We're handing over to our volunteers over the next two weeks to hear a little more about the Royal Edinburgh Hospital case book indexing project they've been working on. Starting us off is Iona, who recently graduated with a first-class history degree from the University of Edinburgh.
Since April I have been helping
with the Royal Edinburgh Hospital Case Book indexing project to create a
database of patients admitted between 1840 and 1932. Every week I work on my own volume detailing
the cases of women admitted from the late 1850s. I have gleaned amazing details
of what these women’s lives were like across social strata within the wider
framework of Victorian attitudes towards medicine and gender. Every case illuminates
the perception of women’s greater susceptibility to different forms of ‘mania’,
many related to life-cycles of puberty, menstruation, childbirth, menopause, and
old age.
Working through the case entries,
I am very aware of looking at a top-down source; the female patients are viewed
through the prism of the medical institution and the men that run it. At times,
it is almost as if I am reading a novel with unreliable narrators, trying to
prise the text apart to catch a glimpse of the patients’ point of view. Despite
this limitation, many stories are harrowing, dramatic, even amusing, with a
strong sense of each woman’s individual character. This interplay between the patients’
experiences, the narratives of the medical men, and my own subjective
interpretations is fascinating, a unique way of bringing history alive.
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| The index to casebook volume 13 |
The intertwining of morality and
medicine pervades the volume, from the formulaic language describing patients’
everyday behaviour as ‘industrious’ or ‘slovenly’ to diagnoses of ‘moral
insanity’. The unsettling combination of familiarity and strangeness in the way
that the doctors evaluate their patients is highly compelling. Through my
modern lens, it seems straightforward to identify symptoms of alcoholism, post-partum
depression, and the simple need for people to receive more care as they get
older. The doctors’ assessment of these cases range from comparatively
up-to-date understandings to the down-right odd, my favourite example being the
condemnation of dissipation through excessive tea-drinking.
The following are my highlights
from my case book volume. I have chosen just a few examples to demonstrate some
of the themes I have found particularly interesting during my time at LHSA.
Work,
work, work
Each entry makes some reference
to the patient’s occupation and class, revealing the social roles of women at
the time. The entries often identify patients by their husband’s profession, such
as brewer’s wife or sailor’s widow, and if employed are most often domestic
servants or seamstresses. I have found tantalising exceptions among these
common entries, such as Clara the London stage-dancer and Helen the
map-colourist.
In addition, cases like that of 26-year-old
Christina reveal contemporary wariness of female education and ambition. Her
‘acute mania’ was caused by ‘something which had excited her beyond ordinary’,
which turns out to be ‘the study of composition’ and her attempt to write a novel.
This diagnosis connects Christina to many women of the later nineteenth- and
early twentieth-century whose literary energies were medicalised in connection
to their mental health. Two of the most famous examples of this are Virginia
Woolf and Charlotte Perkins Gilman, who both wrote about the frustrations of their
medical treatment. In 1882, the Royal Hospital’s own Dr Clouston gave a lecture
entitled ‘Female Education from a Medical Point of View’, which demonstrates
the widespread disapproval of these developments. He states that new school
curricula have ‘warped the woman’s nature, and stunted some of her most characteristic
qualities’, not only to the detriment of the female population but to the
health of the nation itself. In this way, Christina’s case and Clouston’s
lecture hint at how women’s bodies became ideological battlegrounds over medical
practice and appropriate gender roles.
Medicine
and moral sensibility
The doctors’ descriptions of their
patients’ cases frequently act as moral commentaries on their way of life and
their place in society. I came across one woman called Mary Ann who used the
name Jane as an alias; this factor and her diagnosis of ‘moral insanity’
perhaps hints at a criminal past. Although the previously-mentioned Clara is ‘naturally
of a cheerful disposition and steady industrious habits’, the entry notes that
‘employment as a dancer on the stage might not be considered advantageous for
this development.’
Instances of alcoholism elicited
condemnation as a manifestation of both physical and moral degradation. In
another lecture given at the University of Edinburgh, Clouston describes women
as more predisposed towards alcohol abuse because they possess ‘less resistive
power’, as well as the ‘nervous disturbances incidental to the female sex and
to motherhood, and the climacteric period.’ The case of a woman called Flora
with an ‘inclination for stimulants’ caused a great deal of trouble for the
Hospital as the staff debated over her treatment. After escaping to go drinking,
Flora was investigated by the Board of Lunacy and examined by several doctors.
When contacted, her family requested that she remain at the Hospital because
she was ‘quite unable to keep from drinking and from disgracing herself and
them by her conduct’. The Board released Flora, however, because when sober she
was ‘not at present a lunatic in the statutory sense and therefore however
doubtful they may be as to the manner in which [she] may comport herself when
free from control they have no alternative but to order her discharge.’
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| LHB7/51/13 |
As the previous cases show, most
often the entries convey the attitudes of the hospital staff, yet some details display
the strong moral compass of the patients’ themselves. Helen was engaged to a
‘respectable young man’ but ‘began to entertain fears that…he was not a
Christian.’ This led her to postpone the marriage but ‘the delay of her lover
in assuming the Christian character threw her into a deep melancholy.’
Interestingly, her postponed marriage also led Helen to ‘adopt the idea of
going as a missionary to the Indians.’ I like to think that perhaps her work as
a map-colourist encouraged her desire to travel as well as her deep religious
sensibilities.
The
cup that cheers and inebriates
One of the most bizarre
attributed causes of mania I have found in my casebook is the effect of
excessive tea-drinking. For example, another patient called Christina sought
refuge ‘in the inordinate imbibition of tea, which she takes in the form of a
strong decoction several times a day’, a good summary of my own tea habit.
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| LHB7/51/13 - when tea drinking becomes a threat to health... |
The case of Joan, a dressmaker
from Glasgow, also hints at a class dimension that may have influenced the
doctors’ attitudes towards her tea consumption. The record states: ‘She has led
a very unhealthy life, having subsisted like many of her class almost entirely
on tea taken at every mealtime and seldom supplemented by more than bread and
butter, and the occasional salt herring.’ Like Christina, Joan’s ‘indulgence in
tea seems in her case to have amounted to dissipation, leaving her, after the
stimulant effects pass off, in a state of considerable depression.’
As with alcoholism, the risks of
tea were linked to women’s natural weakness and susceptibility. This is also
suggested by an article entitled ‘The dangers of tea drinking’ by a Dr J E
Cooney published in the Windsor Magazine in 1895. Cooney writes: ‘Warm
tea-drinking is very popular with women, and is quite an institution in this
country. It is drunk at all hours – even before rising in the morning – but the
climax is reached at about 4pm. Many, in the course of paying their afternoon
calls, drink no less than a dozen cups of tea…that one is naturally left in
astonishment of the depravity of their sense of taste, without contemplating
the terrible consequent ravages their respective constitutions must inevitably
undergo.’ To me, Cooney’s focus on women’s daily social rituals conveys a sense
of uneasy disdain not just for tea drinking but for codes of female behaviour
in general. This is heightened by the next paragraph, evoking the image of a deviant
female cult: ‘Tea-water worship, carried on by its fair devotees in the
prettiest of drawing-rooms, in the smartest of tea-gowns, with the daintiest of
paraphernalia in the form of silver and china, may to a large extent disarm
them as to the real nature of this insidious but implacable fiend, but
nevertheless it is there.’ The article further reinforces the dangers of this
‘implacable fiend’ through its illustrations, which juxtapose rough men
drinking from bottles on the street with well-dressed women before trays and
teacups. Although this connection of tea with ill-health and morality is funny
with hindsight, it provides a fascinating example of how medical attitudes
could be bound up with ideas of class and gender.
This blog has been only a small
taster of the remarkable stories of women admitted to the Royal Edinburgh Hospital in the
nineteenth-century. My attitudes towards history have been greatly enriched by
this experience; I have thought much harder about the many filters that lie
between the past and present, and about my own subjectivity as a researcher. I encourage
anybody interested to volunteer with LHSA for the privilege of spending time
with these fractured but powerful voices of history.
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