Wednesday, June 2, 2010

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 rĂ©gimes 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.

 
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