The challenging isle: Soho's contribution to health care history
You should be standing outside Tottenham Court Road Underground Station on Oxford Street.
Welcome to this tour, I'm Nick Black. As someone involved in trying to improve health services, I believe it is vital that we understand the history of how they developed. Here in the heart of London lies an island that has made many unique and radical contributions. Today I'm going to show you some of the fascinating and surprising ways modern health care has taken shape.
So, let's get started.
With your back to the tube station, turn to your left and start walking along Oxford Street. Keep it on your right.
VoiceMap uses GPS to pinpoint your location and trigger the relevant audio. This means you can put your phone away now and relax. I will tell you where to go.
Continue walking along Oxford Street.
In a moment we are going to enter Soho which, since its establishment in the 17th century, has always been differed from the surrounding districts. It has been home to successive waves of refugees. French Huguenots in the early 18th century were followed by Greeks, Germans, Italians, Russian and Polish Jews, and Chinese. By 1900 it was one of the most cosmopolitan places in the world.
Immigrants brought with them their food, their art, and energy to create a vibrant and convivial atmosphere. This in turn attracted the unorthodox. Over the past 200 years, residents have included Casanova, Canaletto, Mozart, Garibaldi, Karl Marx and more recently Jimi Hendrix. And with artistic and intellectual freedom came sexual liberalism. From 1800 Soho became notorious for night clubs and prostitution, simultaneously deplored and frequented by the established society.
You'll hear from me again at the next corner.
Enter the isle
Turn left into this side street. This is Soho Street, your gateway into the challenging isle.
This dangerous, almost ungovernable island has proved a fertile environment for radical innovations in health care. It was to Soho that the entrepreneurial and unorthodox came to set up new ways of providing treatments, often in the face of opposition from the medical establishment. I will show you many of the buildings where the key events took place.
Continue walking towards the square ahead.
Cross the street in front of you and enter Soho Square. Once inside, turn left and keep walking. I'll let you know when to stop.
Stop here and have a look across the street on your left. Can you see the building with the blue front door? It's No. 14 and you should also be able to see a blue plaque on the wall.
Well, the social character of Soho and its relationship with the grander areas of London is personified by two towering figures in the history of nursing. The first of these was Mary Seacole, whom you will encounter now, in the heart of the isle. We will meet the second individual at the end of the walk, in the heart of St James, the very zenith of established society.
The building with the blue door was once home to Mary Seacole. She was the daughter of a freed black Jamaican slave and a Scottish army officer. Although rejected by the British authorities, in the 1850s she went and nursed wounded soldiers in the Crimean War.
Mother Seacole, as she was called by British soldiers, used the skills she had learnt from her own mother to nurse the wounded. She based herself on the actual battlefield, unlike the better known Florence Nightingale who was 300 miles from the action, across the Black Sea.
She returned to London destitute, in poor health and dismissed by Nightingale as a 'brothel-keeping quack'. However, her well-wishers enabled her to clear her debts and move into the top floor of this house. Belatedly, she gained recognition, as was evident from the 80 000 who, in 1857, attended a grand military festival in her honour at the Royal Surrey Gardens.
Continue walking along the outer path of the gardens in a clockwise direction. I'll stop you when you're opposite No. 22.
Dispensary for Infant Poor
Stop here and turn to look across the street at No. 22.
In 1772, the house that stood on this site was the home of the first dispensary in England for sick children. At that time half the infants of the poor died, something that many physicians accepted as inevitable.
However, George Armstrong and seven other Scottish physicians thought otherwise. Funded by fees from their private patients, they saw poor children for free three days a week. They had to overcome opposition not only from their landlord, who was worried about appearances and insisted poor children entered via the back door, but also from other physicians who claimed that, quote, "lives are being sacrificed to experimental mass treatment," unquote. Sadly, Armstrong's philanthropy led to him ending up in a debtors' prison and it wasn't until the 20th century that he gained the recognition he deserved.
Carry on round the garden to the next exit.
Leave the gardens
Leave the gardens at this exit on your left, then immediately turn right and continue walking. I'll meet you just before the corner.
The Hospital for Women
Stop here and turn to your left to face the street. You are opposite a large cream building labelled The Hospital for Women. Behind the 1910 facade you see today are the two houses the hospitals' founders took over in the 1850s.
Initially called The Hospital of Diseases of Women, like most 19th century hospitals it relied on voluntary donations. However, potential supporters were put off as they assumed the name referred to venereal diseases, so the prudent decision was made to change the name.
Now, look across at the building in the right-hand corner of the square, called Twentieth Century House. This replaced a fine 18th century house similar to No. 26, the house you can see to your left in the far corner with the elongated fanlight above the door. In the 19th century the house was first home to the Dental Hospital of London and then to the National Heart Hospital.
Let's move on. Turn so that the gardens are on your right and walk to the corner of the gardens, then cross over the street, turn right and carry on walking.
John Harrison Curtis
Turn left on this corner and stop. You should be standing opposite No. 38 Carlisle Street, with its porticoed entrance. This is where another unorthodox entrepreneur subverted established medicine. In 1816, John Harrison Curtis, who was viewed as a notorious quack, established the first dispensary for ear diseases in London.
His lack of medical qualifications was no barrier to his success as he had married a woman of considerable means and social connections. To the consternation of established ear surgeons, he gained the support of aristocrats including the King, George IV. You will hear more about Harrison a little later.
Now, cross over Carlisle Street, turn left and walk towards the next street corner.
Turn right into Dean Street
Turn right here and keep going. You're now walking along Dean Street.
Stop here and turn to look at the large stone and redbrick building on the
opposite side of the street which is now a hostel.
As an island of sexual liberalism, Soho was home to many brothels and molly-houses, frequented by well-to- do gentlemen from more affluent districts. Inevitably, venereal diseases were prevalent. In 1746 the London Lock Hospital had been established in Belgravia, a couple of miles from here, as a specialist hospital to cater for these diseases. By 1842 Belgravia had become fashionable, resulting in the relocation of the hospital to Paddington. This left the male patrons of Soho without a convenient service, so a branch for men was opened here. In 1912 the original townhouse on this site was replaced by this building.
The clinic on the ground floor provided daily urethral irrigation performed by nurse orderlies among whom were the appropriately named Messrs Rodwell, Hardstand and Catchpole. It survived until 1952 after which the building housed a neurology hospital for 20 years.
Cross over to the building, turn left, and start walking back along Dean Street. Keep going and I'll meet you a little further down the street.
Along Dean Street
Well done, you're on the right track! Carry on walking straight.
Although Soho has largely been an area of entertainment, in the 18th and 19th centuries it combined this with education. It became home to several of the main anatomy theatres.
Today we take it for granted that doctors receive their training in carefully designated courses run by university medical schools. But in the 18th and 19th centuries those who wanted to become doctors trained by selecting lectures and ward rounds held in hospitals and colleges across London. Another key component was the private anatomy schools.
The first was established in 1746 and by 1836 there were twenty-one, many of them around here, in the West End. Initially they occupied ordinary domestic townhouses.
By the 1840s most of the large London hospitals had established their own medical schools partly as they provided a valuable source of income. Many of the private anatomy schools were assimilated, although remarkably one functioned until 1914.
Keep going and I'll let you know when to stop.
Hercules of workhouse reform
Stop here and look to your right. This building, Royalty House, was the site of one of the 21 schools of anatomy.
Now turn around and look at the building on the opposite right-hand corner. Can you see a blue plaque on the front wall? This was the home of one of the leading anti-establishment figures of health care reform in the 19th century. Dr Joseph Rogers was known to his admirers as the 'Hercules of workhouse reform'.
Rogers helped instigate the establishment and improvement of the infirmaries in the workhouses throughout London. He campaigned with others, including Louisa Twining and Charles Dickens, for social change. He was medical officer at the Cleveland Street Workhouse, just north of Oxford Street, which is the last remaining Georgian workhouse in London and inspired Dickens when writing Oliver Twist. It's well worth a visit when you are near there.
When you're ready you can continue walking in the same direction as before. Keep following Dean Street and I'll catch up with you a little further along.
Royal Ear Hospital
Stop on this corner and turn to look across the street at No. 42 Dean Street, a Vietnamese restaurant.
Above the first floor window, in gold lettering, you will see that something was founded in 1816. It was our old friend the Royal Ear Dispensary which moved here in 1904. By then the monarch referred to it as the Royal Ear Hospital, further incensing other ear doctors and the royal college of surgeons. It remained here for 22 years before moving to become part of University College Hospital.
Now turn right off Dean Street, along this narrow side street called Bourchier Street. You'll hear from me a little further along.
Keep walking along this street, even as it narrows into an alley.
Interest in anatomical dissection was not restricted to aspiring doctors. As the Medical Times noted, "a knowledge of anatomy was then very properly considered a necessary accomplishment to a gentleman and indispensable to a lawyer". Despite such popularity, concerns meant that dissections were advertised euphemistically as "teaching in the French manner", given that this form of entertainment and education had been established in France twenty-five years ahead of London.
I'll meet you at the end of the alley.
Cross Wardour Street
Cross over the street in front of you and continue walking in the same direction, passing the O Bar on your left.
Along Brewer Street
You're now walking down Brewer Street. Keep going straight.
Until embalming was discovered, dissection had to be restricted to the winter when bodies did not decay as quickly. The resulting demand for corpses encouraged grave robbers or resurrectionists. This was because until 1832 the only legal source of bodies were those who had been executed.
By 1850 all but one of the private anatomy schools had been closed. All the buildings housing the schools were demolished apart from one. Remarkably the first and most famous one survives and we are now on our way to see it.
Continue along here and I'll tell you when to turn off.
Turn left into Great Windmill Street
Turn left here and keep walking. This is Great Windmill Street.
In 1746 William Hunter established an Anatomy School in an ordinary house in Covent Garden. In 1768 he commissioned a purpose-built school with a fine theatre and a museum to house thousands of specimens on Great Windmill Street. I'll point this out to you shortly.
Anatomists were not just interested in diseases in humans. Hunter's anatomical collection covered the whole animal kingdom. Some anatomists maintained private zoos away from central London where they could study exotic animals shipped in from around the world.
William Hunter, who had moved to London from Scotland, was joined by his younger brother, John. Despite the fact that John was largely uneducated, he became one of the finest dissectors of the age and is generally regarded as the founder of modern surgery.
Keep going and I'll let you know when to stop.
Great Windmill Street School
Stop and have a look at the rather sad and neglected, red painted building on your left. This is all that remains of what was the first purpose-built anatomy school in London.
It was designed by Robert Mylne and originally had a grand central porticoed doorway. Note the ground and first floor windows each with 12 panes of glass. Remarkably these windows are all original as are the smaller ones along the top-floor.
In its heyday the school was very popular, with as many as a hundred students crowded into the theatre for anatomical performances, for that is what they were. Given the controversial nature of dissection at the time, students were discouraged from discussing what they saw or heard with members of the public.
When you're ready to continue, carry on walking towards the corner ahead.
Turn left into Shaftesbury Avenue
Turn left at this corner. This is Shaftesbury Avenue and I'll meet you in two blocks.
Cross Shaftesbury Avenue
Stop here for a moment so that I can point out where you need to go next.
At these traffic lights, turn to your right and face Shaftesbury Avenue. Have a look across the street at the side street a little to your left. That's Wardour Street. The tour continues along there. So cross Shaftesbury at these lights and I'll meet you along Wardour Street.
Along Wardour St
Keep going. We're now entering the southernmost part of Soho where the most recently arrived residents of Soho settled, the Chinese.
Until the mid 20th century, skin disease was viewed as being associated with venereal diseases. On moral grounds, both were excluded from the new large voluntary general hospitals that were established during the 18th and 19th centuries. As a result, a specialist skin hospital was started in 1819. But over the next forty years, only two more were established. In 1863 one opened in Soho that was to become the most prestigious, St John's Hospital for Diseases of the Skin.
Carry on along Wardour Street.
Cross over Wardour Street
Now, turn to your left and cross the street. Then carry on walking straight down the street in front of you. I'll meet you just past the shiny, glass building on your right.
St John's Hospital
Stop here and look to your left at the somewhat incongruous building, with its large stepped gable surmounted by an obelisk. This was home to St John's Hospital for 55 years. The name was emblazoned across the gable until it left here in 1990 to become part of St Thomas's Hospital.
During the early years, St John's was dogged with disputes. Within the first week, three of the four doctors who founded the hospital resigned because they objected to their colleague, John Laws Milton, publicising and running a highly lucrative clinic for men focused on treating involuntary ejaculation. Milton continued to provoke colleagues. At one point the hospital matron and nurses resigned when he employed a cook to undertake patients' dressings.
Now turn your back on the old hospital and walk down the street leading off Lisle Street. Keep the modern, glass building on your right and I'll catch up with you at the next corner.
Towards Leicester Square
Keep walking and head over to the garden in the centre of Leicester Square. Walk diagonally across the gardens to the opposite corner.
During the 18th and 19th centuries a variety of exhibitions and spectacles were held here. This included some dubious health care activities including, a certain James Graham who, in the 1780s, put on displays of medicinal mud-bathing aided by what he described as 'a bevy of belles'. Another example of the thin dividing line in Soho between healthcare and entertainment.
The far corner where you're heading to now, used to be marked by a fine bust of John Hunter, the founder of modern surgery. Unfortunately, together with busts of Isaac Newton, Joshua Reynolds and William Hogarth, the local council chose to remove them when refurbishing the square recently. All four were past residents of Leicester Square.
Keep walking towards the gardens' exit, opposite Capital Radio London.
Stop at this exit and have a look at No 28, the brown stone building to the right of the Mezzanine cinema.
In 1783 John Hunter purchased the house on this site at the time. Hunter's fame and wealth allowed him also to purchase the house behind this one, on Charing Cross Road. By connecting them he created a 52-foot long museum containing a staggering 14 000 anatomical specimens. He ran a huge enterprise with as many as twenty-nine staff and pupils. You can see the collection for yourself, as it forms the basis of the Hunterian Museum in the Royal College of Surgeons in Lincoln's Inn Fields.
Now look to your right where you will see the imposing Hampshire Hotel, a fine example of how some small enterprising initiatives that started out in Soho grew to become major establishments. It was built in 1901, not as a hotel but as the Royal Dental Hospital which, as you saw earlier, started life in a house in Soho Square.
When you're ready, turn to your right, walking with the hotel on your left.
Royal Dental Hospital
Turn left down this side street, and carry on walking along the side of the hotel. The shops you see nested in the hotel are not a recent development. Shops were incorporated in the hospital as an additional source of revenue, a feature of several voluntary hospitals in London.
We are now leaving the challenging isle of Soho.
You'll hear from me again on the next corner.
Turn right into Orange St
Turn right here. This is Orange Street.
As we leave Soho, an area of London that has nurtured new, enterprising, and often unorthodox ideas and people, we're heading towards a part of London that is the exact opposite of this, St. James. It is the very heart of establishment London, home to aristocracy and nobility. So it will be no surprise to find that St. James was the home of the Royal College of Physicians for 136 years.
Keep walking straight.
Turn left into Whitcomb Street
Turn left here and start walking along Whitcomb Street.
There are now thirteen medical royal colleges, representing the different branches of medicine. Their role is to maintain the standards of their members and to advance practice. One way they do this is by conducting exams to control entry to their speciality.
While colleges protect the public from untrained practitioners, they also serve to protect the interests of their members by granting them exclusive status. The first college to be created was for physicians, established by Thomas Linacre in 1518. Unlike other practitioners such as surgeons and apothecaries, physicians received a university training. For many years, in England this was only available at Oxbridge, which ensured that only Protestants qualified, as Catholics were excluded from those universities until the 19th century.
Physicians insistence on exclusive rights of practice were undermined in the 16th and 17th centuries by being so few in number, by their high cost, by their tendency to side with the Royalists in the Civil War, and by their abandonment of London during the Great Plague.
I'm going to point out to you the previous home of their royal college in a moment. Just keep walking straight for now.
Royal College of Physicians
Stop and look across the road, to your left.
Can you see the neo-classical building on the corner with six massive columns? This was designed by Robert Smirke for the Royal College of Physicians in 1827, although now it's part of the Canadian embassy. It may be grand but even at the time it was described as "severe almost to the point of dullness".
Initially the physicians' college was based in Moorfields near the city of London where the emerging merchants and financiers, who could afford physicians' costs, lived. As the wealthy migrated west, so did the College, to this custom built home. In 1875 statues of three great physicians – Linacre, Harvey and Sydenham – were added in the three niches behind the columns but they left with the college in 1963. Their current home is in Regent's Park, where you can visit a museum and medicinal garden.
Now turn right and start walking away from the college. This is Pall Mall.
Charing Cross Hospital
The street coming up on your right is Suffolk Street. As you pass it, have a quick look at the house across the far end of the street. That was the original home of Charing Cross Hospital at a time when hospitals required no specialised facilities. Now you can carry on walking along Pall Mall.
Cross over the street in front of you. This is Haymarket and we're now heading into the heart of St James and our final destination at Waterloo Place.
Cross over to traffic island
Cross the first part of the street in front of you and I'll meet you on the traffic island in the middle beside the statues.
Stop here, at the final stop on this tour.
London doesn't get more formal than here. All around are royal palaces, government ministries, gentlemen's clubs, traditional outfitters and other paraphernalia for the establishment. So where better to place a memorial to the fallen of one of the many wars fought by the British in far flung lands. But the tribute to the Crimean War you see on this traffic island is unique in not only commemorating the servicemen who lost their lives but also the contribution of nurses, and one in particular.
Turn your back to Pall Mall and face the three statues. The statue to your left is Florence Nightingale. This partly reflects the decisive contributions she made at the time and subsequently in civilian life, but may also serve to distract attention from the otherwise incompetent execution of the war by the leading soldiers and politicians involved.
Now, have a look at the four bronze bas-reliefs below Nightingale. These illustrate her diverse roles: caring for the injured, negotiating with generals, challenging medical and hospital managers, and teaching. Forever remembered as the Lady of the Lamp, she played a leading role in transforming nursing from an occupation of disrepute to the modern profession it has become. She was able to achieve this because of her social position and the access it gave her to government ministers, generals, aristocracy and other influential people. Unlike other women with similar opportunities, she used them to bring about profound change. In her determination and commitment to relieve the suffering of the ill and injured, she had more in common than she ever acknowledged, with a self-taught nurse from Jamaica who, on returning from the Crimean War, resided in a cheap boarding house in Soho, less than a mile away but in many ways, on a foreign island in the sea of London.
If you've enjoyed this walk today you may like other walks exploring the history of how health care has developed, which are detailed in my book, Walking London's Medical History.
Thank you for joining me on this tour today. Goodbye!