‘Opening Up the Body’ is a project to conserve the Post Mortem Examinations and Case Books of St George’s Hospital, 1841-1946. Our Archive team have been cataloguing and digitising records dating from 1841-1917 – that’s about 27,132 cases across 76 volumes. The comprehensive reports contained within these volumes reveal some fascinating stories, which we’ll be sharing with you via the Library blog. Today’s post comes from Juulia Ahvensalmi, Project Archivist.
Elizabeth Greed was 51 years old in 1888 when she was admitted to St George’s Hospital. Her medical case history, which survives in her post mortem record in the archives, tells us that she was married and had had five children; one of them had died. Another one was said to have tuberculosis, and one was said to be a ‘cripple’. When she was young she was said to have suffered from hysteria and scarlet fever.
Elizabeth herself said that about five years before, whilst walking in her garden, she had suddenly lost power in her legs. Although she recovered from this incident, she had been knocked down in the street the previous summer, and had struggled walking ever since. She also complained of various other ‘abnormal sensations’, including tingling in her limbs and a constricted feeling in her chest. She felt like she was floating in water when sat down, and when she walked, she could not feel the ground. She was also annoyed by a constant smell of sulphur.
She went to ask for treatment at Guy’s Hospital, but, feeling ill-treated there, took a cab to come to St George’s Hospital instead, then located at Hyde Park Corner. She was received by a young doctor called Richard Sisley, who in his notes describes her as ‘olive-skinned’ and her manner as ‘hysterical’. He says she only appeared to be able to walk supported, describing her movements resembling those of a marionette. He thought many of her symptoms pointed to hysteria, although the loss of power and the involuntary movements of her legs were suggestive of ataxic paraplegia – a condition that can be hereditary, or caused by damage to brain or the spinal cord, and is characterised by loss of motor function in the lower extremities.
Elizabeth was admitted as an in-patient to the hospital on 7 March 1888. Further examinations found no abnormalities in her heart or lungs, but she was becoming increasingly paranoid and delirious. She thought she was being poisoned by turpentine mixed in her food. She was worried she would be sent out of the hospital, but she also thought that the ward she was in was filled with paraffin and would be set on fire. She lost weight, becoming increasingly weak, until she was unable to stand. On 11 April 1888, ‘she died without first symptoms, quietly’. The cause of death was recorded as possible mania and dementia, and ataxic paraplegia.
The case notes in the post mortem record of Elizabeth Greed do not elaborate more on her alleged hysteria, but her case gives us a glimpse of how women’s health was approached: despite her symptoms pointing to a physical condition, her behaviour is labelled as hysteric. Life in the 1880s London was not easy, and this was particularly the case for the poorer part of the population. We can assume that Elizabeth was poor, as those able to pay would not have attended a charitable hospital such as St George’s – they would have had the doctors come to them, or visited them at their private practices instead. The census records reveal that Elizabeth was from Clapton, and her husband Robert had moved to London from Taunton in Somerset. They lived in Bermondsey, which in the 19th century was a buzzing industrial hub, specialising in tanning, leather working, cotton work and food processing. All this industry meant that the population in Bermondsey was largely poor: the factories offered employment, but it was not particularly secure or well paid. Elizabeth is described as a ‘needlewoman’ (other related occupational terms include ‘dressmaker’ and ‘seamstress’). This was often work that could be done from home: sewing and mending clothes, making it easier for the women to care for their families. It was also, however, work that was very much underpaid, and the working conditions were likely to have been dire, with insufficient light and long hours, whether the work was done at home or in a factory.
But why was she labelled hysteric? Hysteria is no longer part of the medical vocabulary, but in the 19th century it was a common way to describe and diagnose what was perceived as emotional excess, primarily of women (this usage of course still continues outside medical diagnoses). It was seen to affect women from all social classes. The term encompassed a variety of symptoms, including anxiety, nervousness, agitation and demonstrations of sexual desire. Sexuality was at the heart of the condition; the word hysteria comes to English via Latin hystericus, from Greek ὑστερικός (husterikós, “suffering in the uterus, hysterical”), from ὑστέρα (hustéra, “womb”). Hysterical symptoms were thought to originate in the womb, and a commonly cited method of treatment was said to involve using a vibrator in order to gain release in the form of orgasm – this, however, is a myth rather than a commonly employed treatment.
St George’s also plays a part in the history of hysteria. Benjamin Brodie, one of the most eminent doctors of his time and physician to the royal family, examined cases of ‘nervous affections’ in 1837. In these cases, patients had suffered from articular pain and swelling, but there had been no deterioration of bone or cartilage in the post mortem examination. In Brodie’s view these cases were neurological disorders, perhaps following a minor injury or a strong emotional experience, which could lead to a ‘hysterical knee’, for instance.
Another St George’s doctor writing about hysteria was Robert Brudenell Carter, who worked as an ophthalmologist at St George’s in 1870-1883. In his 1853 book ‘On the Pathology and Treatment of Hysteria’, he (unlike most of his contemporaries) emphasized the effect of emotions on the nervous system, arguing that a strong emotion might lead to a hysteric attack even in otherwise healthy women, as well as men. The prevalence of hysteria among women could, in his view, be explained by women’s heightened emotions, but also due to their having to suppress their emotions more than men, who were allowed to be physically and sexually more active.
The association of hysteria with the nervous system rather than the uterus, and with psychological, rather than physical, causes became more widely accepted during the 19th century. Jean-Martin Charcot was instrumental in re-defining hysteria in terms of neurological disorders, and his use of photography at the Salpêtrière asylum in Paris created controversial imagery of female hysteria.
The American neurologist Silas Weir Mitchell advocated the so-called ‘rest-cure’ to calm the overstimulation of mind, which he believed was the cause of hysteria. This treatment was made infamous by Charlotte Perkins Gilman in her short story ‘The Yellow Wallpaper’ in 1891:
“John is a physician, and perhaps—(I would not say it to a living soul, of course, but this is dead paper and a great relief to my mind)—perhaps that is one reason I do not get well faster.
You see, he does not believe I am sick!
And what can one do?
If a physician of high standing, and one’s own husband, assures friends and relatives that there is really nothing the matter with one but temporary nervous depression—a slight hysterical tendency—what is one to do?
My brother is also a physician, and also of high standing, and he says the same thing.
So I take phosphates or phosphites—whichever it is, and tonics, and journeys, and air, and exercise, and am absolutely forbidden to “work” until I am well again.”
John W. Ogle, a physician at St George’s, discusses the case of Sarah G., 20, who was admitted to St George’s Hospital in 1869. She stated that she had been coughing and vomiting for about a year, and she had never menstruated until three weeks before her admission to the hospital. She had been treated previously at other hospitals for pain in the abdomen and vomiting. Ogle describes her as ‘rather delicate and interesting-looking’, and her manner as ‘somewhat sly and hysterical’.
She was fed beef-tea and milk with limewater: beef broth was standard hospital fare, and the limewater was intended to relieve indigestion. Her constipation was treated with a ‘blue pill’ and the herbal remedies colocynth, senna draught and calumba; she was also given spirit of ammonia and bicarbonate of potassium. The so-called blue pill was (rather than Viagra!) a mercury-based medicine commonly used for this purpose, but also for treating a wide variety of other complaints, including syphilis, toothache and tuberculosis. Later various other medical concoctions were attempted, including calomel (mercury chloride), edemas made of castor oil and rue, belladonna (‘beautiful woman’ in Italian, from its cosmetic use for dilating pupils, the plant is also known as the deadly nightshade, and was used by the Roman empress Livia Drusilla to poison her husband emperor Augustus), brandy, prussic acid and morphine – it’s a wonder she was still alive at this stage, one might think!
Although her condition did not appear to be improving, she was seen to get up from her bed to watch Queen Victoria pass by the hospital on her way to open Blackfriars Bridge. This convinced Ogle that she must have been faking her illness. Despite her continued refusal to eat, she vomited and evacuated her bowels. Ogle quotes in his article a letter allegedly written by her to another patient, asking her to bring her a ‘nice peice [sic] of bread’ and to take care that she should not be seen to do so. She was further treated with faradisation (muscle stimulation by electric currents), and she was given daily baths until she got her period; she was also forced to do some exercise by walking her to the middle of the ward and then ‘leaving her to scramble back to her bed’. She appears to have got into disagreements both with the ward nurse and with Ogle, her doctor, until one day she suddenly walked out of the hospital.
Ogle diagnoses this case as ‘temper-disease’, suggesting that the original symptoms relating to her lungs may have been real enough to begin with, but that the attention received from exhibiting these symptoms had led the patient to feign further, imaginary, symptoms. He describes his patient as ‘by nature self-willed, with a ‘naughty’ disposition, badly trained, too well pleased to attract and receive attention, of an hysterical temperament’. Quoting Benjamin Brodie, he suggests that it is possible that even the cough was a hysterical symptom – a hysterical lung, if you will.
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