Littlemore Hospital in 1874 records that 'a weekly entertainment, usually a ball, is given as a means of amusement for both sexes', but it is most unlikely that such entertainments were mixed. In 1862 the Chaplain was holding separate reading classes, on Sundays for the men and Sundays, Tuesdays and Fridays for the women.
At the Radcliffe Infirmary the wards in the attics were reserved for male patients only. However, in February 1840 the female wards were overcrowded and in consequence women were sent up to the attic wards. They were not put with the men, but they were in adjoining rooms and Vaughan Thomas was horrified (he was a governor of the Radcliffe as well as being on the Warneford Committee). There was nothing to prevent the mixing of men and women at dinner time, for there was only one nurse to a ward and when she went for a meal the patients were unattended. In the evenings the patients were allowed out to the airing courts for exercise and, unlike those of the Warneford, the courts were not segregated. In 1838 a governor was disturbed to find that male and female patients 'are allowed to go into the same Court at the same time', the contact forbidden to them indoors taking place 'in the evening in the airing court and perhaps after dark - this is an Irregularity'. The morals of the patients were a consideration in the rules of the Radcliffe: they were to attend prayers, were not to swear or play dice or cards and were to behave decently. Concern for the virtuous provoked several comments in the Visitors' Book:
The Radcliffe Infirmary also took great care to protect its nurses, for example the 1898 by-laws lay down that the Porter was to attend the male patients in the bath rooms. In 1871 a new arrangement was made for emptying the bed pans in the accident ward. The Committee of Management objected to the proposals on the grounds that 'however virtuous a Nurse might be it was not right that her feelings of delicacy should be pained by the possibility of her having to empty a bedpan in the sink with the chance of there being at the same time a man seated in the water closet so near it, or of her meeting one buttoning up his trousers on leaving the place'. John Briscoe, Honorary Surgeon, pointed out that the arrangements in another, new, ward 'will still more pain the Nurse's feelings of delicacy for while emptying a bed pan, she will have the chance of there being a man in the place for the urinal on her left hand and one in each of the water closets on her right'. Although it is undoubtedly curious to find concern for the nurses' delicate feelings whilst they were engaged in the indelicate occupation of emptying bedpans, it is a surprise to find such feelings mentioned at all. Dr Palmer, house surgeon 1870-1874, described the nurses as 'kind, intelligent, simple women of the superior servant class, without any pretension to being ladies'. The rules of the Brackley Cottage Hospital, founded in 1876, stated that when the nurse visited a house she was to be treated as an upper servant. Such considerations of class were usual. When the Warneford Hospital was opened in 1826 it was intended to cater for the middle class of society, but even this class was divided. The fees for patients were on a sliding scale according to the capacity to pay, and the hospital was arranged on both female and male sides for patients of the superior, second and third classes. The bedrooms, dining rooms and airing courts were all divided: for example the airing courts for the superior class were at the front next to the gardens, those for the second class at the side and those for the third class at the back near the kitchen yard. In 1834 it seems that even the corridors were not to be communal, for the following recommendation appears in the Visitors' Book:
It is possible that all this sounds very Victorian and very English, so it is interesting to find a twentieth century American equivalent. Marjorie Peto, who was Chief Nurse of the US Army's 2nd General Hospital at the Churchill Hospital 1942-1944, records that when the nurses finally returned to America the army delivered a last lecture. 'After having travelled on land and sea with men, bivouaced with them, nursed and cared for them when they were wounded, watched them die and after having worked with them for three and a half years' the subject of the lecture was 'How to Behave in America. With emphasis on deportment with the opposite sex.' It seems that some things never change.
Cold baths, Napoleon Bonaparte and homing pigeons What do these have in common? No, this is not an essay on the British Army in the early nineteenth century; the answer is that all were instrumental in raising funds for Oxfordshire's hospitals in the days before the NHS. Of course, fund raising is still part of hospital financing today, but before 1948 most of our hospitals depended almost entirely on the generosity of the public. The principal source of money for most of the hospitals was the list of annual subscribers, whose generosity usually gave them the right to nominate patients for admission. This income was supplemented by other regular events and donations. Church collections were often given to the local hospital and employees like the University Press would organize an employees hospital fund. Most hospitals held 'pound days' at intervals, when the public were encouraged to give a pound (or more) of produce to help the hospital. Considerable quantities of eggs, butter, jam, flour, soap, soda, sugar and cocoa were forthcoming as a result of these appeals. In Banbury in the 1930s local children were encouraged to join the Banbury Advertiser's Fairy Sparkles Guild. Children who belonged to the Guild collected pennies and silver paper for the benefit of the Horton Hospital. There was an incentive: the parents of Guild members were charged a reduced fee if the child became a patient. Most of the hospitals made use of their grounds and facilities to raise money. In 1772 the Radcliffe Infirmary made 5/- from charging for the use of their baths by persons other than patients; 6d was charged for a warm bath, 3d for cold. Kitchen waste could be sold for pig swill and hospitals which had gardens would sell off surplus produce. In the early years of the century the annual accounts of the Wingfield Convalescent Home (now the Nuffield Orthopaedic Centre) list the sale of pigs as a regular item. Those with extensive land at their disposal could be even more ambitious. The Warneford once owned all the land on which the Churchill, the Park, the Health Authority, a small housing development and a student hall of residence now stand. In the 1920s and 1930s the hospital was able to run a small farm and a market garden. The annual hospital fete, once a prominent event in the social calendar, is the most obvious example of the regular event as a means of raising money. The proceeds of football and cricket matches, dances, sales of work and concerts were given to the local hospital. In 1928 a Mr Potts gave the 'Banbury Guardian Homing Hospital Cup' for an annual homing pigeon event with the combined aims of raising funds for the Horton Hospital and encouraging homing pigeons. In the 1870s concerts in aid of Brackley Cottage Hospital were given prominent coverage in the local papers. The performers were usually amateur musicians with one or two of sufficient standing to be paid a fee. The concert on 9 Mar 1878 raised £20 for the hospital and was given no less than 24 column inches of coverage in the Brackley Observer. Two of the songs were described in these terms: 'the quartette "The Happiest Land", was given with accuracy as to time and tune and with expression, and was thought by some of the ladies to be the piece of the evening. Those of the sterner sex, however, preferred, as why should they not, its successor "Lingering Voices", in which Mrs Williamson and Miss Campbell made our old Hall a place
The accounts of all the hospitals show donations by individuals, usually voluntary, but occasionally imposed by others. It was a common practice for juries to give their fees to a hospital and in the 1780s the Radcliffe Infirmary was occasionally the beneficiary of fines imposed by the Vice Chancellor or other University and College officials. In 1877 the Infirmary received 13/9d for 'wages forfeited by a Servant', but we do not know whose servant or what he or she had done to forfeit the sum. Between 1812 and 1815 a G.F. Stratton managed to make £42 2s 8d for the Radcliffe from his work as a magistrate. Fines imposed for such offences as stealing apples or buying corn by illegal measure were handed over after the expenses of the conviction had been deducted. From these accounts we learn that a fine of two guineas was imposed on William Harris in 1812; he was overseer of the New Mill in Witney and was fined for an assault on one of the children under his care. We also discover that on 26 September 1808 Thomas Stow of Charlbury made a bet 'that Bonaparte would Master of this Country in 5 years from now'. In 1813 the country was not ruled by Napoleon and he had to pay up; the Radcliffe Infirmary benefitted from the wager to the tune of three guineas. Occasionally the hospitals profited from special events which were not repeated from year to year. During the month of May 1929 Banbury shoppers were able to take part in the Blue Star Scheme; each trader who exhibited a blue star had agreed to give 4d from every pound taken in cash sales to the Horton Hospital. In 1907 Town and Gown co-operated on the Committee of the Oxford Historical Pageant, which was held from 27 June to 3 July to raise funds for the Radcliffe Infirmary, Oxford Eye Hospital and other causes. Performances of the pageant took place before a grandstand built by the river at the end of the Broad Walk, all seats covered and available at 5/-, 10/6d and 21/-. Tickets were sold at offices in Oxford and London and reduced price railway tickets were available to those attending performances; a special train was run from Cambridge. Well known artists, writers and musicians were involved, including Laurence Housman, Robert Bridges, Laurence Binyon, Thomas Allen, Hubert Parry and Beerbohm Tree. Sixteen scenes of Oxford history and legend were presented in full costume, complete with horses, coaches and boats. In the following year the Pageant Committee gave £265 to the Infirmary. One of the reasons for the advent of the NHS in 1948 was that hospitals were finding it more and more difficult to raise the money they needed. As time went by the lists of subscribers had reduced and formal organizations and schemes became the pattern. The Radcliffe Infirmary received donations and sheets from the Ladies' Linen League, for example, and the activites of the Banbury and District Workpeoples Hospital Association raised £119,000 between 1910 and 1948. In such organisations can be seen the origins of the work done by the Leagues of Friends. In 1920 the Radcliffe Infirmary started a Contributory Scheme whereby members of the public gave 2d a week; by 1923 the contributions were providing 60% of the Infirmary's income. In the eighteenth and nineteenth centuries the money to run the hospitals came from the wealthier classes as an act of charity; most of them, if sick, would be treated at home. By the twentieth century the money was being raised by those who would benefit directly from the hospital. When trying to raise funds for the Oxford Lunatic Asylum (now the Warneford) in the 1820s the Committee looked to 'that spirit of Liberality with which Public Charitable Establishments are encouraged'; by 1937 the Horton Hospital was approaching the public 'as a Valued Friend might ask Your Aid that He might be Better Equipped, one day, to do You the Best of Good Turns'.
King orders prayers during 'grievous disease' 'If any one is seized with sickness, slight vomiting, and purging, a burning heat at the stomach, with cramp in various parts of the body, and a feeling of cold all over, it probably is the Cholera'. So ran the warning on a poster circulated in Oxford in the early summer of 1832. Cholera was rife all over the country and the first of three epidemics in Oxford was about to begin. It lasted from 24 June to 28 November 1832 and further epidemics followed in 1849 and 1854. Cholera cases were never treated in the Radcliffe Infirmary (although the hospital provided drugs at cost price), but details of the 1832 epidemic have survived in a volume in the hospital's archives. This contains posters and leaflets from Oxford, London and Edinburgh and correspondence of the Oxford Board of Health, and it bears all the hallmarks of the Rev Vaughan Thomas, chairman of the Board and later preserver of the Warneford archives, in whose hands the administration of the epidemic was placed.
The leaflets and posters make fascinating reading; they chronicle the authorities' attempts to make the public aware of the causes of cholera and the ways in which to prevent it. The insanitary conditions which prevailed in many areas, with open drains and dirt, were recognized as the principal cause. A leaflet was addressed on 4 July 'To the Dwellers in narrow Courts and Alleys, and all other confined situations' by 'A Well-wisher to the Poor Man's Health'. It urged people to 'lose no time in turning to your account the gratuitous distribution of Lime which is now going on. White-wash your Houses. Put an end to foul smells. Throw Lime or Lime-water into or upon the matters that produce them; and as we may expect close and sultry weather, make every thing sweet and cleanly, and without loss of time.' Chloride of Lime was recommended as a disinfectant and a quantity was purchased from R.T. Jones, a druggist in the High Street, and distributed to the various parish authorities in the City. A temporary hospital was built at Pepper Hill and Bartlemas at Cowley became a house of recovery. Originally a leper hospital, Bartelmas was later an almshouse to which the mediaeval fellows of its owner, Oriel College, were accustomed to retreat in times of plague, so the new use was appropriate. A House of Observation was established in St Aldgates, to which those in danger were encouraged to go whilst their houses were fumigated. A notice of 2 August bade them 'Look to Godfrey's Row - look to Bull Street - and learn from their afflictions a lesson profitable to yourselves. Like you, they tarried too long in the midst of disease, and, sooner than quit their habitations, many sickened and died. But some there were who sought safety for themselves and families by removal. The Board of Health opened the doors of their House in St. Aldate's to receive them; and .. all did well, and have since expressed their thankfulness'. The epidemic provided an opportunity to press home the temperance message and the public were warned to 'Beware of Drunkenness - nothing is so likely to bring on Disease.' The authorities were particularly concerned about the dangers at St Giles' Fair and on 1 September a notice was issued of 'Caution and Remonstrance To all Drunkards and Revellers, and to the thoughtless and imprudent of both Sexes'. It warned against 'long sittings, dancings, revellings, surfeitings.[and].mixed, crowded Companies in Booths and Showrooms'. The final caution is that many 'who have raised the cup in merriment to their lips, have in agony lamented their excesses and at their deaths have left a last legacy of warning to the Drunkard'. In the end there were 184 cases in Oxford, with a mortality rate of 52%. The forms of prayer ordered by the King in 1831 'to be used in Churches and Chapels during the Continuance of Danger from the Pestilence now spreading over a great Part of Europe' were followed in 1832 by forms to be used in 'all Places now free, or as they shall hereafter become free, from the grievous Disease'. One imagines that the survivors joined in with enthusiasm.
The doctor who didn't believe in germs
A man is brought into the Radcliffe Infirmary after a fight with his wife and operated upon by one of the surgeons. The patient later dies, a post mortem is carried out and the Coroner holds an inquest, the jury bringing in a verdict of murder against the man's wife. At the trial the surgeon is called upon to give evidence and the Judge is outraged. Why? Because the same man was surgeon, post mortem examiner and coroner. Edward Law Hussey was elected as one of the Infirmary surgeons in 1850. He had a quick temper and was a great writer of letters of complaint; the minute books of the Infirmary are full of his complaints about surgical instruments, admission procedures, funding and bureaucracy. Dr Palmer, house surgeon 1870-1874, said of him 'Hussey was a very difficult man to get on with. He had the greatest contempt for anything new and would not adopt any new methods. His operations I always dreaded and usually had to finish. The stethoscope he called 'the Wonder oracle' and the hypodermic syringe 'the Spike'.' Frederick Symons, another of the honorary surgeons, was more willing to take new approaches and this led to differences between Symons and Hussey which continued for many years. The Infirmary rules required a consultation of all the surgeons before a major operation took place. Symons believed that the surgeon in charge of a patient should be solely responsible and his failure to consult led to a flood of correspondence. On one occasion Hussey published and circulated the letters, which action the Committee considered to be 'a breach of the duty he owes to the Infirmary and much to be regretted'. On another occasion Hussey received notice of one of Symons operations and wrote to say that he held 'a confident opinion that the disease will cease' and suggested that Symons should tell the patient that one of the surgeons believed the operation to be unnecessary. Symons reply was: 'I will take an opportunity to mention to the Patient your opinion. I only regret that I have to expose the ignorance of one of my colleagues. Hoping that you may gain more surgical wisdom.' Hussey found it difficult to accept the use of antiseptics which Palmer began to introduce into the Infirmary in the 1870s. On one occasion Hussey complained to a committee that the hospital seemed to be 'at the mercy of a young house surgeon who was doing his best to poison the patients with carbolic acid'. Hussey did not believe in germs; on one occasion he had to be prevented from placing accident victims in a ward with diptheria. In 1874 there was an outbreak of erysipelas at the Radcliffe and four patients died. The new house surgeon suggested that Hussey's refusal to use antiseptics might have contributed to the outbreak. An independent enquiry was arranged and carried out by a Dr Netten Radcliffe who made several suggestions, mostly concerned with limiting the spread of infection in the future. Hussey objected strongly to the intervention of 'a stranger', believing that the Infirmary rules required such investigations to be carried out by the medical staff and that Radcliffe had been biased: 'Mr Radcliffe acted throughout as the servant of the Committee. I look on it as impossible that a Professional man of mature age, with ordinary powers of observation, could suppose that the enquiry he undertook had the countenance of the Medical Officers'. In 1877 Hussey became City Coroner and had the misfortune to find that his first inquest was to be on one of his own patients, making him surgeon, post mortem examiner, coroner and witness. He believed that the only reasons which entitled him to appoint a deputy were illness or absence from Oxford and felt that he had no choice but to go ahead with the inquest. Faced with public critcism by the Judge, the Committee of the Infirmary demanded that 'Mr Hussey make his option as to which of the two offices of City Coroner and Surgeon to the Infirmary it may please him to retain'. Hussey replied: 'I do not understand how the office of Coroner of the City is related to an office for the treatment of the sick or is incompatible with it. The duty of the Surgeon is at an end before the duty of the Coroner begins'. On receiving this reply the Committee considered a motion to dismiss Hussey, but eventually they gave him the chance to resign. When he did not the Committee arranged to elect a new surgeon. Hussey believed that the Committee acted against the Infirmary rules in getting rid of him, citing motions and meetings without proper notice and a lack of attention to his letters. He claimed that the initial complaint about his holding of the two posts was brought by a former physician to the Infirmary of whom 'I have heard that he had been known on former occasions to declare that he would never rest till I was turned out'. Hussey was not a member of the University and there is a strong feeling of town versus gown in his account of the Committee's proceedings, as he records the words of several University men. It is clear that the Infirmary was taking the opportunity to get rid of a difficult and obstructive man, but it is hard to ignore parts of Hussey's account: 'A Member of the University, one of the Honorary Physicians of the Infirmary, the paid Officer of Health, and a Justice of the Peace talked of "incompatible offices"'. Hussey also pointed out that another of the honorary surgeons was Coroner to the University but he had not been asked to resign. Hussey's subsequent attitude to the Infirmary was to show how bitter he was about his treatment. Soon after he left he began to insist that the honorary surgeons attended inquests instead of the house surgeon, even though he himself had never been called in twenty eight years as an honorary surgeon. At that time the hospital was for the poor and the surgeons gave their services free, maintaining themselves through private practice. The house surgeon cared for the patients on a daily basis, but the honorary surgeons made the clinical decisions. The house surgeon was a paid officer and so did not lose income by attending an inquest which paid no fee. However, Hussey insisted that the surgeon in charge should be called, as 'the House Surgeon may give an opinion that the death was caused by a course of treatment or an operation which he did not see, did not understand, or did not remember. He is not responsible for the treatment of the Patients.' The culmination came when Horatio Symons, who had succeeded his father as an honorary surgeon, refused to attend an inquest and Hussey issued a warrant for his arrest. Symons started legal action and the Home Secretary had to arbitrate; he eventually decided that the attendance of the house surgeon was sufficient. In the meantime Hussey had sent a letter of apology for his 'extreme measure' and paid £20 towards the legal costs, which Symons gave to the Infirmary. For the next sixteen years Hussey made use of every opportunity to complain about the Infirmary, particularly when he heard of deaths which had not been reported to him or when there was a delay in sending notice. On one occasion four staff at the Infirmary agreed as to the cause of a death and confirmed the opinion at a post mortem, but Hussey held that an inquest should be held. The relatives did not agree and took the body for burial. Hussey posted officers at the borders of his jurisdiction on Headington Hill to seize the body, but the family were warned and took a different route. In fairness to Hussey it should be said that before his time the findings of the Coroner tended to be very vague, with such verdicts as 'died before his time had come'. Hussey's determination to pursue a full inquest and to establish the Coroner's rights in post mortems laid down good principles for the future. The last dispute between Hussey and the Infirmary arose in 1893, when the Committee objected to Hussey removing bodies to the City Mortuary for inquests. The Committee believed that it was only legal for Hussey to do so if a post mortem was to be carried out and they reported him to the Lord Chancellor. Hussey pointed out that he objected to the mortuary at the Infirmary, a 'damp and unwholesome cell, sometimes crowded with other bodies, is not a fit place for necessary attendance of Jurors, not always persons familiar with such sights'. It is pleasant to record that for once an amicable agreement was reached, with a room being made available for the body and the Committee offering the Board Room for inquests. The entry in the minute book is in stark contrast to the exchanges of the previous forty years: 'a letter from the Coroner was read expressing his hope that the Coroner's work at the Infirmary might be done without unpleasantness during the remaining time of his tenure of the Office, a hope which the Vice Chairman had cordially reciprocated.' Perhaps Hussey was growing tired of the struggles. He resigned as Coroner the following year, at the age of 78. He died five years later.
Warneford doctor attacked by staff
Leaving the Warneford grounds 'Gentlemen, In consequence of the violent abuse I received from Martha Kent, of whose conduct towards a female patient I thought it my duty to complain, and the shameful assault committed here, by one of the keepers, upon a tradesman, a few evenings ago, I have felt it necessary to absent myself from the Asylum for a few nights'. This is the opening of a letter from a resident medical officer to a hospital committee, complaining about two of the staff. It was sent to the Committee of Management of the Warneford (then the Radcliffe Asylum) by Frederick Thomas Wintle, the Resident Apothecary, on 15 October 1828. Wintle was responsible for the day to day running of the asylum, assisted by two female nurses, two male 'keepers', a cook and a housemaid. The overall responsibility was in the hands of the Resident Director, Mr Moore, but it is clear from the rest of the letter that Frederick Wintle did not expect any help from that source. 'Mr Moore does screen the faults of the servants & as it were consents to their bad conduct, for in the case of Martha Kent he stood by & heard her malignant abuse towards me at two separate times without saying one word to reprove or dissuade her, therefore I cannot expect the least protection from him should any of the servants be disposed to assault or abuse me which I conceive is not unlikely as they know I am opposed to, & have exposed, much of their ill conduct. I beg also to be allowed to continue to absent myself at night until the Committee shall have ordered some means for my security.' The Committee had been unfortunate in the matter of the Resident Director since the opening of the asylum two years before. The first to be appointed was a Mr Bakewell, the son of a well known keeper of a private 'madhouse', as they were known, in Staffordshire. However, he lasted only two months, being 'pronounced unfit for the situation of Superintendent owing to his state of mind'. This is intriguing in view of his position as head of a psychiatric institution, but no further details are given. Mr Moore was the next appointment, man who had gained much experience in the London madhouses. It is not always the case that a committee will uphold the complaints of an employee, but Frederick Wintle was on safe ground, for when he wrote his letter both Mr Cummins, the keeper who had assaulted the tradesman, and Mr Moore, the Resident Director, were already under notice to leave. Mr Moore had kept the books badly, used the premises to fatten his own pigs and had fed the patients' veal to his dog; he was dismissed for 'culpable conduct'. We do not know exactly what the Committee said in reply to Mr Wintle's complaints, but we know that his fear of staying overnight in the asylum did not last. Two months later he was appointed Resident Director in Mr Moore's place and he lived in the asylum until his death twenty five years later.
Treating the patients: creosote, laxatives and galoshes The Navigation Officer is rushed to hospital for brain surgery and his usual doctor is horrified. 'Jim', he exclaims, 'you've got to let me go in there. Don't leave him in the hands of twentieth century medicine'. This is, of course, Star Trek IV and Dr McCoy goes on to cure Chekov with ease. However, perhaps we should bear his remark in mind as we look back at some of the treatments of the past in Oxfordshire's hospitals. In earlier years the usual treatment of the mentally ill was the use of cells, chains and whips. By 1844 the Commissioners in Lunacy were able to publish a report which compared 'the old system of keeping patients bound hand and foot in cells often dark, loathsome and disgusting' with 'the present humane method'. Traditional methods were beginning to be replaced. For example, when the Committee of the Warneford Hospital was sent a sketch of a 'whirling chair', a common device which treated the patient by spinning the chair rapidly, it was decided not to use it. The concept of what was called 'moral management' was taking over, the first emphasis being on the removal of chains and strait jackets. In the 1820s and 1830s the Warneford Hospital made several purchases of handcuffs, hobbles, restraining belts and strait jackets to use for violent patients. By the 1880s restraint was being used differently. When a Mrs Gibson attacked her nurses in 1883 she was placed in a padded room. When she tried to injure herself 'her hands were therefore restrained by jacket'. A week later 'canvas gloves were put on to prevent her injuring herself'. The reduction of restraint was only one of the reforms in the treatment of mental illness. As the nineteenth century progressed great emphasis was placed on exercise, open air, pleasant surroundings and amusements. The appointment of Chaplains was advocated, the Commissioners observing that 'independently of other considerations, the regular attendance of patients at religious services has the effect of inducing habits of composure and efforts to preserve self-command'. The mentally ill were treated with both narcotic drugs and stimulants. Dr Wintle of the Warneford was a great believer in the use of opium to subdue excitement and procure sleep: 'I have had recourse to opium extensively over a period of nearly twenty years, and have not known any ill effect. Patients are frequently sick in the morning after taking warm fluids, but this is rather salutary than otherwise ... I had a clergyman, so impressed with the power of opium in controlling excitement, that, after he left this place, he kept a mixture by him at home, and had recourse to it when he felt irritable and losing the control of himself.' Tonics and stimulants given by Dr Wintle included 'steel, quinine, liquor arsenicalis and creosote'. Wine and beer were also used, both alone and to disguise other preparations: 'very frequently patients cannot be induced to take medicine, and then I have recourse to finesse, and give it in porter or beer.' Patients with epilepsy were treated in asylums and opinions varied considerably on the treatment. At Hook Norton Asylum Mr Mallam tried several remedies: 'In young and healthy subjects I employ drastic purgatives ... occasionally setons in the neck [a seton is a thread or piece of tape drawn through a fold of skin to maintain an opening] ... in weak cases, especially in females, I employ the mineral tonics ... I deem it right to add that I have not found much success.' Mr Mallam's reference to purgatives brings us to one of the most common treatments, both of mental and of physical illness. Laxatives were given regularly, particularly strong doses being given in the asylums. The only early case book of the Radcliffe Infirmary which survives is for 1796. In it we find purging prescribed for patients with all kinds of ailments, including dyspepsia, swollen legs and pains in the stomach, hip and knee. The entry for William Ray, suffering from back pain, cough, sleeplessness and loss of appetite records that the 'opening medicine has moved him 5 times' - in twenty four hours. The creation of blisters and the raising of the skin by the application of heated cups were common treatments, designed to produce a superficial effect in order to relieve a deeper irritation. Cupping to the head and neck were applied for mania, as the raising of blood to the surface was supposed to relieve problems in the brain. In 1796 Radcliffe Infirmary patients suffering from cough, stomach pains, palpitations of the heart and weakness of the arm were blistered. John Bryant was admitted suffering from giddiness and trembling. The first application of a blister 'relieved his head' but soon it was 'slow and heavy' again. Another blister was prescribed and two days later the notes record 'The Blister has done its Duty - his Head swims a little upon any Exertion'. Water treatments were common for many ailments. Showers of cold water were applied to the heads of the mentally ill to cool the brain. In due course the moral managers introduced warm baths for calming patients down, but the cold water treatment continued. At the Warneford Dr Wintle advocated warm baths to help sleep and added 'Cold bathing, especially the shower, is also very beneficial; is more to be used in the summer months but is frequently serviceable at all seasons, as a moral agent in patients who from indolence, perverseness or otherwise, persist in dirty habits.' Warm and cold baths were employed by the Radcliffe Infirmary, again for treatment rather than for cleanliness. Patients were also sent to the Sea Bathing Infirmary at Margate, where they were dipped in the sea, wrapped in sea soaked sheets and drank hot or cold sea water.
In the early years of this century treatment by means of exposure to fresh air became popular and balconies appeared on hospital wards, where patients slept whatever the weather. Pulmonary tuberculosis was treated by exposure to sunlight and fresh air. In 1916 a small wooden shelter for patients was built in the grounds of Brackley Cottage Hospital; it was on a turntable so that it could be rotated to catch the sun. The Committee minutes record requests from the Matron which give an idea of the conditions endured by patients in the shelter. A waterproof cloak and galoshes were requested for the nurses and eiderdowns for the patients. On at least two occasions parents removed their children from the shelter. We should not lose sight of the fact that treatments which seem strange now were based on theories accepted as sound at the time. Sometimes the theories changed; blood letting, cupping and blistering continued from the earliest days into this century, but the reasons for them changed several times. Leeches are still used in medicine. Our predecessors were genuinely doing their best for the patients as we do today. If we were to visit an eighteenth century asylum we might say 'What is this? The Dark Ages?'. In Star Trek IV that is Dr McCoy's verdict on one of our hospitals.
On 30 November 1770 the Bishop of Oxford consecrated the Radcliffe Infirmary's burial ground (long since buried itself), and the congregation prayed that it might be the 'only useless part of the Establishment'. We have a record of at least one patient for whom the burial ground was useless, but only because she was discharged a few minutes too soon. In 1786 the Oxford Journal records that 'Ann Jutt was discharged from our Infirmary and had not walked from there more than an hundred yards before she dropped down dead'. Unfortunately a hospital cannot avoid death altogether but the records of deaths can be interesting, sometimes for the social history they provide and sometimes because the circumstances are curious or just bizarre. An examination of the causes of death in the Radcliffe Infirmary's records shows that road accidents are by no means a phenomenon unique to modern life. In nineteenth century Oxford we find a high incidence of death as a result of being run over by carts. However, the most common cause of death was the result of the use of open fires for cooking and heating. There are countless examples of death as a result of clothes catching fire. Accidents at work turn up frequently. There are many instances of injuries from farming equipment, which is itself a comment on the nature of the communities in the Oxford area. One of the most common such injuries, and one which provokes some gruesome descriptions, is damage to limbs after entanglement in threshing machines. In the records of several of the hospitals it is often possible to spot when there was a new railway under construction in the area because of the appearance of the labourers in the admission, discharge and death registers. Indeed, accidents to railway employees appear at regular intervals, usually when an engine driver did not notice a worker on the track. The Radcliffe Infirmary was closely involved in one of the more famous railway accidents of the nineteenth century, which took place at Shipton on Christmas Eve 1874. The 10am train from Paddington to Birmingham was very popular that day and extra carriages were added at Reading and Oxford. The latter was a mistake as the carriage was old and one of the wheels collapsed, causing the carriage to plunge off the embankment with twelve other carriages following. Thirty four people were killed and more than a hundred injured. Forty seven of these were admitted to the Radcliffe Infirmary, of whom only four died. There was considerable praise for the way in which the staff of the Infirmary coped with the simultaneous admission of enough patients to fill nearly a quarter of their beds. Unfortunately we do not have any details of the patients as both the admission and death registers are missing for that period. Occasionally the records give us brief pictures of deaths which seem unusual, but which frequently give an idea of life in a world without antibiotics, manufacturing standards or health and safety regulations. The following causes of death are examples:
Anyone who looks into history can find reasons to be grateful for living in the present age. In 1778 Martha Jewell died in the Infirmary; when the staff cleared her belongings from the box under her bed they found the body of a baby girl, apparently born about eleven days before. It says a great deal about the different standards of the day that no-one knew that Martha had given birth behind the curtains of her four poster bed and that nobody noticed anything unusual about the smell.
The Maternity Home in the 1920s, a far cry from Martha Jewell's experience Martha Jewell's murder of her child was not all that unusual; there are many examples of single women attempting to conceal their pregnancies and dispose of the unwanted child. One of the most famous examples in Oxford's medical history was the case of Anne Greene, who was hanged in Oxford Castle on 14 December 1649 for the murder of her illegitimate child. As usual the hanging was followed by the transfer of the body to the Anatomy School for dissection. Dr Petty, the reader in anatomy, noticed that the body was unusually warm and he and his companions succeeded in bringing Anne back to consciousness. She was dazed and bruised but in a few days the power of speech came back and she started to speak at the point at which she had stopped on the gallows. It transpired that she had lost the intervening period completely and did not remember 'how her fetters were knocked off, how she went out of the prison, when she was turned off the ladder, whether any psalm was sung or not, nor was she sensible of any pain'. She never did recall her experiences, although she lived on into old age, marrying and having a legitimate family. Ten years later Dr Conyers of St John's College had the same opportunity when another girl was hanged for the same reason and the body delivered to him for dissection. Once again the presumed corpse was revived. However the bailiffs, especially one Henry Mallory, were not prepared to allow another convicted criminal to escape punishment. Shortly after midnight they broke down the door of the house where the girl was resting, bundled her into a coffin and carried her out to the field of Broken Hayes (now Gloucester Green bus station). In spite of her cries of 'Lord, have mercy upon me' they hanged her from a tree, later cut down by disgusted local inhabitants. Medical science had done its best to perform another miracle, but the requirements of civic justice were the final victors. |
