Wednesday 17 January 2024

The diagnosis ‘Insanity of Masturbation’ within the Royal Edinburgh Hospital case books, 1862 - 1866

The 19th century case notes contain some derogatory and offensive language and themes of a sexual nature.

Page from one of the Royal Edinburgh Hospital 19th century Case Books

Edward Henry Hare begins his impressive 1962 article Masturbatory Insanity: The History of an Idea by stating ‘A hundred years ago it was generally believed by the medical profession…that masturbation was an important and frequent cause of mental disorder. Today no one believes this; and the masturbatory hypothesis (as we may call it) has in all probability been finally abandoned.’

"He was young, handsome; his mother's fond hope". This illustration is from an 1830 book titled Le Livre Sans Titre (The Book with No Name). The book concerns the perils of masturbation and includes a sequence of illustrations showing a young boy's descent into ill health due to his indulgence in 'self-abuse'. Images courtesy of Dittrick Museum.

"At the age of 17, he expires, and in horrible torment"

The belief that there was a connection between masturbation and ill-health made its debut into Western popular culture after the publication of the best-selling book, titled (ready for it): Onania, or the Heinous Sin of Self-Pollution, and All Its Frightful Consequences, in Both Sexes, Considered, With Spiritual and Physical Advice for Those Who Have Already Injur'd Themselves by This Abominable Practice (c. 1712 - 1716). As you may have guessed by the title, the book is, in essence, a cautionary tale. It is mostly comprised of moralistic admonishments, but the author does touch on how the ‘heinous sin’ of masturbation carries physical consequences as well, even possessing the potential to induce madness or epilepsy. For men, the loss of semen incurred from the act of masturbation would lead their offspring being born ‘commonly weakly little ones, that either die soon or become tender, sickly people, always ailing and complaining; a misery to themselves, a dishonour to humane [sic] race, and a scandal to their parents." 

Michael Stolberg reflects in his article Self-Pollution, Moral Reform, and the Venereal Trade: Notes on the Sources and Historical Context of Onania that: ‘The work's original format was that of a moral treatise, which used medical arguments to support the basic notion that masturbation was a heinous sin against God and nature.’ The author of the book Onania does suggest some remedies and tinctures and a ‘prolifick powder’ for 12 shillings which could help the ‘Injur’d’s’ genitals recover from the ‘abominable practice’.

1756 edition of Onania. 
Courtesy of the Wellcome Collection.

The book was incredibly influential, even capturing the attention of eminent physicians like Samuel-Auguste Tissot who further proliferated information on the array of negative effects masturbation can wreak on the mind and body through his own 1758 book Onanism, or a treatise upon the disorders produced by masturbation.

Skip forward a 100 years and there’s a flurry of patients diagnosed with ‘Insanity of Masturbation’ within the Royal Edinburgh Hospital (REH) case books. You can find the majority of these cases within volume 15 (female patients) and 16 (male patients). These case books cover the years 1862 – 1866, coinciding with the period David Skae was Physician Superintendent of the REH. In fact, it was Dr Skae who was the first to maintain a specific type of insanity due to masturbation. Allan Beveridge wrote in his article Madness in Victorian Edinburgh that: 'Some of Skae’s categories, notably that of Masturbatic Insanity implied an aetiology that was debatable. In fact, although masturbation was repeatedly commented upon in the patients’ case notes, it was only occasionally used as a primary diagnosis.'

In his paper Of the Classification of the Various Forms of Insanity (1863), Skae describes the symptoms prescribed to the ‘masturbators’:

'...the vice produces a group of symptoms which are quite characteristic and easily recognized, and give to the cases a special natural history: the peculiar imbecility and shy habits of the very youthful victim; suspicion and fear and dread and suicidal impulses and scared look and feeble body of the older offenders, passing gradually into Dementia or Fatuity'.

Portrait of David Skae (1814-1873)

I have read all of the case notes relating to REH patients who were diagnosed with Insanity of Masturbation (IM).  It has been an interesting experience, although often rather sad and perplexing. 

It’s curious to note the differences in the descriptions of the symptoms of the female and male patients diagnosed with IM. The women are described as being extremely restless, talkative and sexually forward (reminiscent of the symptoms associated with the once common medical diagnosis of Hysteria). In several instances, the physician notes how the female patient would appear or act overly sexual:

‘Very salacious’

‘Expression very emotional, confused, sexual…’

‘…has an ugly lecherous smile on her face’; ‘The prurient expression of her face still remains’.

The male patients with IM however, are often described as taciturn, shy, physically weak, pale or ‘pasty’ with a strong aversion for making eye contact. There are a few examples of this description within the case books:

‘Pasty, unhealthy complexion…. Rarely looks at you when speaking’.

‘His face is full and puffy, his complexion pasty and unhealthy, his eyes watery and his expression nervous, scared and downcast. His appearance and manner are strongly suggestive of a masturbator.’

‘This patient is a respectable looking lad, with a good, intelligent face but with a nervous, restless, anxious expression. His eyes do not look at you when he speaks but are constantly moving about and if you catch them, they drop almost immediately.’

‘He is an unhealthy looking lad with a pale, pasty complexion and is much emaciated. Does not look more than 16. When this was remarked to him he expressed…that it was all due to masturbation: this he has been observed to be addicted to, to a frightful extent.’

'A gaunt adolescent consults a weary specialist'. Colour process print after C. Josef, c. 1930. Image Courtesy of the Wellcome Collection.

This last patient recovered and gave up his ‘habit’ which the physician believes made a marked difference in his appearance: ‘there is a wonderful change in his appearance, is now stout, healthy looking boy with a fresh, pleasant face’.

For one man there is noted 'this patient's insanity was attributed to masturbation but he himself denies ever having been addicted to this vice'. In The History of an Idea, Hare discusses the difficulty physicians faced in ascertaining whether a patient has masturbated or not, this he says, 'was solved on the principle of Morton's fork: those who admitted masturbation were believed, those who denied it were disbelieved'. 

I was particularly interested in one female patient. Described as being a lady ‘of excellent education and steady industrious habits until her present illness’, her ‘insanity is to a very great extent dependent on her habits of masturbation.’ On her first admission she had shown some improvement ‘but relapses during the time of menstruation, when she behaves very stupid...’.

On this note, her menstruation, and the effects it has upon her person, is frequently remarked upon (which isn’t unusual within the case books):

‘Menstruation regular, habits very much improved; very bad woman when menstruating which is now the only time at which she masturbates’.

‘Sleeps very well except just before menstruation’

On her second admission the physician notes that he thinks she suffers from nymphomania.

There was one entry which I was rather shocked by:

‘Cauterization of the vagina has been tried, but with no good effect – previously her hands had been restrained at night by means of gloves; but although her bodily health certainly improved, no material improvement was noticeable in the mental symptoms. She also has delusions as to the identity of persons around her, and says her mind seems to enter the body of others.’

This is the first time I’ve come across mention of cauterization of genitals at the REH. I'm not sure why the procedure was performed in this instance - if the intention was that of preventing the patient from masturbating.

In the 1879 Manual of Psychological Medicine, there is a reference to cauterization as a way to prevent patients from masturbating: 'Blistering the prepuce we have found useful, but only for a time'. In the same excerpt, it is described how Dr David Yellowlees (who was the Physician Superintendent of the Glasgow Royal Asylum from 1874-1901) adopted 'wiring' as a treatment for male patients who masturbated: 'Dr Yellowlees rings the prepuce with silver wire, as the snouts of swine are wired to prevent their routing. The plan is ingenious and has been to a certain degree successful.' The author then adds 'In females even clitoridectomy has failed'.

Isaac Baker Brown's The Curability of Certain Forms of Insanity, Epilepsy, Catalepsy, and Hysteria in Females (1866). Brown's thesis presented in this volume was that nervous affections complicating diseases of the female genitalia were the direct result of "peripheral excitement of the pudic nerve" or masturbation. Brown proposes clitoridectomies as a cure to these afflictions and performed numerous such operations on women until his career ended in scandal when it was revealed that many of his patients hadn't consented to receiving the procedure. 

Comments within the case notes regarding patients masturbating are almost always written with a condemnatory tone, with the act being heavily stigmatised and pathologised. Although Skae's successor, Dr Thomas Clouston (1840-1915), initially agrees with Skae's belief that masturbration caused insanity,  he eventually concedes that masturbation and dementia 'cannot be put as cause and effect'. Hare writes in his article The History of an Idea: 'What is curious is the fact that until late in the 19th century no writer seems to have asked the question, "How prevalent is masturbation in the community?" and very few seem to have appreciated that the answer to this question might have a bearing on the validity of the masturbatory hypothesis.'

Thursday 7 December 2023

Letters of note

 Our latest blog comes from Carly Davidson, who's been working with us on an internship to make over 100 letters written by Royal Edinburgh Hospital patients accessible to readers through rehousing and listing. Whilst you can visit us and see the hundreds of letters written by patients that were previously kept with their case records, these particular ones (collected separately by the heads of the hospital) need some TLC before they can be used by researchers!

Hello, I’m Carly and I joined the LHSA team at the end of October as the new archive intern. Prior to starting my internship, I recently completed a MSc in Information Management & Preservation at the University of Glasgow back in August, where my interest in indexing records motivated me to apply for this internship. I’m excited to be able to put some of the skills I learnt to use and to gain practical experience working on such an interesting project.

For the duration of my internship, I will be working on an indexing and rehousing project for two boxes of patient letters from GD16, the collection of the Physician Superintendents of the Royal Edinburgh Hospital (REH), then known as the Royal Edinburgh Asylum. While the letters are varied in sender and content, most of them are addressed to Doctor Thomas Clouston, the Physician Superintendent of the REH from 1873 to 1908, with most of the letters being written within that time frame. Many of the patients were writing to Doctor Clouston to express their discontent both at their treatment and their being held within an asylum. For patients whose letters were not intended for Doctor Clouston, their letters were held back as the 1866 Lunacy (Scotland) Act permitted medical personnel to intercept and retain patient letters, particularly patient letters which were critical of life in asylums and those which indicated the severe condition of patients’ symptoms.

Indeed, critiques of asylum life are commonly found in the GD16 patient letters, with patients expressing discontent at their diagnosis, their treatment in the REH, and the living conditions they were experiencing. In one letter titled ‘A list of 31 ‘Ideas for an Asylum for the insane’’, suggestions were made to improve conditions within the hospital, and all other such institutions, with ideas ranging from the provision of a ‘Library of well-chosen books’ to a recommendation that ‘A few docile quiet cats to be kept as pets for the patients.’ Not all of the content is critical, with other letters being written to family and friends, and some acting as evidence of patients’ more severe symptoms, such as the experience of religious delusions prompting a patient to write letters discussing the divine orders they have received. Such letters can prove more challenging to read, with words and sentences often disjointed or incomprehensible.

Two images depicting different ideas from Harriet Henderson’s list of ‘ideas for an Asylum for the insane’.

The first stage of the project has involved reading and scoping the letters to identify information for use in indexing, such as names or dates. The content of the letters proved challenging, not only for the sensitive nature of the letters, but for the challenges presented in identifying necessary information. With most of the letters being from the 19th century, identifying information required strong palaeography skills and the ability to interpret text which was not always clear. Adding to the confusion, some of the letters had already been labelled with information about patients’ names, but this legacy information did not always correlate to the content of the letters, meaning additional research was required to link the letters to patients of the REH.

One such example of this comes in the form of a notebook which was previously labelled as belonging to ‘AJA Dick’ - a name which does not exist in LHSA's database of REH patients. This name, while incorrect, was interpreted from a small signature in the notebook, from which I could only clearly make out the initial ‘M’ and the surname ‘Dick’ which only slightly narrowed down results from the database. As the letters are some of the oldest records I’ve worked with, my palaeography skills and understanding of cursive could only lead me so far in identifying names, and I was dependent on recognising other contextual information in the text to identify the patient themselves. This involved looking for any notes of the patient’s condition, the date of their admission, or personal information concerning places or family members.

The first picture shows the front of the notebook mislabelled as belonging to AJA Dick. Below, a picture of the inside cover of the notebook shows a signature and an address in Kelvinside, Glasgow. The signature was later identified as being Maggie Dick, short for Margaret Dick.

After a few attempts at deciphering the handwriting, and with the help of Louise Williams the LHSA archivist, the signature in the notebook gradually became clear as belonging to Maggie Dick, though this did not result in an exact hit when searched on the REH database. Rather, using context clues in the text itself, such as the frequent mentions of a specific Glasgow address, allowed the notebook to be identified as belonging to Margaret Dick. While Maggie’s writing is the main feature of the notebook, recounting stories of the other patients and her life back in Glasgow, the notebook is also embellished throughout with small sketches which illustrate Maggie’s words. Other letters similarly include artwork, ranging from artworks done by the patients themselves to illustrations and images torn from books. A small number of materials included in the collection are not letters at all, taking the form of works of poetry and small plays or stories. These items have been particularly interesting to look through, with small works of art or poetry adding a very personal touch to a letter in a way which still resonates today.

Images showing two of the sketches from Maggie’s notebook, one depicting two small flowers, and the second a small doodle of her mother. 

With the scoping stage of the project now completed, the next stages will see that letters are rehoused into suitable archival materials, and made accessible through the creation of catalogue entries on ArchivesSpace, a public database of archival records held here at the University of Edinburgh.

Friday 21 July 2023

Medicine past and future: work experience at LHSA

 For two weeks in July, we had the pleasure of hosting Sanya Kuslii, a high school student soon to go into her final, S6 year. Sanya was on placement in the Career Ready programme, a national initiative connecting young people with the world of work through mentorship and hands-on placements. Sanya wants to study medicine, so her career aims are a bit different from people who usually work with us to gain experience. We hope we made the connection between Edinburgh's medical past and its (judging by Sanya's abilities!) very bright future. We'll leave it to Sanya to explain:

Hello, I am Sanya Kuslii and I am doing a 2-week placement with LHSA based at the University of Edinburgh as part of a 4-week internship with Career Ready. The structure of my internship is a bit bizarre – I had worked at the Anatomical Museum during the last week of June, where I helped gather information for the accreditation of the museum, and various bits and bobs. The following week I was at the Medical Campus Week at the University of Edinburgh, before starting my internship with LHSA; after these 2 weeks I will return to the Museum to complete my last week of the internship there. Despite just starting my second week with LHSA as I write this, I have worked on a few projects covering a variety of themes, which I have chosen to mention in this blog.

One of my first assigned tasks was to index some press cutting from the Royal Edinburgh Hospital, previously known as the Edinburgh Lunatic Asylum in the 19th century. The Hospital collected many cut-outs from newspapers or publications printed in Britain which mentioned the hospital or anything relating to it, such as the laws regarding the treatment of patients suffering from mental health disorders or patients that were treated in the Hospital. This was similar to the work I was doing at the museum, where I analysed large quantities of data, rearranging it into a more accessible format; at LHSA I handled the original bound volume from the Hospital and read the stories and news, and I was also able to improve my skills of skim reading and summarising large amounts of information into several sentences for easy interpretation. It was also amazing to see how well the book had been preserved for the past 150 years; the spine, cover and pages themselves were, arguably, in perfect condition.

Building upon the topic of conservation of archival material, I had the opportunity to work on some work surrounding the conservation of accessions with Ruth Honeybone, LHSA Manager. The accessions included some clippings from one of the patients of Prof. Norman Dott, a Scottish neurosurgeon and the first holder of the Chair of Neurosurgery at the University of Edinburgh. Enclosed was a newspaper clipping about Prof. Dott, admittance cards from the patient’s visitors, and an information booklet that had been given to admitted patients. Another accession was a collection of documents from the Edinburgh Cancer Centre and included re-prints of Professor McWhirter, research into cancer therapies, chemotherapy booklets and more. The hands-on work that morning included transferring the sheets of paper out of their original wrapping into acid-free folders to prevent them from decomposing, and making sure the documents sat comfortably in their boxes. What appealed to me through-out the morning was the different factors that you need to consider to efficiently re-house an accession – what paper should I use for this? Should I keep the original housing material, or can I bin it? How much material can I place into one folder before it becomes too much? Given my passion to pursue medicine after high school, the re-housing workshop reminded me of the numerous questions a doctor should be asking themselves when caring for a patient, as well as the methodical approach we took to ensure the accessions were placed in the right order.  

Prof. Norman Dott by William Hutchison (1960), copyright Royal College of Surgeons of Edinburgh

Another project I have enjoyed participating in was organising an activity for the University's Science Insights visit to LHSA, which focused on records from the Dietetics Department at the Royal Infirmary of Edinburgh, Medical Officer of Health reports from the early 20th century, and an 18th century patient case study from Dr John Gregory. For this project, I digitised the majority of the collection items, created questions the students could think about regarding the collections, and a slide show with photographs of the Dietetics Department. Given the short amount of time we had, the plan was to give each group folders with all three collections and let them explore them, before selecting a favourite fact/memorable piece of information to share with the others. They really enjoyed it, and we are hoping Science Insights will come back to LHSA next year.  

To get a better understanding about the kind of things LHSA do, apart from preserving and storing information, I had the chance to work through some enquiries with Louise Neilson, LHSA Access Officer. These queries came in last week, and were asking for some more information about patients. The two enquiries were different from one another: the first was very straightforward, and only required access to one patient register from Longmore Hospital, while the other was more complex, relating to a patient who had stayed at the Royal Edinburgh Hospital for over 3 decades. We had to take out several bound volumes between two store rooms, following notes between pages to complete the search for the end of the records for that patient. I got to explore the two extremes of the types of things people can request from LHSA, and how the medical history of Lothian ties into the modern world.

During my second week I worked with some of the non-paper collections at the archive, which included oral history, photographs, glass plate negatives, film, and other objects. I chose to look at the photographs of medical teaching at the University of Edinburgh from the early 20th century, placing them into melinex sleeves for easier handling and writing up a shorts description about each one. I was excited to see how medicine had been taught at Edinburgh just a hundred years ago. Having recently visited the old lecture theatre where the majority of the lectured had been located, it felt surreal to look back in time at the theatre and imagine what it must have felt like for the students studying medicine at Edinburgh. Arguably, this was one of my highlights of the placement. 

Dr Derrick Dunlop (top) and Dr G Jamieson (below) teaching in the University of Edinburgh Medical School, c. 1930s (Acc20/009)

To conclude this blog I would like to say how lucky I was to get a placement with LHSA. I really enjoyed working with the small but lovely team of Louise Williams, Louise Neilson, and Ruth Honeybone, and I have learned a lot about archives: how they work, how they are relevant to today’s world – not just keeping and preserving information but also reaching out to the public. If you get the chance, definitely visit LHSA in the Centre for Research Collections (CRC) at the Main Library; they have some really interesting things and you will definitely want to come back.

Monday 16 January 2023

Dr George Rice (1848 – 1935) at the Royal Infirmary of Edinburgh.

This post contains racist / offensive terminologies which were used during the period it discusses.

Celebrated for his poem ‘Invictus’, William Henley (1849 – 1903) also penned an unabashed racist portrait of a former student of the University of Edinburgh. After graduating, the student worked at the RIE as house surgeon while Henley was a patient there under Joseph Lister.

The student’s name was Dr George Rice and he had an extraordinary life and career.

As a teaching hospital, the Royal Infirmary of Edinburgh (RIE) has long held a close connection with UoE’s (University of Edinburgh) Medical School. As LHSA is based at the UoE Main Library, we are lucky enough to have the University’s heritage collections at a stone’s throw away from our own archive. One of the great things about the two archives neighboring one another is that we can easily trace former UoE student’s careers if they then went on to work at the RIE.

Entry for George Rice in Royal Infirmary of Edinburgh Student Ticket Journal (alphabetical ledger of tickets sold to students for admission for clinical training) LHB1/16/55.

George Rice within 'Graduates in Medicine' album, 1874. Edinburgh University Heritage Collections. EUA IN1/ADS/STA/8.  

Over the last few years, long belated moves have been made to reveal the stories of BAME alumni who attended Edinburgh University over the course of its history. Brilliant projects like UncoverEd have at their root a decolonising aim, with current students using the University’s archive to create a biographical database of notable BAME alumni. These past students have had a role in the University’s history yet a long heavy silence has erased their contribution to its institutional memory. The UoE has long accepted students from all nationalities (the first known black student was Jamaican-born William Fergusson - he matriculated in 1809) yet the historical students we remember, who have had films, books, and articles written about them, are largely white (and male).

Two years ago, NHS Lothian made a commitment to fully address how the Royal Infirmary benefitted from its ties to the Atlantic slave trade. LHSA welcomed researcher Simon Buck to the team, who has been sleuthing through our RIE archive investigating and uncovering the often painful and shameful truths of how little was untouched by the slave trade, whose profits left an insidious stain on Edinburgh’s history. For its part, the Royal Infirmary inherited an estate in Jamaica from a Scottish surgeon/slave owner in 1750 which the hospital still owned as late as 1892. Included in this inheritance were 39 human lives (or the estate’s slaves, later ‘apprentice’ labourers) who worked on it.

The Hospital’s links to slavery do not end there. The RIE would receive thousands of donations and bequests, a considerable amount of which was ‘blood money’ - or slavery-associated money.

There will be a series of public consultations on the RIE’s ties to slavery in the next month or so, to anyone interested, please do attend.

Royal Infirmary of Edinburgh - Copy of 'Inventory and Appraisement of the Goods and Chattels, Rights and Credits of the Late Archibald Ker'. Inventory includes 39 slaves, each listed with a name (given by slave-owner). LHB1/72/5/6a

Simon recently asked us about BAME staff at the RIE and our Archivist, Louise Williams, mentioned a black American surgeon, Dr George Rice, who was employed by the RIE during 1870s. She had come across his story while researching an enquiry we received last year. Some fascinating research has been written up on his life and career which I will link below. Dr Rice’s story provides links between institutions with every repository holding a fragment of a puzzle which, when pieced together, provides somewhat of a full picture of his life and career.

George Rice was born in Troy, New York, and graduated from Dartmouth College Medical School in 1869. Rice’s father, a steamship steward, wrote to Dartmouth’s President Asa Smith: ‘He wants to be a physician and I shall assist him in all my power to be an accomplished one’.


George Rice image courtesy of, Blacks @ Dartmouth 1828 to 1960 

After being denied admission to Columbia University’s College of Physicians and Surgeons, George moved to Europe to continue his studies.

He was first based in Paris before relocating to Edinburgh after the eruption of the Franco-Prussian war. He enrolled in Edinburgh University in 1870 and graduated in medicine in 1874, thereafter securing the position of House Surgeon at the RIE, working under renowned pioneer of antiseptic treatment in surgery, Joseph Lister.

Mention of George Rice in minute of  RIE Minute book 17th May 1975. LHB1/1/28

Serendipitously, my last blog post covered the nursing career of Janet Porter, who also worked under Joseph Lister as his staff nurse from 1869 to 1877. Undoubtedly, George and Janet must have encountered one another on the wards of the RIE – Janet was described as being ‘esteemed by the many students who came in contact with her’.

House physicians and surgeons were known as ‘residents’. As newly-qualified doctors, they would spend six months (at that time) working in the Infirmary supervised by a senior member of medical staff learning their ‘trade’. Although we do hold some records that feature residents, these do not say what life would have been like for them day-to-day, but are more like proof that they were there. But Henley's poem may give us an insight into Rice's experience of working at the RIE.

George Rice (middle) during his time as House Surgeon at the RIE. Image from 'The Student' Vol V, 1901. Reference: EUA IN20/PUB/1

William Henley was a patient of Lister at the Royal Infirmary of Edinburgh from 1873 for three years. During his time as a patient at the RIE, Henley wrote some 28 poems and a few of these were first published in The Cornhill Magazine as Hospital Outlines: Sketches and Portraits. The poems are impressions of those around him; his fellow patients, the nursing staff in the process of professionalization, and the general atmosphere of the hospital. One of these portraits, a racist description of George Rice, exposes Henley’s own blatant prejudice.

The poem, titled ‘A Student’, was published in the July 1875 edition of Hospital Outlines in the Cornhill magazine and appears just above Henley’s poem of Janet Porter titled ‘Staff Nurse – Old Style’. 

Racist poem in the July 1875 edition of Hospital Outlines in the Cornhill magazine

‘A Student’ is missing from later editions of the Hospital poems perhaps because of this letter written by Lister to Henley in which he reprimands the poet for publishing ‘so severe a picture’.

"It may interest you to see, if you have not already done so, what is said of them by the paper of which I send you a copy. I may add that it expresses very much my own feeling about them: they have surprised and pleased me very much. Of one of your portraits it would not become me to speak; but of another, that of 'A Student', you will I trust forgive me for saying that I cannot help regretting the publication of so severe a picture. I say this as your friend, because I sincerely hope with the Review that we shall 'hear again of' you as a poet; and I am afraid indulgence in this vein may make you needless enemies of those whom you so sharply chastise. I rejoice that you can report so favourably of your foot and quite hope it will soon be sound."

George Rice appears to have held Lister in high esteem (he christened his son with the middle name of ‘Lister’) and this sentiment seems to have been reciprocated. Within a certificate of recommendation written by Lister and held by Sutton Archives, he comments on Dr Rice’s ‘exceedingly efficient manner’ and ‘indefatigable zeal’ in which Rice went about his professional duties, writing that Rice will go on to secure ‘a very high place in the profession’. Dr Rice would indeed go on to have a brilliant career, eventually marrying and then settling in Sutton where we would go on to practise medicine. 

Lithograph of Joseph Lister, n.d. 

University of Edinburgh Journal 7, 1934/1935, p. 179. 
Rice is described as 'the last oldest survivor, with one exception, of Lord Lister's house surgeons in the Royal Infirmary.' 

In 1875, just when Rice was appointed House Surgeon for six months in Lister’s wards, Lister travelled to the Continent, leaving John Chiene in charge of his wards and clinical lectures for two months. Chiene had this to say of Rice: ‘it must have been a disappointment to Dr Rice to have me as his Chief, but I have never forgotten his kindly courtesy of me personally, giving me every help’. 

Dr John Chiene. Etching by W. B. Hole, 1884. Courtesy of the Wellcome Collection. William Brassey Hole was the grandson of William Fergusson (the first known black student to enroll at UoE). 

In an article published in the University Journal in 1991, Edward H. Cohen writes that the poem ‘A Student’ suggests Rice was unpopular in the hospital community and may have had little support during his student days in Edinburgh. One of Rice’s colleagues, G. A Gibson, wrote that Henley’s poem was ‘a rather savage description of a mulatto House Surgeon, whom we all disliked’. Rice’s skin colour is raised pointedly in both Gibson’s letter and Henley’s poem. Why he was so disliked we cannot know for sure but the implications made throughout the poem suggest his being a person of colour was the focus of the hostility.

In terms of context, the 19th century saw institutions across Britain fuelling an imperial and colonial agenda which sought to justify the dominion of whites over non-white people and advance racial inequality throughout the empire. This dogma would creep into the research of the Victorian scientific community with pseudo-sciences such as phrenology (Edinburgh was the principal centre for the study of phrenology in Britain at this time) and polygenism gaining widespread influence. Outwith the scientific community, there was a growing popularity of racist entertainment: human zoos and international exhibitions (which included living exhibits of colonised ‘exotic populations’) as well as popular shows involving blackface minstrelsy.

Back to Henley’s awful poem, I find the first two lines incredibly poignant:

A little black man, admirably neat,

Extremely ‘gentleman’ from head to toe

I can picture Henley’s probing eyes scanning Rice’s appearance from head to toe. He picks apart Rice’s immaculate clothing, his hair ‘peculiar to his race’ which he ‘soaks in water till the curl will smooth away’. 

The poet does his worst to insult Rice’s appearance while also dismissing the doctor's skill and intelligence (thin brilliance, commonplace intelligence). By doing so, he challenges Rice’s position at the RIE as a university-educated and promising young doctor. 

Henley describes Rice as being overly concerned with his appearance ('visits his moustaches day by day'), effeminate ('a very girl'), and conceited ('suspicious vanity') - much like a 'dandy', or 'fop'. Wikipedia describes the dandy as 'a self-made man in person and persona, who imitated an aristocratic style of life, despite his middle-class origin, birth, and background'.' I get the impression Henley is implying that Rice is dressed above his station, performing as a member of white high society. This is evidenced by the way he sandwiches the title of gentleman between air quotes, sneering at what he feels are Rice’s attempts of emulating the garb of a Victorian gentleman. 

Despite his ‘gold links and chain’, his ‘white shirt, and shiny boot’, and his prestigious degree from one of the world’s leading universities, Henley's glare shrinks Rice, reducing him to a ‘little black man’. 

We don't know if Rice read this poem, or what he made of it. What we do know is what Rice went on to make of himself, building a life and career which were nothing short of extraordinary.

For enquiries relating to past students at the UoE please contact the Centre for Research Collections Research Services team at: 

Further reading: 

[For more on Rice's career after the RIE] Object of the Month: October. Article by Whitehall Historic House. 

Black Victorians: the hidden Britons who helped shape the 19th century.

Dr George Rice and the creation of the Community Garden. 

[George Rice's younger sister Harriet was also a pretty incredible physician] 100 Years Ago – Dr. Harriet Alleyne Rice of Newport: The struggles of an African-American physician. 

Tuesday 23 August 2022

Nurse Janet Porter- nursing at the RIE before the 'Nightingale takeover'

Lauren writes about a much beloved nurse and the state of nursing before the implementation of the 'New System of Nursing'.

August 12th marked the anniversary of Florence Nightingale’s death. Having a particular interest in the history of nursing, and being in the unique and privileged position of having immediate access to the archives, I took the opportunity to investigate the state of nursing at the Royal Infirmary of Edinburgh (RIE) before the introduction of the Nightingale nurses and the training school for nurses. I came across several mentions of a Mrs Janet Porter, a staff nurse at the RIE for a total of 47 years. She lived through the incredible changes which took place at the RIE in 1870s with the introduction of the ‘New System of Nursing’.

Dr Joseph Bell painted a rather bleak picture of nursing before the introduction of the Nurses’ Training School: 'Without apparent exaggeration, it is almost impossible to convey to this generation the depths of disgraceful ignorance and neglect in which nursing lay in hospitals in 1854.'

There were nine nurses total in the surgical wards which housed 72 patients. These nine women were-'two staff nurses, each with about thirty six beds to look after, and seven so-called night nurses who had also to do the scrubbing and cleaning of the wards and passages.'

Joseph Bell (1837-1911) was a Scottish surgeon and advocate for the training of nurses.

Bell’s description of the staff nurses Mrs Porter and Mrs Lambert is rather flattering: 'wonderful women of great natural ability and strong Scottish sense and capacity, of immense experience and great kindliness. Up to their strength and opportunity, probably no two finer specimens of the old-school nurse could be found. All honour to their pluck and shrewdness!'

But he spares no punches when describing the other seven nurses: '…poor old useless drudges, half-charwoman, half field worker, rarely keeping their places for any length of time, absolutely ignorant almost invariably drunken, sometimes deaf, occasionally fatuous—these had to take charge if our operation cases when the staff nurses went off duty. Poor creatures, they had a hard life!'.

I had done some research on nursing for the digital resource list on the history nursing and one of the first things I learnt was that the general perception of nurses during the 18th and better half of the 19th century was incredibly negative. Figures like the fictional nurse Sarah Gamp from the Dicken’s novel Martin Chuzzlewit perpetuated the untrained, incompetent and drunk stereotype of the Victorian nurse. The RIE minute books (Nov 1967-Nov 1869 and Nov 1869-May 1871) confirm that there were instances where nurses were caught intoxicated on the job, and there were quite a few complaints made in regards to the general conduct of the nurses.

A dishevelled nurse with her disgruntled patient. Coloured lithograph by W. Hunt. c. 1825. Credit: Wellcome Collection. 

"The Nurse"; anonymous. Credit: Wellcome Collection

Angelique Lucille Pringle was the second Lady Superintendent of nurses. Trained at St Thomas', she was widely considered to be Florence Nightingale’s favourite. LHSA holds Angelique Pringle’s diary from 17th to 23rd Nov 1872, which she kept during a visit to the RIE while Elizabeth Barclay was Lady Superintendent. It is an invaluable record which vividly captures both the state of nursing at the time and the tensions and prejudices between these new, highly trained and educated nurses and the ‘old school nurses’. 

Pringle makes mention of nurses being intoxicated. In one instance, a night nurse called Annie Fisher is caught asleep on the job. After many attempts to wake the nurse up, Mrs Barclay asks Fisher “what about your patients, nurse?” Laughing, Fisher replies “Oh, I had nae mind o’ them”, which Pringle writes is a 'skillful epitome of the state of nursing'. After Pringle and Barclay wake up a Day Nurse to take charge of the ward, Annie Fisher follows the two women, enraged and screaming that she “had seen a good many out and she would see us out too!”

Typescript copy of Miss Pringle’s Diary LHB1/112/2 

RIE Minute Book LHB1/1/24- complaint regarding the conduct of Syme's night nurse, mention that she "has been indulging in intoxicants".

RIE Minute Book LHB1/1/25- report of nurse Janet Houston who had "been found intoxicated and unfit for duty" 

RIE Minute Book LHB1/1/25- nurse Jane Riddoch had been found in a state of intoxication

Much like Bell, Pringle lays it on pretty thick with her description of the nurses and her comments are often cruel and ignorant by today’s standard: 'Two of these nurses were hideously deformed in face, quite unsuitable on that account alone for their post. Their wards looked nice however.' The classism is so abundant within her descriptions of the nurses that it’s a bit hard to stomach at times- 'These were very pale all of them, some were sodden, some were stupid old women, some slovenly young ones of the lowest class.'
It would appear that the nurses bore the brunt of such animosity, when it was the system and the terrible working conditions which were mainly to blame, and no doubt played a part in the general incompetence of the nurses' work. The nurses at the RIE pre-1870s 'were poorly housed, ill-fed, underpaid and over-worked, and many of them were regarded as attendants and servants rather than nurses'. Shockingly, the night nurses’ shifts were extraordinarily long- they would come on duty at 11 o’clock at night and their shift would not end until 5 pm the next day! Their shifts were so long because, after completing their nightly nursing duties, they would still have to make breakfast and clean the dishes and wards and give patients their food.
Improvement to the conditions of nursing was largely overlooked by medical staff at hospitals during the first half of the nineteenth century. Florence Nightingale famously described the state of nursing at this time as a profession for ‘those who were too old, too weak, too drunken, too dirty, too stupid or too bad to do anything else’. 

LHB1/1/25 RIE Minute Book, complaint of nurses diet.

Angelique Pringle mentions Mrs Porter a couple of times in her diary: 'One head nurse, Mrs Porter, looked quite a dear old lady but her wards were not nice. She has been 27 years here and has now one of the heaviest charges.'

LHB1/112/1 Angelique Pringle's diary

Before the introduction of the New System, it would appear that unruliness and chaos were not uncommon in the wards of the Infirmary. It also seemed to be pretty normal for nurses to be dismissed: 'On asking the nurses their length of service, we found several who had been only two days in the house ‘since that night’ said one of them ‘when so many of the nurses got drunk’.'

Even Mrs Porter’s conduct, according to Angelique’s diary, did not seem to comply with the Nightingale model of cleanliness and order: 'We found nearly all the gas blazing, the day nurses running about and a perfect riot of laughing and talking going on among the nurses and patients. Nurse Porter’s wards were the noisiest, the old lady herself being very loud.' Although she isn’t exactly reverential about the “old lady”, she does seem to acknowledge a certain ‘spark’ that seems to have captivated so many people.

Even Florence Nightingale herself wrote a letter to Angelique in which she expresses a fondness for nurse Porter:

'Please give her my kindest Christmas wishes and tell her I remember her perfectly and her care of me 16 years ago when Mr Syme took me over the infirmary. How long ago!'

Nightingale's letter to Pringle. LHB1/111/3a

Another interesting record is 'Biographical notes on Nurses not trained under the new system here, on duty Sep 1887': 'Dear old Mrs Porter, the crown of the staff, who needs no other description.'

LHB1/112/9 Notes on early nurses- nurse Porter is described as 'the crown of the staff'

Mrs Porter provided inspiration for the poet W E Henley who was a patient of Joseph Lister at the Royal Infirmary from 1873 for three years. He wrote the following poem about Porter titled ‘Staff Nurse- Old Style’:

THE greater masters of the commonplace,

REMBRANDT and good SIR WALTER — only these

Could paint her all to you: experienced ease

And antique liveliness and ponderous grace;

The sweet old roses of her sunken face;

The depth and malice of her sly, grey eyes;

The broad Scots tongue that flatters, scolds, defies,

The thick Scots wit that fells you like a mace.

These thirty years has she been nursing here,

Some of them under SYME, her hero still.

Much is she worth, and even more is made of her.

Patients and students hold her very dear.

The doctors love her, tease her, use her skill.

They say ' The Chief' himself is half-afraid of her.

GD1/8/2 Pamphlet, 1957

Henley was a patient during a time of great change at the RIE, when the structure and training of nurses was undergoing a historic transformation. He immortalised these sharp contrasts of the ‘Old Style’ and ‘New Style’ nurse (as he would coin them), in his poems. This one is called ‘Staff-Nurse: New Style’-

BLUE-EYED and bright of face but waning fast

Into the sere of virginal decay,

I view her as she enters, day by day,

As a sweet sunset almost overpast.

Kindly and calm, patrician to the last,

Superbly falls her gown of sober gray,

And on her chignon’s elegant array

The plainest cap is somehow touched with caste.

She talks BEETHOVEN; frowns disapprobation

At BALZAC’S name, sighs it at ‘poor GEORGE SAND’S’;

Knows that she has exceeding pretty hands;

Speaks Latin with a right accentuation;

And gives at need (as one who understands)

Draught, counsel, diagnosis, exhortation.

Here, we can see the marked differences between the two nurses, the 'New Style' nurse is represented as a more educated and ‘genteel’ woman.

Photograph of Janet Porter (middle) c.1870

P/PL1/S/257 Photograph of Angelique Lucille Pringle, with a group of senior nursing staff c.1880

I find it incredible and quite moving how cherished Janet Porter was. She was neither an innovator nor was she a reformer but she seemed to have made a deep impression on those around her. Who says that one has to be a trail-blazer in order to deserve recognition, poems and portraits?

She certainly seemed deserving of recognition- her care no doubt changed many patients' lives. Nurse Porter was clearly very good at her job, although untrained to the degree of the Nightingale nurses, she gives me the impression of having been hard-working and committed to building relationships with those around her- staff, students, patients and professors alike. The fact that she was kept on even after the introduction of the training school is evidence of that. She was an exemplary nurse at a time when nursing was vastly underappreciated and nurses were regarded with distrust. 

Janet Porter was Lister's staff nurse from 1869 to 1877. When the new RIE opened in 1879, she was kept on in the position of a "retainer" rather than an active nurse. She died in 1890 at the age of 80. A bed in Ward 9 was named the Janet Porter Bed and her portrait, subscribed for by the nurses who had been associated with her and presented to the managers in 1890, was hung in the main corridor of the surgical hospital in the vicinity of the ward.

RIE Minute Book LHB1/1/35- report on the passing of Janet Porter. "...true to a marked characteristic of her nature she died literally "in harness"". The Managers unanimously agree to name a bed after her in Ward 9.