Friday, April 22, 2016

The debate over the use of anaesthetics in childbirth

Victoria, Alfred and their children
The nineteenth century, and particularly the Victorian years, saw enormous advances in medicine. New procedures were developed, standards of cleanliness improved and for the first time pain relief was possible with the development and use of anaesthetics.  Progress, however, did not come cheaply.  Reputations were made but, equally, reputations were lost. For every group that argued for progress, there was another group to argue against it.

On 7 April 1853 Queen Victoria was delivered of a son, Prince Leopold. During the birth, she was anaesthetised with chloroform by Dr John Snow.* “The inhalation lasted fifty-three minutes.  The chloroform was given by on a handkerchief, in fifteen minim doses.”** Four years later, in 1857, John Snow was in attendance again and  again employed chloroform in the delivery, this time, of Princess Beatrice.

The Queen's decision to have chloroform administered during the birth was not made lightly.  There had been discussions as early as 1848, with Prince Albert who strongly supported the use of the anaesthetic, and the Queen’s physicians, who apparently had reservations about it. While it had not been used in the delivery of either Princess Louise (1848) or Prince Arthur (1850), when it was finally employed for the birth of the Queen’s seventh child, Her Majesty was delighted.  Writing in her Journal, she had nothing but praise. “Dr Snow administered ‘that blessed Chloroform’ & the effect was soothing, quieting & delightful beyond measure.” Indeed, as she noted, she had “never recovered better.”

Just a little over a month after the Queen gave birth to Prince Leopold, an article appeared in the Lancet, criticising the administration of chloroform to the Queen.  Although not named in the article, it was clearly an attack on Dr John Snow by the owner/editor of the journal, Thomas Wakley. The article was mildly hysterical in tone claiming that
Intense astonishment … has been excited throughout the profession by the rumour that her Majesty during her last labour was placed under the influence of chloroform, an agent which has unquestionably caused instantaneous death in a considerable number of cases. … we could not imagine that any one had incurred the awful responsibility of advising the administration of chloroform to her Majesty during a perfectly natural labour with a seventh child.
Much of the literature related to the consequences of the use of chloroform in the birth of Prince Leopold emphasised the wider acceptance of anaesthetics as a result. While the Royal approval of the use of chloroform might have provided what was at least an informal imprimatur, not all of the medical profession was accepting of the use of anaesthetics, especially chloroform, in childbirth. As The Lancet went on to point out, certainly incorrectly in the face of the Queen’s own statement, the so-called administration of chloroform was all a pretence employed because “some officious meddlers about the Court so far overruled her Majesty’s responsible professional advisers as to lead to the pretence…”

H and T Connor have suggested that it is unlikely that lay opinion was influenced since the press reports of the birth did not, in general, mention the use of anaesthetics. That may indeed have been the case, but by the time of the Queen’s accouchement, the use of chloroform in parturition was common enough for one correspondent to write to the Association Medical Journal shortly after the Queen’s delivery,
Your announcement, a few weeks ago, of the Queen’s accouchement under chloroform and that, under no other than ordinary circumstances, the royal child-birth had been treated by anaesthesia, doubtless gave rise to considerable emotion and excitement both in the professional and the female world. … For some time, however, before this, it was well known that, in certain districts, the married—especially the young married—women, even of respectable society, had been in much agitation respecting the recent discussions upon chloroform, and had become so solicitous for its administration in their own cases…
The debate continued and seems to have accelerated after the Queen gave birth to her seventh child.  The all-male medical profession engaged in rather convoluted arguments to justify the pain of childbirth.  To offer succour to women in labour was, some argued, “meddling or interference” and could not be defended.
If labour be undeniably a physiologic process for the birth of human offspring, and if anatomy and physiology have proved that this process cannot be obtained without fulfilling the Divine enunciation, ‘that in sorrow and pain woman should bring forth’, the whole of this being notwithstanding perfectly consistent with the health of mother and child,--what doctrine can be an excuse for mischievous meddling with such a miracle of contrivance?
Some of the criticism was undeniable valid.  There had been deaths with the use of chloroform. Indeed, its popularity was such as to lead to inexperienced, and even those totally untrained in medical procedures, to act as anaesthetists. Beyond that, even those with a degree of medical training were not necessarily conversant with the best means of administering chloroform and in some cases may have been dangerously enthusiastic in its use. 

John Snow, however, was meticulous and careful.  He was concerned about regulating the dosage and even developed a mask for proper administration of chloroform although this was not used with Victoria. Instead he employed the “open-drop” method where the chloroform was dropped onto a cloth covering the face of the Queen.

Snow was not the first doctor to use chloroform.  It was first used in childbirth by James Young Simpson, Professor of Midwifery in the University of Edinburgh, who had discovered its properties in 1847. Simpson reported his cases in The Lancet, detailing nine of these in the issue of 11 December 1847. In the first case it was the mother’s second birth. “In her first confinement she had been three days in labour, and the infant had at last been removed by craniotomy.”*** Of the effect of the chloroform in the first case he wrote; the patient
...did not awake till after the placenta was removed, and then spoke of having “enjoyed a very comfortable sleep.” She was not in any degree aware that the child was born; and when, in a few minutes, it was brought in . . . I was a matter of no small difficulty to persuade the astonished and delighted mother  that the child … was really her own infant.
It was the work of Simpson and Snow that effectively changed the nature of childbirth through the introduction of the use of chloroform.  Questions as to its safety were effectively laid to rest in 1853 with its use by Queen Victoria, and by the time of his death in 1858, at the age of 45, He had, according to Sir Peter Froggatt,
… no deaths in over 4000 chloroform cases, often bad risk ones, … he anaesthetised for over 30 leading London surgeons and included the Queen and members of the social and commercial élite among his cases …

**A minim is 1/60th of a fluid dram or about the equal of one drop.

***Craniotomy involved the reduction in the size of the unborn child’s head and was used where labour was obstructed.  It was used in cases of foetal death and made vaginal delivery possible rather than run the far greater risk of performing a caesarean section before the advent of anaesthetics.

Monday, November 30, 2015

Begging a humble gratuity, sir

An American view on Tipping

It seems odd that tipping should have been so roundly despised by some Americans who made their way to England in the nineteenth century.  Nowadays, Americans treat it as a “way of life,” although for many travelling overseas, the intricacies of how much to give and under what circumstances is often a source of great confusion. However, for Americans in the nineteenth century, it was often seen as a means by which the English enforced a class structure; a class structure that they found repugnant to their republican sensibilities.

While tipping may have been frowned upon in nineteenth century America, and by Americans visiting the British Isles, it was very much a way of life in Victorian England. It seems apposite, therefore to question what it is that makes people tip.  Dr Ofer H Azar has suggested that the two main reasons for tipping are “conforming to social norms and avoiding embarrassment.” While this may be true, it fails to come to grips with the question of why different countries and different social classes have radically diverse views on the subject. This is clearly bound up with questions of class and the economics of employment.

Tipping is a peculiar phenomenon in that it usually follows the provision of a service for which the user (the tipper) has already paid and which he has enjoyed (or not, as the case may be).  Indeed, this seems to conflict with the view that the term “TIP” was an abbreviation for the words “To Insure Promptness.”  The person receiving the tip would appear to be hoping that by providing an exemplary service or through the general feeling that the potential tipper wants to avoid embarrassment he or she will receive this extra remuneration. Exemplary service may, of course, not just result in a tip, it may act as an incentive for the tipper to return to a particular restaurant or service; this rationale would, of course, only apply where the service is one which has a likelihood of repetition.

Although tipping is never compulsory, there is a strong social expectation that it will be given, especially in those economies where employees are working for low wages.  This is particularly true of service industries. More recently, in many places, a gratuity or a service charge is added to the bill, but that need not concern us in considering the Victorian Era.

What, then was the tipping situation in Great Britain in the 19th century, and why did visitors from the United States object to the practice? The practice of tipping during Victoria’s years extended from the greatest houses to the meanest streets.  Guests on hunting weekends expected to pay the servants who waited on them.  By the middle of the century, this had become such an expectation, that a poor guest who did not give a sufficient tip might find himself abused by members of the household staff. At the other extreme, there were those like the crossing-sweepers described by Henry Mayhew for whom tips totaling a shilling a day would have been considered a decent return.

William Powell Frith, The Crossing Sweeper (1858)
 Writing in the early 1830s, just a few years before Victoria ascended the throne, a visitor to London expressed his views on tipping and its extent.  Grant Thorburn noted that

            This custom of theirs [tipping] is a great annoyance to strangers; for in addition to all your other cares on the road, you have to carry a pocket full of change.  Better would it be to put every charge in the bill and make you pay at the bar.

Thorburn was born in Scotland in 1773 and migrated to American at the age of twenty-one.  In New York he worked as a nail-maker before becoming a grocer at which time he began to sell plants and seeds. He wrote extensively, if not well, and in October of 1833 visited England, by now a successful businessman.  During that time and shortly thereafter, he wrote Men and manners in Britain; or, A Bone to Gnaw for the Trollopes, Fidlers, &c. Being Notes from a Journal on Sea and on Land in 1833-4.

Catherine Kerrigan, in her biographical sketch of Thorburn in the Oxford Dictionary of National Biography,  describes him as a  “dedicated republican” and notes that his book was

a caustic response to Frances Trollope's Domestic Manners of the Americans (1832), in which he pronounces on the savagery of English history, the servility of English shopkeepers, and the profound ignorance of the British about America, but the work is also invaluable for Thorburn's more serious observations of British culture in that period

The Spectator of 21 December 1833, however, was far less kindly in its view of both the author and his work even suggesting that elements of it were written by others. But for us, the section on tipping and the frequency of the demands for gratuities is of particular interest.

In the hotels, besides paying your bill at the bar, you are called on by -- sir, remember the waiter,-- sir, remember the chambermaid ; and also by a slovenly looking fellow whom they call boots. In the stage, perhaps you are drove from London to Coventry, or any other direction, to a distance of fifty miles. There you change the driver and guard, when you are again subjected to the same beggarly impositions -- sir, I have drove from London -- sir, I have guarded you from London. You may give as much as you please, but not less than one shilling to each. In fifty miles more the same beggarly farce is acted over again. Between London and Liverpool, 200 miles, I paid twelve shillings sterling to guards and drivers, besides three sovereigns stage fare.

To Thorburn, it was “a system of organized beggary,” but one to which, if you did not submit, there were likely to be unpleasant consequences.  “Ten to one” he writes, “but your trunk would disappear before you where [sic] half through your journey.”

When Thorburn stopped on the road, the innkeeper

comes out to be sure ; his face as red as a northwest moon, corporation like a ten gallon keg, white apron, shoes, buckles and stockings, bowing and cringing like one of his well-whipped spaniels, but most roundly does he make you pay for all this servility ; and when you are going to leave his inhospitable roof, he sends after you a host of privileged beggars; and after you are seated in the coach, the windows on each side are beset with -- sir, I lashed your trunk  -- mam I brought out your bandbox, &c. I was informed by several gentlemen, that the servants in hotels and drivers on the road had no other compensation for their services, only what they could in this way extort from customers.

Clearly, this was an annoyance, not only to Thorburn, but to other travellers. Travel was difficult enough in the early days of Victoria’s reign, without the necessity of having to fend off those seeking gratuities for, all too often, dubious services.

It was not long, however, before the ubiquitous practice of tipping reached the United States and it was certainly well established there by the beginning of the twentieth century and the end of the Victorian Era.

To read or download a copy of Thorburn's book, click here.

Tuesday, November 17, 2015

Help sought

I received the following query and am posting it in the hope that the person who wrote the initial comment might follow up on it and contact Tony Gee.

Bruce Rosen

I am desirous of contacting 'Anonymous', who posted a comment about needing information on the black prize fighter called "Jem Wharton", following your 25th May 2010 blog, 'The Manly Art of Self Defence'. I am a prize ring historian and wish to inform him that there is a short chapter on Wharton in my recently republished book on the London prize ring, Up to Scratch. In addition I have information from newspapers which may interest him, and would also like to know more about the painting he mentioned.

Thursday, September 24, 2015

Victoria on the Rails

The Royal Saloon, 1869
Although other members of the Royal family had travelled by rail, especially Prince Albert, it was not until 1842 that Queen Victoria recorded her first experience aboard a train.  This was quite a bold step for the reigning monarch considering the poor safety record of this form of transportation.  Hardly a week went by without some reference in the newspapers describing a railway accident and the death or injury of passengers.

Having been at Windsor, the Royal Party left the castle at 11:30 on 13 June 1842, driving to Slough where the Royal carriage was in preparation. Describing the experience in her journal, the Queen wrote
The saloon we travelled in, on the train was very large & beautifully fitted up.  It took us exactly 30 minutes going to Paddington, & the motion was very slight, & much easier than a carriage, also no dust or great heat, -- in fact, it was delightful, & so quick.  We were at Buckingham Palace by 20 m. to 1.
The train consisted of seven coaches, one of which was the Royal saloon. The locomotive  was driven by Daniel Gooch, the chief mechanical engineer of the Great Western Railway, who was accompanied by Isambard Kingdom Brunel, the company's chief engineer. By 1842, Brunel had already designed the Clifton Suspension Bridge and the Great Western, the first steamship to engage in transatlantic service and which had been launched five years earlier.

In a letter to her Uncle Leopold, King of the Belgians, dated 14 June, Victoria described her feelings about the new experience of travel by train, concluding that she was "quite charmed with it."

As they left Windsor Castle, the Queen and Prince Albert were met by two boys from Eton College who presented the Queen with a congratulatory address  on surviving the attempt on her life by John Francis at the end of the previous month. As the Royal couple then headed for the station, the Eton boys ran alongside the carriage back to their school.

Only ten days later, the Queen and Prince Albert were once again on their way to the railway station at Paddington.  Here they boarded the same saloon carriage.  Both were happy to leave London where the weather had been uncomfortably hot and dry although the Queen did express some regret at having to forego "the privacy & convenience" of the Buckingham Palace garden.

The Royal Train, as would be expected, was carefully monitored and cared for.  Even so, it was not immune to mishap.  In the first week of September of 1855 it was on its way from London to Edinburgh when it developed a series of inexplicable problems. Notwithstanding the extraordinary precautions taken to prevent even the slightest casualty, it would seem that shortly after the Royal train left the metropolis it was found that some of the axles of the carriages, especially one of the last break-van, were not in a satisfactory state.

Running repairs were unable to solve the problem.  In the end a man was stationed on the footboards in order to grease the axles as the train was running.  As the train approached Darlington, one of the men stationed on the footboards was knocked off by a girder at a culvert bridge.  "Badly crushed and mutilated" he died soon after.  The situation was considered serious enough for the Queen and Prince Albert to be moved to another carriage, one used by other members of the Royal entourage.

The Royals took to train travel like ducks to water.  Initially, it was a particularly fast, comfortable and efficient means of commuting between Buckingham Palace in London and Windsor Castle.  When, for example, Prince Albert needed to return to London on 5 November 1843, he took a special train from Slough to London. Royal visitors were among those who were ferried from London to Windsor by these special trains.

According to W. M. Acworth in The Railways of England, whenever the Queen travelled by train, special precautions were taken.  All work along the line was stopped, the points were locked, trains going in the opposite direction were halted and level crossings were closed and guarded.

Within 18 months of the Queen's first trip, the use of the Royal train by the monarch had become so common an event that it was being used for longer trips. The Times reported in detail on Her Majesty's  visit to Drayton, Chatsworth and Belvoir castle  in December of 1843, a visit that involved a train trip of approximately 100 miles each way. The Royal carriage was, according to Victoria, "most comfortable ... all lined & furnished in light blue satin." On the same trip, they travelled by train from Chesterfield to Nottingham via Derby.

Less than a year later, the Queen was on her way to visit the Marquis and Marchioness of Exeter at Burghley House, a distance of about 100 miles.  Approximately half the distance was to be covered in a special Royal carriage. By now the various rail companies were vying with one-another to present the most splendid facilities. In this instance the Queen was travelling with the Birmingham Railway Company and departing from Euston station.  An elegant suite had been constructed for the use of the Royal travellers, and, according to The Times, "everything was prepared to afford the greatest degree of comfort to Her Majesty."

The carriage in which she and Prince Albert were to travel had been "built and fitted up expressly for her use on this railway in the most splendid and tasteful manner." In fact, there were, over the years, numerous carriages built for members of the Royal family.

In 1848, the Royal family went by the Royal Yacht to Scotland where they spent a delightful holiday and fell in love with Balmoral castle.  However, when it came time to return to London the weather was so bad the decision was made to return South by train. Part of the trip back involved travelling on a Sunday.  The Queen clearly had strong opinions about this, writing in her journal, being Sunday we had decided to start at 6, in order to arrive in London before the Service as people are so very particular about travelling on a Sunday in England, in my opinion it is overdone.
Almost sixty years after her first trip by train the Queen was to ride, for the final time, in the Royal Train. She was being returned to Windsor from where she had departed on that first trip. Only this time it was for her interment.

Victoria's Funeral Train, 1901
In the last few years there has been speculation that the maintenance, refurbishment and continued operation of the Royal train is no longer economical.  That it makes more sense for members of the Royal family to travel by air.  While there are strong arguments, not to mention sentimental reasons, for continuing to have the Royal train available, it seems likely that before long it will, like Royal yacht, Britannia, be put into mothballs.

Thursday, August 06, 2015

The Full English Breakfast - Myth or Reality

The first time I went to England, in 1967, there were still many reminders of the great Victorian Era.  I remember the rag and bone man coming round and the milkman who still used a horse-drawn float.  But because I was staying in a flat, I was not to know the joy and comfort of that great Victorian institution, the Full English Breakfast.  I did not discover that until 1985 when, en-route to Enschede in Holland, I stopped for a week in London to do some research.

The hotel in which I stayed was a converted multi-storied private home.  My room was on the sixth floor and just under the roof.  Small and cramped though it was, it was comfortable and homey and I struggled up and down the narrow flights of stairs several times a day.  Breakfast was served from 7:00 in the morning, and I was usually down in the basement dining room early.

The first time I came down for breakfast I was greeted with “Good Morning, full English?”  Not quite sure at the time just what this implied, I agreed and it was thus that I was introduced to that amazing institution, The Full English Breakfast.  I capitalise the words purposely as the title of something of such importance should be. Heather Arndt Anderson, in Breakfast: A History, refers to it as “Britain’s greatest . . . culinary achievement.”

There are many different interpretations and opinions about what constitutes this gift to the civilized early diner.  For me, it will always consist of one or two eggs cooked so the yolk remained runny, bacon (less well done than Americans like it – not crisp), sausage (I later discovered Wall’s sausages – pink, bland and absolutely unbeatable when dipped into the yolk of your egg before popping it into your mouth), cooked tomato, baked beans, mushrooms and fried bread. 

According to Jamie Oliver, “Some things are too good to mess about with,” and he is right!1This is one of the great English culinary triumphs, ranked right up there with Fish and Chips.

Back in 1985 British food could well have won awards for its unpalatable awfulness.  Now, of course, all that has changed and foodies and celebrity chefs abound on that small island. But what is the connection between the Victorian Era and the Full English Breakfast? More to the point, perhaps, is the question “is there a connection?”

According to the English Breakfast Society,
The full English breakfast is a centuries old British tradition which dates back to the early 1800's, when the Victorians first perfected the art of eating breakfast and elevated the most important meal of the day into an art form.
The Society goes on to argue that the notion of the English Breakfast as we know it today was developed by the “gentry” and was later taken up by the emergent middle-class.

Even a cursory glance at the many cookbooks of the Victorian period suggest that the English breakfast was not what we know it to be today.  A far greater variety of comestibles were likely to find their way to the table or the sideboard in private homes. Although bacon and eggs were always popular, they were certainly not a prerequisite for an English breakfast in the nineteenth century.2

Mrs Beeton, in her Book of Household Management (1861), despite noting that it was unnecessary to provide her readers with "a long bill of fare of cold joints, &c., which may be placed on the side-board, and do duty at the breakfast-table," goes on to suggest garnished cold meat and "collared and potted meats or fish, cold game or poultry, veal-and-ham pies, game-and-Rump-steak pies" as food appropriate to the breakfast table as well as "cold ham, tongue, &c. &c."

She then turns her attention to hot dishes "for the comfortable meal called breakfast." 

Broiled fish, such as mackerel, whiting, herrings, dried haddocks, &c.; mutton chops and rump-steaks, broiled sheep’s kidneys, kidneys à la maître d’hôtel, sausages, plain rashers of bacon, bacon and poached eggs, ham and poached eggs, omelets, plain boiled eggs, oeufs-au-plat, poached eggs on toast, muffins, toast, marmalade, butter, &c. &c.

In her list one can find at least some of the elements that make up the Full English Breakfast, but clearly there is a much greater variety and a number of elements are still missing. Perhaps what distinguishes the British breakfast is that it has traditionally offered hot dishes.  Its centrepiece has been and remains, bacon and eggs.

George Sala, in Twice Round the Clock (1859)3 talks of fried and poached eggs, bread and butter and bacon.  But in addition he mentions smoked haddock and bloaters as items that "grace our morning repast."  Preserved tongue, and anchovy paste, both from Crosse and Blackwell are included in Sala's list of breakfast foods.

It can be argued that in this passage, Sala is describing the breakfast of the better working and middle class.  Mrs Beeton is, of course, writing for the middle-class. The kind of breakfast she suggests (or at least the comestibles she lists) are appropriate to both that class and its betters.  What then of the lower and labouring classes?  What did their breakfasts consist of?

Sala describes the breakfast available to the workers in Covent Garden, a breakfast that would have been replicated at any of the great markets in London.
There are public-houses in the market itself, where they give you hot shoulder of mutton for breakfast at seven o'clock in the morning! Hot coffee and gigantic piles of bread-and-butter disappear with astounding rapidity. Foaming tankards are quaffed, "nips" of alcohol "to keep the cold out" (though it is May) are tossed off...
Clearly, bacon, eggs and bread were mainstays of the breakfast that many consumed in England.  But the variety was far greater and it seems unlikely that there was anything in the nineteenth century that truly resembled the Full English Breakfast as we now know it.
1To see Jamie Oliver’s Full English Breakfast, click here 

2A number of nineteenth century British cookbooks can be downloaded (or read online) by clicking on the following links:

Breakfast and Lunch Dishes(1904) 

3To read or download George Sala, Twice Round the Clock, click here.