There’s surely no more vibrant a city neighbourhood than the Whitechapel Road in the East End of London. I emerged from the Tube station into a teeming thoroughfare of people with faces and clothing from all over the world. The shops tucked below the old Victorian frontages were selling saris and exotic foodstuffs. A short walk west lies Whitechapel Gallery, where David Hockney had his first show, and Brick Lane, home to one of the world’s most famous street markets. I may be a Londoner, born and bred, but this part of the capital is a far cry from Westminster and has always felt different and exciting to me.
On this occasion I wasn’t here to look at paintings or eat delicious street food. The focus of my investigation was the block of old brick buildings across from the Tube station on the south side of the Whitechapel Road. The Georgian façade, with its gold lettering and clock high up in the pediment, once lent an air of elegance to the bustling street. Now it just looked abandoned. The windows were blanked out with hard-board, pigeons had used its ledges for target practice and weeds were sprouting.
The disrepair was a temporary state as the building was in the process of being repurposed as a new civic centre for the local council, Tower Hamlets. My interest lay in its original purpose, for this was the former London Hospital, which ministered to the sick and dying of this singular part of London for just over 250 years until it closed its doors in 2012. The hospital still exists – behind the old complex the Royal London Hospital (the regal handle was added in 1990 when Queen Elizabeth II visited) continues its work in a gleaming new edifice of blue glass.
Meanwhile the old wards and corridors, operating theatres and emergency rooms, were about to be gutted and rebuilt. Before this happened I needed to get in there and bear witness to the events of the past. For this was the scene of some of the most important breakthroughs in medical history, from anatomical research to X-rays. The hospital also provided an unlikely link between two of Victorian Britain’s most compelling figures, the so-called ‘Elephant Man’ and the depraved serial killer known as Jack the Ripper. There was a lot of history to unravel here and I was anxious to get on with it.
But first, as I stood on the Whitechapel Road amid honking horns and spiced aromas, I needed to remind myself of the background picture. In the late 1880s, around the time that many of the surrounding shops and houses were being built, Queen Victoria had been on the British throne for more than fifty years, presiding over an era of unrivalled economic growth and prosperity. Britain’s pre-eminence in the world was reflected in contemporaneous maps in which the countries of the British Empire, marked in pink, covered much of the globe.
Britannia truly did rule the waves, but not all her subjects lived lives that befitted such a powerful and successful nation. In 1889 another colour-coded map was published that told a different story about Britain. This was a ‘poverty map’ of London, produced by the social scientist and reformer Charles Booth, on which streets and neighbourhoods were coloured according to the wealth of the people who lived there. Before my visit to the Whitechapel Road I had studied it carefully online – and been shocked by what it revealed.
On Booth’s map the West End of the late nineteenth century is coloured predominantly yellow and red, indicating ‘wealthy’ and ‘well-to-do’, but as one’s eye tracks east and south, following the course of the Thames, the map darkens with patches of black and dark blue, representing the haunts of the ‘lowest class’ and ‘very poor’. These dark areas are most concentrated in Southwark and the East End, inhabited by citizens characterized by Booth as ‘vicious’ and ‘semi-criminal’, and suffering ‘chronic want’.
They lived in common lodging houses (the equivalent of night shelters) and slums known as ‘rookeries’, where disease was rife and mortality rates were sky-high. According to The People of the Abyss, a searing account of East End life by the American author Jack London, published in 1903, ‘the obscenities and brute vulgarities of life are rampant. There is no privacy. The bad corrupts the good, and all fester together.’
I zoomed in on the online image of the map and took a closer look. On the south side of the Whitechapel Road, in the very heart of the ‘abyss’ described by Jack London, is a square of neutral grey which marked a beacon of hope. For here stood the charitable institution called the London Hospital, which, on its foundation in 1740, was dedicated to ‘the relief of all sick and diseased persons and, in particular, manufacturers, seamen in the merchant service and their wives and children’.
Originally called the London Infirmary, it was the brainchild of several philanthropic businessmen who funded it by public subscription. Two hundred years before the launch of the National Health Service, the London Hospital was established precisely on the NHS principle of providing free healthcare irrespective of patients’ ability to pay. Having occupied two sites, in Moorfield and Whitechapel, it relocated to the Whitechapel Road in the late 1750s. The people it served were among the most cosmopolitan as well as the poorest in Britain, representing successive waves of immigration – Huguenots originally from France, Jews of Spanish and Portuguese descent, more recent Jewish arrivals from the pogroms of Russia and Poland, labourers from all over Britain and Ireland, and several generations of East Londoners.
As I unlocked the hospital’s old front door, and manhandled my way through ‘automatic’ sliding doors that had lost their electric power, I reflected that the hospital’s role in this cosmopolitan society remained essentially the same down the years. And, as I hoped to demonstrate, the singular needs of a diverse and impoverished neighbourhood were precisely what drove its pursuit of medical excellence and innovation.
On initial inspection the old place was a derelict version of any NHS hospital you have visited featuring familiar signage (‘Pharmacy’, ‘Haematology’) and wards now emptied of their beds but with the wall-mounted anglepoise lamps still in place. The operating theatres still retained those powerful lights, resembling a giant insect’s compound eyes. And in one I found an abandoned white clog, the footwear of choice for modern-day surgeons. But it felt as if this hospital that had seen so much was determined to feed me clues, for in one room I came across some photographic slides scattered across the floor. And when I stooped to pick one up I discovered that it showed a disfigured human face.
The photograph was probably taken within the last twenty years, presumably for training or educational purposes, but it provided me with an immediate and vivid link to an event in November 1884 and a story that reflects the true humanitarian spirit of the London Hospital. On that long-ago day in early winter, a young man made the same short journey that I had, from the north to the south side of the Whitechapel Road and into the hospital. It’s a distance of just a few yards but this man didn’t walk, he took a horse-drawn cab. And he was not wearing the usual street clothes of the day.
Instead he had on a long black cloak, voluminous slippers for his oversized feet and a peaked cap with a face veil. He was also carrying a calling card bearing the name of Frederick Treves, Lecturer on Anatomy at the London Hospital Medical College. The man was called Joseph Merrick and the clothes he wore were intended to disguise his profound physical deformities and spare him the horrified abuse of passers-by. He was better known then as the Elephant Man and though to many people he resembled a monster, he was far from monstrous. Rather, said Joanne Mungovin, ‘he was a gentle gentleman. There’s never been anyone like him.’
I had invited Joanne to the London Hospital to talk me through the Joseph Merrick story because she has a unique perspective. Not only is she from Leicester, Merrick’s home city, but she is a descendant of Tom Norman, the Victorian impresario who exhibited the Elephant Man to the public. Human ‘freak shows’ were common in those days – people suffering from gigantism or dwarfism (such as the American performer ‘General Tom Thumb’), ‘bearded ladies’, ‘fat ladies’, the limbless and multi-limbed could make a kind of living by agreeing to be gawped at. In 1884 Norman displayed the man he promoted as the Elephant Man in one of the shops that still exist near Whitechapel Tube Station (at the time of writing it’s a branch of JD Sports).
The proximity to the London Hospital was fortuitous all round. Having dropped in to view the exhibit out of professional curiosity, a hospital doctor gave a graphic account of the Elephant Man to Frederick Treves, then an up-and-coming surgeon and anatomy lecturer, and suggested he take a look for himself. Treves was duly fascinated by what he saw and arranged for Merrick to come to the hospital for a proper medical examination. It was he who laid on the cab for the short journey and gave Merrick his calling card.
Joanne had brought along an original copy of the paper that Treves wrote based on his examinations of Merrick at this time, entitled ‘A case of congenital deformity’, which was published in Transactions of the Pathological Society of London in 1885. She opened it at a lithograph, taken from full-length photographs, showing Merrick from the front and the back. His right arm and leg are grotesquely enlarged. His left arm and shoulder, however, appear normal and hint at the trim figure Merrick might have been. The left arm, Treves noted, was ‘a delicately shaped limb covered with fine skin and provided with a beautiful hand which any woman might have envied’.
Joanne also showed me a fascinating item she had borrowed from the Royal London Hospital Museum, the cap Merrick was wearing on the day he paid Treves a visit. It is peaked and could have belonged to, say, a railway-station porter of the time, except for its extraordinary size and the face veil sewn into it. ‘His head was about thirty-eight inches in diameter,’ she said, then pointed to the grey flannel mask beneath the peak. ‘If you look there you can see the little pillar-box slits where his eyes would see through.’
For Treves, at this time, Merrick was little more than a fascinating medical specimen. He recorded the man’s deformities with professional dispassion: the ‘enormous and misshapen head’; the skin like ‘a brown cauliflower’; the ‘enormous’ and ‘shapeless’ right arm; and so on. And after their encounter he continued on the upward trajectory of his medical career with no reason to believe their paths would cross again. But fate was to bring them together once more.
On the morning of 24 June 1886 Merrick was found collapsed at Liverpool Street Railway Station, having returned penniless from an ill-fated tour of the Continent during which his ‘manager’ had robbed and abandoned him. The policemen who attended him found Treves’s calling card in his pocket and sent a message to the doctor requesting his help. So it was that Treves rescued Merrick and brought him the short distance back to the London Hospital.
Merrick was put up in an attic room as a temporary measure, but Treves soon realized he could not simply turf him out on to London’s mean streets once he had recovered his health. So he spoke to the Chairman of the London Hospital, Francis Carr Gomm, who wrote a letter to The Times asking for help. It was, you might say, an example of Victorian crowdfunding, for the readers’ generous response enabled the hospital to provide Merrick with a bed-sitting room in the basement of the East Wing and fund his board and lodging till his death in 1890.
The actions of Treves and the hospital authorities in offering sanctuary to Joseph Merrick were extremely enlightened for their day. As Joanne told me, ‘The arrangement was incredibly unusual. This was a hospital for curing people, not a hospital for incurables.’ Treves visited him every day, coming to realize that he was ‘a gentle, affectionate and lovable creature’. And this touching friendship was also, in its way, a remarkable thing, a testament to the unique spirit of the London Hospital. For where else in Victorian Britain would a man at the pinnacle of society – subsequently made a knight and a baronet – sit down on equal terms with society’s ultimate outcast? In 1887 Merrick entertained an even more socially exalted guest when Alexandra, Princess of Wales, dropped in to shake his hand after attending a ceremonial opening of new hospital premises. Merrick had achieved celebrity status and establishment approval – and the London Hospital enjoyed a certain reflected glory from its association with him.
The suite of rooms where Merrick passed his days – and from which, at Treves’s insistence, all mirrors had been removed – was demolished a long time ago. But I was haunted by the thought of his circumscribed but relatively contented life here, strolling in the hospital garden on moonless nights and dreaming of one day living in a ‘blind asylum’ where his deformities could not be seen. He never realized his dreams of another life. He died at the London Hospital at the age of twenty-seven, probably of a broken neck due to the weight of his head.
The London Hospital, I was beginning to appreciate, was the kind of place where extraordinary stories accumulate, overlapping with other extraordinary stories. Much as he would be horrified by the idea, the gentle Elephant Man is linked to one of history’s most reviled and depraved figures through his connection to this place. While Merrick, a man who appeared monstrous, was hiding his face and his gentle nature from the world, a short distance away a man whose countenance we will never know was demonstrating the actions of a true monster. I’m referring, of course, to the serial killer known as Jack the Ripper, whose killing fields were all within a mile of the hospital. Did Joseph Merrick, on his lonely night-time strolls in the hospital garden, pause to listen to distant cries from the surrounding streets and wonder what he was hearing?
The Jack the Ripper case has gone down as the most notorious in the history of criminology, not just in Britain but around the world. He was never unmasked and speculation as to his identity has fuelled a lucrative and usually sensationalistic industry in books and films that shows no sign of abating. Plausible suspects are thin on the ground but they include George Chapman, a Pole who changed his name from Seweryn Kłosowski (he is thought to have been living in the East End in 1888 and was hanged in 1903 for the murder, by poisoning, of three women unrelated to the Ripper case). The American crime writer Patricia Cornwell claims to have spent $7 million in pursuit of her theory that the artist Walter Sickert was the true perpetrator. I rather think the money could have been better spent. Among other unlikely names put forward over the years by writers with books to sell are the author Lewis Carroll and the philanthropist Thomas John Barnardo, of Dr Barnardo’s fame, who studied medicine at the London Hospital.
I needed to bring some academic rigour to a case that, for all the millions of words expended on it, still felt out of focus. Was there a direct link between Jack the Ripper and the London Hospital? And what were the medical and criminological repercussions of the case? To answer these questions and lend their expert analysis I had enlisted the help of the historian and criminologist Dr Drew Gray, who specializes in nineteenth-century crime and punishment, and Dr Richard Shepherd, a consultant forensic pathologist who has conducted many autopsies at the London Hospital and is a student of the Ripper case.
‘The London Hospital is part of the landscape of the Ripper killings,’ said Drew, as we stood in its now unlit, deserted corridors. ‘They all take place within this very small geographical area. It was a dangerous place to live. Brutal attacks on individuals, and particularly on prostitutes working at night, were quite common. There is quite a difference, of course, between the series of murders we associate with the killer known as Jack the Ripper and the more common everyday sort of murders because of the level of violence involved.’
The five killings generally attributed to the Ripper were committed over a ten-week period, starting on 31 August 1888 and concluding on 9 November. The victims – Mary Ann Nichols, Annie Chapman, Elizabeth Stride, Catherine Eddowes and Mary Jane Kelly – were all alcoholics who lived in local ‘common lodging houses’ (or, in the case of Kelly, a single room) and scraped a living from casual prostitution. All were mutilated and as the murder spree progressed, and the savagery of the mutilation increased, the fear and hysteria in the Whitechapel area intensified.
The killings would undoubtedly have been the talk of the London Hospital and there is a theory that the killer was a doctor or medical student at the hospital itself. ‘The speed with which this person mutilates and takes out organs from the bodies – on the street, in dim lighting – suggests to me it’s someone who knows what they’re doing to some degree,’ said Drew. ‘Now whether that’s a person who’s medically trained – it’s a difficult thing to judge. But I think there’s something in it. A doctor might fit the bill.’
Drew had brought along a copy of a letter purporting to be from the Ripper himself. It was sent to the chairman of the Whitechapel Vigilance Committee, a local builder called George Lusk, a fortnight after the murder of Eddowes in mid-October. ‘What’s interesting about this letter is that it arrived with a small parcel attached,’ he said. ‘When Mr Lusk opened the parcel he found inside what seemed to be a piece of human kidney.’ The barely literate note claimed this was ‘half the Kidne I took from one women’. The letter writer, who signed off with ‘Catch me when you can Mishter Lusk’, claimed that he had fried and eaten the other half of the kidney and revealed that ‘it was very nise’. To add to the Gothic tone, the address given at the top (and the name by which the letter has become known) was ‘From hell’.
Lusk’s initial reaction was to dismiss the package as a prank, perhaps perpetrated by a student at the London Hospital Medical College where the organs of dissected corpses could have been purloined relatively easily. Nevertheless Lusk took the specimen in the package to a local doctor whose assistant, Francis Reed, then took it to Dr Thomas Openshaw, the curator of the Pathology Museum at the London Hospital, for further examination.
There is some dispute about Dr Openshaw’s findings. According to Reed and subsequent newspaper reports, the doctor had confirmed the specimen was part of the left kidney of a woman of about forty-five years old (Catherine Eddowes was forty-six) who was a heavy drinker. But Dr Openshaw himself, in a newspaper interview, was far more circumspect, stating merely that the specimen was half a human kidney, probably from the left side. It is significant that even in the midst of the killing spree the sensational aspects of the case were being played out and argued over in the press. The role of popular newspapers in fanning the flames of speculation helped to create the Ripper myth and set the tone for subsequent reporting of gruesome murders.
But Dr Openshaw’s failure to arrive at harder conclusions about the nature and origin of the kidney in the package illustrates just how basic techniques in forensic medicine – the application of medical knowledge to establish the facts of a criminal case – were at the time of the Ripper killings.
No one is better qualified to disentangle medical fact from tabloid myth than the forensic pathologist Dr Richard Shepherd who in a long and distinguished career has acted as a consultant to the Bloody Sunday Inquiry and the investigation into the death of Diana, Princess of Wales. When I met him by the main reception desk he was shocked to find his old stomping ground devoid of life. ‘Walking up here just now was very peculiar because I knew it when it was a very busy, active hospital,’ he said. ‘I was often here doing dissections.’
Richard sees the Ripper murders as a seminal case in the history of forensic medicine, which was at an embryonic stage in the late nineteenth century. ‘They knew they needed to document injuries. They knew they needed to describe things. But they still weren’t doing it to the standard we would want today,’ he said. The case exposed the limitations of medical science and hastened the development of more sophisticated techniques that today form the backbone of criminal investigations. These include photographs and detailed records of crime scenes. Only one of the Ripper’s victims (Mary Jane Kelly) was photographed where her body was found. The others were not photographed until their bodies had been taken to the mortuary. In the Catherine Eddowes case the police made drawings and plans of Mitre Square, where her body was discovered. Eddowes and Kelly were the final two of the five definitive Ripper victims, so it seems the police investigation became more thorough and professional as the case progressed.
In Richard’s opinion the key medical fact common to all five of the murders was that they featured ‘a cut throat – from left to right’. He has also detected a ‘progression’ in the severity of the mutilation which is common in serial killers. Mary Ann Nichols, the first victim, died of a cut throat and then suffered slash wounds to the abdomen. Eddowes had a kidney removed. ‘In the fifth case [Kelly],’ he pointed out, ‘the body had been taken inside. It was in a tenement building, in a room. And what this means of course is that he’s sure that he’s not going to be disturbed. And that fifth body was extensively mutilated.’
As he talked Richard led me up to the third floor, where we entered one of the hospital’s oldest operating theatres, purpose-built around the turn of the twentieth century with large windows designed to admit as much natural light as possible. He agreed that Jack the Ripper could well have had some anatomical expertise. ‘But a lot of people could have had it. Abattoir workers, veterinary surgeons, doctors.’
By the late nineteenth century, the cutting up of human bodies had been the London Hospital’s stock-in-trade for a century or more. ‘The equipment hasn’t changed much in hundreds of years,’ said Richard, producing an old wooden box of bone-handled surgeon’s instruments from the early 1800s. ‘All it is is a set of scalpels and a pair of forceps. The reason they would have seven or eight scalpels in a box is that they would go blunt so quickly.’
Two hundred years ago such knives would have been wielded by a master surgeon in a theatre pretty much like this, as students stood in a gallery craning their necks for the best view. The study of medicine is reliant above all on knowledge of human anatomy. The only way to gain such knowledge is by dissecting recently deceased bodies, but fresh cadavers were often not readily available as few people would agree to having their mortal remains cut up after death – not least because the Christian churches taught that it might preclude their bodily resurrection.
‘Pigs and other animals were very commonly used as a dissection tool in the sixteenth, seventeenth, eighteenth centuries,’ said Richard. ‘There still were huge problems in getting human bodies for dissection and that continued until 1752 with the Murder Act, which meant that bodies could be used – but only the bodies of people who had been executed [by hanging].’
Under the Murder Act the bodies of executed murderers could be taken away and used for public dissections. But this provision made hardly a dent in the shortfall in cadavers. Many anatomy schools resorted, instead, to the services of so-called ‘Resurrectionists’ – bodysnatchers who emptied graveyards up and down the country through the eighteenth and early nineteenth centuries. But even in death the class divide prevailed. The well-to-do took care to bury their dead in locked mausoleums or sealed lead coffins. The corpses of the poor, often buried in pauper’s graves or obtainable through bribery, were far more accessible.
The Medical College at the London Hospital had become the country’s first purpose-built medical school when it opened in a building next to the main hospital complex in 1785. Its high volume of patients and the broad variety of diseases and ailments they presented with made it a particularly good place to pioneer new ideas and train young doctors. It prided itself on the quality of its anatomical dissections and was no different from other establishments in doing backstreet deals with grave robbers. But it also had a source of bodies even closer to home than the cemeteries of the East End.
At this point in the story I left Richard to his memories of the London Hospital and stepped outside to keep an appointment and breathe some fresh air. The air proved to have something of a fetid flavour, however, as you might presently appreciate. I left the main hospital building by the back steps, which led down to a large, empty yard of puddles and weeds. Behind it, the new buildings of the Royal London Hospital rose in a dazzle of blue-green glass. Waiting for me in the middle of the yard was Louise Fowler, an archaeologist with the Museum of London who had made an astonishing discovery here a little over a decade ago.
‘If you were standing on this spot in the early nineteenth century you’d have been in the burial ground that was attached to the hospital,’ she told me. The site of this burial ground was well known – but what it contained proved a revelation when Fowler and her colleagues carried out an archaeological dig here in 2006. They recovered the remains of at least 259 people and traces of 111 coffins, dating from the first half of the nineteenth century. ‘There was something quite unusual about some of the remains that we found in the coffins,’ she said. ‘We didn’t just find burials of complete individuals. We also found dissected remains.’ What had dumbfounded researchers was that half the men and a quarter of the women and children found in single graves had been cut up, while some coffins contained a mix of bones from several different men, women, children and foetuses.
Some of the bones were wired, indicating they had been used as models. Others had been sawed or nicked by scalpels. The conclusion, explained Fowler, was that ‘at the London Hospital they were using the bodies of dead patients for anatomical demonstrations. The bodies were being buried in the burial ground and then they were being dug up at night and taken into the medical school.’ This happened not just once or twice but as common practice: those who had died on hospital wards or in operating theatres were interred by day, exhumed by night, recycled through the Medical College for dissecting purposes and reburied once they had served their purpose – all with the collusion of the hospital authorities. There is also the suggestion that individuals within the hospital were profiting through the trade of these bodies to private medical schools.
Did patients understand what was going on? Did they watch the macabre spectacle of exhumations and reburials from their ward windows, in mortal terror of suffering the same fate? Contemplating this possibility, Louise and I both raised our eyes to the rows of hospital windows overlooking the yard. The windows were covered in hardboard – as if the hospital were maintaining a deliberately blank expression, refusing to admit this shameful episode of its past.
Medical progress, it seems, often comes at a cost – in this case the illegal, unethical practice of robbing its own dead from their graves and the horror felt by patients who feared for the future of their own mortal remains. In the case of the next breakthrough at the London Hospital, it was the doctors themselves who suffered. For centuries the only means of revealing the inner workings of the human body was to open it up with a scalpel – hence the unscrupulous trade in corpses. But at the end of 1895, at Würzburg in Germany, Professor Wilhelm Röntgen made an extraordinary discovery. Using electromagnetic radiation he created a ‘ray’ (he dubbed it ‘X-ray’) which produced an image of the inside of objects. His first proper X-ray was of his wife’s hand and he realized immediately the revolutionary medical potential of this technique: for the first time the internal structure of the human body could be examined for diagnostic purposes without the need for surgery.
By 1896 doctors at the London Hospital were already experimenting with the new technique, using a shed in the garden where Joseph Merrick had walked just a decade earlier. I returned through the back door for an appointment with Dr Adrian Thomas, a radiographer and student of the history of radiography. He had brought along one of the very first X-ray machines, an unwieldy wooden tripod supporting a glass tube, and set it up in a side room. ‘The problem with radiation is, it comes out in all directions,’ he said, patting his antique machine. ‘These early tubes had no protection around them which meant that everyone around was irradiated.’
The same applied to the next bit of kit he produced, an object that looked like a megaphone but was known as a ‘cryptoscope’. It was a handheld X-ray device that enabled the doctor to view the patient in real time, without the need to record an image on glass, paper or plate. ‘This imaging enabled us to make a diagnosis. The trouble was, both patient and physician were being irradiated,’ said Adrian. The results were certainly groundbreaking. He produced a radiographic sheet and held it up to the light. This was an X-ray of a knee, taken at the London Hospital in the early twentieth century. ‘Here’s the fibula, with a tumour inside it,’ he said, indicating a shadow where the bone joined the knee. But the pioneering radiographers who created such images were playing Russian roulette with their personal health. One of them was called Ernest Wilson and his dedication to medical investigation knew no bounds.
‘People used their own hands as test objects,’ said Adrian. ‘What happened to Ernest Wilson is that he had progressive damage to his hands called radiodermatitis. It’s like really bad sunburn that produces spasm and pain. Then his fingers began to show more severe changes and in a poignant way he took a series of X-rays that showed their progressive destruction.’ Adrian revealed the actual X-rays to me, which clearly indicated how Wilson’s hands and fingers had begun to disintegrate. Even as he fell critically ill, his capacity for objective self-analysis did not waver. ‘In the end,’ said Adrian, ‘he had his hands amputated and then died from radiation malignancy.’
Ernest Wilson was one of four radiographers at the London Hospital who sacrificed their lives to their pioneering work. Nowadays we may take the X-ray procedure completely for granted, but the next time I have one I’ll certainly remember Wilson and his colleagues in this hospital – just some of the early radiographers who came to be known as the ‘X-ray martyrs’.
Wilson’s sacrifice was entirely in keeping with the spirit of this hospital, which has always tested the boundaries of what is medically possible at the same time as reaching out to the impoverished community it served. Thomas John Barnardo studied to be a doctor here before establishing what would be the first of his Dr Barnardo’s orphanages for destitute children in 1870. In 1873 the hospital opened a School of Nursing, based on the principles of hygiene and organization championed by Florence Nightingale, and which from 1880 was run by her protégée, Eva Lückes, whom Frederick Treves described as ‘one of the ablest and most remarkable women of the age’.
By the end of the nineteenth century it was the largest charitably funded hospital in Britain, with more than 1,000 beds, and it retained its independent charitable status and philanthropic ethos until the creation of the National Health Service in 1948. The fabric of the original complex had been much adapted over the years, but by 2012 the old buildings were no longer considered fit for the purpose of a twenty-first-century inner-city hospital. The new hospital, which rose like a phoenix behind it, remains in the vanguard of best medical practice.
So I shut the door on the past and left the old place. Soon it will be a centre of local government, serving the community in a different way. I hope the new occupants erect an appropriate memorial to the doctors, nurses and staff who made this such a special hospital over so many years. And I trust those who work here and visit will spare them a thought for they – we – have all benefited from the pioneering work carried out under this roof.
My investigations, however, were not quite over. Having spent so long in the past, I took a trip into the twenty-first century – in the lift that transported me to the roof of the new Royal London Hospital. The view from up here rivals any in the capital – west to the shimmering skyscrapers of the City, east to the blue haze of the Thames estuary and the North Sea beyond. A windsock was flying, billowed out by a brisk south-westerly. And below it sat the symbol of the new hospital – a red MD902 Explorer helicopter with yellow and green flashes that indicate its role as an emergency vehicle.
This was one of the two choppers of the London Air Ambulance fleet, formed in 1989 and based on the top of the original London Hospital until 2012, when it switched to the roof of the new building. The air ambulances are crewed with an advanced trauma doctor and a paramedic who are capable of performing life-saving operations, including open-heart surgery, at the scenes of accidents. Whizzing above London’s congested streets, where the average traffic speed is 9 mph, they are capable of reaching 10 million people in an area of 600 square miles in just twelve minutes. This means they can attend to patients well within the crucial ‘golden hour’ when treatment is most likely to be effective.
We’re talking fine margins here. On 16 April 1999, a twenty-two-year-old man from east London was knifed through the heart in the Swan pub in Stratford. One of the two men who now strode forward to greet me took up the story. ‘We got a call: “There’s a stabbing in a pub,”’ said Alastair Mulcahy, a consultant anaesthetist at the Royal London and a trauma doctor on the Air Ambulance team. The victim was the man standing alongside him, Stephen Niland, who grinned ruefully.
When medics found Stephen slumped and losing lots of blood they knew it wasn’t just a question of stabilizing him and flying him back to the hospital for emergency care. They had to act swiftly and bravely, on the spot. Alastair and his colleague each took a pair of scissors and cut through Stephen’s chest from either side, meeting at the sternum. When they opened up the cavity they saw that the heart had stopped beating: ‘Then a jet of blood came out,’ said Alastair. Stephen’s grin froze at this point in the story. He may have heard and recounted it a million times, but no one likes to remember how close they came to death.
Stephen’s heart had been penetrated by the knife, so Alastair did the only thing he could do in the circumstances. He stuck his finger in the hole to stem the blood. He swiped up a photograph on his tablet, of an open and bloody chest cavity. ‘Here’s Stephen with his chest open. There’s my hand with my finger in his heart.’ We gathered round the screen, squinting in the sunlight. It’s an image that sums up the 250-year history of the London Hospital, whose staff have never been afraid to take risks nor to push the boundaries of what’s possible. Saving lives, in this most chaotic and vibrant of neighbourhoods, has depended on it.