A Labour in Vain – The Tragic Death of Princess Charlotte Augusta

A Labour in Vain – The Tragic Death of Princess Charlotte Augusta

Princess Charlotte Augusta

Princess Charlotte August was in labour for more than two days before she died on 6th November 1817.

Princess Charlotte Augusta of Wales (1796 – 1817) was the only child of George, Prince of Wales (later King George IV) and Caroline of Brunswick. If she had lived Charlotte would have become Queen of the United Kingdom.

Before her marriage, Charlotte was what we might call a ‘wild child’. She was a good horsewoman and a bit of a ‘tomboy.’

Charlotte’s parents loathed the sight of each other and separated soon after she was born. Her father debauched himself with every form of excess except fatherly love and attention. Her mother lived the lonely life of an abandoned woman. As an only child, Charlotte’s welfare was left in the hands of palace staff and her estranged mother whom she visited regularly at her house in Blackheath.

As Charlotte entered her teenage years, members of the Court considered her behaviour undignified. Lady de Clifford complained about her ankle-length underdrawers that showed. Lady Charlotte Bury, a lady-in-waiting to her mother Caroline described the Princess as a “fine piece of flesh and blood” who had a candid manner and rarely chose to “put on dignity”. Her father, however, was proud of her horsemanship and her tolerably good piano playing.

By the time she was age 15, the curvey Charlotte looked and dressed like a woman; she developed a liking for opera and men and soon became infatuated with her first cousin, George FitzClarence, the illegitimate son of the Duke of Clarence.

To put an end to the budding romance FitzClarence was called to Brighton to join his regiment, and Charlotte’s gaze fell on Lieutenant Charles Hesse of the Light Dragoons, reputedly the illegitimate son of Charlotte’s uncle, Prince Frederick, Duke of York and Albany.

Her mother colluded with Charlotte as far as Hesse was concerned not because she approved of the romance but to peeve her husband who did not. Caroline allowed the pair to meet in her apartments but the liaison was shortlived. Britain was at war with France and Hesse was called to duty in Spain.

Her father’s plan was to marry Charlotte to William Prince of Orange, the Dutch king. Neither her mother nor the British public wanted Charlotte to leave the country to pursue such a match.  Charlotte, therefore, informed the Prince of Orange that if they wed, her mother would have to live with them at their home in the Netherlands. This was a condition sure to be unacceptable to the Prince of Orange and their engagement was broken before it was started.

Charlotte finally settled on the dashing young Prince Leopold of Saxe-Coburg-Saalfeld, Leopold had a commission in the Imperial Russian Army and fought against Napoleon after French troops overran Saxe-Coburg until Napoleon’s defeat at Waterloo.

The Marriage

The marriage ceremony was set for 2 May 1816. The war with France was over and the people of London were in the mood to celebrate. On the wedding day, huge crowds filled the streets and at nine o’clock in the evening in the Crimson Drawing Room at Carlton House, with Leopold dressing for the first time as a British General (the Prince Regent wore the uniform of a Field Marshal), the couple were married. Charlotte’s wedding dress cost over ₤10,000, an enormous sum of money – the average doctor earned less than £300 per year. The only mishap was during the ceremony happened when Charlotte was heard to giggle when the impoverished Leopold promised to endow her with all his worldly goods.

At the end of April 1817, Leopold informed the Prince Regent that Charlotte was pregnant and that there was every prospect of the Princess carrying the baby to term.

Charlotte’s pregnancy was the subject of the most intense public interest. Betting shops quickly set up a book on what sex the child would be. Economists calculated that the birth of a princess would raise the stock market by 2.5%; the birth of a prince would raise it 6%.

The mum to be Charlotte spent her time quietly, however, spending much time sitting for a portrait by Sir Thomas Lawrence. She ate heavily and got little exercise; when her medical team began prenatal care in August 1817, they put her on a strict diet, hoping to reduce the size of the child she was carrying. The diet and occasional bleeding they subjected her to seemed to weaken Charlotte and did little to reduce her weight.

The Pregnancy

Much of Charlotte’s day to daycare was undertaken by Sir Richard Croft. Croft was not a physician, but an accoucheur, or male midwife. Male midwives were much in fashion among the well-to-do. In, ‘The Princess Charlotte of Wales: A triple obstetric tragedy’ Sir Edward Holland (J Obst & Gynaec Brit Emp 58:905-919, 1951) describes Sir Richard Croft as a diffident, sensitive man without much self-confidence despite his skill and experience. “He was not the sort of man to deviate from the rules of practice by doing something unconventional or risky. He played it by the book, but his library was small.”

Charlotte was believed to be due to deliver on 19 October, but as October ended, she had shown no signs of giving birth and drove out as usual with Leopold on Sunday 2 November. On the evening of 3 November, her contractions began. Sir Richard encouraged her to exercise, but would not let her eat: late that evening, he sent for the officials who were to witness the birth of the third in line to the throne.

A Labour in Vain

The first stage of labour lasted 26 hours, which is not uncommon for a first child. With the cervix fully dilated, Croft sent for Dr. Sims, perhaps because the uterus was acting inertly and irregularly, and also because, should a forceps delivery be necessary, Sims had been chosen consultant on that point. Sims was the “odd man out” among the four doctors; his principal work was as a botanist and editor, but he was also physician to the Surrey Dispensary and Charity for Delivering Poor Women in their Homes.

Almost certainly the outcome would have been better had the second stage of labour not lasted as long as the first. The optimal time the second stage is around two hours. Dr. Sims arrived at 2:00 am on November 5 after the second stage had been in progress for about seven hours.

Thirty-three hours after Charlotte’s labour had began Dr. Sims was ready with the forceps, but his assistance was not called for. Croft continued to let nature take its course. After 15 hours of second-stage labour, about noon on November 5, meconium-stained amniotic fluid appeared. Three hours after that, the baby’s head appeared. At nine o’clock in the evening of 5 November, Charlotte finally gave birth to a stillborn boy weighing nine pounds. Efforts to resuscitate the child proved fruitless. Onlookers commented that the dead child was a handsome boy, resembling the Royal Family.

The third stage of labour was no less distressing. Croft informed Sims that he suspected an hourglass contraction of the uterus. This happens when the placenta gets trapped in the upper part of the womb as it contracts  Croft removed the placenta manually with some difficulty, and it seemed to do the trick. Soon after midnight, Charlotte began vomiting violently and complaining of pains in her stomach. Croft returned to Charlotte’s bedside to find her cold to the touch, breathing with difficulty, and bleeding profusely. He placed hot compresses on her, the accepted treatment at the time for postpartum bleeding, but the bleeding did not stop. Charlotte died an hour and a half later.

The Aftermath

Charlotte had been Britain’s hope: George III and Queen Charlotte, had had thirteen children but only Charlotte survived. She was the sole legitimate heir to the throne of Great Britain and Ireland. Her father, with his spendthrift behaviour and penchant for womanising, was already unpopular with the public and his brothers were viewed in much the same light. The Prince of Wales’s girth and reputation for gluttony prompted his critics to dub him the “Prince of Whales.” The people were devasted by Charlotte’s tragic death.

Post-mortems on Charlotte and her stillborn son exonerated the Croft from any wrong-doing. The postmortem results showed Charlotte died because she lost too much blood, her baby because of lack of oxygen. In 1817 there were no blood transfusions for Croft to call on when Charlotte began to lose blood but he could have done things differently and she may not have died. Croft decided not to use forceps, had he Charlotte and her baby might have been saved. Croft was following fashion and the dictum of Dr. Denman an authority of midwifery and childbirth at the time. Since the death of the hugely influential Scottish obstetrician William Smellie’s in 1760, the use of forceps had fallen into disfavour because of the injuries that could be caused by the instrument when used by unskilled accoucheurs. Hundreds of unskilled or partially trained doctors were operating in Britain’s unregulated medical market at the time. The late Dr. Denman had overreacted to these injuries and had advocated a policy of “Let nature do the work. …The use of forceps ought not to be allowed from any motives of eligibility (i.e. of choice, election, or expediency). Consider the possible mistakes and lack of skill in younger practitioners.”

Denman had however hedged his position with a qualification: “Care is also to be taken that we do not, through an aversion to the use of instruments, too long delay that assistance we have the power of affording. In the last edition of his book (1816, posthumously) he wrote: “But if we compare the general good done with instruments, however cautiously used, with the evils arising from the unnecessary and improper use, we might doubt whether it would not have been happier for the world if no instrument of any kind had ever been contrived for, or recommended in the practice of midwifery.”

Croft had relied on Denman’s ultraconservative precepts, his passive obstetrics was just as dangerous as meddlesome obstetrics. The adroit accoucheur steered a middle course, but Croft was not adroit. Three months later, Croft was involved in a similar case, and, when the patient died, he shot himself with a pistol he found in the house. What happened in the wake of Princess Charlotte’s death was too much for Croft to bear.

By today’s standards, the first and second stages of Charlotte’s labour were far too long. Modern obstetricians would use forceps to extract the baby and drugs would be given to speed-up and strengthen the contractions.The most recent CEMD report indicates that in 2009-12, 357 women died during or within 6 weeks of the end of their pregnancy. This represents a decrease in the maternal mortality ratio (MMR) from 11 (2006-8) to 10.12 per 100,000 live births (2010-12), mainly due to a decrease in deaths due to direct obstetric causes. However, there has been no change in the MMR for indirect maternal deaths in the last 10 years; the current ratio (6.87 per 100,000 live births) is almost twice that of direct deaths (3.25 per 100,000 live births).

Sources:

THE YALE JOURNAL OF BIOLOGY AND MEDICINE 65 (1992), 201-210
Obstetrical Events That Shaped Western European History
WILLIAM B. OBER, M.D.
Bergen County Medical Examiners Office, Paramus, New Jersey
Received March 26, 1991

http://www.who.int/maternal_child_adolescent/epidemiology/maternal-death-surveillance/case-studies/united-kingdom/en/

 

Cabinets of Curiosities

Cabinets of Curiosities

Cabinets of Curiosities

Julia Herdman is fascinated by 18th-century cabinets of curiosities because they show a love of learning and the natural world.  The 18th century saw a huge growth in the public interest in science and medicine. Cabinets of curiosities were a feature of many large houses because they were a way to show that their owners were taking an intellectual interest in the world. The 18th century was a time when it was cool to show off one’s intellectual prowess. Most of the collections consisted of rocks and minerals, shells, feathers and small animal skeletons. Cabinets of curiosities were works of art and a popular way to establish and uphold the owner’s rank in society. Because of the wonderful things they had in them these collections were sometimes called ‘wonder rooms.’ They were collections of the most extraordinary objects.

Peter The Great’s Cabinets of Curiosities

Russian Emperor, Peter the Great created his Kunstkamera in Saint Petersburg in 1714. It was a haphazard collection rarities with an emphasis on natural specimens.”, rather than the man-made objects called “artificialia”.

Julia Herdman Blog

Frederik Ruysch (1638 – 1731)

Peter was interested in anatomy because he wanted to improve Russian medicine. He encouraged research into human deformities by issuing a royal edict requiring examples of malformed and still-born infants to be sent to the imperial collection where he put them on display as examples of accidents of nature. This collection of human specimens became the core of the Russian Academy of Sciences. 

In 1716, he added a mineral cabinet to the Kunstkamera, with the purchase of a collection of 1195 minerals. Russian minerals were added to the collection that eventually became the core of the Fersman Mineralogical Museum in Moscow.

Peter the Great also bought many specimens from Holland particularly from the pharmacologist, Albertus Seba, and the anatomist, Frederik Ruysch (1638 – 1731).

The illustration shows one of the scenes created by Ruysch and displayed in his museum in Amsterdam. Ruysch’s creations were so intricate and detailed they were known as 8th wonders of the world. Ruysch’s daughter prepared the delicate cuffs and collars that were slipped on to arms and necks of the skeletons which were positioned to show them crying into handkerchiefs. To add to the bizarre scene the skeletons were wearing strings of pearls and playing the violin. Ruysch was an expert showman and a scientist. His dissections were public spectacles held by candlelight and accompanied by music and refreshments. A major new voice in historical fiction.

John and William Hunter’s Cabinets of Curiosities

In Britain, the anatomists, John and William Hunter were renowned collectors of curiosities. The brothers collected what is called the  Hunterian Collection which is split between London and Glasgow.

William Hunter played a prominent role in the most prestigious cultural and scientific institutions of the 18th century, both in Britain and abroad. He appears in Zoffany’s painting, Life Class at the Royal Academy (1771-1772). He also appears in James Barry’s Distribution of the Premiums by the Royal Society of Arts and Manufactures (1777-1783).

The curiosities he collected are now on display at the University of Glasgow. The exhibition explores Hunter’s personal and professional life and highlights both his passion for collecting and his hugely successful career as a royal physician, outstanding teacher of anatomy and surgery and pioneering scientific researcher. It is one of the best-known collections in the country and contains 650 manuscripts,10,000 printed books, 30,000 coins.r new voice in historical fiction

William Hunter (1718-1783)

Cabinets of Curiosities

John Hunter

 

William Hunter teaching anatomy

John Hunter FRS (1728 – 1793) was one of the most distinguished scientists and surgeons of his day. He came to London in 1748 at the age of 20 and worked as an assistant in the anatomy school of his elder brother William (1718-83), who was already an established physician and obstetrician. He was an early advocate of careful observation and scientific method in medicine. John Hunter was a great showman and entrepreneur as well as one of London’s most famous surgeons.

Hunter devoted all his resources to his museum. It included nearly 14,000 preparations of more than 500 different species of plants and animals. As his reputation grew, he was supplied with rare specimens such as kangaroos brought back by Sir Joseph Banks from James Cook’s voyage of 1768-71.

In his lifetime, John Hunter collected and prepared thousands of natural specimens, which he displayed in his museum including the skeleton of the Irish Giant Charles Byrne. In 1799, the British government purchased the collection and presented to the Royal College of Surgeons.

La Ronde Cabinets of Curiosities

A La Ronde is an 18th-century 16-sided house located near Lympstone, Exmouth, Devon, England, and in the ownership of the National Trust.

 

Jane and Mary Parminter – La Ronde
Cabinets of Curiosities

Collecting was not just the rage for anatomists and princes. Curious Parsons and Lords of the manor had their own cabinets of curiosities. It was part of what has been called the 18th century’s elite ‘learned entertainment.’

Many houses had cabinets of curiosities; one of the most beautiful collections of seashells was gathered by two spinster cousins, Jane and Mary Parminter. The two cousins became greatly attached to each other and in 1795 decided to set up home together in Devon.

The sisters created a magical world in their sixteen-sided house with diamond-shaped windows. The spinster cousins went on a tour around Europe and were avid collectors. They decorated the walls of their quirky house lovingly with hundreds of feathers and shells. They crafted pictures using sand, seaweed, and card and hung them on the walls. The cabinet of curiosities in the library is jam-packed with a jumble of Parminter family souvenirs such as shells, beadwork, semi-precious stones and votive statues. This is a real treasure house with every nook and cranny crammed with bizarre items collected over the years.  It is a treasure trove overflowing with everything from ancient Egyptian artifacts and precious rocks to prints from Switzerland. The cousins lived secluded and somewhat eccentric lives for many years. Their happy lives together came to an end in 1811 when Miss Jane died. A major new voice in historical fiction.

Cabinets of curiosities la ronde

Cabinet of shells from La Ronde

http://www.bl.uk/learning/timeline/item107648.html
https://en.wikipedia.org/wiki/Royal_College_of_Surgeons_of_England#Hunterian_Museum
https://en.wikipedia.org/wiki/William_Hunter_(anatomist)
https://en.wikipedia.org/wiki/Hunterian_Museum_and_Art_Gallery
https://en.wikipedia.org/wiki/Kunstkamera
https://www.nationaltrust.org.uk/a-la-ronde
http://www.sciencemuseum.org.uk/broughttolife/people/johnhunter

Dress to Impress Princess

Dress to Impress Princess

In 2013 novelist Hilary Mantel wrote in an article in the London Review of Books. The subject of the article was giving a book to someone. The book she chose was published in 2006 and was by the cultural historian Caroline Weber. The book was called Queen of Fashion: What Marie Antoinette Wore to the Revolution and she chose to give it to Catherine Duchess of Cambridge.

“It’s not that I think we’re heading for a revolution,” said Mantel. She was concerned that Kate was becoming a jointed doll on which certain rags were hung. “Marie Antoinette was a woman eaten alive by her frocks,” says Mantel. “She was transfixed by appearances and stigmatised by her fashion choices.

Politics were made personal in the tragic French Queen. Her greed for dresses and self-gratification, her half-educated dabbling in public affairs, were adduced as a reason the French were bankrupt and miserable. It was ridiculous, of course. She was one individual with limited power and influence, who focused the rays of misogyny.

Marie-Antoinette was a woman liked to dress to impress but she couldn’t win. If she wore fine fabrics she was said to be extravagant. If she wore simple fabrics, she was accused of plotting to ruin the Lyon silk trade. But in truth, she was all body and no soul: no sense, and no sensitivity.

The Queen was so wedded to her appearance. As the royal family tried to escape Paris she did not leave her wardrobe behind instead she had several trunk loads of new clothes sent on in advance and took her hairdresser along for the trip. Despite the weight of her mountainous hairdos, she didn’t feel her head wobbling on her shoulders. When she found herself back in prison it is said her hair went grey overnight.

Of course, the Duchess of Cambridge is no Marie-Antoinette. She is a modern, educated woman who has married for love but Mantel is right about royal women of the past and strangely prophetic in describing what has happened to Kate in the press recently. Duchess of Drab! wrote Sarah Vine in the Daily Mail on 8th April 2016, “It’s the mystery of the cosmos… How DOES a beautiful woman make designer outfits look so frumpy?”

Unlike her late mother-in-law, Diana Princess of Wales, Kate has not courted fashion or the press a crime she will pay heavily for I suspect but as a woman with a mind, she probably knows she’s damned if she does and damned if she doesn’t. If she courts fashion and sex appeal, she will be lambasted and lauded like tragic Diana, if she doesn’t she’ll remain a dowdy, uptight mouse.

In this respect, Kate is like so many royal women in the past who receive only a passing reference in mainstream history books. When Kate ventures out to visit some charity or other on her own she is lauded patronizingly by the newscasters as if they were talking about a child. Surely, it’s not hard for a woman in possession of one of the country’s most expensive educations and a good university degree to talk to children or politicians for a half an hour after a briefing by Palace aids!

The Duchess of Cambridge is just the most recent in a line of royal women living out their lives in gilded cages. The difference between Kate and her Georgian forbears is that she has chosen her life and consciously sacrificed her private life and career for love. This was not a luxury afforded to princesses in the past.

This summer Meghan Markle was criticised for a pale pink off the shoulder dress she wore to her first Trooping the Colour ceremony. The sleeveless dress caused a Twitter storm with Tweeters slamming the look as “inappropriate” for Queen Elizabeth’s annual birthday parade.

Disney may believe every girl wants to be a pastel packaged franchise of a slender-waisted fairy-tale princess but if they knew what most princesses went through in the past and even today they would not be so keen to join their ranks. It’s not all about the dress. The truth is many of these women were child brides, exchanged by their families to secure some dynastic advantage or to settle political deals; personal happiness and fulfilment were never part of the transaction.

 

Sources:
http://www.lrb.co.uk/v35/n04/hilary-mantel/royal-bodies
http://www.dailymail.co.uk/femail/article-3530869/Duchess-Drab-s-mystery-cosmos-DOES-beautiful-woman-make-designer-outfits-look-frumpy.html

Sarah Wilson – Queen Charlotte’s Fictitious Sister

Sarah Wilson – Queen Charlotte’s Fictitious Sister

I am delighted to welcome Geri Walton as my guest today.

Geri Walton

Writer and Historian Geri Walton

Geri is a history graduate and writer. Her first book, Marie Antoinette’s Confidante: The Rise and Fall of the Princesse de Lamballe, examines the relationship between Queen Marie Antoinette and Marie Thérèse, the Princess de Lamballe. Based on a wide variety of historical sources it captures the waning days and grisly demise of the French monarchy.

 

Guest Post – Queen Charlotte’s Fictitious Sister

The story of Sarah Wilson.

When Charlotte of Mecklenburg-Strelitz arrived in England, no one would have called her a beauty. However, she did have other impressive qualities. She had an agreeable manner, “unaffected modesty,” and a graceful and expressive way of speaking. Charlotte was also unbendingly loyal to her servants and there were no household upheavals related to party connections or political issues. Yet, of all the Queen’s qualities, it was her goodness that shone the most and the thing that many people remembered.

Charlotte 1767 Cotes

Pastel of Queen Charlotte with her eldest daughter Charlotte by Francis Cotes in 1767, Courtesy of Wikipedia

An example of the Queen’s goodness was demonstrated around 1771. In June, shortly after the Queen delivered her son Ernest-Augustus, a woman named Sarah Wilson became a maidservant to Caroline Vernon. Vernon was lady-in-waiting to Queen Charlotte, and because of that, Wilson was allowed access to the Queen’s apartments.

Access to Queen Charlotte’s Apartments

With access to the Queen’s apartments, Sarah Wilson snuck in and pilfered clothing and other items belonging to the Queen. Wilson also broke open a locked cabinet, rifled through it, and stole several valuables. Of course, it did not take long for the thefts to be discovered and for Sarah Wilson to be charged as a thief.

The Trial and the Journey to America

After Sarah Wilson was apprehended, she was tried, found guilty, and sentenced to death. The Queen’s goodness showed when she intervened on Wilson’s behalf and had Wilson’s sentence reduced: Sarah Wilson would not be executed but rather sent to the colony of Maryland. Thus, Wilson arrived in Baltimore, Maryland, in the fall of 1771 and subsequently became an indentured servant to a William Devall of Bush Creek, of Frederick County.

Henrietta Young Blog

Henrietta Maria, the French Princess and Queen Consort of Charles I after whom “Maryland,” was named. Courtesy of Wikipedia.

Wilson did not remain with Devall for long. A few days after Wilson began working for Devall, she escaped to Charlestown, South Carolina, and there began to pass herself off as a sister to the Queen. Sarah Wilson called herself Princess Susannah Caroline Matilda. Apparently, Wilson had also retained some clothes of the Queen, some jewels, and a few other possessions, “among which was a miniature of Her Majesty.” These possessions allowed Sarah Wilson to appear regal and royal.

More Deception

To ensure the ruse worked, Sarah Wilson told everyone she left England to avoid an unpleasant marriage that was about to be thrust upon by her “august relations.” Her ruse was so perfect that the Charlestown town crier announced her as “her Serene Highness,” and she met some of the most respectable and important people of the area. In addition, under this pretense as the Queen’s sister, Wilson travelled from house to house making “astonishing impressions in many places, affecting the mode of royalty so inimitably, that many had the honour to kiss her hand.”

Advertisement Julia Herdman

Advertisement by William Devall to Retrieve Sarah Wilson. Public Domain.

Despite Sarah Wilson’s skill at impersonating royalty, not everyone she met was gullible. Some people questioned why Wilson only spoke English, when, similar to Queen Charlotte, she was supposedly born in Germany. Another thing that raised people’s suspicions was that most people were unaware Queen Charlotte had a sister, let alone a younger one.

Eventually, Sarah Wilson’s impersonation ruse came to an end when Devall received word that someone looking much like Wilson was claiming to be the Queen’s sister. He published a notice in the newspaper that stated: “SARAH WILSON … has changed her name to Lady Susanna Caroline Matilda, which made the public believe that she was his Majesty’s sister; she has a blemish in her right eye, black rolled hair, stoops in the shoulders, makes a common practice of writing and marking her clothes with a crown and a B. Whoever secures the said servant woman, or takes her home, shall receive Five Pistoles, besides all costs and charges.”

The five pistoles went to a Michael Dalton who found Wilson near Charlestown in Virginia and dragged her back to Bush Creek. There Wilson remained for two years until Devall became a rebel in America’s War of Independence. At that time, Wilson once again fled. The last report of Wilson was when she married a Dragoon officer named William Talbot. They later opened a business in the Bowery area of New York and had a large family.

 

References:

  • “Advertisement,” in Caledonian Mercury, 26 June 1773
  • “America,” in Caledonian Mercury, 26 June 1773
  • “America,” in Reading Mercury, 28 June 1773
  • Appleby, Joyce and et al, Encyclopedia of Women in American History, 2015
  • Watkins, John, Memoirs of Her Most Excellent Majesty Sophia-Charlotte, 1819

 

You can find out more about Geri and her book using the following links: WebsiteFacebook (Profile)TwitterAmazon | Pen and Sword

The Man Who Transformed the Health of Londoners

The Man Who Transformed the Health of Londoners

Edwin Chadwick is the man who transformed the health of Londoners.

In a time when diseases like smallpox, cholera, and TB were insatiable in their taking of human life Edwin Chadwick used his position to persuade the government to invest in public health. Chadwick must be credited with being Britain’s premier pioneer in public health reform.

In 1834, he was appointed Secretary to the Poor Law Commissioners. Unwilling to administer an Act he was largely the author of in any way other than as he thought best, he found it hard to get along with his superiors. These disagreements contributed to the dissolution of the Poor Law Commission in 1847. Chadwick believed that public health should be the domain of the local government who he said should train and select their own experts.

While still officially working with the Poor Law Commissioners, Chadwick took up the question of London’s sanitation in conjunction with Dr. Thomas Southwood Smith. Their joint efforts produced a salutary improvement in the public health.

Chadwick’s report on The Sanitary Condition of the Labouring Population (1842) was researched and published at his own expense. A supplementary report was also published in 1843. The formation of the Health of Towns Association and the creation of various city-based branches followed rapidly. These national and local movements contributed to the passing of the Public Health Act 1848.

In 1848, Chadwick was appointed Sanitation Commissioner and a new Central Board of Health. The Board of Health was created with the powers to clean the streets and improve both the water and sanitation systems. Chadwick had many ideas on how he could improve the lifestyle of the poor. His priorities were a constant supply of fresh and clean water, toilets in homes and a sewage system that would carry the sewage from the cities.

One of his innovations was the use of glazed earthenware pipes for sewage, which reduced the possibility of contamination of drinking water. He also ensured that shallow drinking wells were abolished and replaced by a mains water supply.

Chadwick’s efforts were acknowledged by at least one health reformer of the day: William James Erasmus Wilson who dedicated his 1854 book Healthy Skin to Chadwick “In admiration of his strenuous and indefatigable labors in the cause of Sanitary Reform”.

Chadwick and Florence Nightingale corresponded on methodology. He encouraged her to write up her research into the book Notes on Nursing. He promoted it among well-placed intellectuals, making her much more visible.

Thomas Robinson Leadam 1809 – 1881 MD Cleveland 1853 MRSC Eng 1853 LRCP Edin. was the descendant of John Leadam surgeon of Tooley Street who inspired my series of Tales of Tooley Street. He was a British orthodox physician who also practiced homeopathy. He was the Surgeon to St. Olave’s Union, Surgeon Accoucher the London Homeopathic Hospital, Surgeon, and Surgeon Accoucheur to the Marylebone Homeopathic Dispensary.

In 1848, Thomas Robinson Leadam was a witness called before the Metropolitan Sanitary Commissioners. Leadam was the Medical Officer and Surgeon to the Poor Law Union of St. Olave’s, Southwark, and present during the Cholera and Typhus epidemic in 1848, when he partitioned off part of a workhouse to become a Cholera Hospital.

In his report to the Commissioners on this epidemic, Leadam described his district as a very poor area with no water supply beyond a few street taps, with cesspools and open stagnant ditches such that the stench outside his house was terrible.

Leadam continued that the effluvia often floods into the houses. This local doctor’s recommended was that Parliament should instruct landlords to connect the houses of Southwark to the sewers and initiate appropriate sanitation and drainage, as well as street paving.

Volume One, Tales of Tooley Street by Julia Herdman is available on Amazon worldwide. myBook.to/TalesofTooleyStreet

Whistle-blower in the Maternity Ward

Whistle-blower in the Maternity Ward

Key Words: Whistleblower, Maternity

Ignaz Semmelweis was the Hungarian obstetrician and a whistle-blower who spoke out about bad practice in maternity wards. The work done by Semmelweis all but removed puerperal fever, commonly known as Childbed fever, from the maternity wards he worked in. He was not the first to try to change the medical practices of his day and like his predecessors, he was to suffer for his outspokenness.

The son of a tenant farmer from Aberdeen was the first modern doctor to realise how the infection was passed from person to person but he had no proof to back up his findings. Alexander Gordon was born in the hamlet of Milton of Drum, eight miles west of Aberdeen in 1752. His twin brother James went on to contribute to the development of farming introducing the Swedish turnip – the swede to Scotland and improving the diet of the Scottish people. James died at the grand old age of 90; his brother Alexander was not so lucky.

Alexander became a medical student and studied at the medical faculty of the University of Leiden in the Netherlands in March 1776. Teaching at the University took the form of topics rather than through learning the writings of the ancient Greek and Roman treatises on medicine. Students learned to exhibit a caring attitude at the bedside and to take meticulous notes.

After his time in Leiden, there is evidence that Gordon attended physicians’ ward rounds at Aberdeen Infirmary, although the city had no formally established medical school. His notes of lectures by Alexander Monro Secundus in the library of the University of Aberdeen indicate that he studied for a time in Edinburgh. After his time in Edinburgh, Gordon joined the Royal Navy, serving as a surgeon’s mate and ship’s surgeon, a move that would have offered the opportunity for adventure but also funding for further medical training before setting himself up in practice.

In April 1785, he retired from the Navy on half-pay and spent nine months in London, as a resident pupil at the Middlesex Hosptial and Store Street lying-in hospitals, where he heard lectures from leading obstetricians and attended dissections and lectures in surgery at the Westminster Hospital. Early in 1786, with an education gained in prestigious medical centres, he returned to practice in his native Aberdeen.

Gordon became a physician to the city Dispensary in February 1786. Here he saw sick people as outpatients or in their own homes, an activity that continued throughout his time in Aberdeen. The keeping of accurate medical records was a hallmark of the Scottish medical Enlightenment. Gordon was required to maintain a log of the dates of each patient’s attendance, their name, age, address, the presenting condition and its outcome; this discipline was to prove important for his later discovery about the spread of puerperal fever.

There were two major outbreaks of puerperal fever in and around Aberdeen while Gordon was there. From his notes, Gordon noticed that mothers living in the villages developed the fever if they were in the care of midwives from the city, where the infection was rife; village mothers attended by country midwives, who had no previous contact with the fever, avoided the disease.

Secondly, in common with what was becoming part of informed medical inquiry at this time, he created a table and noted the appearance of cases in date order, the maternal place of residence, the outcome and crucially, the name of the person who attended the birth. It was immediately apparent that cases of fever began in date sequence after visits by particular midwives. Furthermore, with impressive scientific objectivity, he implicates himself in the transmission, stating: It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women. This evidence-based discovery long preceded the findings of Oliver Wendell Holmes in 1843 and Ignaz Semmelweissin 1847, whose names are commonly associated with establishing the mode of transmission of puerperal fever.

Gordon’s advice to any physician who had seen a patient with severe fever was to return home and change and fumigate his clothes. By instituting hygiene measures that included hand washing, fumigation of rooms and burning of infected clothing, Gordon was able to claim, ‘In my practice, of 77 women, who were attacked with the puerperal fever, 28 died; so that very near two-thirds of my patients recovered.’ He goes on to quote contemporary reports of puerperal fever mortalities in the range 68–100%. Alexander Gordon died at the age of 47 in 1799. No one had listened to his advice and he had left the job in loved to work once more as a naval surgeon.

Ignaz Semmelweis suffered a similar fate. Semmelweis was not prepared to accept the belief that poison air was killing his patients in the No. 1 labour ward in the Vienna hospital where he worked. Semmelweis believed that the cause of so many deaths in the maternity ward was the nearby post-mortem room. Ward No. 1 was the preserve of doctors and trainee doctors whereas Ward No 2, where the death rate was lower, was the domain of the midwives who did not perform routine autopsies. Semmelweis believed that there had to be a link between the work done in the post-mortem room and the rate of infection in Ward No 1.

In 1847, a colleague of Semmelweis, Jakob Kolletschka, died from septicaemia. He had been cut with a scalpel during an autopsy. Semmelweis attended his colleague’s autopsy and noticed that the lesions on his body were very similar to those on many of the women who had died in Ward No 1. Semmelweis believed that it had been the scalpel that had transferred the ‘miasma’ from the corpse to his former colleague.

Semmelweis ordered that all medical staff in Ward No 1 had to wash their hands in chlorinated lime before visiting a patient and that the ward itself had to be cleaned with calcium chloride. The mortality rate in Ward No 1 dropped dramatically and by 1849, just 2 years after the death of his colleague Kolletschka, death from ‘miasma’ had all but disappeared.

Semmelweis provided his evidence to the medical elite of Vienna. He stated that cleanliness was the way to defeat ‘poison air’ and backed this up with the statistics he had gathered. His views were not part of the general medical beliefs of the time and he was immediately attacked by most senior medical figures – three did support him but none of them had a background in obstetrics. Semmelweis was dismissed from his position and went to live in Budapest. In Ward No 1, the doctors went back to their old ways and fatality rates immediately increased to their level pre-1847.

Semmelweis gained employment at the St. Rochus Hospital in Budapest and applied his findings there. The death rate in the maternity units there dropped drastically. In 1861, Semmelweis published ‘Die Aetiologie, der Begrif und die Prophylaxis des Kindbettfiebers’ (Etiology, Concept, and Prophylaxis of Childbed Fever) – “which stands as one of the epoch-making books of medical history.” (History of Medicine by Roberto Margotta)

The work was filled with a mass of statistics and proved difficult to read. It was met with hostility by the medical profession and many simply mocked its findings. It took another twenty years before his findings were universally accepted. For years many of Europe’s leading medical practitioners believed that childbed fever was a disease of the bowel and that purging was the best medicine for it.

The years of rejection by his colleagues almost certainly took its toll. Semmelweis suffered from severe depression and may have suffered from premature dementia as he became very absent-minded. After the effective rejection of his 1861 work on puerperal fever he wrote a series of ‘Open Letters’ to his main critics in which he openly called them “ignorant murderers”.

In 1865 he was tricked into visiting a mental asylum. When he tried to leave Semmelweis was forcibly restrained and put in a straitjacket. The injuries were such that they became infected and he died two weeks later.

Ignaz Semmelweis died in 1865. He was buried in Vienna. Very few people attended his funeral. In 1891, his body was transferred to Budapest. A statue was only erected to him and his achievements in 1894, nearly thirty years after his death; Alexander Gordon remains almost entirely unknown.

Sources: http://www.historylearningsite.co.uk/a-history-of-medicine/ignaz-semmelweis/

Image: The Knick—Steven Soderbergh’s riveting Cinemax series, which looks inside the Knickerbocker Hospital in Manhattan at the turn of the last century.