Long life in Georgian asylums

John Rendall was 104 when he was buried at Box, Wiltshire, on 21 January 1821. This great age is even more striking because he had been confined to an asylum for more than 60 years. Peter Carpenter asks if there were other exceptionally long lived residents of early asylums.

There are few surviving records of patients in Georgian asylums for mentally ill patients. There are registers for Bethlem and St Luke’s available online, but provincial “madhouses” of the time were relatively rare, and little documentation survives. The main early entries regarding patients are in other records, such as parish churchwardens’ accounts and relate to admitted paupers.

“Box Mad House” shown in Andrews & Drury’s map of 1773 (courtesy Wilts History Centre).

Kingsdown House Lunatic Asylum at Box, Wiltshire, six miles to the east of Bath, has claim to be the longest running private asylum in the country.[i] It was operating by 1687[ii] and was closed in 1946 by its proprietor Gerald McBryan, in between his own psychiatric admissions and attempts to rule Sarawak and Brunei.[iii]

As part of my study of Kingsdown House, I explored a surviving folder of correspondence between its proprietor and the churchwardens of Trowbridge[iv] a substantial market town about 9 miles from Box. This together with the Trowbridge accounts[v] and newspaper records throw light on the case of John Rundell/ Rundle/Randal.[vi]

In November 1758, the churchwardens’ accounts note payment for: “Horsehire & Turnpikes Dr Jefferys at Kingsdown relating to John Rundall junr of Studley 1/9d”.[vii]  James Jeffery, a surgeon, is the first well documented operator of the asylum.

And the next month:

“Expence of sending John Rundle weaver to ye Madhouse under the Care of Dr Jefferys at Kingsdown. Viz: 26th Dec [1758]: Two guards all night and part of ye next day with expenses  6/10d

27th: 2 guards and hire of two Horses to Kingsdown 8/6d [viii]

Jeffery then charges 7/- a week reducing to 5/- over 6 months. He does not charge for the period 18 -22 August 1760.  The reason is revealed in the account entry: “Expence on account of John Rundle discharged from ye madhouse upon trial, but attempting to drown himself sent again under a guard.”  9/1d

In 1763 Jefferys writes: “altho’ Rendall is not so bad as in time past yet he still persists in surprising odd Whyms & Fancys which undoubtedly might end in some bad consequence was he not under proper care.”

In 1775 the churchwardens negotiated a much reduced fee as John, who though still disordered in his senses, was able to work around the asylum.  His delusions probably lasted most of his life, as he would have otherwise returned to the cheaper Trowbridge poorhouse. Overseers of the poor were not famed for their financial benevolence.

Rendall’s death clearly made the newspapers take notice: [Died] 7 Feb at Dr Langworthy’s Asylum, Kingsdown house, Box, … John Randall, aged 104 years, upwards of 69 of which he had been a patient at that institution, enjoying good health, and working regularly in the garden until a few weeks prior to his death. He was an early riser, and was confined to his bed but a few days, in possession of his retentive powers to the last.[ix]

If the age is correct, then John Rundle was born about 1717 and admitted at the age of 40.

The only other long lived asylum inmate I know of is an 1806 reference to: “The poor inoffensive idiot whom the passenger may have seen for nearly half a century past sitting at the door of the Magdalen Hospital in Holloway [Bath], died last week, aged 92. He has been for some years the only patient supported in that institution”[x]

In fact, the hospital’s later evidence in a charity inquiry states he was aged 95 and had been 75 years in the house but gives no other information.[xi]  Are these the only long lived inmates known before the 1830s? I welcome evidence of others.

Two of John Rundell’s letters . A letter with a similar list of clothing refers to Mr James  Jefferies suggesting it is from the early period of his illness.

Peter Carpenter is a retired psychiatrist in intellectual disability who has researched the history of mental health institutions in Bristol. 

References

[i] See http://www.boxpeopleandplaces.co.uk/inside-box-mad-house.html for a short description. See also Leonard Smith: Private madhouses in England, 1640-1815. Palgrave MacMillan. 2020

[ii] Minute Book of the Men’s Meeting of the Society of Friends in Bristol 1667-1686. Bristol Record Society vol XXVI.

[iii] See for example accounts of him in Philip Eade: Sylvia, Queen of the Headhunters. London, Weidenfeld & Nicolson. 2007

[iv] Wiltshire & Swindon History Centre, Ref.No. 206/93

[v] Wiltshire & Swindon History Centre Ref No: 206/ 60-73

[vi] Rundle’s letters are briefly described in William Ll. Parry-Jones The Trade in Lunacy. London: Routledge & Kegan Paul,1972 p168-9

[vii] Wiltshire & Swindon History Centre 206/64 Trowbridge churchwarden accounts 5 Nov – 3 Dec 1758.

[viii] Wiltshire & Swindon History Centre 206/64 accounts 3-31 Dec 1758

[ix] Taunton Courier and Western Advertiser 21 Feb 1821: deaths.

[x] Bath Journal Monday 28 July 1806 page 3e.

[xi] Sixth report of the Commissioners of Inquiry concerning certain Charities in England and Wales (British Parliamentary Paper 1822 (12) IX 1) page 737.

Searching for Mary Wardell (1832-1917)

Philip Milnes-Smith is investigating the undeserved slide into obscurity of Mary Wardell, founder of a scarlet fever convalescent home.

During the pandemic, a freelance archive opportunity introduced me to the forgotten public health pioneer Mary Wardell, who founded an isolation convalescent home for Londoners with scarlet fever at Brockley Hill, Stanmore in North London. I am now looking for new leads.

Mary’s experience with Ellen Ranyard’s London Bible and Domestic Female Mission revealed to her the impossibility in the homes of the poor of separating the well from the sick (who might remain infectious for six weeks or more). Ordinary convalescent homes could not take people with infectious diseases.

The institution Mary founded was credited with helping to reduce the spread and consequently the mortality rate from scarlet fever, but it was still deemed unique decades after it opened.

We do not know why she selected Alexander Patrick Stewart (1813-1883) as the physician to whom she explained her vision. Perhaps she consulted the Medical Directory and noted his publications distinguishing typhus from typhoid fever, on cholera and on sanitary reform.

Other backers from the medical profession so far identified include Henry Wentworth Dyke Acland (1815-1900), Sir James Risdon Bennett (1809-1891), Sir George Buchanan (1831-1895), Sir George Burrows (1801-1887), Sir Joseph Fayrer (1824-1907), James Hill Gibson (1856-1912), Sir Edward Henry Sieveking (1816-1904) and Sir Thomas Watson (1792-1882).

Perhaps one of them was the gushing “patriarch” The Girl’s Own Paper’ quoted as having said: “I wish I were a young man, that I might plant my foot in the work, and help you with all my might.”

There are so far no known links between Mary Wardell and the first generations of qualified medical women. However, some connections to the broader Victorian movement for female education and emancipation seem likely for a middle-class woman who chose to work as a governess, and whose public health project had some backing from the Ladies’ Sanitary Association. It should also be noted that personal reticence did not prevent her standing up for her project in publications like The Hospital and The Lancet.

While stories of pioneering women doctors and nurses are kept in circulation by their respective professions, Mary had no such metaphorical descendants to keep her flame alive. Her undeserved slide into obscurity began with the conversion of her facility to an auxiliary hospital in the First World War and  further accelerated with her death in 1917. So far, no image of her has been identified. The quest for Mary Wardell continues.

References

“A Convalescent Home for Scarlet Fever Patients”. The Quiver. 24: 635. 1889.

Stewart, A. P. (1882). “Are Homes For Convalescents From Scarlatina Desirable? And, If So, At What Period Can The Patients Be Safely Removed To Them?”The British Medical Journal1 (1107): 374–375. doi:10.1136/bmj.1.1107.374ISSN 0007-447JSTOR 25259190PMC 2371537PMID 20750140.

https://www.victorianvoices.net/ARTICLES/GOP/London/1889-ScarletFeverHome.pdf

Philip Milnes-Smith was freelance archival consultant for Pegleg Productions’ Searching for the Grey Lady project at the Royal National Orthopaedic Hospital. The digital archivist at Shakespeare’s Globe, he also undertakes freelance archival and oral history work, and volunteers for the Archives and Records Association.

One-way systems to keep patients separate

Eastern Dispensary, Bath Photo: William Rogers, britishlistedbuildings.co.uk

The Corona virus pandemic prevention measures were not the first one-way system in British health care, as William Evans explains.

One feature of the measures imposed or encouraged by the UK government to stop Corona virus spreading was one-way systems for human traffic. In premises such as doctor’s surgeries, one-way systems aimed to reduce close contact between people and avoid transmission of the virus.

One-way systems are not new. We are familiar with them in the management of road traffic. Although fewer accidents and a reduction in personal injuries are some results, the main aims are to relieve traffic congestion and reduce conflict among road users. Another example comes from the household goods sector. The retailer Ikea makes customers follow a prescribed route through its stores. In this case, the aim is not safety, but more sales by bringing to customers’ attention all the goods offered, not just those the customer may be interested in.

There is a historic precedent for a one-way system in a medical context from the Eastern Dispensary in Cleveland Place East, Bath. Opened in 1845, it was designed by the local architect, Henry Edmund Goodridge (1797-1864). The external design is neo-classical: the entrance at the front through a portico with columns and a pediment. Inside, the design was innovative. On entering, patients were directed into one of two waiting rooms at either side of the building (one for women, one for men?). In each waiting room, the patients sat on, and moved along, benches. The first bench was attached to the left side wall, the next one to the right, and so on.

As a result, patients moved along the benches in queue until they were summoned to rooms at the back of the building where they were seen by an apothecary or surgeon or went into a dressing room. They then left the building by a back door from the room where they were seen or treated.

Plan of the dispensary The Builder, (1849) 160

The purpose of that layout may have had much to do with keeping order in what could otherwise have been a melee, but no doubt it also helped to limit the transmission of infectious or contagious diseases. Goodridge’s radical design was commended by The Builder magazine as a model for future dispensaries. It would be interesting to know whether his Bath layout was followed elsewhere.

After it ceased being used as a dispensary, the building housed various activities: in the 1910s, for example, colleges and pharmacies. It is now a bistro.

References

Plan of the dispensary: Bath & NE Somerset Council Archives, 0033

The Builder, (1849) 160; https://archive.org/details/gri_33125006201806/page/160/mode/2up?view=theater

Michael Forsyth, Bath, in the Pevsner Architectural Guides series, Yale UP 2003

For Goodridge: HM Colvin, A biographical dictionary of British architects 1600-1840, Yale UP 1997

For dispensaries: Michael Whitfield, The dispensaries: healthcare for the poor before the NHS, Author House 2006

William Evans is treasurer of Avon Local History & Archaeology, the umbrella group for local history in the Bristol and Bath area.

Recycling Penicillin from Urine in Post-War Germany

Limited supplies of penicillin and Allied restrictions on German access to the drug in the immediate aftermath of World War II led to its recovery from the urine of treated patients. Susanne Krejsa MacManus explains.

German research on penicillin started only in 1942 and then on a very small scale.[1]  Gerhard Domagk (1895-1964), the German scientist who in 1935 had developed sulfonamides, had advised the Nazi government to concentrate on improving of “his” type of antibiotics instead of trying to get its own penicillin production going.

It took Germany till the end of 1943 to really understand the importance of penicillin, but because of the efforts of the Allies to restrict information and materials,[2] German scientists were not able to learn about the right mould, nor could they develop the process to get a good supply.

From autumn 1945, British and American forces increased the amount of penicillin flown into hospitals in Berlin – mostly for their own soldiers as a treatment for sexually transmitted diseases. But the occupying forces faced a dilemma: on one hand, they had to look after the health of the population of the occupied areas; on the other hand, there was a hostile atmosphere against the German population – at least in the first months after the end of the war. Germany was categorised as a “defeated enemy” – in contrast to Austria which was categorised as a “victim”.

There was even a third aspect. The German pharmaceutical industry was known as being innovative and effective. The occupying forces hoped for “penicillin made in Germany” and encouraged companies like I.G. Farben, Hoechst and Chemie-Grünenthal to start such an undertaking.

The USSR did not have penicillin production of its own, although they claimed two of their scientists had invented the antibiotic long before Alexander Fleming. As early as early May 1945, Soviet forces who were eager to get penicillin as part of German reparations were pushing the German company Schering .[3]

Since one of Schering’s production sites lay in British territory, the company got support from the British element of the occupation forces for building laboratories and getting raw material (as this ad shows.).[4] 

Salzburger Nachrichten, 9/1/1946  Schering AG produces penicillin Berlin,  As the British broadcast has reported, the Germany pharmaceutical company Schering AG in Berlin will manufacture penicillin for Germany. The British military government has promised its support to the company in procuring the laboratory and the necessary material, so far as it is available in Germany.

But sufficient output was not available before the end of 1946/the beginning of 1947.

Two-thirds excreted

During their struggle to set up a production site, scientists at Schering recalled that two- thirds of penicillin given by injection left the body very quickly, so quickly that injections had to be repeated every few hours.[5] “If we could get the urine of patients treated with penicillin”, the scientists speculated, “we might be able to reclaim and concentrate this substance.”

The British and American forces permitted them to collect the urine from their hospitals on the condition that they got their share of the recycled substance. From March 1946, Schering’s scientists organised milk-churns and bicycles and went from hospital to hospital to collect patients’ urine. The recycling process was successful, and in spring 1947 it was extended into American and British areas of West Germany. In April 1949, nearly 5000 liters of urine from 3153 patients were collected from hospitals. This activity lasted till 1950, when the manufacturers’ penicillin production was sufficient to meet demand.

Recycling penicillin from urine was not a new idea, but its use on this scale was was exceptional. It showed that the German researchers had clearly understood the character of penicillin being excreted from the organism so quickly. Secondly, the process of recycling penicillin purified the substance, which at the initial injection had produced sharp and unpleasant feelings for the patient. And third, it shows how Schering’s researchers could act on their own initiative, without having to ask boards and committees for permission as they would have to do today.

Susanne Krejsa MacManus PhD is an independent journalist, author and archivist in Vienna. She is a member of the History of Medicine/Medical Humanities working group of the Commission for History and Philosophy of the Sciences at the Austrian Academy of Sciences (ÖAW).

References

[1] I. Pieroth: Penicillinherstellung – Von den Anfängen bis zur Großproduktion, Heidelberger Schriften, 1992, p. 103.

[2] P. Rostock: Die Wunde, Berlin: De Gruyter, 1950, p. 290.

[3] J.-P. Gaudillière, B. Gausemeier: Molding National Research Systems, OSIRIS 2005, 20:180-202.

[4] Schering A.G. Berlin produziert Penizillin, Salzburger Nachrichten, 9. 1. 1946, p. 2.

[5] J.H. Humphrey: Excretion of Penicillin in Man, Nature 3920, 1944, 765.

 

 

Illustrations of the History of Medicine from the Art of Barbara Hepworth

Consultant orthopaedic surgeon, Norman Capener had a considerable effect on the work of sculptor Barbara Hepworth (1903-1975), as James Scott explains.

 In 1944, Barbara Hepworth’s daughter Sarah developed osteomyelitis of her proximal femur, – a much feared condition with a mortality of about 30% at the time. I was able to discover that she was treated with an infusion of penicillin directly into her thigh, which she recalled to me was “quite painful’. She, thus, would have been among the very first patients to receive penicillin for infection of the bone.

Initially in hospital for about nine month, Sarah underwent many local procedures. Norman Capener was her surgeon. He had a strong interest in sculpture, and he and Hepworth became friends.

With his help, Hepworth attended many operations about which she wrote: “I became completely absorbed by two things: first the extraordinary beauty of purpose and co-ordination between human beings all dedicated to the saving of life…and secondly by the way this special grace of mind and body induced a spontaneous space composition and articulated an animated kind of abstract sculpture very close to what I had been seeking in my own work.” This resulted in an iconic series of painted drawings of operations, and informed much of her subsequent sculpture. (Drawing by Barbara Hepworth © Bowness

A little more than 25 years ago, I founded the Arts Project at the Chelsea and Westminster Hospital, which was shortly to open. There were a great many works of art in the six hospitals which were to close as a result, including a ‘Resurrection’ by Veronese in the chapel of the old Westminster Hospital.

The architects were very encouraging, and during the first few years of the life of the new hospital, we were able to introduce about 1500 new works of art and incorporate many from the previous hospitals. One of the works we borrowed for the Dermatology Department was a sculpture by Barbara Hepworth.

We also created a flourishing program of music, dance, poetry etc., followed later by opera. The great value of this endeavour for everyone staff, patients and visitors was clear from the outset.  The project has since grown enormously in scope and flourished.

Where were the women?

When I was a medical student at the Middlesex Hospital in London in the mid-1960s, (with wonderful murals by Cayley Robinson in the front hall), I had seen some sculptures in Battersea Park by the sculptor Kenneth Armitage. I particularly remember a piece by him called Pandarus. Many years later, I discovered that he had a studio 

in Olympia, West London, and we became friends. After an exhibition to celebrate his 80th birthday at the Yorkshire Sculpture Park, he lent me four sculptures for the hospital, – including Pandarus (right). 

Researching a book about him for the publishers Lund Humphries, I noted that a woman called Lillian Somerville had successfully promoted his career and those of many more Modern British Artists internationally for the British Council through the Venice Biennales over a period of 15 years. Little was known about her.  Some further research revealed many other women who had promoted all aspects of modern art in this country at that time, again about whom little was known.

A couple of years ago I contributed towards a book for Unicorn Press, describing the work of the arts project and the Chelsea and Westminster Hospital. During lockdown, I prepared a further book for them, simply telling the stories of many of the women to whom my attention had been drawn, including a description of Barbara Hepworth’s connection with Norman Capener. 

James Scott is a retired orthopaedic surgeon and emeritus editor of the Bone and Joint Journal. He is the author of The Women who Shaped Modern Art in Britain and a co-author of The Healing Arts: The Arts Project at Chelsea and Westminster Hospital. Both are published by Unicorn Publishing Group.

References

Norman Capener obituary. British Medical Journal, 19 April 1975, p 145

Read, Herbert, Barbara Hepworth, Carvings and Drawings, Section 5. Lund Humphries, 1952