2015 Meeting Blogs

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WSHOMS AUTUMN LECTURE PROGRAMME 2015

10th October 2015.

“Orthopaedic Surgery, has it a history?”
Professor Sean Hughes MS FRCS Ed(Orth) FRCS FRCSI DHMSA

This was the first of our meetings of the year and Professor Sean Hughes questioned whether Orthopaedic surgery had a history. He then took us for a romp from ancient to modern references to bones and their setting. Galen and Hippocrates, the Artists and anatomy of Michaelangelo and Leonardo, Vesalius and Sydenham were cited. He then brought in the Surgeon Anatomists of John Hunter, Percival Pott Colles, Dupytren and Astley Cooper.

Dominique Jean Larry treated soldiers on both sides, Joseph Lister and Crawford Long and Robert Lister who performed amputation by anaesthesia. Virchow , Pasteur and Koch and germ theory were important to the success of operations on the bones.The Thomas Splint and the bone setters of Anglesey, X rays by Roentgen and Robert Jones who stipulated that
soldiers should be fit to be discharged brought us to the use of Penicillin in WW2 and the treatment of Polio in 1950. Charley put in artificial hips in the 60s, back surgery became possible and disc replacement.

We were certainly aware that Orthopaedic surgery had a long and progressively successful history.

 

“How Illness in World Leaders has Affected History”.
Dr Robert Palmer MB BS FFARCS DRCOG

Dr Robert Palmer spoke to us about how Illness in World Leaders has affected history.

The Narcissistic Personality Disorder was illustrated by Mao Tse Tung, Stalin, Hitler and Putin.

The Hubris Syndrome was characterised by Rooseveld, Lloyd George ,George Bush, Tony Blair and Margaret Thatcher. Woodrow Wilson, Hindenberg, Ramsay Macdonald and Churchill.

Regan had Dementia.

Abraham Lincoln ,Churchill and LB Johnson had Bi Polar Disorder .

Many world leaders were Alcohol Dependent, including Asquith, Churchill, Kruschev, Nixon and Bush.

Dr Palmer pointed out that these World Leaders were severely affected at the height of their careers, and several medical cock ups were cited particularly by Anthony Eden and JF Kennedy.

blog by John Sedgwick

 

WSHOMS 2015 lecture Oct 24th
by Afifah

A Very Unromantic Disease: Tuberculous Lives from Smollet to Orwell

Dr Helen Bynum BSc MSc PhD

The 2015 season of WSHOMSoc talks started a fortnight ago but I was unable to attend the first event, so I am very glad that I was able to make it to this, the second meeting.

The first speaker, Helen Bynum explored the thinking behind the historical treatments for consumption – which is now always taken to mean tuberculosis since mycobacterium tuberculosis was identified in 1882 – by considering the lives of three historical figures, Toby Smollet (1721-1771), John Keats (1795-1821) and George Orwell (1903-1950)

Throughout the 18th and 19th centuries humeral medicine was the dominant medical model, the orthodoxy. The fact that people with consumption coughed up blood was interpreted as an indication that the patient had excess blood. Blood letting would presumably have seemed an entirely logical treatment, but it is hard to believe that it produced any positive effect very often. So convinced were doctors of its benefits that the practice continued, and not only for TB, but for a great many conditions and for centuries. It may have been that no one came up with a better idea until Germ Theory took over as the new orthodoxy. Other popular treatment methods, were water ‘cures’, which required dousing the patient with copious quantities of cold water – a practice that we would now assume likely to cause pneumonia, yet such treatments were popularly recommended and endured by thin, ill, and fast-fading TB patients. I shudder to think of the suffering and misery endured by so many due to both the disease and its hopeless treatment!

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The first of our historical figures is the author Tobias Smollet (1721-1771). Fortunately for us he wrote about his experiences with ‘the great adversary’, consumption, which had taken his daughter and later took him. His description of taking the waters at Bath are quite hilarious, but disturbing at the same time. In a piece from his last book, ‘The Expedition of Humphry Clinker’, published in the year of his death, he expresses great misgivings about the therapy:

“I can’t help suspecting, that there is, or may be some regurgitation from the bath house into the pump-room. In that case, what a delicate beverage is quaffed by the drinkers; medicated with the sweat and the dirt, and dandriff; and the abominable of various kinds, from twenty different diseased bodies, parboiling in the kettle below.”

Certainly the idea of TB as a romantic disease ends here! I feel sure Mr Smollet could have recovered had he avoided the ministrations of his doctors and the treatments of the times and simply gone to southern Europe to lap up the sunshine and fresh food available there. He had travelled extensively, and was scathing of many of the foreign ways, so perhaps he thought to take his chances with the devil he knew.

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Our second example was John Keats (1795-1821). Having trained to be a physician prior to choosing poetry as his career path, he was all too aware of consumption.This medical training, combined with the death of his younger brother at 19, left him under no illusion about the state of his own health once he started coughing up fresh arterial blood. His short life was filled with trials and stresses, and when he was being nursed by his friend Joseph Severn, the artist, during a trip to Italy for the purpose of regaining his health, he was made far worse by the prescription of a ‘thin diet’ consisting of ‘one anchovy and one slice of bread per day’, according to Alison Flood writing in The Guardian in October 2009. This was prescribed by his physician, Dr Clark, who also bled him removing nearly half a pint of blood right after Keats had lost blood inadvertently through a gastrointestinal bleed, and loss of ‘two cups’ of blood. The doctor felt that Keats’ complaint was chiefly ‘situated in his stomach’ so I would expect a diet of some sort to be prescribed, but a starvation diet, including bread, of all things, was, evidently, a grave mistake. It is another example of the astonishing failures of medical thought on TB in that era. Keats died after a torment of wild desperation and deep regret at not marrying his beloved Fanny Brawne while he was healthy. He was also in anguish regarding the complete trashing of his poem Endymion by critics when it was published. He would never know that, far from being a failure, the first line of Endymion – ‘A thing of beauty is a joy forever’ – has entered into the consciousness of the English speaking world, and his total poetry output is lauded the world over as a pinnacle of the perfection of the Romantic School.

So, extreme stress due to a sense of failure in his professional calling, failure in love, and now failure in strength and vitality together with abysmal medical treatment conspired to destroy one of the greatest poets who ever lived.

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Our third figure, George Orwell (Eric Blair), was the third of Helen Bynum’s consumptives, and brings us into the early 20th century. Orwell effectively invited TB into his life. On top of having been a chesty child who suffered with the English disease (i.e. bronchitis) and had pneumonia more than once, he became a heavy smoker!. In researching his books Down and Out in Paris and London (1933) and The Road to Wigan Pier (1937) he literally lived as one of the homeless. This wretched experience, which he continued for months on end, could only have worsened his health and contributed to his relatively short life.

Interestingly, the new treatment of Streptomycin, used twice in Orwell’s case, some months apart, appeared to improve symptoms initially. However, according to John Ross’s article at one point he had a bad adverse reaction to it, with a horrible rash and bleeding from the mouth and loss of finger and toe nails.

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Orwell finally died at age 46, after a determined struggle to finish his masterpiece Nineteen Eighty-Four. Much of it was written from a remote Hebridean farmhouse where he spent the preceding summer, failing to get the much-needed UVB light from which he could have made vitamin D which would have helped his immune system in the wrestling match which is TB. The compelling story of Orwell’s final days can be read here, in a Guardian piece by Robert McCrum

To wrap up her talk, Dr Bynum reflected on the fact that TB is an ancient disease that has afflicted man for millennia. It is only during a relatively narrow window that modern medicine has managed to banish it from everyday life for most of us living in developed countries, yet, with the rise of antibiotic resistance that window may now be closing. To underline her point – the newspapers this month have reported that tuberculosis rates in parts of London are now higher than in Rwanda and Eritrea.

On a brighter note, we may now be in the fortunate position of having the knowledge to defend ourselves from this bacteria and prevent it from taking hold by means of plenty of sun exposure (without sunblock) in the summer and vitamin D supplementation in the winter; the avoidance of cereal grains, replacing them with nutritient-dense foods instead; and a new respect for our gut microbes – the ‘microbiota’ – in their role as protector, as opposed to taking antibiotics as readily as has been the case for the past half century. There is a plethora of safe natural means, such as herbal medicines, which have stood the test of time too. Thyme, Inula, Pleurisy root, Mullein, Horehound, Liquorice and, of course, Garlic, all of which have been used by Medical Herbalists for generations, and have a clear rationale for their observed effects unlike the cold water and ‘thin’ diets that some of our great literary minds suffered.

Lecture 2:

Darwin and the Doctors

Dr William Bynum MD PhD FRCP

This lecture was relevant to me personally, as I have a family connection with Charles Darwin; Indeed as a child I spent many happy hours at Downe House (Darwin’s home) in Kent, where the curator let me hold and investigate many of the finches and other stuffed birds and butterflies in the beautiful glass cabinets. My mother’s family, Westalls, were friends of the Darwins, the Wedgewoods and the Sedgwicks, and somehow that meant that, at the age of 8 or 9 I was permitted to step over the low security rope in the drawing room and actually play the Darwn family’s grand piano, and was priviljeged to be charged with the task of closing the shutters round the house at the end of the day.

Anyway, the theme of this lecture came from the extensive correspondents that Charles Darwin maintained with many doctors of the day. Darwin’s letter writing was prolific, helped by the highly efficient mail service that existed at that time, and reveals a continuous exchange of intellectual questions and ideas. A common theme in these discussions was the relevance of evolution to medicine and human development, questions that were of considerable importance at a time when many intellectuals were concerned that the human race might be undergoing ‘degeneration’.

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Diseases of Modern Life by Benjamin Ward Richardson, 1876

Key ideas they were grappling with included issues of ‘inheritance’ and ‘diathesis’ (a familial tendency to manifest certain conditions) and whether this was a general ‘susceptibility’ or more of a ‘genetic inevitability’. The work of one of these corresponding doctors, Benjamin Ward Richardson, neatly embodies some of this early evolutionary thinking; His book entitled Diseases of Modern Life, can be read on-line. It requires no great leap of imagination to see how such thinking leads to the modern notion of ‘the diseases of civilisation’ – diseases that are high on the WHO agenda today, and are being addressed by proponents of contemporary evolutionary medicine, such as myself.

Charles’s father, Robert, and his grandfather Erasmus were both physicians and had a great influence on the young Charles, and may even have entertained atheistic thoughts. Initially Charles intended to follow in their career footsteps but he found a natural aversion to causing pain to others and a squeamishness in relation to blood, finding natural history, and beetle collecting more interesting. His path was set once he was invited to join HMS Beagle as a gentleman naturalist and companion to the captain in the two year expedition to chart the coast line of South America. The rest, as they say, is history.

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From left to right: The young Charles Darwin, Robert Darwin , his father, and Erasmus Darwin, his grandfather
The ideas of young Charles Darwin (left) were heavily influenced by those of his father, Robert Darwin; and his grandfather Erasmus Darwin (right)

It took more than a century for the Human Genome Project to be complete, and only now are we able to meaningfully apply the insight it affords, for individuals. The price of genetic testing is now low enough for many people to chose this option in order to short circuit the long journey between their symptoms of ill health and solving them. Indeed I now offer genetic testing in my clinic where I test for a collection of genes known to be influenced by food/nutrient availability, and we now have the added and utterly significant new science of epigenetics (i.e.the understanding that environmental factors, such as diet, markedly alter gene expression, an effect that influences more than just one generation), which will change the face of the medical model we have all hitherto worked within. Thanks to Darwin and the intellects of the people that he bounced ideas off, we are in a very different position now to genuinely remove barriers to health.

Charles Darwin’s own health was famously terrible and could only have been made worse by the stress and anguish of the death of his ten year old daughter Anne, from either TB or the treatment she received for it (including dousing with cold water). Two other of his children died in infancy, the tenth child being born when Emma Darwin was fully 48, and who had Down’s Syndrome.

I came away from these lectures with real sadness for those subjected to such abominable treatments. Cold water, bleeding, and starvation diets are simply idiotic in the face of current knowledge, but even now some pretty unpleasant treatments are regularly prescribed for diseases that we are still probably being mislead about. But, I enjoyed the company and the lunch that followed, and it doesn’t take a lot to cheer me up again.

Thank you doctors Bynum for your brilliance and for reminding us all of just how far we have to go.

7 November 2015

by Afifah

“Veiled Warriors: Allied Nurses of the First World War”
Prof Christine Hallett PhD(Nursing), PhD(History), RGN FRSM FRSA

We were treated to a pair of lectures about the First World War since this meeting was so close to Remembrance Day, and what lectures they were!

Who better than Professor Christine Hallett who holds not only a PhD in nursing but another PhD in history RGN FRSM FRSA to be given the opportunity to take the podium and present the subject “Veiled Warriors: Allied Nurses of the First World War”. The description which followed of the work these women performed was riveting, and delivered at break neck speed, leaving me scribbling in darkness, trying to take notes in order write for you, dear reader, such that you get a feel for the event.

Professor Hallett described the various ranks and requirements of the many nurses that served in this new type of war, previously unseen in the history of mankind.

There was a 2-3 year training course which produced the professional and highly proficient nurses, often drawn from the higher social classes and they wore the gorgeous and readily recognised uniform you see here in an original black and white photo, but you can see a museum mock up of it to the right.

These Professional Nurses worked closely with the VAD (Volunteer Aid Detachment) nurses, who’s uniform became the icon of the ‘nurse’, with the pale blue dress, white full apron, short white veil worn quite far back on the head, and the large red cross on the front of the apron. I even found this child’s nurses costume available on Amazon, which demonstrates just how clearly we all know this uniform for what it represents and alongside it is a photo of one of these brave and dedicated young women from WW1.

The nurses of Australia, New Zealand and the Allies of Belgium and France were organised in their own manner, in similar ways to our own, but in some countries nursing was primarily done by nuns,
or simply volunteer women. It was probably this war, more than any other, that established the importance of the role of the nurse in every country in the world.

The circumstances and conditions that these women were plunged into could not have been anticipated and many became casualties along with the soldiers they tended as field hospitals were hit by shells, hospital ships torpedoed or trucks ferrying soldiers away from the front line were attacked. It was due to the experiences of this war that the need for medical care far closer to the front line was recognised, and became a priority. This continues today, with mobile helicopter medical teams that fly in, collect casualties, treat them sufficiently for maintenance of life and deliver them to better equipped land based hospitals further away from the action. In this way we now have a vastly improved survival rate following what would otherwise have been fatal injuries. In WW1 these were called Casualty Clearing Stations (CCSs) and as these were developed, with immense input from the nurses, the terrible rate of fatalities that shocked Whitehall in the earliest months of the war did reduce significantly.

Below is a photo of Miss Kate Evelyn Luard who was a supervisor of an advanced abdominal surgery ward. She was one of the most responsible and also most at risk nurses at a CCS during the Battle of Passchendaele. Below is a book of her letters written from the front.

This is one of the beautifully ordered wards, with soldier patients, doctors and nurses posing for the photo. Trench warfare conditions presented appalling challenges to survival. Even without the shelling, gas attacks, shooting, dysentery, typhus and frost bite, there was the dreaded ‘trench foot’ to contend with! Oh, and shell shock, of course. Nurses had to handle all this and the actual war itself, and they too fell ill with the same contagious diseases as the men, or just from utter exhaustion.

The horrors of WW1 can be seen from many different standpoints, and the experiences of nurses is a very close perspective indeed. Their care made a very significant contribution to the outcome for countless people.

 

“Wounded – The Long Journey Home from The Great War”

 by Dr Emily Mayhew MSc PhD.

The subject Dr Mayhew brought to our attention is illustrated in the book cover, left; the Unknown Warriors were the Stretcher Bearers.

Dr Mayhew is a Military Historian and Historian in Residence at the Royal British Legion Centre for Blast Injury Studies at Imperial College London and in recent years has focused on this thoroughly overlooked aspect of the Great War. Stretcher bearers were absolutely vital to the survival of our troops on the front line. Frequently recruited from the conscientious objector community, including Quakers, these men were put through a six-week training to ensure physical capability and strength, which involved carrying 10 stone (63.5 kg) weights, on stretchers, up and down Box Hill in Surrey (the very same has more recently been used by Sir Bradley Wiggins in his training for the Tour de France and Olympics).

They were also taught life saving skills that could be employed right there in the field or in the trenches, and the number saved through their ministrations cannot be known. Another aspect of their work was that of kindness, reassurance and compassion in hand holding, gentle words and deep understanding, which is truly immeasurable in its impact to a wounded or dying young man.

It is very easy to overlook certain vital factors in how things actually work. For example, to a great extent we overlook and ignore the connective tissue in our bodies, even though nothing could function without it, as it connects all the other more identifiable tissues, organs and structures. In the same way we, en masse, have somehow overlooked the essential role that the stretcher bearers played. And not only have we overlooked their active work but also some of the vitally important innovations they brought to medicine.

Dr Mayhew used no images, but none were needed as her verbal illustration, knowledge, and passion conveyed all one needed. Having said that, stretcher bearers are not really invisible, it is just that it has not been discussed before. Many, many images of the Great War actually do show these heroes, who not only saved others but were frequently casualties themselves, being easy slow moving targets once they had their charges in their stretchers. They simply have not hitherto been focused on even though theirs was a pivotal role.

Here then are classic First World War photographs, but this time I want you to focus on these men and note how you, as I, recognise that their role has been overlooked and their images interpreted as impersonal images of that war. I need write no more, as the pictures tell the tale far better.

Thank you Dr Mayhew for opening my eyes to the labour, goodness and sacrifice of these unsung heroes.

 

Nov 21st 2015
Blog by Afifah

 Dr Alfred Carpenter: ‘Archbishops, East India Company & Public Health: Life as a Busy Victorian GP’

Nicholas Cambridge MD MRCS FSA FLS FRSA

 

The first slide in the lecture showed an effigy of Dr Carpenter being burned during an outpouring of public anger in 1884. The cause of this outrage was due to this Victorian public health advocate’s vociferous support for the temperance movement and particularly the calling for pubs and taverns to be closed on Sundays. Brits, it seems, just don’t like being finger-wagged when it comes to traditions they hold so close to their hearts.

It was not always that way though. Dr Alfred Carpenter (1825 – 1892) started out as a humble son of a country apothecary who stood in for dad when he was ill and found he rather liked doing the doctorly thing. This led to him studying at a number of institutions where he gained many prizes for academic excellence, leading finally to his occupation as a general practitioner in Croydon, which, in the 1850s, was a small town outside London boasting eighteen doctors, one for every 1000 townspeople.

It was here that he made his home and his reputation in the subsequent four decades. During this period he cared for the physical wellbeing of no less than four archbishops, which must surely be a record. They were John Bird Sumner, Charles Thomas Longley, Campbell Tait (whose whole family suffered rather disastrous health outcomes) and lastly Archbishop Benson, after whom a school in Truro is currently named.

Probably the most important and lasting effect of Carpenter’s work in Croydon was due to his abiding interest in public health. Indeed he had written a book ‘The Principle and Practice of Public Hygiene’ in 1848, before arriving Surrey, so was able to work to bring about things like sewers in Croydon which had hitherto had none and, as a rapidly growing town, suffered waves of epidemics of cholera, typhoid and smallpox. We were shown a remarkable picture of the newly built domed reservoir for the town (see below) which was opened by the Archbishop of Canterbury. Although everyone was very hopeful that such population threatening diseases would now be a thing of the past, Croydon went on to lose 10% of its inhabitants to typhoid fever in 1852, leading to repairs and further improvements to the infrastructure. Even so, another outbreak of 1200 cases of typhoid, in 1875, lead to a lot of head scratching.
This domed reservoir is a remarkable example of Victorian public health infrastructure that was promoted by Dr Alfred Carpenter (1825-1892)

Public baths were set up, which must have given a boost to to personal hygiene, but smallpox struck in 1879 leading to a lot of controversy about smallpox inoculations, with Dr Carpenter fining parents 5 or 10 shillings if they declined to have their children vaccinated, so certain was he of their efficacy. Interestingly, the term ‘conscientious objector’ was coined in describing those people (many of whom were doctors) who did not acquiesce to the pressure to vaccinate their children.

Following his exposure to the progressive work of John B Lawes FRS in a talk titled ‘The Sewerage of London’ Dr Carpenter worked on the concept of sending Croydon’s sewage to the fields of ryegrass nearby, to grow grass good enough feed local dairy cows. This process was a complete success, and no taint of microbes from the human sewage was found in the milk when tested independently. Everyone was mightily impressed with this.

Alfred Carpenter, who died a wealthy man at the age of just 66 of ‘cerebral exhaustion’, had a hand in many good works, including an involvement in ‘schools for ragged children’, on hospital boards, with the temperance movement, as president of the local cricket club (though a non player), the church choir (though a non singer) and with charities of all sorts, but to me his involvement in sewers and fresh piped water places him in a genuinely important historical position.

Here in Chichester we were twenty years behind Croydon, building our sewers only in the 1870s and it took us until the 1890s for water pipes to reach this little town. Well done Dr Alfred Carpenter for getting this process up and running so much sooner in Croydon.

 ‘Sir Henry Wellcome’

by Professor Tilli Tansey OBE PhD PhD DSc FMedSci FRCP

Henry Wellcome almost needs no introduction as we all know the importance and influence of this handsome and extraordinary man, but hearing about his origins, personal journey, obsessions and achievements was really wonderful.
I had not realized that he was born in the era of covered wagons and efforts to claim the land from the natives in northern USA (Wisconsin, 1853). The son of an itinerant missionary his family and others literally arranged the wagons in a circle round a fire in the evening and set a watch in case of attack by the local Sioux Indians who were trying to drive out these imigrants from their lands! To go from that unprepossessing start to the status of a man of immense wealth, head of his own super successful pharmaceutical company and outstanding world renowned museum is quite something! I am afraid the Sioux did not do so well from this clash of cultures.

Henry (back left) with brother George and parents Solomon and Mary in about 1876.

Starting with selling invisible ink at the age of 16 (yes, it was just lemon juice, as you and I have used) to becoming the most brilliant salesman possibly of the century, this chap really recognised gaps in the market to exploit like no one else. His ability to present his drugs was striking, and he introduced the concept of drug reps, and customer feedback, all totally innovative and game changing.

Henry’s life was about collecting, as well as marketing. He loved medical equipment from all corners and cultures of the globe; he was fascinated with collecting herbal medicines, statues, mummies, and archeological artifacts of every sort. Travelling must have taken decades of his life, as he went all over South America, many parts of Africa, including setting up a large archeological excavation in the Sudan, and all over the globe, collecting and collecting as he went. They say that when he died in 1936 at the age of 82 there were warehouses filled with crates of items he had caused to be brought to England. Indeed it is reckoned that every museum in the UK, and probably many abroad too, house artifacts directly from his sources.

Henry Wellcome and his wife Syrie, daughter of Dr Barnardo, are shown here in an awkward pose, representing their awkward and unsuccessful marriage which lasted from 1901, when she was just eighteen, to 1910 when she left him though the divorce was not finalized until 1916, amidst great media interest. She had been having an affair with the writer W Somerset Maugham, and became his wife, producing a daughter with him. The son she had with Henry, called Mounteney, was something of a disappointment to him as he did not have a head for business or running the extraordinary emporium that his father had created. However he did enjoy the life of a farmer which he settled to in one of the Home Counties.
↑Henry Wellcome with some of the Sudanese workers at the archaeological site there.
Wellcome_in_SudanWellcome surveying the Sudanese archeological site. ↑

The museum built and paid for my Henry Wellcome to house his astounding collection is as grand and wonderful now as it was when it was opened in 1931, situated as it is at 183 Euston Road, London. Here it is lit up for Christmas, looking utterly inviting.

A trip to this exciting and fantastical place is highly recommended.

Here is a glimpse of part of the interior:

Thank you Professor Tansey for your enlightening presentation.

 

 

 

 

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