#MyrtleMondays: The Victorian Hospital, part 1

As I plot and scheme new ideas for the Myrtle Hardcastle Mysteries, I am constantly on the lookout for settings and situations that make for high stakes, high drama, and high adventure. One of the most perilous places I could think of to send Myrtle & Co. is one we now consider a place of safety and refuge—somewhere we go when we’re in need of help and care. But, in fact, the Victorian hospital was teeming with dangers! Let’s take a look at cutting edge medical care of the 1890s—and the thrilling setting of In Myrtle Peril!

Thomas Eakins, The Agnew Clinic 1889 depicts a cutting edge surgical procedure carried out at a modern teaching hospital: the patient is clearly illuminated by electric lights, the doctors wear clean white surgical garb, the unconscious patient gives an air of serene, scientific Progress.

Hospital care has an old, old history. The word hospital comes down to us from Latin, and originally referred to a place of lodging (it is related to hotel). But thanks to convents and monasteries, its meaning as a place for medical care was established by the 1400s, and some of those early hospitals are still with us. St. Bartholomew’s Hospital in London is getting ready to celebrate its 900th birthday, and remains a state of the art teaching hospital to this day.  The oldest hospital in the Americas, Mexico City’s Hospital de Jesus Nazareno was established in 1524 by Spanish missionaries to care for wounded Aztec soldiers.

St. Bart’s in the early 1800s, sporting modern architecture for the day, including huge windows, critical for lighting and for curbing the spread of infection.

For most of history, hospitals were considered places to care for the poor and destitute—and for physicians and surgeons to learn their trade. And a trade it was. Doctors worked with their hands and were considered little better than tradesmen. Well-to-do patients, therefore, received medical care in their homes, just as they would be called on by the fishmonger or chimney sweep.

It took advances that the Victorian age brought to medical care and technology for hospitals to become a safer, more practical, and more reliable place for prosperous patients to seek care, too. And those wealthier patients demanded ever more comfortable accommodations and advanced treatments.

Thomas Eakins, The Gross Clinic, 1875 shows the state of surgical care just a few years earlier: darker, hastier, a little more desperate. The surgical team wear their street clothes and operate by oil lamp, without an understanding of antiseptic principles

The first of these transformative advances came about with the advent of reliable anaesthesia, the development of ether in the 1840s. Until then, patients had no choice but to literally grit their teeth (or hope to pass out from the pain and shock) during a surgical procedure—which meant that surgeons had to work as quickly as possible. Surgeries were limited to what could be achieved superficially, like amputating an injured limb.

An engraving depicting the milestone surgery in 1846 on a patient in Boston

After ether, though, everything changed—especially the survival rate of patients… and not for the better. Now that their patients were peacefully unconscious during surgery, surgeons got braver and more experimental, delving deeper into the mysteries of human organs, developing new and more advanced surgical techniques that simply weren’t possible on patients who were awake.

A typical 19th century hospital ward

But that boldness came with a price. Without an understanding of the hazards of infection, surgeons took no precautions against the spread of germs—because they didn’t yet know about them. Communicable disease was understood to be spread by foul air—“miasma”—so recovering patients received lots of fresh air. (See the massive windows visible in the hospital wards?) The primary concern in the 19th century hospital was keeping the patients from dying—that is, succumbing to hospital-acquired infections that they would not have been exposed to otherwise. Patients admitted for even relatively “simple” procedures could easily catch a deadly illness like erysipelas, a skin infection caused by staphylococcus bacteria that was rampant in 19th century hospital wards.

These Philadelphia surgical nurses perform one of the 19th century nurse’s most important duties: cleaning

Germ theory, the realization that these infections are caused by microscopic organisms, took some time to be fully understood—and even longer to convince the medical establishment. Doctors and nurses would go blithely from patient to patient, from ward to ward, from the anatomy lab (autopsies) to the maternity ward, without changing their clothes, washing their hands, or sterilizing their instruments—little understanding they were spreading deadly infections.

Joseph Lister performs a surgery through the antiseptic mist of carbolic spray, circa 1865

Pioneering British surgeon Joseph Lister is considered the “Father of Germ Theory” for his work in identifying microscopic bacteria’s role in infections, and for developing methods to combat them. It took decades of controversial research and practical experiments for Lister’s ideas to catch on. Personal hygiene, sterile equipment, and the application of antiseptic dressings became the keys to preventing hospital-borne infections. (Antibiotics would not be available for several more decades—well into the twentieth century.)

Diagrams from Aseptic Surgery by William Watson Cheyne. Cheyne, a student of Lister, became one of the staunchest advocates and proponents of the new methods. His landmark publications on the subject of surgery and wound care helped spread the word about germ theory.

By Myrtle’s day, however, the 1890s, Lister’s procedures were commonplace practice, and hospital-acquired infections had dropped dramatically. A hospital became a place even a relatively prosperous middle class professional, like Myrtle’s father, might turn for a surgical procedure.

Not that a hospital stay was entirely without peril, of course—and Myrtle and friends encounter some truly unexpected dangers at the Royal Swinburne Hospital in In Myrtle Peril. Catch up with the latest Myrtle Hardcastle Mystery now!