Hermitage and heritage: Augustinians in history

Austen (the surname of one of England's best-loved novelists and Austin (the capital city of Texas) are both abbreviations of the name Augustine. That name became popular from Saint Augustine of Hippo, Father and Doctor of the Church (354-430), philosopher and theologian (left: Wellcome Library no. 3493i).

In England the name Augustine later acquired added lustre from the Roman missionary Saint Augustine of Canterbury, who re-introduced Christianity to Britain in the 6th century. The earlier Augustine, Saint Augustine of Hippo, was a Roman citizen of the province occupied today by Algeria. At one time a professor of rhetoric in Rome and Milan, he returned to North Africa and died there after writing numerous works of theology and philosophy. His studies of such subjects as time, memory, mind, and magic are still much admired: today the School of Life in London recommends Saint Augustine's Confessions to its students, while a writer in a recent New York Review of Books boldly declared that he was "surely one of the mightiest intellects ever to walk this earth" [1].

The high intellectual standing of Saint Augustine of Hippo underlay the success of the Augustinian Order formed from various groups of hermits, and explains why he and members of his Order are so abundantly represented in the Wellcome Library. By Augustine himself the Library has an incunable edition of his De civitate Dei (Venice 1490), three incunable editions of his sermons, and many other works.

Of his followers, the Wellcome Library has nine editions of works by the Augustinian philosopher Giles of Rome (Aegidius Romanus, ca. 1243-1316), three of which (On the material of the heavens, On possible understanding against Averroes, and a Commentary on Aristotle's Physica) are edited by another Augustinian called Giles, namely Giles of Viterbo (Aegidius Viterbiensis, 1469-1532), also a cardinal and a student of Jewish mystical writings. The Wellcome Library's incunable edition of the work of the two Giles's has the inscription "Egidius in Phis." (Giles on the Physica) written on the bottom edge (above right): before the mid-17th century, books were generally stored with their edges facing towards the room (not their spines, as today), and the owner of this book in the sixteenth century evidently knew who "Giles" would be and what the "Phis" were. [2]

One of Giles of Viterbo's contemporaries north of the Alps was George Ripley (d. ca. 1490), a canon of the Augustinian priory at Bridlington, Yorkshire, whose scrolls of alchemical symbols have recently been discussed on this blog.

Another Augustinian of the same era was Saint Thomas of Villanova (1486-1555), Bishop of Valencia and a professor at the University of Alcalá, after whom many universities and schools are named. In the engraving on the left (Wellcome Library no. 11665i), a young woman finds her leg ulcers relieved after her cheek is brushed with a locket containing a portrait and a relic of Saint Thomas of Villanova.

The Wellcome Library has many writings by the Augustinian satirist and preacher Abraham à Sancta Clara (1644-1709), a famed communicator of his day both in Vienna and internationally.  The print below of a man literally dicing with death illustrates one of his popular books on death in the time of the bubonic plague.

 Nineteenth-century Augustinians include the experimental gardener Johann Mendel (1822–1884) -- or Brother Gregor, to use his name in religion -- after whom is named the Mendel University in Brno, Czech Republic (and, on a smaller scale, a meeting room in the headquarters of the Wellcome Trust in London). He was a member of the Augustinian Abbey of St Thomas in Brno, and from 1868 its abbot. In his horticultural work, Mendel grappled with botanical manifestations of the questions discussed by his predecessor Giles of Rome in the latter's De formatione corporis humani, written around the year 1270. An up-to-date introduction to the work of the Augustinian Order today can be found in the website Augnet.

Wellcome Library no. 47111i (detail)

The most monumental Augustinian work in the Wellcome Library is surely a gigantic etching (approx 145 x 160 cm.) produced on twelve plates in 1614 by the Italian engraver Oliviero Gatti of Bologna (1579-ca. 1648?). It bears the heading Mysticae Augustinensis Eremi sacrum gloriae decorisq. Theatrum ("Sacred display of the mystic glory and distinction of the Augustinian hermitage"); for brevity the work is also called Arbor augustiniana ("The Augustinian tree"). Gatti was commissioned to create this magnificent baroque print by two Augustinian friars, Marc Antonio Viani (from Bologna) and Paulus Vadovita (from Wadowice in Poland). Seven copies are known, not all of them now complete: the Wellcome Library's copy lacks two of the twelve plates. The print exists in two states: one from 1614 dedicated to Pope Paul V and King Philip III of Spain, the other dated 1678 and with updated dedications to their successors, Pope Innocent XI and King Charles II of Spain: the Wellcome Library's copy is of the first state. The print has been cleaned and conserved this year by Amy Junker Heslip in the Wellcome Library's Conservation department; during conservation, the superb quality of the paper and the vigour of the etching were revealed.

 Wellcome Library no. 32491i (plate 8 of the Arbor augustiniana) 

In the centre of Gatti’s composition, Saint of Augustine of Hippo sits holding the Rule of his Order (above), while around are representatives of the sacred and knightly orders associated with him, saints and martyrs, and eminent Augustinian friars and nuns, including his mother, Saint Monica. Giles of Rome appears no fewer than three times: once as a bishop, once as a cardinal-archbishop (left: Wellcome Library no. 32476i), and once among those who renounced a princely or royal title to become an Augustinian hermit: Giles of Rome was widely believed to be a member of the Roman noble family of Colonna, though the truth of this has been doubted. [3] A full analysis of the work is of course beyond the scope of this posting, but the prints themselves are available in the Wellcome Library to anyone wishes to study them, or indeed just to enjoy the brio of their draughtsmanship.

If we turn back from the Augustinian Order to Saint Augustine of Hippo himself, in addition to the many graphic representations of the saint the Wellcome Library has an oil painting, the subject of which has recently been identified by Mr Roberto Tollo in the course of his studies of Augustinian iconography. The painting is painted on a large sheet of copper (69 x 85.7 cm.) and was acquired by Sir Henry Wellcome in Granada in Spain in 1934.

  Wellcome Library no. 44998i

The copper support, the Spanish provenance, and the costumes in the painting (similar to those in paintings by the Antwerp painter Frans Francken II) together suggest that this is a Flemish painting made in Antwerp in the mid-seventeenth century and painted on copper for export to Spain or Latin America. Paintings on copper travelled well, and once exported, could serve as models for larger paintings on wood or canvas for display in the churches, hospitals and convents of Spain and New Spain. [4]

Mr Tollo has now confirmed this by pinpointing the exact source of the composition as an engraving by the Antwerp artist Schelte Bolswert (1586-1659), apparently after his own design. That Schelte Bolswert's prints of Augustinian iconography were popular in the Hispanic world we know from the painted versions of them that have been found in Seville, Madrid, Quito, and Lima: the evidence is given in the Wellcome Library catalogue.

The subject derives from an episode in Carthage in the year 388, described by Saint Augustine himself [5]. The man in bed on the left is Innocentius of Carthage, who suffered from a rectal fistula, and was about to be treated for it by a painful surgical operation: in Augustine's words, "curabatur a medicis fistulas quas numerosas atque perplexas habuit in posteriore et ima corporis parte" (he was being treated by doctors for the many and difficult fistulas which he had on the posterior and lowest part of the body). However, for reasons of propriety, Schelte Bolswert shows the patient instead with a bandaged leg which a surgeon is expecting to amputate.

The surgeon, dressed in early 17th-century clothes, is sitting nearby with a brazier full of cautery irons – red-hot irons for sealing blood vessels -- and, on a table, an amputation knife for cutting the flesh around the bone: the surgeon's instruments are described in Augustine's account as "tremenda ferramenta". In the centre, blessing Innocentius, Saint Augustine is portrayed as a tonsured friar. Beyond him is a group of hermits of Saint Augustine, kneeling in prayer. Innocentius believes himself to be cured by a modern miracle without surgical innovation, and the surgeon almost lets go of his amputation-saw in surprise. On the right, a "marvellous Alexandrian surgeon" mentioned by Augustine as having been called in as a consultant raises his hand in an expression of astonishment, as well he might. He here represents those who assumed that miracles ceased in post-Biblical times, an assumption challenged by Saint Augustine from his own experiences. Augustine's message is that even eminent consultants cannot afford to take anything for granted.

[1] London review of books, 19 May 2011, p. 22. New York review of books, 27 October 2011, p. 54
[2] Questio Egidii Romani Eremite de materia celi. Padua: Hieronymus de Durantis, 1493, fol. B1v "F. Egidius Eremita Viterbiensis castigavit et dedit"
[3] M. Anthony Hewson, Giles of Rome and the medieval theory of conception: a study of the De formatione corporis humani in utero, London: Athlone Press, 1975, pp. 3-4 and 25 (find in the Wellcome Library here)
[4] Isaac van Oosten, Noah leading the animals to the ark, painting on copper 69.5 x 86.8 cm., Sotheby's, London, 6 July 2006, lot 101 (discussion in catalogue entry). Note that van Oosten's painting is very close in dimensions to the Wellcome Library painting. Pablo Escalante Gonzalbo and Martín Olmedo Muñoz, 'De invloed van de Zuid-Nederlandse gravure in Nieuw-Spanje', in Werner Thomas et al., Een wereld op papier: Zuid-nederlandse boeken, prenten en karten in het Spaanse en Portuguese wereldrijk (16de-18de eeuw), Louvain 2009, pp. 212-232
[5] De civitate dei, book XXII, chapter 8 (online at http://www.augustinus.it/latino/cdd/index2.htm)

Cardiac history roundup

Wellcome Library no. 679722i

The photograph above, dated 1931, portrays the cardiologist Edward Franklin Bland. Born in Virginia in 1901, Bland spent most of his career at the Massachusetts General Hospital (MGH), where he was an Intern, House Officer, Cardiac Fellow, and finally in 1949 Chief of Cardiology, a post he held until his retirement in 1964. The photograph was kindly presented to the Wellcome Library by Dr Arthur Hollman FRCP, the biographer of Sir Thomas Lewis: Dr Hollman had acquired it as a result of the fact that in 1930 Bland had spent a year on research in Lewis's laboratory at University College Hospital (UCH) in London. [1]

As a result of Bland's year with Lewis, the Wellcome Library has in its Thomas Lewis archive (PP/LEW) a letter from Lewis to Bland dated 25 March 1933. Lewis thanks Bland for submitting a paper to the journal Heart (edited by Lewis) but has to decline it because Heart was about to be replaced by a new journal Clinical science. Lewis advises Bland to "cut out a lot of stuff about coronary anomalies" because it "doesn't really give anything new": coronary anomalies were a special interest of Bland, and one of them is named Bland-White-Garland Syndrome after him, his former colleague at MGH Paul Dudley White, and Joseph Garland, who was a visiting physician at MGH while editor of the New England Journal of Medicine (and himself the owner of a congenital cardiac anomaly).

Lewis then goes on to offer for Bland's consideration a view which, in its teleological phrasing, could mutatis mutandis have been written by Galen. Explaining why, if arterial blood is not available, the myocardium clutches at straws by accepting venous blood as being better than nothing, Lewis says "In these cases Nature performs an experiment on the effects of supplying the heart with venous blood. Now in cases of occlusion of the coronary arteries, the heart is thought by some to be supplied by the Thebesian vessels [named after their discoverer Adam Christian Thebesius (1686–1732)]. The Thebesian vessels open chiefly into the right heart so that if the myocardium is supplied through these vessels it is being supplied chiefly with venous blood." Lewis does not elaborate further.

Finally in this letter Lewis refers to a forthcoming visit by Bland, who must have been about to return to the UK in 1933: "I will talk about them when I see you in a few weeks. We are looking forward to that very much. It is good of you and Jones to drive us about the country." Jones was possibly T.Duckett Jones, Bland's co-author in several papers on the heart disease rheumatic fever. Evidently Bland and Jones had offered to act as chauffeurs to Sir Thomas and Lady Lewis in exchange for Sir Thomas's gifts of physiological wisdom.

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One of the puzzling things about heart transplantation from an outsider's point of view is the sudden emergence to world-wide fame of the previously obscure Dr Christiaan Barnard. Today, he is probably the only transplant surgeon whose name is widely known, yet when experts talk about the history of transplantation, names of other great figures tend to be mentioned, such as Norman Shumway, Roy Calne, Thomas E. Starzl, and Denton A. Cooley. These worked in international centres of surgical research such as Stanford University in California; Houston, Texas; or Cambridge, England — while the man who beat them to the goal and outshone them all in the public mind was apparently a relative outsider: Barnard, working at the University of Cape Town (above) under the pressures of the apartheid regime of the time. How did that happen?

The recent history of Groote Schuur Hospital by Anne Digby and others [2] shows that research at Groote Schuur had developed after a slow start in the 1950s and flourished until the 1980s, though bedevilled by government policies: in the 1960s and 1970s black students were not allowed to cross the corridor which separated the wards for black patients from the white wards. It really was Barnard's first transplant operation on 3 December 1967 which put the hospital on the international map.

The background to these events is presented in a vivid lecture given on 25 January 2011 by Dr. David Cooper to the C.F. Reynolds Medical History Society at the University of Pittsburgh. The lecture has been made available on the internet by Dr John Erlen at the School of Medicine, University of Pittsburgh. [3] Dr. Cooper was a surgical associate of Barnard and evidently knew him well. As Cooper shows, there were other names as well, notably "the great John Lewis" (whose achievements in the field went unrecognized) and James Hardy of University of Mississippi at Jackson. Still, Barnard had had the idea of a full human heart transplant in his head for a long time (as Cooper shows from a chance remark made by Barnard early in their acquaintance, while talking about the inadequate treatment a heart patient was receiving). As a result, when he did carry it out, he was remarkably casual about it, showing that he had gone over it in his mind many times without telling anyone. Contrary to legend, Cooper shows that the procedure (apart from a bad patch in the 1970s) was usually very successful in prolonging the lives of patients.

It's a long way from the work of Edward F. Bland, though there is a connection: Barnard developed his techniques of cardiac surgery in the Tetralogy of Fallot, one of those anatomical anomalies that Bland was so interested in. Bland did live to see the establishment of transplantation: he himself must have been blessed with a good heart, for he died in 1992 at the age of 91.

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The history of the Knights of Malta (Knights of Rhodes, Knights Hospitallers, Knights of St John) was one of the interests of the founder of the Wellcome Library, Henry S. Wellcome. He acquired a substantial archive of their papers in Paris in 1933 (subsequently returned to Malta), and several iconographic documents, most notably this painting by Antoine de Favray. In recent years the Knights have focused their medical activities on specific fields such as refugees, people with leprosy, and – most conspicuous in Great Britain -- emergency services: their British outcrop St John's Ambulance is a familiar presence at crowded events such as football matches, gigs and royal weddings.

One of their contributions to emergency medicine was a campaign in France in the 1960s called "Don du souffle" (Gift of breath). Judging from this poster (above: Wellcome Library no. 744037i) which sports the Cross of Malta in the top right corner, it was intended to educate the French public in the possibilities of cardiac resuscitation. The heart — a small organ normally enveloped by the larger lung — is here brought into the foreground, being presented as a red berry on the green leaf of a single lung which folds out from the trachea. Highly stylised anatomy, of course, but all in the aid of saving lives by drawing attention to what can be done with the heart and lung.

[1] Memoir of Bland: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376608/pdf/tacca00084-0039.pdf

[2] Anne Digby and Howard Phillips with Harriet Deacon and Kirsten Thomson, At the heart of healing: Groote Schuur Hospital, 1938-2008, Auckland Park, South Africa: Jacana, 2008, pp. xiii, 281-285

[3] David K.C. Cooper, 'Chris Barnard and the story of heart transplantation', URL: http://mediasite.cidde.pitt.edu/mediasite/Viewer/?peid=0934815fd4154df984f71032e0fe61d1. See also his book Open heart: the radical surgeons who revolutionized medicine, New York: Kaplan Pub., 2010

In the mood for surgery

Hot on the heels of this week's Classic Rock Awards in London comes the revelation that surgeons use music to promote an atmosphere of calm during operations, including songs by the Eagles (truly 'Classic') and David Bowie. This was never a particularly well-kept secret but one surgeon recently revealed that he programmed a series of his favourite 5 minute tunes especially for the tricky removal of a prostate. This gave him an audible way of marking time as the procedure took about 25 minutes.

You can listen to music inspired by DNA held in the Library or even read about the history of music therapy here. All together now, "the first cut is the deepest..." I know that's terribly cliched, so please feel free to post me your better efforts...

A novelist's bicentenary

Elizabeth Gaskell, the novelist, was born 200 years ago today, on 29th September 1810.

The huge success of the BBC’s version of Cranford (which added several of her other short stories to the adaptation) and, a few years before that, a high-quality version of North and South, have made her name a familiar one to a modern audience. For many years, however, she seemed destined to be treated as a footnote to other people’s stories. For much of the nineteenth and early twentieth centuries, she was known as a novelist basically for Cranford: for all its charm, this is perhaps one of her minor works and certainly made it possible to see her as a milder, more demure figure than the reality. In addition, as feminist critics rightly pointed out, the tendency during this time to refer to her as “Mrs Gaskell”, without a forename, tended to reduce her individuality (it also made it hard to distinguish her from similarly-named lesser writers such as Mrs Oliphant or Mrs Humphrey Ward). During her years of neglect, the other one of her works to enjoy continued currency was her biography of Charlotte Brontë: again, this gave her prominence but only as the friend and biographer of Brontë (whose biography, being first in the field, would often be attacked ritually by anyone seeking to justify the need for their own subsequent work).

From the 1950s onwards, her novels exploring the social consequences of the industrialisation she saw around her in Manchester – Mary Barton and North and South – were given more and more prominence, but again at the cost of lumping her into a literary-historical moment, treating these works as part of a collective whole called “The Condition of England novel”, in which Gaskell, Kingsley, Disraeli and others formed a rather undifferentiated supporting cast to Dickens’ Hard Times. It has taken the determined rediscovery and re-excavation of women’s writing from the 1970s and 1980s onwards to bring her to prominence on her own merits as an accomplished and varied writer: not as someone else’s wife or biographer, or a bit-part player in literary history, but as Elizabeth Cleghorn Gaskell (née Stephenson), novelist.

We might not think of her instantly as a writer who explores medical themes (although anyone who saw the TV adaptation of Cranford will have vivid memories, maybe too vivid, of Philip Glennister as Mr Carter having a leg amputated without anaesthetic). However – as any visitor to the Wellcome Library can vouch – what is “medical” can be defined very broadly, and many broad social or scientific issues turn out to be grist to the medical-historical mill. The industrial revolution involved huge social and scientific changes, very many of which had medical implications, and Gaskell’s works demonstrate a vivid eye for this changing world around her. Science and industry impinge on her novels frequently, even in those not explicitly to do with “the condition of England”: the rural idyll of Cranford, for example, is invaded by the newly-invented railway, and in her last novel Wives and Daughters the central male character, Roger Hamley, is a naturalist whose commitment to scientific rigour and clarity mirrors his personal qualities of honesty and uprightness. Most notably, of course, it is in those novels that explore the social consequences of industrialisation, and take the reader into the same Manchester slums that Engels described, that the public-health consequences of the Industrial Revolution are all around us, the ill-lit and ill-drained slums where the poor sleep surrounded by filth. The presentation of Gaskell as a meek, dove-like figure whose works were limited to a female world of charm and manners, which predominated in the early twentieth century, is a long way from the truth.

With that in mind, it should perhaps come as no surprise that Elizabeth Gaskell is represented in the archives collection of the Wellcome Library. Our MS.7141 comprises a letter from Gaskell to a friend named Ann Scott (the wife of the principal of Owens’ College, which would evolve into Manchester University), written around 1854, in which she discusses the medical case of a Mrs Glover of Bury. Mrs Glover is suffering from a uterine cancer and, it is clear, her prognosis is not good. Gaskell explains that there is a possibility of her being operated upon by Dr Protheroe Smith at the Women's Hospital in London; however, she makes it clear that she thinks that this is unlikely to heal her and that there might be no point in subjecting Mrs Glover to the pain and stress of unnecessary surgery. (Dr Smith, she indicates, has a track record of pressing ahead in such circumstances to an extent that she feels might amount to positive cruelty.) The alternative, she suggests, might be to experiment with reducing pain by using mesmerism: a concept that had been around since the start of the century, and which - despite the lack of an agreed model explaining it – had been used to perform pain-free operations in the place of anaesthetic. (Coincidentally, active in Manchester at the same time as Gaskell was the general practitioner James Braid, whose work on these phenomena was to explain them in terms of actions upon the mind of the subject rather than the nebulous physical explanations centring on a “magnetic fluid” that had been favoured by mesmerism’s inventor Franz Anton Mesmer: it was Braid who gave these phenomena their modern name, “hypnotism”.)

It is a suggestive vignette, pointing us in various directions: demonstrating Gaskell’s interest in medical issues and a willingness to think beyond the box of orthodoxy in looking at therapies, opening discussions on male practitioners’ treatment of the female body and of women’s illness, echoing modern concerns about medical invasiveness versus palliative care for the terminally ill. The letter is discussed in detail in an article in Medical History (Christopher Hilton, "Elizabeth Gaskell and Mesmerism: An Unpublished Letter", Medical History, 1995, 39: 219-235), published not long after the Library acquired it; the article - including a transcript of the letter - is freely available here. Although it is our only Elizabeth Gaskell item, it fully earns its place in our holdings: it links to all sorts of issues discussed elsewhere in the collection and demonstrates another way in which this intelligent, aware woman engaged with the changing world around her. Two hundred years on from her birth, we salute her: Elizabeth Gaskell, nobody’s footnote.

Images, from top:
1/ Elizabeth Gaskell, c.1851, from Wikimedia Commons.
2/ Manchester soup kitchen, mid-19th century, from Wellcome Images (image number L0004800).
3/ Manchester workers' dwellings, mid-19th century, from Wellcome Images (image number L0004801).
Images made available under Creative Commons licence.

Fire, Riot and Compound Fracture

"Hannah Stewart, 21 years of age of a good habit of body, a married Woman was brought into the Hosp[ita]l on Wednesday night the 7th Inst. with a compound Fracture of the Wrist Joint wherein both Radius and Ulna were fractured, and the soft parts received considerable Injury…"

On June 7th 1780 – almost exactly 230 years ago - a young woman is brought, no doubt frightened and in severe pain, to St Bartholomew's Hospital with a serious injury to her wrist, and other soft tissue wounds. She is seen by Percival Pott, the Surgeon of St Bartholomew's: a man of considerable eminence in his field, and as luck would have it someone who is chiefly remembered now for his work on compound fractures. A medical man named Watt writes notes on the case in a tall, narrow volume now held at the Wellcome Library as MS.4337. For the moment, the survival of her arm is in the balance. Her pain and distress, however, form part of a wider historical picture: she comes to the hospital on that summer night as a result of a train of events that began a few days earlier, exactly 230 years ago on June 2nd 1780.

London in 1780 was a city in ferment. The explosive growth in Britain's trade and industry during the preceding century had led to an expansion of the city's population and even further strain placed upon the creaking assemblage of local bodies, many of them private or voluntary, responsible for the city's infrastructure. Perhaps most significantly, there was no centrally organised professional police force. The London mob was notoriously volatile and, in these days before the vote was extended to any but the better-off, riot and civil disorder were almost the only means whereby the populace could make its views felt to power.

To this explosive mix was added the strain of war. By 1780 the American colonies had been in revolt for some years and there was considerable political division, not merely over the competance of the government's war effort but also over whether the war should be fought at all: many sympathised openly with the rebels, whose maxim that if one was taxed by a government one should have the right to elect it struck a chord with many radicals on this side of the Atlantic. The colonists' allegations of despotic behaviour by George III and his ministers mirrored similar allegations made by British critics of the status quo.

Into this volatile situation arrived the issue of Catholic emancipation, in the shape of the 1778 Papists Act that reduced some of the restrictions placed upon Roman Catholics by law. To the twenty-first century reader, it seems axiomatic that greater religious tolerance is a progressive cause. In the eighteenth century, however, this was not necessarily accepted. Catholicism for many had been associated with attempts by foreign despots to subdue English or British independence: the liberties of the British subject and of Parliament, as established most notably after the Glorious Revolution of 1688, had been prised out of the grip of Stuart monarchs who were Catholic in their sympathies and often allied with Catholic absolutist régimes abroad, such as the France of Louis XIV. There was widespread fear – whether or not this was justified – that extending liberty to Roman Catholics was the thin end of a wedge that would end up with absolutism and the denial of liberties to all. Particularly pointed was the issue of the army. The inheritors of the Glorious Revolution settlement had a strong mistrust of a large standing army, as a tool that could potentially be used by a despotic monarch. One driver of the 1778 Act was the need for more soldiers to wage war in America: in order to achieve this, it would be made easier for Catholics to join the army by absolving them of the requirement to take an oath to defend the established religion. To some this measure looked profoundly dangerous: not merely letting loose a force that tended to despotism, but arming it. To understand the events of 1780, we have to put away our modern ideas about religious tolerance and try to see this situation as its contemporaries did; only then can we make sense of the forces that converged to bring Hannah Stewart to St Bartholomew’s on that June night.

In 1780 Lord George Gordon, a gifted and eccentric propagandist, became President of the Protestant Association, whose aim was to force the repeal of these new measures. Playing on the fears of despotic monarchy and a Catholic army outlined above, he managed to prevent the legislation being extended to Scotland, but had no success in gaining its repeal in England and Wales through peaceful channels. In late spring 1780, he took his campaign to the streets. Now the pace of events quickens, hurrying Hannah Stewart towards her injury and meeting with the surgeon Percival Pott.

On June 2nd, 230 years ago today, the Protestant Association led a march to Parliament to deliver a petition for the repeal of the 1778 Act. The march on June 2nd was huge, estimated at around 50,000 people and swelling as it passed through the city waving banners proclaiming "No Popery". On arrival at Westminster the crowd attempted to force their way into the House of Commons: Lord George Gordon was allowed in to hand the petition over but his followers remained outside, milling around in a state of agitation without a clear object. It was almost inevitable that this situation turned ugly. Members of the House of Lords, arriving for a sitting, were attacked and their carriages destroyed. Although troops eventually dispersed the mob around Parliament without violence, it was the beginning of several days of sporadic, increasing disorder. Later that night there were attacks on the embassies of Catholic powers and areas known to house rich Catholics. The following night the poor area of Moorfields, home to many Irish Catholic immigrants, was ransacked and many houses burned. Dickens in his novel Barnaby Rudge gives vivid descriptions of days of mounting disorder, of how the Lord Chief Justice's house was attacked, how Newgate Prison was broken open and largely burned down, how streets filled with looters were lit by burning houses as the gutters ran with blazing alcohol. The situation deteriorated until 7th June, when the Army was called out to disperse any assemblies of more than four people, with orders to start shooting if they refused.

Here we return to Hannah Stewart. It is the night of 7th June when she is brought to St Bartholomew's, and the passage immediately after the one quoted at the head of this article identifies the cause of her injury:

Both Radius and Ulna were fractured, and the soft parts received considerable Injury from a musket ball shot by one of the soldiers who was on duty quelling the disturbances that arose…

Whether a rioter or a bystander, Hannah Stewart is one of the walking wounded who were the casualties of that night. In a sense, she is lucky – almost three hundred were shot dead in the suppression of the rioting. Although she cannot have thought herself fortunate, she is also in luck in the man who sees her. Percival Pott was a senior man at the hospital, at the height of his career, and an important figure in the slow rise of surgery to medical respectability. Before the advent of anaesthesia and antisepsis in the second half of the nineteenth century, surgeons were the poor relations of the medical world: their profession depended heavily on speed and strength as much as skill and knowledge, and deaths of their patients were common. The rise of surgery to its current exalted position, rather than its being perceived as next door to butchery, was a slow process. Pott was instrumental in some of the steps along the way. He was born in London in 1714, in Threadneedle Street – the rioters who attacked the Bank of England in 1780 were probably attacking a building put up over his birthplace. Like most surgeons of the time he learned on the job, by apprenticeship to the then Assistant Surgeon at St Bartholomew's, Edward Nourse. He became Assistant Surgeon himself in 1745, the year in which the Surgeons at last formed their own professional organisation: previously they were governed by the one of the City of London's craft guilds, the Barber-Surgeons' Company, a combination that reflected the way one man might in the medieval and early modern period combine surgery and bone-setting, hair-cutting, tooth-drawing and various other skills. In this year, however, a separate Company of Surgeons was formed, marking a step in the march to medical respectability. (Twenty years after the Gordon Riots, the Royal College of Surgeons of England was founded and replaced the Company.)

Pott himself was instrumental in another such step when, in 1756, he was thrown from his horse and suffered a compound fracture of the leg. At the time, amputation was often seen as the only remedy; however, Pott and Nourse, his old master, concluded that the leg could be saved. Convalescing afterwards and unable to work, Pott discovered a talent for writing about medicine; he used the time at home to write a treatise on hernias that was the start of a string of monographs issued over the next decades. Among them, in 1768, was a work on Fractures and Dislocations which drew on his own experience when describing compound fracture of the long leg bones. The combined fracture and dislocation of the ankle that he analysed in this treatise is now known as a Pott’s Fracture after his description. As well as writing copiously, Pott had a large and eminent private practice, being consulted by (among others) the writer Samuel Johnson, the painter Thomas Gainsborough and the actor David Garrick. Hannah Stewart is being seen by London's top surgeon, and a man who had made a particular study of her type of injury.

The seriousness of that injury can be judged by the fact that Pott, according to the casebook, gave little hope for her hand: "From the appearance of the Fracture at the Time, … it was thought advisable to amputate". Hannah Stewart, however, refuses: "the woman not giving her consent, the wound was put up in a common Poultice." "Opiates were given to appease the pain" but she must have remained in severe discomfort. The case history, written up a few days later, notes "her arm today looks less inflamed - but rather painful – her hand is swell'd and also painful. Mr Pott saw it and ordered her to go on with the Poultice. Some small fragments of loose stones were taken out on her admission."

At the foot of the page, Watt scrawls "Discharged well." The absence of inflammation means, perhaps, that she has escaped serious infection, which would be a key factor in keeping the limb; Pott identified the presence or not of inflammation as a key to prognosis in fractures when describing his own case. Whether infection developed later and she lost the hand after all, where she went on leaving the hospital, and where her bones lie – shattered or otherwise – is unknown. But in this one page from the hospital casebook we see a vivid window opening into the past, showing us how various historical forces converge on that summer night in 1780 and how, at the point that they meet, a young woman lies afraid and in pain, not knowing whether the next day will bring her an appointment with the surgeon's knife.

After the rioting was put down by troops, Gordon was tried for treason, but found not guilty. However, he died some years later in the rebuilt Newgate prison, confined there after further political activity. In a final interesting twist, he was buried not far from the Wellcome Library. Just north of the Euston Road lies the former churchyard of St James's, a church that was originally a chapel in a burial ground serving the parish of St James Piccadilly, set up when central London began to run out of space for burials. In the nineteenth century the space was converted to a park and the gravestones stacked around the edges. A Victorian plaque at the Hampstead Road entrance, now sadly dilapidated, proudly records its conversion to public open space, but makes no mention of the eccentric agitator whose grave lies somewhere below the pleasure garden and children's playground.

Illustrations show, in order: Wellcome MS.4337 (close-up and full page); the burning of Newgate Prison; an early 19th century collection of images of St Bartholomew's Hospital; Percival Pott; and the entrance to St James's Gardens today.

Re-edit medical history film

A new addition to the Wellcome Film project has been made: downloadable videos to keep, edit and watch as you wish from your own computer. The videos are H.264 (MPEG4) format and broadband resolution (2Mbps), easily playable by both Mac and PC users. To download, simply find the title you want in the catalogue searching the Wellcome Film homepage, and click on the 'Download entire title' link in the catalogue record.

All videos on the Wellcome Film website are made available under a Creative Commons Attribution-Non-Commerial 2.0 UK licence, so go ahead and edit away! If you do use any of our videos in one of your projects, please let us know by leaving a comment on our blog or on our YouTube channel - we'd love to see them!

In other Wellcome Film news, our YouTube channel was featured on Wired's website bringing a new audience to these medical films. The most popular video as a result of this is now Prefrontal Tuberculoma, a 1933 surgical film showing the removal of a brain tumour caused by tuberculosis (not for the faint of heart - see below).

Author: Lucy Smee

Baffling Bodies

If you have difficulty telling your clavicle from your patella, and have never considered who discovered Fallopian tubes this is the course for you. A weekend of workshops and activities will take you through the history of how we have understood and learnt about our bodies, looking at the human form through the eyes of artists, scientists and history buffs. Designed for beginners, you’ll need curiosity and enthusiasm but no previous knowledge. The event will be held on September 5-6 between 10am and 4pm.

Activities will include:

Dem Bones – exploring human remains with osteoarchaeologists from the Museum of London

Renaissance surgery demonstration – Roll up ! Roll up ! Get your gangrene seen to here ! Volunteers for amputation will be required.

Pickled bits and stitches – a visit to the Hunterian Museum at the Royal College of Surgeons, plus a surgical skills workshop.

A beginner’s guide to the history of anatomy - an informal talk with the chance to explore original material from the Wellcome Library’s collections.

Exquisite Bodies – a tour of the Wellcome Collection temporary exhibition looking at 19th century anatomical models.

Creative workshop – inspired by the Exquisite Bodies exhibition, you will create your own model with the help of a professional artist.
Cost: £30 per person. Refreshments and lunch will be included on both days.

Booking will open later in July. If you would like to be notified when booking opens, or have any queries, please email us.

Author: Eleanor Lanyon

Blood and Guts in the Wellcome Library

Currently airing on Saturday nights on BBC2 – and so available to watch through the BBC iplayer – is Blood and Guts: A History of Surgery.

First shown on BBC4 last year, the series charts the "brutal, bloody and dangerous history of surgery", often with the use of graphic imagery from modern day operations.

Slightly less visceral is the accompanying book for the series, which includes the following acknowledgement from its author, Richard Hollingham:

"If there is one institution that made this book possible, it is the Wellcome Library. I have spent many happy hours there, leafing through old books, papers and journals... The biggest problem with the Wellcome Library is that it is very easy to get diverted. I spent an afternoon reading graphic case notes on early eye operations, only to realize there was no space for them in the book..."

The continued adventures of Wound Man

Late medieval anatomy works often contain a standard set of illustrations, copied and recopied from text to text. Typically, these depict the body front and back; the skeleton and muscles within it each from the same two viewpoints, and so on. Strangest to our modern eyes is the illustration that usually comes last: the Wound Man, a compendium of all the injuries that a body might sustain. Captions beside the stoic figure describe the injuries and sometimes give prognoses: often precise distinctions are drawn between types of injuries, such as whether an arrow has embedded itself in a muscle or shot right through. (The latter is better – the arrowhead can be cut away and the shaft withdrawn smoothly, whilst the embedded arrow will tear the muscle with its barbs when pulled out.)

Once seen, never forgotten: the Wound Man feels like an old friend to many Wellcome Library users, and the example here from our MS.290 has adorned several items of Library publicity. It’s interesting, then, to see him appearing in a new twenty-first century context: as part of the current Queer Up North festival, the one-man show The Adventures of Wound Man and Shirley sees our medieval figure reimagined as a superhero, a “freelance social interventionist” (now decently clad in a posing pouch). The centuries pass and Wound Man endures, dealing with everything that life can throw at him, an example to us all.

History of Surgery Timeline

'The Operation: Surgery Live' will be shown on Channel 4 on four consecutive nights from 25 May to 28 May. The series is being made by Windfall Films in association with Wellcome Collection. It aims to offer a unique insight into modern surgery by allowing viewers to interact with the operating theatre as the operations are carried out.

To provide context for the series, Windfall Films have worked with the Wellcome Library to produce a History of Surgery Timeline, illustrating surgical techniques and practices from the Neolithic period to the present day.

More information on the series is available through the Wellcome Trust's website.