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

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.

Sinclair Extras – Onboard the Sherwell

Sinclair Extras – Onboard the Sherwell

Sinclair Extracts -This scene was almost entirely edited out of the final version of the book. I enjoyed writing it as I was developing the characters of Sinclair and Greenwood. In these scenes, the men emerged as they appear in the final novel. The scene is based very loosely on the events surrounding the sinking of the East Indiaman, Halsewell in 1786 which was one of Britain’s greatest maritime disasters. I hope you enjoy reading it as much as I enjoyed writing it.

Once again he made his excuses early and retired to his cabin and as he lay on his bed thinking about the other passengers his attention was suddenly aroused by voices coming from below. He strained to hear what was going on. He was sure something was not right. He put on his greatcoat and his hat and set out to find out what was happening. With his lantern in hand he climbed the narrow flight of steps to the Saloon and opened the door but there was no sign of the Captain or the ship’s officers so he went on to the upper deck. The light from the Saloon skylights illuminated the ship’s deck. All was quiet on deck as he knocked on the Captain’s door. He waited then knocked again but still, there was no reply. A passing midshipman came to his aid. “I’m looking for Captain Richards,” he said holding the lantern up to see the man’s face.

“He’s down below, Sir,” replied the seaman. “We’re taking on too much water, see. There’s five feet of water in the ‘old.  T’aint good if you ask me, sir, t’aint good. Refitted, she’s supposed to be an’ as good as new; t’aint good,” he muttered blowing out clouds of white breath into the freezing night air.

“Thank you,” said Sinclair hesitating not knowing the man’s name.

“Franklin, sir; my name’s Franklin,” the man said removing his hat and bowing. “The captain will have everything ship shape when ‘es got the pumps going. No need to worry sir, no need to worry.”

“Aye, well, thank you, Franklin, thank you very much.”

“You’re welcome, sir,” replied the man as he disappeared into the shadows.

Unsure what to do next Sinclair returned to his cabin to find the commotion below replaced by the rhythmic thud of pumps and the unwelcome smell of stinking bilge water in the air. Above him, he could hear the muffled sounds of the women’s conversation as they prepared to settle down for the night. He lay in his cot thinking about what had happened and what Franklin had said and wondered if the ship was in danger. Then he heard the ship’s officers making their way to their beds. They made no mention of the commotion or the water in the hold so he told himself that everything was alright. He took out his pocket watch to check the hour; it was past 10 o’clock and time to be turning in for the night himself. As he lay in his cold and uncomfortable cot his thoughts began to wander as he recalled Franklin’s words. Taking on too much water was a serious thing, should he go back to the Captain and demand an explanation or should he leave things alone now that everything seemed to be under control? He held the thought in his mind for a moment then he decided on the latter course of action and pulled his coat over him to get warm. The lack of sleep from the previous night, the fresh sea air and the excitement of everything was taking its toll on him, he was exhausted. He closed his eyes and soon he was fast asleep.

He woke cold and to the sound of pumping in the hold. He washed and dressed quickly without shaving wondering if he should grow a beard then pulling his coat over his shoulders he made his way to the Saloon where his fellow passengers were already up and warming themselves on a barely adequate brass charcoal brazier. When he had taken tea and a bowl of porridge he made his way onto the deck again. The sunshine of the day before had been replaced with a blanket of thick grey cloud and a fine drizzle of snow was filling the crevices in the deck planking as he walked the length of the ship. Above him, the great sails were hanging stiff and motionless covered in a thick coat of ice and salt and the ship was motionless, becalmed in a flat grey sea that seamlessly merged with the sky in whatever direction he looked.

As the morning progressed the snow became heavier and Captain Richards was forced to order his men to clear the decks with brooms. In the Saloon, the women chatted and sewed while Sinclair read his book. The room was warm and steamy, the skylights, obscured by a lace of dense condensation that dripped intermittently onto the dining table provide a feeble grey light. As the snow fell on the outside it silently slid down the panes forming icy drifts at the bottom.  The day’s light faded and the wind began to fill the sails again. This time it was coming from the south and much to everyone’s delight the ship began to move again.

At supper, Sinclair fell into conversation with the handsome Captain Greenwood a young man like himself intent on forging a successful career in the East. He was a retired British Army officer who like so many others had been let go after the defeat in America. Greenwood, much to Sinclair’s chagrin, was admired by both the men and the women on board. His good looks and easy temperament seemed to smooth all his social interactions. He was gracious, charming and good company. He spoke eloquently of his experience in the American War telling Sinclair that he had had a mainly diplomatic role and had not seen much in the way of fighting. His main role had been  in organising the evacuation of New York in 1783; he told Sinclair that he had sailed from Nova Scotia up the mighty Hudson River with his commanding officer Sir Guy Carleton the last British Army and Royal Navy commander in British North America to a conference with General Washington at Orangetown to discuss how what was left of the British Army and the thousands of ordinary people who had remained loyal to the Crown were to be removed from the new and Independent country of America.

Greenwood recalled the animated discussion between Washington and his commander of the subject of Negroes, a subject he understood well as his family owned a good many of them on what he called their small Jamaican plantation, and how Carleton had refused to return those men of colour he considered to be free saying that they could go anywhere they wanted which had incensed Washington and the Americans much to Carlton’s delight but that it was something his father would have been furious about too because slaves were a man’s property and jolly expensive too. Then he told him how he and a group of fellow officers had removed the cleats and greased the flagpole of the fort in New York so that the victorious Americans could not remove the Union Jack without chopping the flagpole down as their parting gift to the victors. How they had howled with laughter he said. They drank a bottle of claret and played a game of chess after supper and Sinclair found himself feeling quite jealous of this man of easy conversation and conscience. Greenwood it seemed had no moral qualms about slavery and seemed to accept the world as he found it. For him what was moral was what most people accepted as normal, he was comfortable in the world and saw no reason to change it. After their game, they made their way to their cabins and said good night both feeling happy and relaxed for the first time.

The next morning Sinclair was woken abruptly by the sound of his books falling on the floor. The ship’s rafters were creaking and the wind was whistling through the leaky wooden hatch covering his porthole. The ship was listing at a good 20 degrees making it difficult to get about and impossible to shave so he dressed quickly and headed to the Saloon for breakfast. This was the first time he had really needed his sea legs. The ship was being buffeted by the wind and ploughing at speed through wall after wall of white-topped waves. He made his usual sortie onto the deck and met Mr. Hodge doing the same.

“Bracing isn’t it?” said Hodge holding onto his hat.

“Aye, you could say that,” replied Sinclair. “It’s a wee bit rough for my liking,” he said looking out at the rows of white horses prancing on top of the ocean.

“Ah, this is nothing laddie, wait till we get to the Cape. You’ll know what a rough sea is when you’ve been through that.”

“I look forward to it,” he shouted against the wind. His teeth were already chattering and he was holding onto his hat. “I don’t think I’ll be out here long.”

“Come on then laddie, once round the deck then back inside,” Hodge shouted back and headed off towards the bow. Sinclair followed but when Hodge suggested that they do it again he declined and went below to lash his furniture to the floor and walls with a strong rope given to him by Franklin. He did the same for Greenwood but found that the ship’s officers had already done their own. By lunchtime, the wind was gusting into a gale and the ship was pitching and crashing through a battery of ten-foot waves.

Like the other passengers, he felt sick; he craved distraction from the fear that was welling up in his belly. The usually chatty women and girls were quiet. In one corner of the room Miss Morris was trying to sew, in the other, the Richards girls were trying to read, and perched on the lockers he could see Mrs. Evans and her daughters who were trying to distract themselves by knitting but they were physically shuddering at every creak and crack in the ship’s wooden hull as it lumbered through the barrage of waves. Sinclair was unable to read so he spent the afternoon playing whist with his fellow Scot, Mrs. Campbell. From his position at the table, he noticed that the wind now contained squalls of snow. With each gust, the skylights were covered with a thick layer of it which then slid down the panes forming little drifts that were washed away each time a wave broke over the gunwales. Mrs. Campbell looked over the top of her half-moon spectacles and tapped the table. “I can’t go. It’s your turn, Dr. Sinclair.” He looked at his cards, his hand was all hearts, he was going to win without much effort but he knew that he would not enjoy his victory.

In the hold, Captain Greenwood was with his men. They were all young and inexperienced, boys from farms and small towns unaccustomed to the confines of a ship. The lack of air in the hold coupled with the motion of the ship and the stink from the bilge was making them fatigued, disoriented and now as the ship pitched up and down they were vomiting freely across the deck and in their hammocks. Anything not tied down slewed across the stinking planks rattling backward and forwards through the pools of vomit and piss. For Greenwood and his men, the ship’s hold was beginning to feel like a condemned cell, a prison from which the only escape route was death.

As the afternoon went on Greenwood found himself having to assert his authority in disputes between his frightened men. On the one hand, he found himself quietening down spats between the more aggressive men and on the other reassuring those who were whimpering for their mothers in their hammocks.  He was doing his best to maintain morale and keep his men under control but he was as seasick and as frightened as they were.

The afternoon drifted into the evening and the atmosphere in the ship was as tight as a drum skin. The ship lurched to starboard with a mighty crack. In the Saloon Sinclair found himself being flung to the floor. The table stayed in place but the chairs slewed across the floor crashing into the women passengers as they piled into the wall lockers on the starboard side and the plates and glassware crashed and smashed around inside them. He looked up and saw the hot coals from the upturned brazier searing the wooden lockers at the far end of the room. He pulled himself up and staggered towards the brazier and kicked the hot coals back into the pan.

The women slowly steadied themselves; their faces dazed and white with fright. They looked at each other and at the room; the chandelier was hanging at forty-five degrees and above them, they could hear the waves smashing into the deck. As they silently wondered what would happen next the ship suddenly righted itself sending them and all furniture hurtling back to the other side of the room. It was dark, the candles had gone out but the women picked themselves up again and started to search for the lights.

Mrs. Evans was the first to light one of the fallen candles using the hot coals in the brazier. In the gloom, Sinclair could see the young girls rubbing their bruised limbs and holding each other while Mrs. Campbell was scrabbling around of the floor looking for her spectacles and Miss Morris was searching for her shoes. The Richards girls who were crying and Mrs. Evans was reassuring her daughters. Sinclair pulled himself up from the floor and finished scraping up the scattered coals with the dustpan and the sole of his boot. Then a strange calm came over him. He mentally moved from passenger to doctor and found himself attending to each little group of women asking them about their injuries, checking their bumps and bruises and assuring them that they were no longer in danger. Much to his surprise, the women seemed to accept his reassurances and once he was sure that they were calm enough to be left he went to find out what had happened.

He climbed the narrow steps up to the door that led onto the deck and forced it open. Immediately he was blinded by a blast of snow-laden wind that stung his eyes and face. He put his hand up to protect his eyes and was able to make out a party of men struggling to tie down what was left of the mizzen mast at the back of the ship, this was the short mast that helped with steering and it had snapped in two and that he thought accounted for the awful crack they had heard in the Saloon. He stepped forward to ask what was happening but was immediately told to get back inside by Mr. Allsop. Reluctantly Sinclair obeyed and returned to the Saloon where he told the women that a small mast had snapped and that everything was now under control. He did not mention that without this small mast steering the ship would be more difficult as there was absolutely no point in alarming them further.

He sat down and took out his pocket watch, he rolled it in his hand and flipped the case open to check the hour, it was six o’clock and the wind was still screaming like a demonic choir outside. He felt isolated and alone as the exhausted women huddled together to comfort each other. Mrs. Campbell pulled a small prayer book from her bag and began to pray, “Thou O Lord, who stillest the raging of the sea, hear us, and save us, that we perish not. O blessed Saviour, who didst save thy disciples ready to perish in a storm, hear us, and save us, we beseech thee. Lord, have mercy upon us.  Christ, have mercy upon us.  Lord, have mercy upon us. O Lord, hear us. O Christ, hear us.”

As he watched the group of praying women his thoughts turned to Voltaire again. He could see that in the face of overwhelming fear a belief if a supernatural father who would rescue them was an undeniable comfort, indeed as Voltaire himself had written, “Si Dieu n’existait pas, il faudrait l’inventer” in other words “If God did not exist, it would be necessary to invent him.” But for him, the act of prayer was one of self-delusion. How could the words of man alter the course of nature? His knowledge of science told him that it needed much more than words to do that. And then he thought about his own father and how he had spent his life attending to the needs of this tyrannical God trying to placate him with his prayers whilst ignoring or ridiculing his own child’s needs and fears and treating them as weaknesses that were to be beaten out of him. How could he believe in a god that would have such followers?

Just as he and the women passengers were beginning to get used to regular thumps of the vicious waves again, the ship rolled on its side again sending them and all the furniture flying like gaming counters against the cabin walls once more. The shock was just as great as the first time it had happened and they were all stunned into silence and fear seized their hearts and their tongues. They were in the dark again. He fumbled around in the pile of furniture and frocks searching for a candle. He found one and took a tinderbox from his pocket and lit it. When the ship had stopped moving Sinclair looked up to see the women sprawled across the lockers once again with their petticoats and stockings on full display and the saloon chairs jammed hard against them. They lay there waiting for the ship to right itself like it did before but this time there was no correcting movement, the ship simply sat in the water being battered by the waves listing at a horrifying 45 degrees.

He scrambled to his knees again steadying himself on the storage lockers while the women re-arranged their dresses and huddled together for comfort. A feeling of overwhelming loneliness flooded over him and he was unsure what to do. Fear was pulsing through his veins but he did not want to join the women in their prayers. He knew that if he was going to survive it would be due to Captain Richards’ seamanship or his own wits or a combination of both.

His suppressed panic was broken by the sound of an ear-splitting crack followed by a thunderous crash. His heart leaped and he let out a low groan, surely this was it, he was going to die! His mind was racing, the ship was breaking up and in moments he would be on his way to a cold watery grave. He felt the whole ship shudder from bow to stern then in one swift motion it righted itself again throwing him and the women around the Saloon.  When the ship was the right way up again he scrambled to his feet. He was still holding the candle and found that by some miracle it was still alight. The Evans girls were screaming on the saloon floor refusing to stand up but before he could get to them the Captain’s daughters Eliza and Mary-Ann got to them and took them in their arms and started to comfort them. Their mother was helping Mrs. Campbell up to her feet and searching around on the floor for her spectacles again and Miss Morris was like Sinclair already on her feet and assessing the situation.

“What’s happening, Mr. Sinclair?” cried Mrs. Evans.

Sinclair looked to Miss Morris unsure what to say.

“I think the Captain has cut down the mast,” she replied for him.

“What!” exclaimed Mrs. Campbell smoothing down her clothes to regain some composure and putting her spectacles back on again.

“My uncle is trying to save the ship,” asserted the ashen-faced Miss Morris rubbing away the pain in her sprained wrist. “Now could you help me get these coals back in the brazier before we are on fire to boot?”

Sinclair was in the process of scooping up the coals with Miss Morris when Lieutenant Merrick opened the door to the saloon. “Good evening ladies, I know that you have had a dreadful fright but please be assured everything is under control now. The Captain will be along to see you shortly but as you can imagine he is somewhat occupied at the moment. Dr. Sinclair, would you please come with me, Mr. Hodge needs you.”

Sinclair looked around the room, “Is anyone injured?” he asked. The women shook their heads signalling that apart from more bumps and bruises they were well. “In that case, I will gladly come, Mr. Merrick,” he said and he followed the officer out of the room leaving the women to comfort each other.

Writers of influence – Hilary Mantel

Writers of influence – Hilary Mantel

The dead are always present, says Hilary Mantel, they live with us in our memory, in our genes and in the legacy of their decisions and actions that shaped the world we live in today. In the words of St Augustine, she says, they are ‘invisible, they are not absent’. My inspiration for it Sinclair was family history.  Whoever we are we all have some sort of family and some sort of history, we could not have got here without it even if we do not know that history.

There is a poem by WH Auden, called “As I Walked Out One Evening”:

‘The glacier knocks in the cupboard,

The desert sighs in the bed,

And the crack in the tea-cup opens

A lane to the land of the dead’

Like most people I come from a long line of very ordinary people; people who struggled most of their lives to make ends meet them to keep a roof over their head.  These are not the people we think of when we think of history. History was, until the last century, very much the domain of great men and great events. When we imagine the past in drama, in books, and, in films, the characters are always the movers and shakers of history; their decisions and actions change the world. Rarely do we think of the ordinary run of the mill people in the background who were most likely our ancestors.

My grandparents were born at the turn of the 19th century, they were Victorians.  They lived through great events, the Great War, the economic depression of the 1930s, the Second World War, and the post-war boom but they did not shape them.  They were lucky, they survived these huge historic events and so did their children; all of them living to ripe old age thanks to the introduction of the National Health Service in 1947. They were the first generation to live in Council Houses, proud tenants who always paid the rent on time. They worked hard and life was not easy but it was certainly better than it had been for their parents who had lived in overcrowded city-centre tenements with no interior sanitation. My Victorian ancestors worked hard, feared the workhouse, died young and were buried unceremoniously and as cheaply as possible.

My novel, Sinclair, is inspired by my husband’s family, the Leadams, who came from Walkington near the market town of Beverley and city of Hull. Christopher Leadam trained as a surgeon in York then moved to London sometime in the 1770s. I recently visited Walkington to look at the place he left to work at Guy’s Hospital. The contrast between this rural idle of the East Riding and the busy streets of Southwark could not be greater. Walkington is a beautiful place but as the 10th child in a family of farmers Christopher, who was clearly bright and adventurous, knew that if he was going to make a life for himself he had to leave the place of his birth.

Christopher died when he was relatively young, probably around 40. We know from the historical record that when he died he was the owner of an apothecary shop in Tooley Street and that he had a 14-year-old son and a wife. Christopher was not a great man of medicine but he was one of the cast of players who helped to heave medicine out of its medieval roots into the modern scientific age.

The Leadams of Tooley Street has led me on a journey into the 18th century and early 19th century. My novel begins in the aftermath of the disastrous American War and ends as France is about to throw the shackles of the ancient regime. Most historical romance is about aristocratic families, families with connections and status. My fiction is about a family too but this family has to make their own way in the world. They have no estate or inheritance to come into; they have to use their hands and their brains to make their way in the world. Men like the Leadams and the fictional Sinclair were men of the professions, industry, ideas, and commerce; they were the men for a new and enlightened age, the men who shaped the world we know today.

As a novelist, I want to tell the story of that change, of the development of the middle class if you like. The middle class is much maligned and forgotten in the pages of history and novels. Today middle-class values are under attack from libertarian capitalists who view government as a barrier to the unfettered accumulation of personal wealth, they do not believe in society or collective endeavour. In the historical novel, the middle class gets lost between the aristocratic splendour of the ballroom and the rags to riches stories of the poor.

‘The pursuit of the past makes you aware, whether you are novelist or historian, of the dangers of your own fallibility and inbuilt bias’ says Mantel. I agree I am the product of my own history. I am not the past I am now writing about the past in a language that is understood today. I am a writer of fiction but I am a historian too; an anachronism an oxymoron. The 19th-century historian Lord Macaulay said, “History has to be burned into the imagination before it can be received by the reason.” I burn with a passion for the past, but I also burn with a passion for the future, for a better future for my children and mankind. I’m biased and I don’t feel guilty about it; all history is biased, I am not perturbed about my desire to tell stories about people who live in townhouses and not country estates, people who value education for its own sake, people who want to engage in the political life of the nation because they want to improve the lives of others and build a better future.

Mantel says, “The historian and the biographer follow a trail of evidence, usually a paper trail. The novelist does that too, and then performs another act, puts the past back into the process, into action, frees the people from the archive and lets them run about, ignorant of their fates, with all their mistakes unmade.” Sinclair makes plenty of mistakes.

Julia Herdman writes historical fiction that puts women to the fore. Her latest book Sinclair, Tales of Tooley Street Vol. 1. is  Available on Amazon – Paperback £10.99 Kindle £2.42  Also available on:

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