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Case Studies in Blame: Victorian Physicians, Working-Class Women and Tuberculosis in Scottish Charity Hospitals by Amy W. Farnbach

“Uncleanliness of the mind and body act and react,” wrote the Edinburgh-trained physician J. Milner Fothergill in his 1874 Maintenance of Health, “and perfect health of one is incompatible with an unhealthy state of the other.” The Victorian middle classes held that good health was an individual responsibility, requiring careful attention to moderation in diet, dress, activity, entertainments and habits of mind. Although medical science during this period progressed rapidly toward an evidence-based understanding of the causes and diagnosis of disease, physicians too embraced these attitudes. For diseases such as tuberculosis, physicians and laypeople alike believed that illness was prevented by healthy (that is, middle class) behavior, even after Robert Koch’s 1882 discovery of the bacteriaresponsible for the disease. Women and the working classes were particularly called upon to rein in their behavioral excesses: women due to their perceived risk for illness and their responsibility for the moral health of the social body, and the working classes due to the prevalence of infectious diseases in poor neighborhoods and their contributions to the physical and fiscal health of the social body. These middle-class fears about the declining health of the social body are illustrated in the ways working-class women are doubted, blamed or held blameless for their own and their families’ ill health in three tuberculosis cases from the mid- to late-Victorian Era at Glasgow Royal Infirmary and the Royal Infirmary of Edinburgh.

In December 1855, Mary R. was admitted to the Royal Infirmary of Edinburgh for a cough of three years’ duration, recently increased and accompanied by blood (Lothian Health Service Archive LHB1/129/5/22, pp. 105 – 109). Her occupation noted as dressmaker, the medical staff recorded that Mary “states that she has always been well-fed and well-kept, and little exposed” to the elements – indicators that she has taken appropriate care to maintain health – “but she is reputed as a femme du pavé,” or prostitute. Despite this negation, Mary’s own account of her health is corroborated later in the intake notes, where she is described as “tolerably healthy looking and well nourished.” Both Mary’s self-report and the evidence of her appearance as to her healthy habits are called into doubt by the rumor that she engages in sex work. In this way, evidence of immorality – however flimsy – could be used to explain Mary’s tuberculosis even though she and her appearance suggested that she endeavored to stay healthy.

Women’s behavior could make others ill as well. In June 1893, John T. presented at the Glasgow Royal Infirmary complaining of weakness and weight loss (Greater Glasgow and Clyde Health Board Archive HH67/7/5, pp. 200 – 201). He blamed his “little cough” on drafts in his office. However, medical staff took care to note, “Patient is married but owing to the intemperance of his wife has been separated from her for some years. He has been much neglected in consequence, careless housekeeper, badly cooked food et cetera and this may have to do with his present condition.” Here, two women’s failure in their domestic duties are identified as a cause of the patient’s tuberculosis. As in the case of Mary R., the patient’s own account is discarded in favor of an explanation rooted in middle-class beliefs about women’s responsibility to maintain the health of the social body.

Even when held blameless, women’s medical treatment illustrated the importance of these social norms in explaining ill health. Grace M. was conveyed in a very weak state to the Royal Infirmary of Edinburgh in March of 1855 following a three-year decline (Lothian Health Service Archive LHB1/129/5/19, pp. 180 – 182). Her history was recorded with Dickensian flourish by the medical staff, who recorded that although Grace’s dwelling was “never gladdened by the presence of a winter fire … the fatal glow of fever defended her unprotected body against the piercing cold of the night.” Medical staff noted further:

Even the morsel of bread which now and then fell from the hand of charity or was earned at the price of the most abject labour, did not every day fall to her share; and to satisfy the cravings of hunger, to restore a little warmth to her shivering limbs, and to drown in oblivion the remembrance of her former days and the wretchedness of her present condition, she had given herself up to the use of ardent spirits.

Here, three distinct explanations are given for her excessive use of alcohol alone. Indeed, it is noted that “having been brought up in comparative ease and affluence, she had suddenly been thrown into the midst of the greatest poverty and entire destitution.” Grace is poor by circumstance, not by constitution, and her blamelessness extends from poverty to all her deviance from middle-class norms of behavior, including her illness.

Through doubt, blame and exoneration in these three illustrative cases, the medical staff of the Glasgow Royal Infirmary and Royal Infirmary of Edinburgh echo and underscore middle class unease during the mid- to late-Victorian Era regarding the physical and moral health of the working classes. A recursive relationship between health status and social status led Mary R.’s apparent care for her own health to be doubted as a result of her rumored sex work, John T.’s intemperate wife and careless housekeeper to be blamed for his illness, and Grace M. to be pitied for the fall in socioeconomic status that led to her illness. In all three cases, it is necessary for the women involved to adhere to middle-class expectations in order to mitigate the stigma of contributing to their own or others’ illness. We are left with an impression of ill health as deviance that is compounded by other forms of marginalization such as poverty, femininity and unregulated behavior, increasing the stigma faced by the marginalized ill. This is, in a sense, performance of the Victorian social order within the clinic, and establishes the clinic – despite its increasing reliance on an unbiased, scientific posture – as a microcosm of the prevailing social order.

Amy W. Farnbach Pearson received her PhD in Anthropology from Arizona State University. She is a historical anthropologist specializing in the social construction of medical knowledge and practice; her dissertation focused on the diagnosis and treatment of tuberculosis in nineteenth-century Scottish charitable hospitals. This blog draws upon both her dissertation and her 2020 chapter “Restoration to Usefulness: Victorian Middle-Class Attitudes Towards the Healthcare of the Working Poor” in Disability and the Victorians: Attitudes, Interventions, Legacies, edited by I. Hutchison, M. Atherton and J. Virdi (Manchester University Press).

Doré, Gustave. 1872. Wentworth St, Whitechapel. Credit: Wellcome CollectionAttribution 4.0 International (CC BY 4.0)