So delighted with this Critic’s Report of my book from BookLife Prize, I just had to share. So grateful it’s called a “richly developed historical mystery”. I’ve never had a reviewer understand exactly what I was doing!
Plot/Idea: Murder at Old St. Thomas’s is a richly developed historical mystery filled with fascinating period details, including those surrounding the medical profession, theatrical productions of the era, and societal conflicts.
Prose: Lane’s prose is layered, immersive, and immediately transports readers to nineteenth century London. The police procedural aspects of the story are carefully constructed and finely detailed.
Originality: Lane’s novel readily calls to mind works of classic mystery, while allowing the events, atmosphere, and characters to fully resonate with modern readers.
Character/Execution: The story’s many characters range from doctors to nurses to apothecaries to actors to an extremely intelligent and observant 12-year-old boy. Lane creates a complex and decidedly unlikable character in the novel’s victim, effectively establishing early on the number of potential suspects. While the Dickensian cast may overwhelm readers, Lane brings them each to life. References to historical figures provides verisimilitude and context, while both central players and peripheral ones add to the splendor of the world Lane creates.
In anticipation of my Conversation to benefit the Old Operating Theatre and Herb Garret in London, which will take place in Zoom on December 8 at 7pm British time, I am posting here about the history of the old hospital and its time in Surrey Gardens. I will be talking about some of this during my presentation. This is a re-post from March of 2020, as I was starting to write the book. Enjoy!
St. Thomas’s Hospital at the Zoo
The cholera ward, of course, was in the giraffe house…
In my recent researches of St. Thomas’s Hospital, Southwark, I have discovered an unusual episode, a time when the hospital went to the zoo.
St. Thomas’s Hospital was located on Borough Street in Southwark from the medieval period until 1862. (What remains of it, the Old Operating Theatre Museum and Herb Garret, is my all-time favourite museum in London.) At that time, the railway was forcing itself through the area as companies competed with each other. The proposed railway went right through the heart of the hospital grounds. So in 1862 the hospital was sold to the railway company, for £296,000, according to this.
Guy’s and St. Thomas’ Hospitals shown on “Improved map of London for 1833, from Actual Survey. Engraved by W. Schmollinger, 27 Goswell Terrace”
‘St Thomas’s Hospital 1860’, aerial view. Credit: Wellcome Library, London. Wellcome Images, Roberts, G.Q., A brief history of St Thomas’s Hospital (1920)
A new hospital site was arranged to be built where most of it still stands, in Lambeth, across from the Houses of Parliament. But this site wasn’t complete until 1871.
View of St Thomas’s Hospital with plan taken from Henry Currey’s, St. Thomas’s Hospital, London. [London] : [Royal Institute of British Architects], 1871 [St Thomas’s Historical Books Collection PAMPH. BOX RA988.L8 T1 CUR]
Most sources skip over this gap. Where did the hospital go in the meantime, for nine years?
It went to Surrey Gardens, in Newington, Walworth, in September 1862. Surrey Gardens had been a pleasure garden, like Vauxhall. It had a zoo. But as business declined, the animals were sold off to build a huge music hall. The hall was gutted by fire in 1861, which coincidentally led to a court case that determined you cannot hold someone to a contract when it’s impossible to fulfill it (in this case, a concert reserved for a burnt-out hall).
St. Thomas’s Hospital decided to lease the whole property, repaired the building, and repurposed some of the zoo.
I’ve been looking for histories and records of St. Thomas’ Hospital to learn more about the situation at Surrey Gardens. The St Thomas’s Hospital Report of 1867 is available, for some reason, at Google Books. Amputation fatalities, I discovered, were lower at the new location.
[Aside: there were also some figures in the Report tables that seem odd to me. How could the average stay in hospital for an ankle sprain be 11 days (p602)? This made me wonder whether one had to stay in hospital to be allowed off work, or whether people really had no one at home to take care of them (or no home — quite possible in a poor neighborhood), or whether ankle sprains were for some reason more serious then? Four men and four women had sprained their ankle that year, and the average stay was 11 days? Perhaps they had more wrong with them than a sprained ankle.]
The giraffe house really was the cholera ward, and the old elephant house was used for dissections. That piece of information comes from a book about Florence Nightingale, who was a big part of all this. She had opened her first nursing school at Old St. Thomas’ only two years before the move, and helped provide for room and board for nurses at the hospital. She also helped design the new Lambeth hospital for maximum light, ventilation, and separation of patients into pavilions. [And she promoted hand-washing as the best anti-infective, as true now as it was in 1860.]
The Illustrated London News of December 1862 (copy available at HathiTrust) features a quick column on how the facilities at Surrey Gardens boasted the “rapid and complete conversion of the old buildings to their new and beneficent uses”, and imagined the gardens would provide a unique opportunity for medical students to stroll and contemplate. Nightingale, who believed in patient access to the outdoors, would have approved this. She wrote a letter to Henry Bonham Carter (her cousin and the Secretary of the Nightingale Fund) on the advantages of temporary buildings for hospitals, but it isn’t available online.
The 9-year relocation gets only a single-sentence mention in Wikipedia. That’s a shame. It seems like such an interesting interlude.
Murder at Old St. Thomas’s is set in London in 1862, which was the year of an Exhibition. Although it was not as beloved as the 1851 Crystal Palace Exhibition, the Great Exhibition of 1862 in London was extraordinary, as I noted in a previous post.
In addition to celebrating industrial and artistic achievement, the Exhibition also hosted meetings of several international groups. This included the International Congress of Charities, Correction and Philanthropy. On June 13, the speaker was Sarah Parker Remond.
A free person of color born in Massachusetts, Remond was anti-slavery from an early age. It is reputed that she made her first speech against the practice when she was 16. Her parents were successful business people. They were active in anti-slavery societies, and made sure their children got a good education, despite the lack of good schools for non-white children.
Sarah was already known as a lecturer for the American Anti-Slavery Society (founded by William Lloyd Garrison) before she was asked to go to London in 1858. Her intention was to get a better education, and she enrolled at the Bedford College for Women while continuing to lecture. While she was there, the American Civil War began.
Her speech at the Exhibition in 1862 emphasized support for emancipation, and by implication the Union blockade against the Confederacy. Britain had declared itself neutral in the conflict, and British ships continued to bring in products to northern ports. She pointed out how the British cotton industry used the products of slaves, although Britain itself had outlawed slavery in 1824. The British Parliament had further passed the Slavery Trade Act of 1873 and were actively involved in confiscating slave ships, but were continuing to benefit from the manufacture of cotton grown by slaves in America. She said,
Let no diplomacy of statesmen, no intimidation of slaveholders, no scarcity of cotton, no fear of slave insurrections, prevent the people of Great Britain from maintaining their position as the friend of the oppressed negro, which they deservedly occupied previous to the disastrous civil war.
This was despite the fact that she recognized that:
Thousands among the commercial, manufacturing, and working classes, on both sides of the Atlantic, are dependent upon cotton for all material prosperity. . .
As the result of the efforts of Remond and others like her, Britain respected the Union blockade of the Southern states. But the result of the decline in raw cotton importation was mill closures and starvation in places like Lancashire. There it’s become known as the Lancashire Cotton Famine.
In 1862, as now, the problem was not just that economic strain had thrown people out of work. It was that there was not enough of a social safety net to provide for them when they lost their jobs. The British government engaged in some compensation experiments, including minor funds distributed directly (similar to today’s stimulus checks), but it was minimal and in many cases never reached the people who needed it. The new Poor Laws had funded workhouses rather than “outdoor” relief to help people at home. Ultimately, some relief occurred when the government provided money to local councils, who then created new opportunities for employment in public works. But that wasn’t until 1864. Before that any efforts were supported primarily by private charity (similar to today’s GoFundMe), partly out of a suspicion of increased government activity*.
In 1862 the issue was the moral culpability involved in profiting from slave labor. Now it is the moral culpability of forcing workers into plague conditions. Jobs that take place indoors have the greatest risk of infection, while those outdoors have the least. Safer jobs could include massive infrastructure repair on America’s roads, bridges, and parks. Designs could be implemented to move commercial, educational, and political enterprises into better ventilated conditions.
Perhaps public works, and a bit of advice from Miss Nightingale (see previous post), might be an answer beyond 1864.
____
* Hall, Rosalind. “A Poor Cotton Weyver: Poverty and the Cotton Famine in Clitheroe.” Social History 28, no. 2 (2003): 233.
Whenever historians discuss the “first” of anything, they use qualifiers. In the case of the first female doctor in the UK, there might be several candidates, depending on how one qualifies the word “doctor.” The innumerable wise women and healers who made diagnoses and prescribed treatment for centuries may be unknown to history. So we define “doctor” in terms of official qualification and credentials.
The honor of being the first female doctor in the UK thus goes to an extraordinary person, Elizabeth Garrett Anderson. Although she had been refused admissions to the College of Surgeons and Physicians because of her sex, she was admitted to the Worshipful Society of Apothecaries because their rules stated nothing forbidding women (an oversight they remedied shortly afterward). The University of Paris then admitted her to the examination necessary to certify her as a medical doctor in the 1860s.
Before her, one might argue, was Elizabeth Blackwell, the first woman on the UK Medical Register as a practicing physician. She would not have been able to obtain a medical degree but was grandfathered into the Medical Act of 1858.
But there is an even more startling possibility. Dr. James Barry was a famous figure in nineteenth-century military circles. He obtained his medical degree from the University of Edinburgh and might have been prevented from sitting his exams due to his youthful appearance but for the intervention of the Earl of Buchan, who was friends with his tutor.
Portrait of James Barry, Wellcome Collection
Dr. Barry was a good physician, known for an excellent bedside manner, and he became a talented surgeon in the army. He served in South Africa and the Caribbean and performed the first successful European caesarean section in Africa. He became Inspector General in 1857 and traveled the British Empire enforcing sanitation in hospitals.
There is much evidence of Dr. Barry’s personality. He was known for his squeaky voice and violent temper. Florence Nightingale, whom he met in the Crimea, hated him, even though his emphasis on hygiene was as energetic as her own. Others reported that he was quarrelsome in the extreme.
He also never undressed in front of other people. This, and his clean-shaven face, curly hair, and short stature do not appear to have caused much comment among most of his colleagues. Later, however, there were rumors of duels caused by insults about his appearance and the expected posthumous claims that “I always suspected” or “I always knew.”
When he died in 1865 of dysentery, a charwoman named Sophia Bishop laid out his body. This action was against Barry’s known wishes that under no circumstances should his body be disrobed in death. The woman claimed that his body had full female genitalia and stretch marks, indicating a possible pregnancy. Barry’s own doctor, Major D.R. McKinnon, simply refused to care about his patient’s sex, having been called upon to identify the body and sign the death certificate. He had written the sex as male on the certificate. When Bishop told him her observations and tried to get him to pay for her silence, McKinnon famously reported to George Graham of the General Register Office:
The woman seems to think that she had become acquainted with a great secret and wished to be paid for keeping it. I informed her that all Dr Barry’s relatives were dead, and that it was no secret of mine, and that my own impression was that Dr Barry was a Hermaphrodite. But whether Dr Barry was a male, female, or hermaphrodite I do not know, nor had I any purpose in making the discovery as I could positively swear to the identity of the body as being that of a person whom I had been acquainted with as Inspector-General of Hospitals for a period of years.
The army sealed the records, supposedly for a hundred years. Isobel Rae’s 1958 book The Strange Story of Dr. James Barry, based on access to those papers, broke the story in the subtitle: Army Surgeon, Inspector General of Hospitals, discovered on death to be a woman. The only evidence, despite the new batch of papers, was the word of the woman preparing the body.
James Barry qualified as a doctor in 1812, so if one says he was female, then he would be the first woman doctor by several decades. The story has fascinated many, and more documents have since been uncovered demonstrating that Barry was Margaret Ann Bulkley in his earlier life. (This includes items like a letter from young Barry to a family solicitor where the recipient wrote “Miss Bulkley” on the outside of the envelope.*) The current wisdom that James Barry was, in fact, a woman, is happily disseminated in more recent books, both for adults and children.
It is natural that current discussions of gender would play into how we interpret James Barry today. Did he simply dress as a man to have a career not open to women? Is it right to call him the “first female medical doctor” if we believe he identified as male? Should we call him a transgender man? Or is it best to respect his own view of himself?
Even if we accept the report of the avaricious charwoman and the handwriting analysis of Margaret Bulkley, we have no way of knowing whether Dr. Barry actually identified as male or would simply be labeled a cross-dresser hiding his female identity. His last wish that he not be undressed for burial seems to speak to something deeper. But here, we are certainly engaging in supposition unsupported by the sources. Instead, it might be best to celebrate an extraordinary career, acknowledge the good he did with his medical skills, and enjoy critiques of his explosive personality from a safe distance.
*see Pain, Stephanie. “The Extraordinary Dr. James Barry.” New Scientist, vol. 197, no. 2646, Mar. 2008, pp. 46–47.
Murder at Old St. Thomas’s is set in 1862, so I did quite a bit of research. For me, this was stepping back 25 years from my usual research area, so I found a lot of surprises, in addition to this novel technique for social distancing:
The first thing to do after putting on my crinoline was to find good maps of London, big maps where you can see street names and even buildings:
Guide to the what? The International Exhibition of 1862. Although the Great Exhibition of 1851, with its Crystal Palace, is more famous, this one was supposed to be even bigger. You can see the catalogue here. It took place in South Kensington, on Cromwell Road, where the Natural History Museum would be later.
The Victorianist blog has some good information, and points out that the death of Prince Albert in December 1861 put a damper on the whole proceedings from the start. And it says the building, above, cost £300,000 but the cost was covered by the profits from the Great Exhibition of 1851. My studies of Victorian science education claim that the entire system of British science education was basically financed by the same pool. Which makes me think that the money from the Great Exhibition of 1851 is like pieces of the cross. There is no possible way that they made enough profit in 1851 to fund everything that’s been claimed.
The Exhibition caused a lot of traffic snarls, especially in west London. And it really was international, with exhibitors and visitors coming from all over the globe. More in my next post…
While she was not writing about people quarantined in their homes, Florence Nightingale’s Notes on Nursing (1859) were about caring for people in their homes, and doing it well.
Nightingale is known, of course, for her service during the Crimean War and her active reform of nursing and hospital hygiene in the mid-Victorian era. She’s the one who realized that many deaths in military hospitals were unnecessary, caused by unhygenic conditions rather than wounds or injury. And she came to this conclusion when aneasthetics were in early days, and antiseptics as yet unknown (Joseph Lister would start his famous work after the war).
Contrary to her “lady with the lamp” image, Nightingale was a no-nonsense, if not actually abrasive, person. She was once even cussed out by a doctor who might have been the first woman to get a medical degree in Britain, except that s/he identified as a man (more on this person in a future post).
I have had a copy of Nightingale’s Notes on Nursing for awhile. I don’t even recall why I bought it. I assumed it was a book for teaching nurses, since Nightingale founded her school of nursing at St. Thomas’s Hospital. But it’s a book about nursing, not just in hospitals, but in the home. And her emphasis, not surprisingly, in on creating healthy conditions.
It is also not surprising that this was considered a job for women, and in my opinion this book should reside on a shelf alongside Mrs. Beeton’s Book of Household Management, published in series at the same time, and printed as a book only two years later. Most people know that Ms. Nightingale was a big advocate of fresh air. In fact, the odd configuration of the new St. Thomas’s Hospital, opened in 1867, was the result of her promotion of cross-ventilation.
Have you ever opened a window for fresh air, and it became so chilly you wished you could leave the heat on? Nightingale recommends this, or at least keeping the fire going with a window open, so that an ill person can have fresh air. She points out that you can keep the patient warm with blankets, and safely allow fresh cold air into the room.
Her book also notes that opening doors and windows is to no avail if the air that comes in isn’t fresh. If your room opens onto a utility closet, or you leave your chamber pot open under the bed (oh those master bathrooms!), or your window overlooks a refuse heap, you are not doing any good with air. Ill people really should be taken out into the garden to get a little sun and air, which I see done all too seldom. I’ve been in elder nursing homes where the windows don’t open and the only outside is a little paving of cement in a courtyard. Nightingale was not a fan of courtyards — the air isn’t fresh enough, going round and round.
Too much bedding, too many visitors
All of her advice was based not only on her experience, but on research and statistics. Her faith in scientific endeavor was firm. In the early 1860s, when the plot was being hatched for passing the Contagious Diseases Act, she argued against it based on statistics. The idea was that preliminary arrest and examination of prostitutes would prevent venereal disease in the military. The act would give the police power to arrest any woman they suspected of being a prostitute. Many who were against the idea argued on the basis of feminine modesty, or the inappropriateness of making a private disease a public issue, or the likely abuses by the police. Nightingale argued on facts: everywhere that harsh measures arresting and examining prostitutes had been enforced by a state, the V.D. numbers had actually increased rather than decreased.
Her household nursing advice seems so common-sense, and yet is often ignored, then and now. She had to recommend that damp towels be spread out to dry, that one not chit-chat inanely with someone who wasn’t feeling well, and that one should always sit beside the sickbed rather than hovering over it, forcing the ill person to crane their neck. And here’s more:
Reading the patient the funny bits of a book you’re reading (update: bits and memes off the internet) is extremely annoying to the ill person.
Quiet is important, because when someone is ill certain sounds can be distressing or even intolerable.
A bedroom, where one sleeps, is not the same as a sickroom. A person in bed because they are ill needs not only air but light, and should be able to see out an open window.
The bed needs to be aired daily — in fact Nightingale suggests two different beds so the sheets of one can always be aired. Not doing this, or using too much bedding and thick mattresses, leaves the patient essentially in their own waste of sweat and their own breathed air. (The current metal hospital bed is likely based on the iron ones she recommended.)
Cleaning must be thorough. Damp cloths, not dusters that just raise the dust into the air. Carpets are horrible even if lifted and beaten 3 times a year (I can just imagine what she’d think of wall-to-wall carpeting). Bad smells indicate organic matter is stuck to things, and it shouldn’t be.
See why I want this filed next to Mrs. Beeton? It’s far less about medical nursing than about good housekeeping. The medical advice reminded me of Hippocrates, especially when it came to diet (“The diet which will keep the well man healthy may kill the sick one”). But at this time, when there is more than the usual concern about people being ill at home, it’s still good advice.
So delighted with this Critic’s Report of my book from BookLife Prize, I just had to share. So grateful it’s called a “richly developed historical mystery”. I’ve never had a reviewer understand exactly what I was doing!
