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Victorian: Colney Hatch

My forthcoming book, Moriarty Takes His Medicine, revolves around a private madhouse — a hospital run by an alienist for well-to-do women with nervous disorder. So I’ll be writing about lunacy and the treatment of same several times over the next few months.

Today I’m in a bit of a rush, so I’m going to blog about the thing I have to learn to revise the book: the Middlesex County Pauper Lunatic Asylum in Colney Hatch. It’s at the opposite end of the spectrum from my luxurious private hospital, but Moriarty has to go there twice to get information from a nerve specialist who consults there on a weekly basis. Then as now, doctors often practiced in a variety of institutions in addition to their private consultations.

A little groundwork

This state-of-the-art facility was opened in 1851 by Prince Albert. Here’s the description from Daily Life in the Asylum: “With its Italian style, six miles of corridors and capacity for 1,000 people, it was a model of modern asylum design. It had its own gasworks, brewery, farm and even an aviary breeding canaries. Its catchment area was north and east London.”

Is there something especially fitting about putting lunatics to work breeding canaries?

Alas, they vastly underestimated the need. Within 15 years, the patient population had doubled. At its peak, the hospital housed 3,500 mentally-ill men and women, many of them drawn from impoverished communities in London’s East End. For some reason, there was a Jewish subcommunity large enough to require the construction of a kosher kitchen and the hiring of a Jewish cook.

Here’s one more quote from Daily Life, which has many other goodies for the interested person: “Within 50 years, Colney Hatch had effectively become a small, overcrowded, enclosed town with all the bustle and drama of the multicultural London streets that its patients had once left behind.”

That doesn’t sound so horrible to me, but there must have been scarcities and fights and virtually no personal treatment of any kind. Still, better than being kicked around helplessly on the street. Oh, but now I learn that by 1880 the place was starting to fall apart.Thirty measly years! We get more mileage out of the postwar baby boom houses flung up with few standards and much haste all over America. So now we’re over-crowded and the place is leaking.

The building

I’m not spending any time inside the place, so I don’t need to imagine that intriguing community. Someone else will have to write that novel (and please tell me when you do.) I just need to get in and get out, which you’d think wouldn’t be so difficult. But if the information is there, I have to abide by it, which means I have to understand it, which means I have to study it, which means I might as well write it up. Pfui.

The building is lovely from the outside. Handsome Italianate design with a central tower topped by a cupola and charming smaller towers spread along its phenomenal six miles of corridors. The rolling hills behind it are parkland formerly known as Colney Hatch Park. There’s no name on today’s map, but the building still runs the full length of the park. I call that salubrious.

Here it is. I took this image from Wikipedia, who got it from the Wellcome Library. I’m sad for that source, because I can’t read the tiny letters on the floor plan indicated in the legend, so I can’t tell where exactly the surgeons’ dining rooms are, not to mention the attendants’ library, which I could actually use if I could find it.

I can’t begin to tell you how much that annoys me. If you’re to provide historical documents, make sure obsessive people, the only ones likely ever to look at the thing, can read all of it!!!

Middlesex County Lunatic Asylum, Colney Hatch

Of course the one at Wikipedia is bigger, but still not big enough. You can tell by the fold in the middle that it comes from a book, which we might very well have in the UT library, but Wellcome doesn’t give me a book reference, just a dadblasted lithograph. So it’s a good thing Francis Bacon never lived here, huh? ‘Cause then I really would be in a pickle.

Anyway, the floor plan only gives the ground floor, but we obviously have two floors on all the long wards and three on the blocks that punctuate the long runs. Dining rooms are going to be on the ground floor; maybe also visitor rooms. What would you find on the top floor of a badly built hospital building? Those rooms would be stuffy in the summer, clammy in the spring, and freezing in the winter.

Why, you’d put records there of course. You don’t seriously think the Victorians aren’t going to keep a file on every single patient who walks through their doors; not to mention the stream of interns, consulting physicians, specialists, nurses, orderlies, cooks, gardeners, etc etc etc. Handwritten, my friends, because we don’t have typewriters yet. A clerks were treated a lot like old-fashioned room-sized computers: they were stored somewhere out of the way.

I’m thinking consulting physicians would have shared offices on the first floor (English style; US second.) Some of these would be upper crust gentlemen, accustomed to endless square yards of polished oak paneling and at least a small coal fire. I want Moriarty to have to walk down one of those long stark corridors, so I’m going to put the doctors who specialize in women’s disorders in one of the smaller towers on the east wing, which the plan labels “Female Wing.”

Walking down the corridor is necessary for two reasons. First, it’s my chance to give a bit of the flavorcolney-hatch of the place. Moriarty can look out the window onto the airing yard, which is crowded with women taking their exercise or just hanging out. The doctors wouldn’t want to rely on drugs, but they would certainly use them (as we do) in preference to restraints. So some women would be wobbly. Then on the other side of the corridor, I am forced to assume because this photo isn’t clear enough (but thank you for providing it, Daily Life) we have the rooms that women lived in. Mentally ill people can be very vocal, so Moriarty will hear some alarming sounds. This contrasts with the private hospital, which has the look and feel of a luxury hotel, with a private room and a personal attendant for each patient.

Second, I need for Moriarty to look out a window and see Sherlock Holmes disguised as an orderly, staring intently back at him. Holmes is a master of disguise, except for that unfortunate hawk-like nose which sticks out like a sort thumb.

Daily Life puts this corridor on the north range, which must be the one added on above the end of the east range. The thing that frustrates me is that I don’t see doors on the right side of this corridor. It’s possible there were few doors onto the corridor and that each let onto a long room divided, perhaps, by partitions – or not divided, long wards with rows of beds. Good thing I don’t need to go in there!

The location & orientation

And just so you understand what I mean by ‘obsessive,’ I’ll show you this snip from Google Maps which I spent fifteen minutes finding so I could see how the building was oriented. You can’t very well refer to the east wing if the thing runs north-south, now can you? Of course not! 

Nowadays it’s called Princess Park Manor, a fully rehabilitated range of luxury apartments. You can get a seven-bedroom place for a mere £1,500,000. I assume they throw in the kosher cook as a perk.

colney-hatch-today

References

https://en.wikipedia.org/wiki/Friern_Hospital

https://historicengland.org.uk/research/inclusive-heritage/disability-history/1832-1914/daily-life-in-the-asylum/

 

Book review: Blood and Guts by Roy Porter

Blood and Guts by Roy Porter is a whirlwind tour of the history of Western medicine, organized by topic. Porter’s aim is to situate beliefs and practices in the culture of the times, a subject I find fascinating. He knows the territory inside and out, being one of the preeminent historians of medicine, and has adroitly managed to be comprehensive and brief, but not shallow. Hats off and thumbs up!

I’m writing this post as I type up my notes from the book, so you’re getting snippets that caught my attention, rather than a carefully crafted reprise. The book is a zippy read; if you want more, read the whole thing. I hit 1000 words for this post with just the first two chapters. Others chapters discuss with the same high degree of information and entertainment the body, the laboratory, surgery, therapies, the hospital, and medicine in modern society. 

Disease

plaguePorter begins five million years ago, when the Australopithecines emerged from our family tree. In a few million years, Homo sapiens spread across the globe, hunting and gathering. Porter says life was short and I guess it was, but the principal hazards were childbirth, starvation, accidents, and being eaten by wild animals. Not, significantly, infectious diseases, which didn’t become a serious threat until after the agricultural revolution moved people into year-round residence in ever-denser communities. Hello, Plague!

Domestic animals gave us tuberculosis, smallpox, influenza, measles, and the common cold (from horses!) The vermin that grain and farm animals attract spread salmonella, cholera, polio, typhus, diphtheria, and bubonic plague. I’m getting woozy just typing in all these names. Stable populations would build up immunities to some degree, then go galloping or sailing off to infect new communities. The Black Death took about 25% of Europe’s population in four years. European diseases wiped out 50-90% of the indigenous peoples of the Americas in the fifteenth century. Mind-boggling.

The twentieth century discovered the causes of most of these diseases and then developed actual cures, in a stunning victory over an ancient enemy. But new diseases arise, like AIDS, Ebola, and Lassa. Porter warns, “From an evolutionary perspective, man’s global fight against disease seems more like a a holding operation in a war without end.”

Doctors

medicine-man
A medicine man

Prehistorically (and forward), healers were shamans, in tune with the supernatural causes of illness and accident, and communicators with potential sources of better luck and supernatural protection. “With the evolution of more complex settled societies, herbalists, birth-attendants, bone-setters, and healer-priests followed.” One might say, a class of health professionals arose once there was surplus food to sustain them.

When writing was invented, rituals, spells, and recipes for healing were among the first things to get written. In ancient Egypt, physicians might be female as well as male. The most famous was Imhotep, (male) chief vizier to Pharaoh Zozer (2980-2900 BC), “renowned as a physician, astrologer, priest, sage and pyramid designer.” Smart guy. Papyri have survived with his sayings about health and healing. “Egyptian medicine combined religious beliefs and magical techniques with an impressive array of practical drug treatments and surgical skills.”

Hippocrates broke with this millenias-old tradition, advocating a secular medicine based primarily on regulating the diet to maintain health. His teachings were similar to Indian Ayurvedic medicine in that they explained health and illness in terms of the humors: the four essential fluids which regulated the body. Health obtained when they were in balance; when out of balance, various forms of illness resulted.

medieval-doctor
A medieval doctor

Here’s an example: “If, perhaps through faulty diet, the body made too much blood, sanguineous disorders followed as one grew overheated and feverish. One might, by consequence, have a seizure, an apoplectic fit, or grow maniacal.” The obvious treatment is a little judicious blood-letting.

The job of the doctor under this system is to evaluate the state of the humors. This was done chiefly by studying urine samples. The doctor didn’t even have to leave his chambers; patients could send a sample to be analyzed.

Porter notes, “The appeal of the humoralism which dominated classical medicine and formed its heritage lay in its comprehensive explanatory scheme, which drew upon bold archetypal contrasts (hot/cold, wet/dry, etc.) and embraced the natural and the human, the physical and the mental, the healthy and the pathological.” It was a powerful theory, given the knowledge available.

The training and accreditation of physicians moved out of churches and into the universities from the twelfth century. Healing split into several branches. First in status were physicians, who were educated in these temples of learning and who limited themselves to diagnosis and prescription. They did not need to touch their patients or even necessarily visit them. They elicited symptoms, perhaps by means of an early modern questionnaire, from which they determined the nature of the disease and formulated a treatment. They also studied those urine samples.

Second came apothecaries, the professionalized class of herbalists. They were originally part of the Grocers’ Guild in England. Third were surgeons, the only ones who always laid their hands upon their patients. They had to be strong and fast to do their work, before the development of effective anesthetics. Both apothecaries and surgeons learned their trades through apprenticeships.

doctor-bashir
The doe-eyed Doctor Bashir

Doctors couldn’t do much more than alleviate symptoms until the nineteenth century, when things really began to pick up. Thermometers were available from the 1860s; sphygmomanometers measured blood pressure. Pain could be alleviated with opiates. Aspirin was invented by Bayer in Germany in 1896. The stethoscope was invented in 1816. We consider these basic diagnostic tools, although we do still surrender those urine samples. Microscopes (and better) make it increasingly possible to identify specific diseases and new medicines make it increasingly possible to cure them, rather than merely mitigate symptoms.

As the effectiveness of doctors rose, so did their popularity. “The average American visited the doctor 2.9 times a year in 1930; by 2000 this had doubled.” People learned that going to the doctor could help them; also they learned through advertising that there were many, many more ways to be sick than they would otherwise have imagined.

References

Porter, Roy. 2002. Blood and Guts: A Short History of Medicine. London: W.W. Norton & Co.

 

 

 

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