Fanny Burney and Her Mastectomy

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Fanny Burney

In 1811, before anesthesia was invented, Frances Burney d’Arblay had a mastectomy aided by nothing more than a wine cordial. She wrote such a gripping narrative about her illness and operation afterwards readers today still find it riveting and informative.

Fanny came from a large family and was the third child of six. From an early age, she began composing letters and stories, and she became a phenomenal diarist, novelist, and playwright in adulthood. Certainly, her skillful writing was a primary reason her mastectomy narrative had such appeal.

In her narrative, Fanny provides “psychological and anatomical consequences of cancer … [and] while its wealth of detail makes it a significant document in the history of surgical techniques, its intimate confessions and elaborately fictive staging, persona-building, and framing make it likewise a powerful and courageous work of literature in which the imagination confronts and translates the body.” Prior to her surgery, she had written similar works about “physical and mental pain to satirize the cruelty of social behavioral strictures, especially for women.”

Samuel_Johnson_by_Joshua_Reynolds-wikipedia

Dr. Samuel Johnson

Fanny grew up in England and had been embraced by the best of London society. She had served in George III and Queen Charlotte’s court as Second Keeper of the Royal Robes. Moreover, she was admired by such literary figures as Hester Thrale, David Garrick, and Edmund Burke. Fanny also befriended Dr. Samuel Johnson, the English writer who made significant contributions to English literature as a poet, essayist, moralist, literary critic, biographer, editor and lexicographer. In fact, some of Fanny’s best revelations are about Johnson, how he teased her, and the fondness that he held for her.

In 1793, Fanny married Louis XVI Alexandre-Jean-Baptiste Piochard d’Arblay and became Madame d’Arblay. D’Arblay was an artillery officer who served as adjutant-general to the famous hero of the American Revolution, Gilbert du Motier, Marquis de Lafayette. D’Arblay had fled France for England during the Revolution just as had many other Frenchmen. However, in 1801, d’Arblay was offered a position in Napoleon Bonaparte’s government. He and Fanny relocated to France in 1802 and moved to Passy (the same spot where Benjamin Franklin and the princesse de Lamballe had lived), and they remained in France for about ten years.

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Baron Dominique-Jean Larrey (left) and Antoine Dubois (right)

While living in France, Fanny suffered breast inflammation in her right breast in 1804 and 1806. She initially dismissed the problem but then in 1811 the pain became severe enough that it affected her ability to use her right arm. Her husband became concerned and arranged for her to visit Baron Dominique-Jean Larrey, First Surgeon to the Imperial Guard, as well as the leading French obstetrician, surgeon, and anatomist, Antoine Dubois.

The French doctors treated Fanny palliatively but as there was no response to the treatment, it was determined surgery was necessary. Fanny’s surgery occurred on 11 September 1811. At the time, surgery was still in its infancy and anesthesia unavailable. Cocaine was later isolated, determined to be an effective local anesthetic, and used for the first time in 1859 by Karl Koller. So, it must have been horrific for Fanny to experience the pain of a mastectomy with nothing more than a wine cordial that may have contained some laudanum. Fanny was traumatized by the surgery and it took months before she wrote about the surgery details to her sister Esther exclaiming:

“I knew not, positively, then, the immediate danger, but every thing convinced me danger was hovering about me, & that this experiment could alone save from its jaws. I mounted, therefore, unbidden, the Bed stead – & M. Dubois placed upon the Mattress, & spread a cambric handkerchief upon my face. It was transparent, however, & I saw through it, that the Bed stead was instantly surrounded by the 7 men & my nurse. I refused to be held; but when, Bright through the cambric, I saw the glitter of polished Steel – I closed my Eyes. I would not trust to convulsive fear the sight of the terrible incision. A silence the most profound ensued, which lasted for some minutes, during which, I imagine, they took their orders by signs, & made their examination – Oh what a horrible suspension! … The pause, at length, was broken by Dr. Larry [sic], who in a voice of solemn melancholy, said ‘Qui me tiendra ce sein?”

Fanny went on to describe “torturing pain” and her inability to restrain her cries as the doctors cut “though veins – arteries – flesh – nerves.” Moreover, she noted:

“I began a scream that lasted unintermittingly during the whole time of the incision – & I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, & the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp & forked poniards, that were tearing the edges of the wound. … I attempted no more to open my Eyes, – they felt as if hermetically shut, and so firmly closed, that the Eyelids seemed indented into my Cheeks. The instrument this second time withdrawn, I concluded the operation over – Oh no! presently the terrible cutting was renewed – and worse than ever … I then felt the Knife rackling against the breast bone – scraping it! – This performed, while I yet remained in utterly speechless torture. “

Despite the excruciating pain, Fanny lived through the operation, and her surgery was deemed a success. Larrey produced a medical report about his brave patient stating that he removed her right breast at 3:45pm and that Fanny showed “un Grand courage.” Courageous as she was, there was no way for doctors to determine if Fanny’s tumor was malignant or if she suffered from mastopathy.

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Fanny’s Commemorate Plaque. Courtesy of Bath-heritage.co.uk

Fanny’s healing took a long time, and while still recuperating, she and husband returned to England in 1812. Six years later, in 1818, her husband died from cancer, and she died twenty-two years later, at the age of eighty-seven, on 6 January 1840 in Lower Grosvenor-street in London. As Fanny had requested, a private funeral was held in Bath, England, and attended by a few relatives and some close friends. She was laid to rest in Walcot Cemetery, next to her beloved husband and her only son Alexander, who had died three years earlier. Their bodies were then moved during redevelopment of the Walcot Cemetery to the Haycombe Cemetery in Bath and are buried beneath the Rockery Garden.

References

DeMaria, Jr., Robert, British Literature 1640-1789, 2016
“Died,” in Northampton Mercury, 18 January 1840
Epstein, Julia L., “Writing the Unspeakable: Fanny Burney’s Mastectomy and the Fictive Body,” in Representations, No. 16 (Autumn, 1986), pp. 131-166
Madame D’Arblay, in Evening Mail, 20 January 1840
Madame D’Arblay’s Diary, in Evening Mail, 18 May 1842
“The Journals and Letters of Fanny Burney (Madame D’Arblay), Volume VI, France 1803-1812,” in Cambridge Journals 

61yLoQ9ugKL._SX345_BO1204203200_-347x381Geri Walton has long been interested in history and fascinated by the stories of people from the 1700 and 1800s. This led her to get a degree in History and resulted in her website, geriwalton.com which offers unique history stories from the 1700 and 1800s. Her first book, Marie Antoinette’s Confidante: The Rise and Fall of the Princesse de Lamballe, discusses the French Revolution and looks at the relationship between Marie Antoinette and the Princesse de Lamballe.
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Sex, Contraception, and Abortion in Medieval England

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Artemisia absinthum (Wormwood)

Centuries of nostalgic medievalism have given us some funny ideas about sexuality in the Middle Ages. We know religion ruled, no one married for love, and sex was for procreation only…right?

Not so much. When studying the Middle Ages, you need to consider the sources. Every author had a bias and could only write what they saw. Most of our modern ideas about sexuality come from Canon Law, but people did not obey all of the laws of the Church in the Middle Ages any more than they do today. To get a better idea of what life was really like, we have to draw on other sources as well.

Today we’re going to jump into the deep end with medieval contraception and abortion. The popular assumption is that contraception did not exist and abortion must have been a serious crime, if it happened at all. The issue with this argument is that we take for granted that they must have had a similar understanding of pregnancy and a greater sense of religious morality when it came to the issue of contraception and abortion. To get to the bottom of this, we have to throw out these assumptions and start at the beginning.

Sex

Fornication was still a sin, but it was one most were guilty of. When primogeniture became the rule in the eleventh century, it created a whole class of people were unlikely to ever marry. Noble families with multiple children could only pass on their property to the eldest. The rest of the children would remain in the household even as adults until they married other property-holding people or until circumstances changed. Many entered the Church, where marriage and concubinage among the clergy was still common until the twelfth century. Wealthy families might equip younger sons as knights. Knights could not be expected to marry until they inherited property or came by it through other means; most younger sons never married at all. As for daughters, the pool of landed noblemen to marry was pathetically small. With larger families and fewer opportunities for marriage, much of the nobility never married. To assume they all remained celibate in a culture that all but deified love and had a popular handbook for conducting romantic, sexual, and frequently extramarital relationships is naïve at best. (1)

As for the lower classes, marriage was almost a fluid concept. It was common for people to marry in secret, and these marriages were every bit as valid as any performed outside a church. According to Gratian’s Decretum, all it took to make a marriage legal was three things: love, sex, and consent. As long as the love and consent were there, sexual relationships including those with concubines could be considered informal marriages.

Because the line between fornication and legal marriage was a bit blurry, fornication was more or less accepted in practice. Who’s to say the consenting couple did not marry in secret? Many penitentials appearing during and after the twelfth century classified sex outside of marriage as only a minor sin. Members of the Synod of Angers in 1217 stated unequivocally that they personally knew many confessors who gave no penance for it at all. In practice, the Church tolerated fornication as long as there was no adultery being committed.

Prostitution was legal and common. Although the Church did not condone it, this did not stop it from regulating and profiting from it (see Prostitution and the Church in Medieval Southwark). After all, someone had to see to the needs of the scores of unmarried men and those who had entered the Church out of necessity rather than desire. The Church viewed prostitution as a necessary evil. While active sex workers could not be viewed as respectable members of society, they nevertheless performed an important public service.

Outside of the Church, many medieval writers, such as Albertus Magnus and Constantine the African, viewed sex as a crucial component to overall health on equal footing with food, sleep, and exercise. Sexual release was believed to be the best way to get rid of toxic humors and abstinence could lead to weakness, illness, madness, and death. Sexual enjoyment was necessary for men and women, and was an essential component to conception.

Sex happened. Penitentials were distributed throughout the Church to prescribe penance for every vice we can imagine today (and a fair few we can’t). Troubadours sang about it in their filthy, filthy songs. Pregnancy was inevitable and dangerous. So how did they deal with it?

Menstrual Regulators

It sounds obvious, but people in the Middle Ages did not have the same understanding of pregnancy that we have today. As they could not pinpoint the moment of conception, there was no distinction between the prevention of pregnancy (contraception) and the ending of one (abortion). “Remedies to regulate the menstrual cycle” were common and arguably more widely accepted than they are now. Recipes were recorded in medical texts, shared between women, and they appeared in household handbooks. They could be made at home with a few ingredients most women would recognize.

This ninth century recipe appeared in the Lorsch Manuscript, a medical treatise written by Benedictine monks:

A Cure for All Kinds of Stomach Aches
For women who cannot purge themselves, it moves the menses.

8 oz. white pepper
8 oz. ginger
6 oz. parsley
2 oz. celery seeds
6 oz. caraway
6 oz. spignel seeds
2 oz. fennel
2 oz. geranium/ or, giant fennel
8 oz. cumin
6 oz. anise
6 oz. opium poppy

These recipes did not come out of the blue. There is evidence that similar abortifacients had been used as far back as ancient Egypt. Pepper had been used since the Roman period as a contraceptive, and fennel is related to silphium, the ancient plant farmed to extinction for its contraceptive properties. The other ingredients have been found to have antifertility effects, and the opium was used as a sedative. Other similar recipes were employed throughout the period and beyond; menstrual regulators using the same ingredients continued to be sold as late as the nineteenth century.

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Juniper

In addition to those mentioned above, artemisa and juniper were both known to inhibit fertility. Artemisia is a genus of plant in the daisy family asteraceae. There are more than two hundred types of artemisia, among them mugwort, tarragon, and wormwood, the key ingredient in absinthe centuries later. In the twelfth century, Trotula recommended artemisia as a “menstrual stimulator” and in the thirteenth century, Arnald of Villanova advised taking it with capers for maximum efficacy. Modern medicine has confirmed its use: artemisia inhibits estrogen production and can prevent ovulation much like pharmaceutical contraceptives today.

Artemisia was not without its side effects. Wormwood is a notorious toxin known to cause hallucinations and changes in consciousness. Ingested in large quantities, it can cause seizures and kidney failure. (2)

Juniper had been used as a contraceptive since the Roman period. Pliny the Elder recommended rubbing crushed juniper berries on the penis before sex to prevent conception. Its popularity continued throughout the Middle Ages; Arabic medical writers Rhazes, Serapion the Elder, and ibn Sina all list it as an abortifacient, and this knowledge was made more readily available throughout Europe when Gerard of Cremona translated their words in the twelfth century. According to ibn Sina, juniper produced an effect very similar to a natural miscarriage, and so it could be employed without detection.

Historian John Riddle argues that all women knew which plants inhibited fertility and how to use them effectively. They were under no illusions as to their purpose. Although most of what we know about medieval contraception and abortion does come from medical texts written by men, they would have come by the information from women who were using it on a regular basis.

Morality

In the ancient world and even the early Christian Church, abortion was not considered immoral. Although it is often interpreted differently today, the medieval church followed the guidelines of the Bible in believing that life began at birth (Genesis 2:7). St. Thomas Aquinas argued that souls are created by God, not by man, and that the soul did not enter the body until the infant drew its first breath.

Abortion or “menstrual regulation” was not explicitly mentioned in the Bible except to recommend it in the case of suspected unfaithful wives (Numbers 5:11-31) (3), and whether or not it was immoral in the Middle Ages depended on who was asked.

Burchard of Worms’ Decretum tackled the issue of abortion in the section titled Concerning Women’s Vices. Burchard unequivocally opposed it, but the penance recommended varied. To Burchard, the severity of the sin was not dependent on the act itself, but the status of the woman and the circumstances of conception. The worst crime was that resulting from adultery. For this he orders seven years of abstinence and a lifetime of “tears and humility.” Abortion stemming from fornication was also bad (penance for ten years on fast days), unless the woman was poor or a sex worker (statistically likely). If the woman was poor and acted because she would not be able to feed a child, it was understandable and no penance was prescribed.

Regardless of the Church’s recommendations, abortion was not actually illegal. In fact, the first law that made abortion illegal in the English-speaking world did not come until the Ellenborough Act of 1803, and even that only outlawed abortions obtained by taking “noxious and destructive substances.” It was not until 1869 that the Catholic Church decided that life began at conception.

Conclusions

If there is one thing we should take away from this, it is that when it came to sex, the Middle Ages were not as different from today as we often assume. People married for love, they had sex for fun, and family planning existed and was used more or less effectively. Due to centuries of literature and art portraying the Middle Ages as an idealized time of chastity and moral superiority, we have come to collectively accept a fiction that bears only a passing resemblance to a much more complicated truth.

Through this Contraception in History series, I have tried to show that although reproduction has been the primary purpose of sex throughout history, it was not the only purpose, and people have always found ways to take their reproductive destinies into their own hands.

Jessica Cale

Sources

Brundage, James. Sex and Canon Law. Garland Reference Library of the Humanities Volume 1696. Issue 1996: Pages 33-50.
Burchard of Worms. Decretum (c. 1008).
Burford, EJ. Bawds and Lodgings, a History of the London Bankside Brothels c. 100-1675. London, Peter Owen, 1976
Cadden, Joan. Western Medicine and Natural Philosophy. Garland Reference Library of the Humanities Volume 1696. Issue 1996: Pages 51-80.
Capellanus, Andreas. The Art of Courtly Love. Translated by John Jay Parry. New York, Columbia University Press, 1960
Gaddesden, John. Rosa anglica practica medicine. Venice, Bonetus Locatellus, 1516.
Gies, Frances and Joseph. Marriage and Family in the Middle Ages. New York, Harper & Row, 1987
Payer, Pierre J. Confession and the Study of Sex in the Middle Ages. Garland Reference Library of the Humanities Volume 1696. Issue 1996: Pages 3-32.
Riddle, John M. Contraception and Early Abortion in the Middle Ages. Garland Reference Library of the Humanities Volume 1696. Issue 1996: Pages 261-274.
Tannahill, Reay. Sex in History. New York, Stein and Day, 1992

1. See The Art of Courtly Love.

2. Fun fact: Nicholas Culpeper claimed that wormwood was the key to understanding his 1651 book The English Physitian. Unlike the rest of the book, the entry for wormwood is a stream-of-consciousness ramble that reads like someone who was ingesting it at the time.

3. It is very possible the bitter waters in this verse refer to wormwood, a notoriously bitter substance known to induce miscarriage.

If you would like to know more about Contraception in History, see below for the rest of the series:

Contraception in History I. Aristotle, Hippocrates, and a Whole Lotta Lead

Contraception in History II. Contraception in Ancient Egypt: Hormonal Birth Control, Pregnancy Tests, and Crocodile Dung. 

Contraception in History III. Ancient Birth Control: Silphium and the Origin of the Heart Shape

Contraception in History IV. Minos, Pasiphae, and the Most Metal Euphemism for V.D. Ever

Contraception in History V. “Love’s Pleasing Paths in Blest Security”: Seventeenth Century Condoms

 

Bones, Blood, Barbers, and Butchers: Surgeons in the 18th Century

In the eighteenth century, the record for the fastest amputation at the thigh was nine seconds, start to finish, including sawing through the bone. Are you impressed yet? Even the average, thirty seconds, was pretty damned fast.

And speed was of the essence. Let’s face it. If you needed surgery in the eighteenth century or the first half of the nineteenth, you’d better be strong and brave, because it wasn’t a doddle. Not for the surgeon, and not at all for the patient.

Patients faced three major killers

They’d solved one of the major issues that killed people who needed surgery, reinventing ligatures to tie off blood vessels so the patient didn’t bleed out on the table. Before the sixteenth century, they’d used cautery—burning—to seal any gushers, vastly adding to the pain. And, of course, closing up the wound as fast as possible helped.

And pain was the second issue. No effective anesthetics. Not until the mid-nineteenth century. The patient was awake for the entire operation, which was the main reason why speed (and some strong helpers to hold the patient down) mattered.

The biggest killer was factor number three. Germs.

Not that they knew that, of course. The prevailing opinion was that wound infections were caused by air, though how nobody quite knew. They had no way of knowing that the surgeon’s hands and clothes, the bed sheets, the surgical instruments, the dressings, and a myriad of other surfaces that would come into contact with the patient were covered with organisms too tiny to see, but that would infect the wound. Most people sickened. More than half died.

Keep out the air to keep out the contagion

Some hospitals did pretty well. Their theory was that the infective element was carried in noxious fumes; that is, if it smelled like bad air, it would be bad for their patient. Alexander Monro (Primus and Secundus), a father and son team who headed the Royal Infirmary in Edinburgh, must have run a clean operation. They managed to get the death rate for amputations down to eight percent. Given that other hospitals of the time managed rates of 45 to 65 percent, that’s truly impressive.

Most surgeons relied on speed to limit the amount of time the wound was exposed to the air, thus—they hoped—cutting down on the damage the air did to the tissues.

More butchery than medicine

So a fast surgeon was far more likely to be a successful surgeon for three reasons: less blood flow, a shorter time of acute agony, and (they thought) less contagion. No wonder that, to the rest of the human race, surgery seemed more a matter of butchery than medicine.

Naturally, as they thought at the time, physicians did not perform surgery. Physicians had, since medieval times, been university trained. They were gentlemen’s sons with a medical doctorate, highly educated and knowledgeable about the humours of the body and the appropriate ways to balance them. In theory, their superior knowledge made them the only proper people to practice medicine and oversee surgery. They did not involve themselves in physical labour, but expected rather to command those who distilled the medicines they prescribed (apothecaries) or who carried out operations they deemed necessary.

Surgeons, barber surgeons and apothecary surgeons

Specialist surgeons learned their craft on the job, working as a surgeon’s mate in the navy or the army, or as the apprentice to a barber surgeon or an apothecary surgeon.

Barbers were good men with a blade, so an obvious choice for removing some part that shouldn’t be there or performing a beneficial bloodletting. The familiar red and white barber’s pole dates from the time of the barber surgeon, representing the rod the patient held tightly during the operation and the bloodied and clean bandages used. When washed and hung to dry, they would twist together in the wind, forming the spiral we see today.

Apothecary surgeons had won a landmark case in the first decade of the eighteenth century, when an apothecary was taken to court by the Guild of Physicians for compounding and administering medicines without the benefit of a physician’s advice. The Physicians won, but the Society of Apothecaries appealed to the House of Lords, who were unimpressed with the argument that allowing apothecaries to care for the sick would:

“Deprive the gentry of one of the processions by which their younger sons might honourably subsist and be a great detriment to the Universities.”

The Lords reversed the judgement.

The rise of a profession

By the eighteenth century, surgeons were giving physicians a run for their money, some attending university as well as learning their craft by apprenticeship. However, they seldom had any formal qualifications before the Royal College of Surgeons was founded in London in 1800. They were ‘Mister’ compared to the physician’s more prestigious ‘Doctor’, though the brilliant work of a plethora of eighteenth century surgeons raised their status and the work of medical teaching hospitals such as the Royal Infirmary mentioned above raised their knowledge.

By the time Victoria ascended the throne, the confidence of surgeons, and the income they could command, had risen to the point that the cheeky surgeons made the former insulting honorific into a badge of honour. In the UK, Eire and New Zealand to this day, surgeons are called ‘Mister’ rather than ‘Doctor’.

Jude Knight’s writing goal is to transport readers to another time, another place, where they can enjoy adventure and romance, thrill to trials and challenges, uncover secrets and solve mysteries, delight in a happy ending, and return from their virtual holiday refreshed and ready for anything.

She writes historical novels, novellas, and short stories, mostly set in the early 19th Century. She writes strong determined heroines, heroes who can appreciate a clever capable woman, villains you’ll love to loathe, and all with a leavening of humour.

A Raging Madness is out May 9th. Stop by our sister blog today to see surgery in action in a new excerpt and enter two giveaways!

Smallpox vs Edward Jenner: How One Doctor Invented Vaccination and Cured the World

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The deadly disease smallpox had been feared by man for thousands of years by the 1800s, and rightly so. It was highly contagious, incurable, and killed a third of those unlucky enough to catch it.

Those who survived it were rarely left unscathed. Aside from the inevitable permanent scarring, it could leave victims blind and doomed to spend the rest of their days battling lung or joint problems. The disease also did not discriminate between the rich or poor.

Several royals and world leaders contracted it. Queen Elizabeth I, George Washington and Joseph Stalin all had pock-marked faces which they took great pains to disguise. The 18th century fashion for wearing patches stemmed from the desire to hide the damage smallpox had done to aristocratic skin. Smallpox killed both King Louis XV of France and Queen Mary II of England, monarchs who could well afford the best physicians to try to save them, so the merest threat of it was enough to send the population into a panic.

Of course, it didn’t help matters that medical scientists had no idea how the disease was spread and had no way of treating it. The concept of bacteria and viruses would not begin to enter into medicine until 1861, so physicians were clueless. Theories abounded over time, blaming God, the alignment of the planets, and eventually evil miasmas (bad air) as the root cause of an epidemic. Treatments were equally as primitive. Prayer, smelling sweet nosegays, and bonfires were the only weapons the Western World had for centuries. As a result, outbreaks could kill thousands in a very short space of time with terrifying speed, especially children or the old. The only thing they did know, was once you had caught it, you couldn’t catch it again.

In the East where medicine was traditionally more advanced and largely unencumbered by religious interference, physicians expanded upon this idea. Using the healing scabs of a recovering smallpox victim, which they scratched into the skin of healthy people, they protected them. Although they did not realise it at the time, what they were doing was building up the body’s antibodies using a weakened dose of smallpox and thereby rendering the body resistant to any stronger. It’s still a common practice nowadays with certain diseases. Polio is a classic example. Variolation (or inoculation as we now know it) was brought to Britain in 1715 by Lady Wortley Montague, an ambassador’s wife who had suffered smallpox as a child and lost a brother to it.

Whilst inoculation did work in a great majority of cases, it was not without serious risk. By exposing people directly to smallpox, albeit a significantly weaker version of the disease, at least ten percent of those inoculated contracted full-blown smallpox in the process, often with fatal consequences. King George III lost his son Prince Frederick after he had the boy inoculated. When even the king could not guarantee its safety, a great many preferred not to take the risk. Inoculation was also very expensive, which put even more off it, so smallpox remained a devastating killer throughout the eighteenth century.

In 1784, after extensive study of smallpox victims during an epidemic in his hometown of Chester, Dr John Haygarth became convinced smallpox was transferred by human contact. He recommended quarantining anyone with smallpox and gave sound advice as to how anyone coming into contact with a victim should stop the infection spreading:

“During and after the distemper, no person, clothes, food, furniture, cat, dog, money, medicines or any other thing that is known or suspected to be bedaubed with matter, spittle, or other infectious discharges of the patient should go out of the house until they have been washed…When a patient dies of smallpox, particular care should be taken that nothing infectious be taken out of the house so as to do mischief.”

Haygarth’s methods were soon widely adopted. Wherever possible, smallpox victims were isolated away from the rest of the community. Every item of clothing and bedding used was burned to avoid contaminating others. Sometimes, this occurred using quarantine ships. These were hardly floating hospitals as there was little doctors could do other than let the disease run its course, however, moving sufferers offshore was fairly successful in containing the disease if they caught it quickly enough.

cowpoxThe big breakthrough came thanks to a country doctor called Edward Jenner. He decided to test the validity of an old wives’ tale which claimed all those who worked with cows were immune to smallpox. Over the course of many years, he discovered that those new to working with cattle–such as milk maids–often caught a relatively harmless disease from them. Cowpox caused a mild fever and an irritating skin rash in humans which quickly cleared up of its own accord. Jenner began to suspect cowpox was the key to the immunity from smallpox. However, to test his theory he would need to infect a human with cowpox who had never come into any contact with cows before.

In 1796 he paid the parents of James Phipps, and then injected the pus from a cowpox pustule into the boy. A few weeks later, he exposed the boy to smallpox and when nothing happened declared it a resounding success. He called his new treatment vaccination as the word vacca is Latin for cow and was convinced it was the only thing capable of defeating the ‘speckled monster’. However, the Royal Society did not welcome his research with open arms. They declared it too revolutionary and asked for more proof. It took until 1798, and several more experiments with cowpox including one on his own baby son, before they published his findings.

Although conclusive, the people were less enthusiastic to this new miracle prevention. There was an enormous backlash against Jenner’s vaccination accompanied by an extensive propaganda campaign. Aside from the fact the new prevention was more expensive than the old-fashioned inoculation, the widespread resistance came because of two things:

Firstly, and perhaps most importantly, vaccination was seen as ungodly. The very religious masses listened to the anti-vaccination sermons preached from pulpits the length and breadth of the British Isles. After all, in Corinthians is stated quite clearly: “All flesh is not the same flesh: but there is one kind of flesh of men, another flesh of beasts”. Mixing the two things was grossly unacceptable according to the scriptures.

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James Gillray, The Cow Pock. An anti-vaccination cartoon from 1802.

Secondly, although Jenner was able to prove vaccination did work with none of the risks caused by inoculation, he had no earthly idea why. Even the educated struggled to justify agreeing to vaccination without knowing the science behind it. Perhaps it was possible they would begin to sprout horns and udders in the future? Nobody could say for certain this wouldn’t happen.

Others were less resistant. Napoleon honoured Jenner with a medal after the Frenchman vaccinated his troops. Before that, more of his army were killed by smallpox than by battle. Another fan was President Thomas Jefferson who, in 1806, wrote a gushing letter of thanks to Edward Jenner:

“I avail myself of this occasion of rendering you a portion of the tribute of gratitude due to you from the whole human family. Medicine has never before produced any single improvement of such utility… Future nations will know by history only that the loathsome small-pox has existed and by you has been extirpated.”

While history proved Jefferson’s prediction correct, such accolades from Britain’s then enemies did not really do Edward Jenner any favours at home. Vaccination remained hugely unpopular with the masses and some dyed-in-the-wool physicians despite overwhelming evidence of its success and continued to be during Edward’s lifetime and beyond. He died in 1823 with his vaccination still as controversial then as it had been in 1796.

Things came to a bit of a head in the UK when the government stepped in. In 1840 they declared the old inoculation illegal, thus eliminating the choice. Then, the 1853 Vaccination Act made it compulsory in law for all babies to be vaccinated before they were three months old. Failure to do so resulted in a one pound fine and potentially the risk of prison. People argued they were now denied the right to decide what they could put into their own bodies and many took to the streets to protest. Compulsory vaccination was so unpopular, the government had to back down and stopped prosecuting those who refused.

It was only once the brilliant French scientist Louis Pasteur began to do more experiments on vaccination in the late 19th century, and was finally able to explain why it worked, that public objection lessened. Smallpox vaccination became widespread and the catastrophic and destructive epidemics died out. The last known recorded case of smallpox was in Somalia in 1977 and in 1980 the World Health Organization declared the disease eradicated save the few samples kept secure in laboratories. And all thanks an old wives’ tale and a tenacious, mild-mannered country doctor from Gloucestershire who never wanted to be famous.
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Virginia Heath writes witty Regency romantic comedies for Harlequin Mills & Boon. The first book in her ‘Wild Warriners’ series, A Warriner to Protect Her, will be released in April 2017.

Civil War Hospitals Were Enough to Make You Sick

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A nurse and the wounded outside a hospital in Fredericksburg

When people find out that I wrote the non-fiction companion to Mercy Street, the PBS series set in a Union hospital during the American Civil War, they almost always ask me whether the show gets the historical details right. Particularly whether the medicine is accurate. I tell them that the series does a great job with historical accuracy with one exception: the television version of Mansion House Hospital isn’t dirty enough.

Today we think of hospitals as bastions of sanitation. But in the mid-19th century hospitals were dangerous, dirty, smelly places that many people rightly regarded as death traps. Add in the chaos of war and you had breeding grounds for contagious diseases, including smallpox, measles, pneumonia, influenza, tuberculosis, typhoid and yellow fever.

At the beginning of the war, the Union Army had a few hospitals attached to forts in the west, but none along the eastern seaboard. In order to cope with the crisis of illness and injury that began before the first battle was fought, the Army’s Medical Bureau requisitioned buildings for use as general hospitals throughout Washington DC and surrounding towns, primarily hotels and schools. Many of them were run down and most suffered from inadequate ventilation and poorly designed toilet facilities, which aggravated the problems of disease.

The largest of the Washington hospitals was the Union Hotel, where Louisa May Alcott served as a nurse for a little over a month. The hospital opened on May 25, 1861, and was soon infamous for its poor condition and worse smells. A report on its condition, made shortly after the first Battle of Bull Run in July 1861, stated that

…the building is old, out of repair, and cut up into a number of small rooms, with windows too small and few in number to afford good ventilation. Its halls and passages are narrow, tortuous and abrupt…There are no provisions for bathing, the water-closets and sinks are insufficient and defective and there is no dead-house [a room or structure where dead bodies could be stored before burial or transportation—a grim necessity in a Civil War hospital.] The wards are many of them overcrowded and destitute of arrangements for artificial ventilation. The cellars…are damp and undrained and much of the wood is actively decaying. (1)

Alcott was more blunt. In a letter home, she complained “a more perfect, pestilence-box than this house I never saw,–cold, damp, dirty, full of vile odors from wounds, kitchens, wash-rooms, and stables.”

Nurses, supported by convalescent soldiers, occasional chambermaids, and an army of laundresses, fought to keep hospitals clean in the face of a seemingly endless stream of mud, blood, and diarrhea—a common element of Civil War military life seldom mentioned in letters and memoirs of the period. (An average of 78 percent of the Union Army suffered from what they called the “Tennessee quick-step” at some point each year.) It was a monumental task, even by standards of cleanliness that required patients’ undergarments to be changed once a week and saw nothing wrong with reusing lightly soiled bandages.

Keeping a supply of clean shirts, clean underwear, clean sheets, and clean bandages required a heroic effort—especially when a given patient might require three clean bandages and a fresh shirt daily, all of which would need to be thrown away because they were so stained with blood and pus. The newly constructed general hospital at Portsmouth Grove, Rhode Island, reported boasted a new-fangled steam washing machine that could wash and mangle four thousand pieces of laundry a day. It was an innovation that hospitals improvised from hotels and schools could only dream of with envy. Most hospitals had to make do with wooden washtubs, soap-sized kettle for heating water, and elbow grease. Washable clothing, bed linens, bandages and rags were washed in hot water using soft soap and a scrub board, boiled to kill lice and insects, rinsed several times in hot water, allowed to cool, and then rinsed again in cool water. Water had to be carried by hand from water sources that varied in degree of inconvenience. Once acquired, water was heated in large kettles on wood- or coal-burning stoves and carried from kitchen to washtub. It was not unusual for a general hospital laundry to process two or three thousand pieces of laundry in one day.

Even the best efforts to keep hospitals clean did not deal with the root causes of contagion. A bacterial theory of disease was some decades in the future. The prevailing medical theory of the period focused on clean air rather than clean water because doctors believed that diseases were spread through the poisoned atmosphere of “miasmas.” Doctors interested in hospital sanitation were concerned with eradicating foul smells. New hospitals were built with an eye toward providing fresh air. Hospital designers would have been well advised to focus on handling human waste instead.

The sanitary arrangements in Civil War hospitals made it easy for diseases linked to contaminated water, like typhoid and dysentery, to spread. Many latrines and indoor water closets had to be flushed by hand, carried by hand from a water source some distance away. As a result, they were not flushed out as frequently as required to keep them sanitary. Worse, in some hospitals, latrines were located too close to the kitchens. Even when there was an adequate distance between the two, flies carried bacteria on their feet as they flew between latrines, kitchens and patients’ dinner trays.

It’s no wonder that disease was responsible for two-thirds of all Civil War deaths.

(1) Quoted in Hannah Ropes. Civil War Nurse: The Diary and Letters of Hannah Ropes, ed. John R. Brumgardt. (Knoxville: University of Tennessee Press, 1980) p. 40.

(2) Quoted in Ropes, p. 40

Further Reading

Humphreys, Margaret. Marrow of Tragedy: The Health Crisis of the American Civil War. Baltimore: Johns Hopkins University Press. 2013

Rutkow, Ira. M. Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine. New York: Random House. 2005.

Schultz, Jane E. Women at the Front: Hospital Workers in Civil War America. Chapel Hill and toler_heroinesofmercystreetLondon: University of North Carolina Press. 2004.

Pamela D. Toler is a freelance writer with a PhD in history and a large bump of curiosity. She is the author of Heroines of Mercy Street: The Real Nurses of the Civil War and is currently writing a global history of women warriors, with the imaginative working title of Women Warriors. She blogs about history, writing, and writing about history at History in the Margins.

“A Second St Domingo”: Sickness during the Walcheren Expedition of 1809

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Terrain of the Walcheren campaign, from France Militaire: histoire des Armees Francaises de terre de mer de 1792 a 1833…by A. Hugo, 1837.

In 1809, the British government sent an amphibious force of 40,000 men and 600 naval vessels to the Scheldt to destroy the French fleet and dockyards at Antwerp and Flushing. It was Britain’s biggest expeditionary undertaking since the beginning of the wars with France in 1793, part of the War of the Fifth Coalition and a diversion to assist the Austrians against Napoleon in central Europe.

The expedition, under the military command of John Pitt, 2nd Earl of Chatham, was a complete failure. The Austrian allies were defeated before the expedition left; although the British captured the island of Walcheren, they advanced too slowly across the neighbouring island of South Beveland, allowing the French to reinforce Antwerp. The expedition was finally withdrawn after a catastrophic outbreak of ‘Walcheren fever’, a combination of several diseases, including malaria.

The impact of this sickness can best be gauged through dry statistics. Of the 39,219 rank and file sent to Walcheren, 11,296 of them were on the sick lists by February 1810. By this time 3,960 were dead. A further 106 had died in battle, but those numbers were swallowed up in the sheer scale of the tragedy.

‘Walcheren fever’ struck the troops suddenly and savagely. One source, the anonymous Letters from Flushing, recorded fatalities from sickness as early as 12 August 1809, but on 8 August the British Chief of Staff reported ‘We have as yet no sick,’ and on 11 August the commander-in-chief Lord Chatham thought ‘the Troops upon ye whole continue healthy.’[1]

By 20 August, however, things had changed. The official Proceedings of the Army recorded on 22 August: ‘Sickness began to show itself among the Troops in South Beveland. On the 20th the number of Sick was 1564, and within the two following days it increased very considerably.’ The next day, the 23rd, the Proceedings recorded ‘Sickness increased very much within the last 24 hours.’ By the 24th the sickness had spread to Walcheren.[2]

At first the officers were not too worried. One of the aides-de-camp to Sir Eyre Coote (Chatham’s second-in-command) recorded in his diary on 24 August: ‘5000 French Troops are said to have fallen a victim to the climate last year, but I consider this as a very exaggerated statement, and at any rate, the constitutions of our men & their habits of life, are much better adapted to this moist atmosphere.’[3]

But by the 27th there were 3467 sick. The following day the officer compiling the official returns could not restrain his concern: ‘The sickness increased to an alarming Proportion, some of the General, and many other Officers were seized with fever, and the Number of Men on the Sick List was nearly 4000.’[4]

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The evacuation of South Beveland, August 1809

The sickness was described by Lieutenant William Keep of the 81st:

The disease comes on with a cold shivering, so great that the patient feels no benefit from the clothes piled upon him in bed, but continues to shiver still, as if enclosed in ice, the teeth chattering and cheeks blanched. This lasts some time and is followed by the opposite extremes of heat, so that the pulse rises to 100 in a small space. The face is then flushed and eyes dilated, but with little thirst. It subsides and then is succeeded by another paroxysm, and so on until the patient’s strength is quite reduced and he sinks into the arms of death.[5]

The British army had been sent to Walcheren with medical supplies for only 30,000 men. It was caught completely off-guard by the scale of the sickness. Things were not helped by the fact that the British had bombarded one of Walcheren’s largest merchant towns, Vlissingen (Flushing), in mid-August, which restricted the accommodation available to the British troops. By 30 August there were nearly 900 sick in Flushing alone, ‘all of them laying [sic] on the bare boards without Paillasses & many without Blankets.’ Two days later Coote’s aide concluded in despair: ‘This island is a mere Hospital and an Inspector of Hospitals will shortly be a more useful officer than the General Commanding.’[6]

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Flushing Harbour. Photograph by Jacqueline Reiter

All these circumstances contributed to an atmosphere of near-panic. Nobody knew who would be next, and no rank was exempt. ‘A considerable degree of apprehension of Climate and Disease has prevail’d too generally, and there has been much anxiety shewn to get away from this Island as if it had been a second St Domingo,’ the Chief of Staff reported disapprovingly, but by this time several generals (including General Mackenzie-Fraser, who later died) were dropping like flies.[7] By mid-September the Adjutant-General of the army was sending in daily (rather than weekly) sick reports, and Chatham decided to start sending the sick home ahead of official orders from the War Office.

According to one account, one doctor ‘and his assistant [had] nearly five hundred patients prostrate at the same moment … the whole concern was completely floored’. [8] By 23 September the army had almost completely run out of bark (now quinine, used to treat malaria) and the medical corps were of course also losing staff to sickness. Sir Eyre Coote (who took over from Chatham, who was recalled) reported to the Secretary of State for War: ‘I can assure Your Lordship, without any Fear of Exaggeration … that the Situation of the Troops in this Island is deplorable … The Sick are so crowded, as to lay Two in one Bed in several Places, and have no Circulation of Air.’ In Flushing, by contrast, many of these places had rather too much air circulation, owing to ‘the damaged State of the Roofs, never repaired since the Siege.’[9]

Totally overburdened, the medical corps became desperate in their attempts to stem the disease. They had no idea what was causing it: they knew it wasn’t contagious, but thought it was due to ‘local or endemic Causes, viz. the Miasmata or Exhalations from the Soil.’ They did, however, notice that the sailors on board the British ships remained healthy, with the exception of the ones who had gone ashore to help with the siege of Flushing (naturally, as mosquitoes do not breed around salt water). One proposed treatment therefore was to pack the British sick into ships and sail them around the islands, in the hope that the sea air and a change of scene would restore them to health. Unsurprisingly, this did not work.[10]

The impact of Walcheren fever on the British army was significant and long-lasting. The soldiers who had served on the campaign continued to relapse periodically for years after. In March 1812 Lord Wellington, in the midst of fighting in the Spanish Peninsula, lamented the fact that his troops had been ‘so much shaken by Walcheren.’ [11] The careers of the commander-in-chief of the Army, Lord Chatham, and the naval commander, Sir Richard Strachan, were destroyed by the disaster.

The British government that had planned the expedition under the Duke of Portland fell, and its successor nearly foundered during the ensuing parliamentary inquiry into the debacle. Two government ministers, Lord Castlereagh and George Canning, ended up fighting a duel. None of this, of course, was especially comforting to the four thousand men who had died from ‘Walcheren fever’.

References
[1] Letters from Flushing … by an Officer of the Eighty-First Regiment (London, 1809), p. 120; Sir Robert Brownrigg to Colonel Gordon, 8 August 1809, BL Add MSS 49505, f. 9; Chatham to Castlereagh, 11 August 1809, PRONI D3030/3220; John Webb to the Surgeon General, 27 August 1809, A Collection of Papers relating to the Expedition to the Scheldt (London, 1809), pp. 588-90.
[2] The National Archives WO 190, 22-4 August 1809.
[3] University of Michigan Coote MSS, Box 29/3, Diary of the Walcheren Expedition, 24 August 1809.
[4] The National Archives WO 190, 27-8 August 1809.
[5] Quoted by Martin Howard, Walcheren 1809, Barnsley, 2011, p. 161.
[6] University of Michigan Coote MSS, Box 29/3, Diary of the Walcheren Expedition, 30 August, 1 September 1809.
[7] Sir Robert Brownrigg to Colonel Gordon, 8 September 1809, BL Add MSS 49505 f. 69.
[8] Rifleman Harris, quoted by Howard, Walcheren 1809, p. 172.
[9] Sir Eyre Coote to Castlereagh, 17 September 1809, A Collection of Papers, pp. 137-40.
[10] Memorandum dated 25 September 1809, A Collection of Papers, pp. 623-5; Sir Eyre Coote to Lord Liverpool, 23 October 1809, A Collection of Papers, pp.177-8.
[11] Howard, Walcheren 1809. p. 215.

Further reading
Gordon Bond, The Grand Expedition (Athens, GA, 1971)
Martin R. Howard, Walcheren 1809 (Barnsley, 2011)
John Lynch, ‘The Lessons of Walcheren Fever, 1809’, Military Medicine 174(3) 2009, pp. 315-19
T.H. McGuffie, ‘The Walcheren Expedition and the Walcheren Fever’, English Historical Review jacquelinereiter_bookcover62(243) 1947, pp. 191-202

Jacqueline Reiter has a PhD in late 18th century political history from the University of Cambridge. A professional librarian, she lives in Cambridge with her husband and two children. She blogs at www.thelatelord.com and you can follow her on Facebook or Twitter. Her first book, The Late Lord: the life of John Pitt, 2nd Earl of Chatham, was published by Pen & Sword Books in January 2017.

“A Cesspool in the Palace”: Prostitution and the Church in Medieval Southwark

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London Bridge, from Southwark facing north. Southwark Cathedral is in the foreground. Claes Van Visscher, 1616.

Prostitution flourished in medieval London, and in the 12th century, Southwark became the city’s official red light district by order of Henry II. His ‘Ordinances touching the gouerment of the stewhoulders in Southwarke under the direction of the Bishop of Winchester’ (1161) gave control of the Southwark brothels to the ecclesiastical authorities, which would allow the church to draw untold sums of money from them through the sale of licenses. At the time of the ordinance, there were eighteen licensed brothels in Bankside employing about a thousand prostitutes at any one time. As a result of the church taking control, most of London’s churches built during this period were largely financed by prostitution.

Why Southwark? By the 12th century, Southwark had already been a hot spot for prostitution since the Romans built the first known brothel in England at what was then an obscure military outpost. Southwark itself grew out of a brothel. More than that, Southwark had been a privileged borough for most of its history, its many churches creating a place of asylum that extended to protecting criminals and prostitutes from the full extent of the law. Southwark served as a “bastard sanctuary,” offering a kind of asylum to those rejected by society: prostitutes, criminals, lepers, and the poor lived among brothels, jails, rubbish tips, and the smellier trades, just far enough away from London that they could not be seen without a boat ride or a long walk across London Bridge.

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The Last Hour. Florence Harrison.

While the church officially condemned prostitution and sexual promiscuity, they had no reservations about profiting from it. St. Thomas Aquinas himself compared it to “a cesspool in the palace; take away the cesspool and the palace becomes an unclean evil-smelling place.” Southwark already smelled pretty evil; it was the perfect place for a ‘cesspool.’ Prostitution was accepted as a necessary evil, and from the end of the 12th century onward, regulated to maximize revenue for the church.

As E. J. Burford explains:

“By this act of recognition, the King and the Archbishop of Canterbury gave certain advantages to the licensed brothelkeepers or stewholders. It was much easier for them to carry on business in a protected premises in a protected area. The regulations and penalties, although set out in great detail and with seemingly terrifying (or at least terrifyingly expensive) punishments, were of little practical consequence. Most infractions would be hard to prove, and all could be nullified with a little judicious bribery.”

Brothels or “stews” had been traditionally run by bawds, but Henry’s ordinance put their management into the hands of (mostly male) brothelkeepers licensed by the church. Single women were not allowed to own brothels with exceptions being made for those who had inherited one from a relative or left one by a husband.

The ordinance was devised both to protect the women employed in the sex trade and to limit certain behaviors. One of these protections was freedom from accusations of consorting with the devil. It sounds obvious to us (and convenient for them), but at the time, witchcraft and prostitution had been almost synonymous in the public mind since King Edward the Elder linked them in the 10th century.

Prostitutes were no longer individually licensed as they had been in Roman times and did not have to wear special clothing to set themselves apart. They could not be bound to or enslaved by bawds or brothelkeepers, with limits placed on how much they were allowed to borrow from their employers at any one time (six shillings and eightpence) to prevent them from being imprisoned for debt or obliged to remain in the employ of their moneylender.

Brothels became boarding houses that rented rooms to prostitutes without board. Like the provisions preventing women from borrowing large sums of money from the brothelkeepers, this was designed to protect them from those looking to take advantage of them through inflated food prices, keeping them in poverty and confined to the precinct where they worked. Brothels were closed on holy days to encourage the women to attend services. They were refused Christian burial, but could still receive Holy Communion.

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“No grabbing!”

In return for these protections, prostitutes were ordered to refrain from aggressive soliciting on penalty of imprisonment. They were not allowed to grab or call out to potential customers, or curse or throw rocks at them if refused or cheated. As Burford puts it, Southwark “was a dockside area with dockside manners” and prostitutes were known not only to throw stones but chamber pots at any customers who thought to make a run for it without paying their fee.

Quarterly inspections were ordered to ensure no women were working unwillingly and to reduce the spread of venereal disease. Gonorrhea and “burning sickness” (likely chlamydia) were common and even expected; those found to be infected were fined twenty shillings and sacked. Symptoms were treated by washing in white wine, animal piss, or a mixture of vinegar and water. Many cases of gonorrhea are asymptomatic in women, so it would have been impossible to remove all infected parties, as evidenced by the epidemic of 1160.

In his Compendium Medicine (1190), physician Gilbert Anglicus described another kind of sexually transmitted disease resembling leprosy. If what he saw was syphilis, this would have been one of the earliest documented cases of it in Europe, three hundred years before Columbus is thought to have brought it back with him from the Americas.

Bizarrely, the harshest punishment was reserved for prostitutes who had lovers on the side. Men were permitted to whore out their wives and married women could sell themselves to their hearts’ delight, but any prostitute discovered to have a lover not paying for her services would be fined six shillings and eightpence, imprisoned for three weeks, and subjected to the humiliating punishment of the cucking stool – being tied to a chair and publically immersed in filth. Naturally the woman’s lover would not receive any punishment for his involvement with her; the rule would seem to have been in place to maximize profits while cutting down on her leisure activities.

Another interesting rule is that for the last customer of the day, once the woman had taken his money, she was obliged to lay with him all night. Brothelkeepers were prohibited from keeping boats and the boatmen that worked the Thames were not allowed to moor their boats on the south side of the river after dark. Once customers were in Southwark for the night, there was no leaving until morning. Burford suggests the reasoning for this is that political plotters or criminals were easier to monitor with reduced traffic on the river. Anyone needing to cross would have to go via London Bridge and they would be seen on the way.

While the Bankside brothels flourished with Henry II’s statues, Southwark’s reputation for vice was cemented when Edward I cracked down on those he deemed undesirable* a century later. He believed that these “women of evil life” attracted criminals, so prostitutes were no longer allowed within the city of London at all. Any woman found breaking this rule was subject to forty days in prison. This effectively forced any and all prostitutes well south of the river where they would stay for centuries. Although Covent Garden became something of a red light district with Harris’ List in the 18th century, the vast majority of London’s prostitutes lived south of the river through the 19th century.

Jessica Cale

* Prostitutes, Jews, the Welsh, the Scottish…how long have you got?

Further reading
Arnold, Catharine. The Sexual History of London. St. Martin’s Press, 2012.
Burford, E.J. Bawds and Lodgings: A History of the London Bankside Brothels c. 100-1675. Peter Owen, 1976.