TRANSFORMATIONS IN INVALID LIFE
Legislation for the helpless in health or in sickness the exclusive
feature of the Victorian age. Early interest of the English Court
through the Prince Consort in the housing of the poor. This coincided
with, and helped forward, the organized public movements for popular
sanitation. General summary of these, as shown by results. The new
nurse contrasted with the old. Hospitals to-day twice blessed.
Specific progress of sanitary reform. Demonstrable connection between
these improvements and figures of the death rate. Preventive and
curative medicine also entitled to credit. General course of medical
progress. Special researches of English physicians. Their ascertained
usefulness and their latest aspects. Improvement in English doctors,
with particular instances.
Before the Victorian age, there had been no legislation for the purpose of
helping the helpless, housing the homeless, providing for the health of
those whose birth-right was the squalor, the starvation, the disease, that
come from systematic neglect. Here, as in other things, the representative
of the Crown, transformed from a political power into an agency of social
good, led the way. The Prince Consort, moved by the condition and by the
address of the ballast heavers in the East End of London took the
initiative; the legislature gradually followed. Thus was the principle
established and acted on that one of the prime duties of the State is to
those for whom from any other quarter there is no help.
The last instance of that wholesome truth was the Dilke Commission for the
better housing of the poor aptly presided over by the Prince Consort's
eldest son in 1885. Exactly forty-five years earlier than this, Colonel
Slaney's[98] motion in the House of Commons produced an enquiry into the
health of towns. Local Improvement Acts had been multiplied to the number
of 500. There was still no proper drainage. The Duke of Buccleuch's
Commission of 1848 led to the Public Health Act of the same year. As the
cholera invasions of 1853 and of 1865-6 showed, the Local Boards
established by the Act of 1848 were too permissive in their operations to
be fully effective. Edwin Chadwick, and Southwood Smith had from the first
co-operated with the Queen's husband. Their activity did not cease when
the earliest steps to reform had been taken: 1858 witnessed fresh
improvements.[99]
It was not till 1875 that the confused mass of sanitary laws was
consolidated. Then the Local Government Board which, with the powers of
the superseded Poor Law Board, had been established in 1871 was in full
and in most beneficent work. Still the Commission that last investigated
the matter, due as it was largely to Lord Shaftesbury, showed many evils
still to remain. Overcrowding was worse in the West London rookeries than
it had been in the East. In 1885 the Dilke Commission Act gave fresh power
to local authorities to destroy unhealthy dwellings.
The machinery which thus exists as the sixth decade of our epoch draws to
its close, is therefore tolerably complete. Guarantees for its promptly
being put into motion are still wanted. Not only the credit, but the very
conception of this wholesome function of the State belongs entirely to our
era, and arises out of the enlarged idea of Royal service which fills the
modern mind.
Strictly consistent with family tradition is the effort of the Prince of
Wales to help those who are only one degree more helpless than the
dwellers in city and suburban alleys and courts in time of need. To free
the London hospitals of debt will crown the edifice of sick relief that in
Crimean days the Queen and her husband began.
From the departure of Miss Florence Nightingale[100] and her trained staff
for the Crimea in 1854 must be dated the birth of nursing as a polite
profession. But for that mission of mercy one would hear nothing of the
contemporary parade of nurses in the height of the London season in the
grounds of Marlborough House. The fashionable vogue of the vocation may
sometimes attract modish recruits who have not counted the cost.
Amiable sympathy is not the sole qualification which the lady nurse needs.
Self-consciousness is as much a disqualification as a shuddering dislike
of sick room scenes. It is also the attribute that the patient is the most
quick to observe. Not a few of the sick whom the ministering angel of the
new school desires to relieve may still sigh for the presence by their
bedside of the displaced Mrs Gamp instead of the young lady in the
coquettish muslin cap and dainty grey frock who casts complacent glances
at herself as she passes the mirror, and with an air not quite suited for
a sick room offers her patient his medicine or his barley water as if she
were suggesting black coffee, green Chartreuse, and a cigarette after a
whitebait dinner. These defects will no doubt be mended when the lady
nurse is more habituated to her calling. Decayed billiard markers, and
scripture readers who have gone wrong, will not eventually figure so
largely among the self-sacrificing males who also find their career in
tending the invalid. The scandals of which the nurse (old style) was
sometimes the heroine still live in the pages of Dickens. They arose from
the rumoured hastening of the sick man's death by the scriptural practice
of laying a wet cloth over his mouth. Any scandals with which the nurse
(new style) might be connected would perhaps come from the desirable
marriage that she arranges for herself in the sick room or from the
legacies made to her by grateful patients, but disputed by thankless
relations. These things, therefore, should be no doubt regarded not as
slurs upon her disinterestedness, but as tributes to her efficiency.
Inside the hospital the same transformation has been effected as in the
aspect of the ministering angels themselves. The grave young gentlemen in
training for the medical profession have nothing about them left of the
lamp breaking, policemen baiting, medical student of Albert Smith. If
sometimes one reads of the too engrossing attractions for these youths of
the sylphs who flit to and fro in the wards, the answer is obvious--'Evil
be to him who evil thinks.'
Hospital management is the subject not for a few pages in a single book,
but for a library in itself. One or two not controversial facts may be
given. Throughout the Victorian age a marked feature in medical charities
has been the supplementing of the historic hospitals with many new
dispensaries and establishments for special diseases. If the latest
hospital endowments are smaller than those originating in an earlier
century, the explanation is less a decline in eleemosynary purpose or
power than the development of the value of the property assigned to the
older foundations.[101] Thus the revenue of St Bartholomew's in the middle
of the sixteenth century seems to have been only L371 a year. Towards the
close of the nineteenth century it is L32,000 a year. During our own era
hospital benefactions approaching a quarter of a million are far from
unknown. These do not include such special and comparatively recent
hospitals as that for consumption, with the 40 new dispensaries connected
with it.
To epitomize the facts; the total of London hospitals or infirmaries with
wards for the sick amounts to 49. The movement still goes forward. So vast
is the scale on which these buildings, less houses than towns in
themselves, were first planned that in many of them there is yet room for
fresh beds. This is only a specimen of what has been, and is being, done
throughout the kingdom. There thus seems a fresh argument in favour of
continuing to London itself an institution like St Thomas's, Southwark,
the removal of which to the country was not long since suggested.
Like all gracious works, these places are twice blessed. They relieve
those who are in need. They humanize those whom prosperity and comfort
might make callous. Before our age began, no one thought of sending game
or fruit to the sufferers or convalescents within these places of refuge.
Now it is the exception for the millionaire not to make the spoils of his
fashionable battue pay tithe to those for whom such food is often the best
of physic. The costly flowers that decorate the drawing rooms or dining
rooms during the season are not discarded as rubbish when the festivity is
over. They are scrupulously tended so as not to lose their freshness.
Presently their hues and fragrance will relieve the bleak expanse of
white-washed wall in those places where our sick are nursed away from
their own homes.[102]
* * * * *
The contrasts of our age include a marked connection between the
organization of the healing art and the advance of medical science on the
one hand and the reduction of the death rate on the other. In 1855 the
mortality of the United Kingdom was 23 per 1,000. In 1875 it was 21 per
1,000. In 1895 it had fallen to 18 per 1,000. The figures,[103] and the
conclusions to which they point, are tributes, not only to medical skill
in healing disease, but to sanitary reform in preventing it.
Before the Victorian age began the whole population of these Islands
awaited the periodical onsets of pestilence with the resigned fatalism of
the Turk, or with the passive submission of latter day London to the
incubus of snow. The notorious consequences of unhealthy living prompted
no preventive measures. Divine wrath was believed to express itself in
deadly epidemics. When that anger was assuaged health would return. Till
then human remedies could do little. Meanwhile, the truth that Providence
helps those who help themselves was being scientifically shown. Hence in
1838, a State enquiry into the whole matter was instituted. In 1848 the
legislation began which, by promoting cleanliness, at once disarmed
disease. John Simon proved the propagation of pestilence to proceed by
impure particles. In 1858-65, on his initiative, the Government
strengthened the defences of public health. The entrance of foreign
plagues was stopped at our ports. Three sons of a clever West of England
doctor named Budd[104] had been trained from their childhood in practical
medicine by their father. These doctors showed the connection between
impure water and typhoid fever, as before them Snow had shown between
cholera and water. When the improvements suggested by these researches
were adopted health generally benefited. Consumption statistics became
less alarming every year. Fevers of all kinds were successfully combated.
Since vaccination had become general, smallpox cases had fallen by at
least one-half.
Meanwhile, the discovery of anaesthetics, of chloroform by Professor J. Y.
Simpson of Edinburgh in 1848, of ether in 1846 by Morton and Robinson of
the United States, at once robbed surgical operations of their terrors,
and rendered them practicable in cases where till then they could not
safely be tried. In 1860 came the antiseptic treatment of Sir Joseph,
since Lord, Lister. Before then, the nervous system had been explored
successfully by Carpenter.[105] Instruments for examining by reflected
lights the hidden parts of the human frame had been invented by several
English surgeons. Operations for certain internal tumours, that had
hitherto defied removal, were first performed by Caesar Hawkins, born 1798,
brother of the famous Oriel Provost, a pupil of Brodie at St George's; and
more recently by Spencer Wells.
More than a half of the medical discoveries of the period are English.
The latest perhaps, certainly not the smallest if the least known, was the
treatment by the late Sir William Gull of the swellings technically known
as myxoedema by an entirely new process, that of supplementing deficiences
of the thyroid gland with matter taken from animals. The throat
specialists of Germany found much to learn from the late Morell Mackenzie.
Not till 1860, was the scheme of medical education perfected in its
present shape by the College of Physicians, which to-day, under its
President and two Censors, arranges all examinations; while the Medical
Association represents the whole profession, bringing its grievances and
needs before the legislature. The average of ability throughout the
practitioners of the country is as noticeable as the achievements of its
scientific pioneers. The treatise on _Heredity_ in disease by Dr Douglas
Lithgow, on gout and allied complaints by Dr Robson Roose, and on the
medical uses of electricity by Dr W. S. Hedley, are instances of permanent
contributions by busy practitioners to the scientific knowledge of their
daily labours.
The late Dr Quinn, the late Oscar Clayton, are men who have improved the
status of their calling by their social services and gifts, and have
helped to extend the authority of the physician over every department of
life. We have long since shaken off the rule of priests. Some may think we
have already placed ourselves under a despotism of doctors, who by their
word can make or mar the reputation of places and climates if not of
characters and of men; and on whom the obligations of professional
etiquette seem at least equal to their sense of responsibility to the
public.[106]