The 19th Century's Lottery for Life

April 12, 1835. London. The weekly Friday lottery draw is about to take place and a young woman clutches her ticket with desperate hope as she speeds up Denmark Hill.

A ticket is difficult to get as it all but guarantees that you’ll see a favourable outcome in the draw. So every morning for the past three days the woman visited various wealthy homes, begging the servant who answered the door to let her see their master so she can plead her case for her worthiness of a ticket. And eventually she was thankfully gifted one.

However, once she arrives at her destination the staff on the door tell her the draw started ten minutes ago and they won’t admit her. She begs, telling them it’s a matter of life and death. But she’s simply reminded about the importance of punctuality to this establishment and asked to leave.

Dejected and distraught, she leaves the building and the city of London and returns to her home in the countryside. A few days later she dies.

The young woman – The Times reported – was suffering from a fistula, inflammation of the brain, and consumption. The ticket was to give her the chance of admission to King’s College Hospital. She’d been at the hospital earlier in the week, showing symptoms like abnormal discharge, fever, headache, vomiting, chest pain, shortness of breath and swelling. However, she was turned away. It was a Monday, and she was instructed to return on Friday’s “taking in day” — the sole day of the week when new patients were accepted.

Lindsey Fitzharris in her book The Butchering Art tell us more:

“In the nineteenth century, almost all the hospitals in London except the Royal Free controlled inpatient admission through a system of ticketing. One could obtain a ticket from one of the hospital’s “subscribers”, who had paid an annual fee in exchange for the right to recommend patients to the hospital and vote in elections of medical staff. Securing a ticket required tireless soliciting on the part of potential patients.”

The ticketing system was just one of the many cruel and arbitrary features of 19th-century London hospitals. Governors, not medical staff, determined which patients were admitted. Patients were required to attend daily chapel services, facing the threat of going without food if they did not comply. Punishments were meted out for offenses like gambling, swearing, and drunkenness. No patient could be admitted more than once with the same disease, and those deemed “incurable”, such as those with cancer or tuberculosis, were turned away. As were those with venereal infections.

The plight of this woman underscores the stark injustices of Victorian healthcare. It was an era where medical assistance was often a privilege reserved for the wealthy or well-connected, leaving countless people facing insurmountable barriers to treatment. And it serves as a reminder that despite the abolition of such Victorian healthcare systems, modern healthcare will still harbour poorly designed systems that perpetuate bias, cause needless delays, and foster negative outcomes.

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