Wednesday, April 7, 2010

Charles Dickens’ Model for the Modern Rehab Facility: Victorian Health Care Reform

On November 29, 1842, London’s Morning Chronicle published a short, unusual piece by Charles Dickens, already a celebrated writer and novelist, titled The Sanatorium.

Written shortly after Dickens’s return from his first American tour, it reflected both his deep and lasting interest in public affairs and his fascination with medicine and the medical profession, particularly mental illness, detailed descriptions of which form central passages in several of Dickens’s novels.

Thomas Chapman was chairman of the Sanatorium Committee and a personal friend of Dickens (the character of Mr Dombey was supposedly based on Chapman). Chapman asked Dickens to write a brief piece describing and expounding the principal of The Sanatorium to attract press coverage. Dickens enthusiastically wrote an eloquent and convincing case for the importance of a sanatorium, rising to a pitch of dramatic urgency reminiscent of passages from his novels.

The middle classes - students, young professionals, the daughters of 'reduced gentlemen' - were to be the beneficiaries of the scheme:

“Let it never be forgotten that the Sanatorium is not a charity ... It is a self-supporting Institution where, in consideration of an annual subscription of one guinea in time of health, and the most moderate and economical weekly charge possible in time of sickness, any of that large and most respectable class of persons who are seeking a subsistence in the Metropolis can, being stricken ill, repair, as to a home Private cheerful and wholesome rooms; the first medical advice; the most delicate and unremitting attention; the best provision that can possibly be made for tranquility, rest and mental ease.”

The Sanatorium was housed in Devonshire Place House, York Gate, Regent's Park, directly across the street from Dickens home. It was the brainchild of physician and philanthropist, Dr Thomas Southwood-Smith. and although it achieved its purpose admirably it was not a financial success. Yet “it was the forerunner of the modern nursing home and private patients' wing” (F.N.L.Poynter. Thomas Southwood-Smith: The Man in the Journal of the Royal Society of Medicine 1962).

The autograph manuscript of The Sanatorium is now being offered for sale and is one of the highlights of the upcoming, ABAA-sponsored, 50th New York Antiquarian Book Fair, April 9-11, 2010, at the Park Avenue Armory.

Accompanying the manuscript is a three-page autograph letter dated December 27, 1842 written to Thomas Chapman (chairman of the Sanatorium Committee) within which he explains the effect he is trying to achieve and advises discretion about 'disorders of the mind’:

“ ... it is as indispensable to our well-doing to keep the subject quiet, as to keep them quiet, supposing we have any,” adding that the attending matron should  be “as cheerful as possible,” and not “as if she were a warranted mouser and they all mice.”

 In other words, Nurse Ratched need not apply. It'a rest stop for the discreet treatment of the nervous disordered, the dispsomaniac, and deeply distressed, with dignity, the business model an innovative pre-paid medical plan that if ultimately unsuccessful, foreshadowed later, successful by economy of scale, modern iterations. It was a convalescent home for those in need of rest and recovery from whatever; in short, a rehab facility in the broadest sense, part of a reform movement to improve the care of those whose needs fell between the medical hospital and the mental asylum, and at an affordable price.

The manuscript of The Sanatorium is being offered by Jonkers Rare Books, which last week made headlines with the sale of the most significant presentation copy of Jane Austen’s classic, Emma.

It was acquired at Christies sale no. 5822, lot 91, last year. The estimate was £8,000 - £12,000. It sold for £17,500 ($28,490). Jonkers is asking £45,000 ($68,632). Considering that Dickens manuscript material is highly desirable yet rarely finds its way into the marketplace, the price is not unreasonable.

DICKENS, Charles ORIGINAL AUTOGRAPH MANUSCRIPT “THE SANATORIUM”   [1842]. A four page manuscript “sketch,” including various emendations and deletions, with a three page autograph letter dated 27 December 1842 to Chapman. With two letter wrappers both addressed to Chapman and signed by Dickens. All window mounted and bound in full scarlet morocco by Riviere.

Of related interest: 2010 New York Antiquarian Book Fair or Sunny?

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