Chapter XXVIII: 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]

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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]