BBC Free Thinking Feature: Bamburgh Castle Surgery, c. 1770-1800

Over the past few years I’ve been working on the records of a unique eighteenth-century medical institution. The eighteenth century saw the rise of institutional medicine, first in the form of hospitals and infirmaries, and later dispensaries. The former were large, imposing buildings in a town landscape, housing inpatients and treating surgical cases, as well as other conditions. Dispensaries were smaller, sometimes occupying existing buildings, but generally acted as outpatient services where the poor could be given medicines, patched up if necessary, and sent on their way.

Both hospitals and dispensaries were funded by subscription. Subscribers were invited to pledge an annual sum of money, put towards the building, running and upkeep of the institution. In return, subscribers had the right to recommend patients for treatment, according to the size of their donation. Unlike today, patients could not simply turn up at the doors, unless in absolute emergency. Instead, they required a certificate of permission, signed by a subscriber and, as such, could be difficult to access at times.

Image from Wikimedia Commons
Image from Wikimedia Commons

Also, institutions were firmly urban in nature. They were closely bound up with the civic ambitions of Georgian towns. A hospital could be a strong statement about a town’s importance and beneficence to the poor. ‘See how kindly we look upon our poor objects’.

Unsurprisingly demand for these facilities was high. Even outside London, annual admissions could number in the thousands. Especially in the crowded and often unsanitary conditions of towns, conditions like epidemic fevers were rife.

But one medical institution stood apart – both literally and notionally – from the rest. In the 1770s, Dr John Sharp, Archdeacon of Northumberland, philanthropist, and member of a family which included a prominent surgeon and famous anti-slavery campaigner (Granville Sharp) was a trustee of a large charitable fund established by the late Nathaniel Lord Crewe. Crewe had set aside large amounts of money from land revenues, stipulating in his will that these were to be put to charitable use.

Image from Wikimedia Commons
Image from Wikimedia Commons

One of the properties was the dilapidated medieval Leviathan of Bamburgh Castle. Undertaking a massive programme of restoration, Dr John Sharp adapted the castle to a variety of charitable uses, including a school, corn charity, home for shipwrecked sailors and the surgery/infirmary.

With his brother’s advice (a surgeon at St Bartholomew’s hospital in London), Sharp equipped Bamburgh with the very latest in medical technologies, including an ‘electrical machine’ for literally electrocuting patients back to health, a full stock of medicines and equipment, and other modern apparatus such as the ‘machine for the recovery of the apparently dead’ – used to try and revive the recently-drowned.

L0011748 Title page: Report of the Society...recovery of persons

Last year I visited Bamburgh and made a short radio programme for BBC Radio 3, which is now available online.

Click on the link and then the ‘play’ icon in the new page to access the programme

For more about Bamburgh and its facilities, you can also click here for my ‘History Today’ article about Dr Sharp and his medical charity.

Reviving the ‘apparently dead’ in Georgian Britain

In the course of my research, I often come across great sources which, although they might not be directly relevant to what I’m looking for at the time, make great ideas for future topics. One that I encountered recently, while looking into the history of steel surgical instruments, was the following:

Charles Kite, An Essay on the Recovery of the Apparently Dead (London: 1788) containing “A Description of a Case of Pocket Instruments for the Recovery of the Apparently Dead”.

The question of whether it was possible – and indeed ethical – to revive the dead was certainly a hot topic towards the end of the eighteenth century. On the one hand, an increasing interest in the possibilities created by scientific and technological advances was increasingly rendering the impossible possible. This was the age of technological innovation and artisanal skill. Industrial luminaries such as Benjamin Huntsman, Josiah Wedgewood, James Watt and Matthew Boulton were all investing massively in new technologies, and their creations – from steam engines and pumps to everyday household items – were themselves heralding a new age. Scientific societies offered prizes to inspire would-be inventors to create useful products. Useful, in this case, often meant something that could advance agricultural or military prowess. But, with the creation of the Royal Institution, and an emphasis upon experimentation, endeavours towards the advancement of science for its own sake were also promoted. Science, it seemed, had the potential to unlock many of the mysteries of life and the universe…even death.

On the other hand, however, there was still a lingering tension between science and its relationship with religion. Could, and indeed should, man interfere in the natural processes and cycles of life. In many ways he already did. At the most basic level, medicine itself sought to prevent or delay death, or at least to palliate symptoms. There was some degree of uncertainty about when death actually occurred, and how to discern the point beyond which revival or resuscitation was possible.

Charles Kite’s book was part of a new interest in the question of death, approached from a scientific and essentially detached point of view. Among the types of death that men like Kite were interested in preventing were those caused by drowning. There was, indeed, even a whole society dedicated to the subject!

Accidental drowning represented a large percentage of causes of death, whether by accident or intention. It was also recognised, however, that this was a state that had the potential to be reversed. The opening sentence of Kite’s book reveals something of attitudes towards death by drowning.

“THAT the principle cause of the want of success in the recovery of the apparently dead, is the length of time that elapses before the proper remedies [my emphasis] can be applied, will admit of no doubt. It is equally certain, that this too frequently depends on circumstances wholly out of our power to prevent: but it is no less true, that cases terminating unfavourably often occur, to which, if proper and timely assistance could have been given, it is extremely probable they might have had a more fortunate conclusion”

It is firstly interesting to note that death is something potentially to be “remedied”; this immediately places it out of the metaphysical and into harsh corporeal reality. It is reversible. But more importantly, as Kite recognised, time was of the essence. If speedy assistance could be rendered, then more people could be saved.

The answer, as Kite saw it, was a device that could restart the respiratory process. Such devices were already in existence. In 1775, one “Dr Cogan” had contrived an apparatus and brought it to the attention of the Royal Society. According to Kite, “it soon came into common use and has remained so until the present day”. The problem, though, was one of size. Cogan’s apparatus was unwieldy and the delay in moving it from place to place often meant that the patient was dead (properly dead!) by the time it arrived. It involved, for example, an ‘electrical machine’ which was too impractical to use in the field and could not be scaled down. This image of the proposed apparatus highlights the problem!

Kite’s answer was a set of ‘pocket-sized’ instruments that could be carried from place to place with more ease, reducing the delay and thus raising the chances of successfully reviving the drowned person. Standard practice involved taking blood from the jugular vein of the patient but, depending on the length of time they had been in the water, getting blood from their rapidly deteriorating venal system could be tricky. The solution was to use Kite’s handy small instruments along with anything else at hand – even coffee cups – to draw off the requisite amount of blood, which was seen as the first stage in the process of revival.

Secondly, and more interestingly, though, was the recognition that the “suspended action of the lungs” had to be reversed. This was “of the utmost importance in our attempts to recover the apparently dead, let the original cause be whatever it might”. But how was this to be achieved?

Kite suggested an elastic tube, about twelve inches long, which had an ivory or silver mouthpiece, or bellows, attached to a conical screw. The other end had an ivory appendage to allow it to be passed into the deceased’s nostrils.  One person was to be stationed at the head of the body to insert the tube into the nose, and then to blow air “with force” through the tube. It was the job of the other person (the “medical director”) to keep the deceased’s mouth closed whilst also maintaining pressure on the windpipe to ensure that the air went into the lungs, rather than the stomach.

What is essentially being described here is artificial respiration. Perhaps less conventionally, however, Kite recommended the use of tobacco as a stimulant to further jolt the person back to life. This could be administered either as smoke passed through the tube and into the lungs, or passing it in solution to the stomach.

What can we learn from this source? Firstly, it highlights the sometimes remarkably ‘modern’ attitudes towards the body, and of reviving the dead, thought about and adopted by eighteenth-century medical practitioners. The application of sustained scientific enquiry into the body, together with the knowledge gained from anatomical studies was beginning to have a profound effect on medicine; some see this as the change to a ‘medicalised’ view of health and the body.

Secondly, though, it is a fascinating glimpse into an eighteenth-century medical treatise, written by a practitioner for practitioners. The sharing of essential knowledge, the questioning of accepted truths and the willingness to test new theories all come together to make the eighteenth-century a rich and absorbing period in the history of medicine.