Blog 25th October 2014

25th October  Meeting of WSHOMS.

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The second of the 2014 season of presentations was a classic example of what WSHOMS does so well – it juxtaposes subjects that while coming under the broad definition of ‘history of medicine’ succeed in simultaneously fascinating, informing and astounding us.

The first presentation was by Julie Wakefield:

Healing Rituals in West Sussex in the 19th Century, by Julie Wakefield

Julie became interested in the history of medicine when a curator at the Museum of the Royal Pharmaceutical Society and she currently works at the Old Operating Theatre and Herb Garrett in London, where she researches Historic Herbalism and Folk Remedies. Indeed she is collecting tales and remembered experiences from the older generation along these lines.

Probably everyone present at this lecture was expecting to hear about some interesting details regarding sick room practices from the old days; poultices, leeches and bizarre contraptions to hold hernias in, but no, we learned about healing methods that were of an altogether different ilk, and very strange they were too!

During the middle Victorian period we West Sussex folk apparently approached illness and injury in ways entirely unrelated to theories of physiology, either the newer more scientific understandings or the ancient humoral sort. Perhaps the expense of seeking out a trained physician precluded serious efforts to resolve diseases (or previous experience with such doctors put people off taking that course of action), or maybe it was deeply held religious beliefs drove these actions, but either way the common people appear to have relied rather heavily on superstition and magic for relief of their ills.

The Reverend Thomas Firminger Thiselton-Dyer (1848 –1923) author of The Folklore Of Plants, gripped our speaker’s attention, and with good reason. In it he describes places and people, some by name, including which village they lived in and their occupation, and goes into some detail as to how they dealt with their various ailments, not only through the usual recourse to herbs or drugs of the wise woman, cunning folk or doctor’s devising but through the offices of quasi-religious purveyors of charms. These charms are pretty odd in general. We heard a couple of variations that went something like this: An old woman will murmur over the one to be healed “There came two angels from the north, they brought fire and frost; out fire in frost. In the name of the father, son and holy ghost”. The direction, number of angels and other details would differ but ending the charm with standard Christian liturgical tropes may have been a device aimed at defending the charmer from charges of heresy or witchcraft. Calling such a charm ‘a blessing’ was likewise a common practice.

Storrington – a Sussex village where charms were sold as cures along with medicinal plants

One such old lady who offered charms is reported by a Mrs Latham of Storrington as a collector of simples and a maker of ointments and who specializes as a ‘charmer of wounds caused by thorns’. This old lady was taught a charm (full of Christian imagery) by a shepherd who said she could earn a little money from the use of it. This suggests that, like the cunning folk and wise women (both of which were lay physicians with various degrees of training and experience in the use of medicinal plants) who charged small sums for their ministrations and advice, but significantly less than the physicians.

The combination of pagan and Christian terminology and imagery was very common in superstitious rituals. One that I found particularly interesting was the one that was used by the head of the household in the treatment of whooping-cough. It starts in such a way as to bring you up short, thus… ‘Boil a donkey’ (see what I mean).. ‘Make a silk bag and put the hair from the donkey’s pelt, specifically from the area of the cross on its back, into the bag. Pin this bag on the patient and have them sit backwards on another donkey, a live one, and have it lead back and forth by someone for three days. This will cure the whooping-cough’. Interestingly, the live donkey was lent by the local vicar for this purpose, so it was not considered so pagan or antipathetic to her Christian beliefs as to make involvement impossible, as I suspect it would now. Clearly in 1870 or thereabouts, West Sussex was far more liberal and experimental than it is now. What we don’t hear about is what, if any, were the results of the use of charms and strange practices such as this. Three days sitting backwards on a donkey being led back and forth for a patient with whooping-cough sounds rather bad for one’s health, I am sure you agree.

We also heard about Cleft Tree Magic which consisted of villagers cutting a tree down the middle in order to create a cleft in it and passing sick people through the gap a prescribed number of times, from east to west, or other specified directions, in order to heal ruptures (!). The number of passes was frequently nine, which must have made such processes into significant events, with ritualistic properties and all that this implies, including the belief that if the tree is cut down following this procedure, the patient for whom it was undertaken will die.

A more disturbing aspect of this sort of bizarre and unlikely approach to healing was described too, and involved being touched by the hand of a dead person, usually a felon or just someone who had died in an accident. Again, this was done in a ritualistic way such as the dead hand of a drowned boy applied in a stoking manner, nine times mark you, to a woman endeavoring to heal her goitre. One would think that she and all those observing this would pretty soon see that it made no difference to the goiter and therefore should not be considered a useful method of resolving such things, but no, corpses continued to hold all sorts of promise of healing to the living, unsavory as this undoubtedly was.

Although herbal preparations often had ritualistic masses or the Lord’s Prayer said over them (nine times of course) it didn’t actually make any difference to the efficacy of the herb, though might have appeared to, to the gullible peasant. The lesser celandine (Ranunculus ficaria) is very effective indeed in the treatment of haemorroids, as the folk name, pilewort, implies, but it is effective whether or not someone with priestly assumptions tries to manipulate another into thinking that he or she has endowed it with extra power of some kind. Indeed in my Home Herbal Range I include Pilewort Cream (in little 30g glass pots at £4 each) for precisely that nasty personal problem that for generations before you have utilised this herb, and I certainly don’t perform any incantations over it!

Humans of all cultures were and are very, very susceptible to superstition, and religious rituals of any doctrine are still today clear conduits for this tendency.

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The second presentation of the day was by Lt-Col Ngozi Dufty MRCP MCGI DTM&H RAMC and a very different subject it was:

 Syphilis and War – the necessary requirement for an epidemic

The great physician William Osler once said “He who knows syphilis knows medicine”  because it can appear in many different and confusing forms.

The history of ‘the pox’ is still somewhat mysterious but in Europe seems to date from the late 15th century and was spread by sailors, prostitutes, armies, prostitutes, husbands and more prostitutes. The name given to this dreaded disease whenever it cropped up related to whoever was being blamed, ‘the Neapolitan disease’, ‘the French disease’, ‘Pox of Naples’, ‘the Spanish Pox’, ‘the Portugese disease’ ‘the Turkish disease’ and ‘the Christian disease’ but the theory that the Treponema species of spiral shaped bacterium may have originated in The Americas has gained traction. There is some evidence that a disease with similar bacterial origins was common in the pre Christopher Columbus era as the skeletons of young people from Florida and other parts of America show typical markings, and suggests that a non-sexually transmitted version of a Treponemal disease was the cause, like yaws, bejel or pinta. Once in Europe this bacterium may have evolved to the form we now know as syphilis; the sexually transmitted horror that brought down so many people. This is known euphemistically as The Columbian Exchange.

The Italian poet and physician Girolamo Fracastoro first used the term ‘syphilis’ in a poem written in Latin in 1530 which told of a Greek shepherd named Syphilus who led a revolt against the god of the sun and later suffered from this disease. The name stuck.

Throughout the 1500s the diabolical disfiguring disease raged across Europe and at various times and places the authorities closed the brothels surmising rightly that they had something to do with it. Female patients in these houses of ill repute (an apt term) could be hanged if they did not leave and go to hospitals, but unfortunately prostitution was driven underground by that strategy and the dissemination of Treponema pallidum continued unabated. Women, it seems were generally blamed for it.

The treatments that physicians, cunning folk, herbalists, apothecaries, doctors, barber surgeons and aspiring chemists alike applied to the unfortunates, of whom there were many, were frequently drastic. Mercury, the one about which we have the most knowledge, being a toxic metal to mammals, causes a major expelling reaction, with huge amounts of salivation and sweating and loss of teeth, and loss of mind. Of course some people appeared to recover following such treatments, leading to the persistent belief that such an approach was worth pursuing, even though it killed many of those who undertook it.

The herbs Guaiacum officinalis (lignum vitae) and Smilax officinalis (sarsaparilla) were also used extensively in the treatment of syphilis throughout the 16th and 17th centuries and have some similar effects to mercury, though with none of the latter’s terrible toxicity. Both these herbs stimulate the body to expel pathogens, through internal warming, much as the production of a fever does (their diaphoretic effect). Fever evolved as a method of non-specific bodily defence which not only speeds up all cellular reactions but also alters the internal environment such that microbes are stressed by the raised temperature and are rendered more vulnerable to attack by the highly activated white blood cells. These days Medical Herbalists use these herbs to treat persistent inflammatory states, such as arthritis, as they stimulate blood flow, oxygenation, immunological activity and nourishment of the tissues of the joints etc and thus enable resolution of inflammatory vicious circle but for syphilis I doubt if their effects were sufficient to make much difference. Mercury brought about some of these effects through being a toxin, whereas the herbs brought about these effects through helping the system fight off toxins.

Only in 1905 was the spirochete finally properly identified by Fritz Richard Schaudinn, a German zoologist, and Erich Hoffmann, a dermatologist, and a year later a test for it was developed, the Wasserman Reaction test (or WR for short) by a German bacteriologist, August Paul von Wassermann, who had worked with the great Robert Koch. This was later refined such that false positives were less common, though they are still possible, as certain auto-immune disorders can trigger the test to come out positive when no T. pallidum is present.

Our hero in this sorry tale, and we desperately need one, is Colonel L. W. Harrison who, in 1913, when VD was declared a National Emergency, transformed the approach to sexual health. By insisting on each patient having privacy and free treatment he, almost single-handedly, changed the face of this area of medicine, which can still be seen today in our free access GUM clinics. Harrison put a lot of effort into education of soldiers and had them issued with prophylactic packs. He also had a pathology lab set up so that testing could be efficiently performed and promptly acted upon. Soldiers were always the most vulnerable to sexually transmitted diseases, in all the wars from 1493 to the present day. His work was done before the advent of penicillin in 1943, when various forms of mercury and arsenic, and the combination of the two, were still the mainstay of treatment, and unfortunately caused an appalling array of side effects, such as necrosis of the liver, but he was dogged in his attempts to minimize them.

Prior to this man’s brilliant work we saw how health authorities, in their attempt to get to grips with venereal diseases in some countries put in place utterly stupid and counter productive practices. For example, in France prostitutes were lined up and checked for VD regularly using a speculum. But, unbelievably, the same speculum was used again and again, woman after woman!

Once the sulphonomides and penicillin arrived on the scene in the 1940s treatment was revolutionized. Our speaker told us about the shocking and shameful experiment in Tuskegee, Alabama, which ran from 1932 to 1972 in which the US Public Health Service wanted to see what happened if syphilis was left to its natural progression. To find out they enrolled 600 poor black people, 400 of whom were found to have syphilis but were not informed of this diagnosis nor treated in any way but left to go on infecting others and developing late stage complications, and bringing about congenital syphilis in their children.

The incidence of syphilis dropped between 1930 and 2010 but unfortunately has risen again.

This talk was delivered with enthusiasm and it was very educational about a subject that is not often talked about.

Blog Oct 11th 2014

 

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Today was the first of the 2014 WSHOMS Season and I am pleased to say that not only was I present

but I also managed to dodge the downpours that occurred throughout the morning.

 

The inaugural Dr Brian Owen-Smith Memorial Lecture, given by

 Dr Nicholas Cambridge MD FSA FLS FRSA.

Brian Owen Smith memorial lecture

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Dr Cambridge was the speaker for both of today’s lectures.

“Medical Science and Philanthropy: Fothergill, Lettsom, Priestley and Their Circle”

 “Scrofula, Gout and Dropsy: Dr Samuel Johnson and His Physicians.”

 

“Fothergill, Lettsom, Priestly and Their Circle”

 

This group of luminaries were significant in their era of 18th Century London when Enlightenment thinking was stimulating the minds and actions of so many.  The three gentlemen that Dr Cambridge was discussing were firmly in the dissenter camp of those times, which produced a great many remarkable people and fuelled lasting social and political movements. Clearly they caught the imagination and provided the motivation for a generation of educated and enquiring people to change their mental and social frameworks. Whether here in England, (where meetings at coffee houses between doctors, political radicals, clergymen, industrialists and instrument makers thrived), or over the channel in France (Priestly was a supporter of the French Revolution and had to escape England when his house was attacked by arsonists who distrusted him) or deep into North America (the Bostonian Ben Franklin was intimately acquainted with these men during his various sojourns in London), these three thinkers amongst many others, helped to shape our history and established organisations that still function today, including the prestigious Hunterian Society, which was so dear to Brian Owen-Smith, in whose memory today’s meeting was held.

The first of the three, John Fothergill, was a Quaker and a physician. He could, apparently, be reached by post by addressing a letter simply ‘John Fothergill, London’. I wonder if the postman would find me if such a brief hint of its intended destination was written on an envelope. I doubt it, but I guess I could test the local knowledge of my postal district by sending a letter to myself addressed in this way. (We could all try this. Perhaps it would inform us of our true fame, or infamy even.)

Fothergill not only tended to the medical needs of John Wesley (founder of Methodism) and Benjamin Franklin (for malaria) but he also developed a famed physic garden in order to share his knowledge of herbal medicine and the skills and craft of apothecaries. Indeed a flowering shrub, fothergilla, was named after him, though it does not, to my knowledge, possess therapeutic properties. He was a great friend of Ben Franklin and supported the American political project which was largely due to Franklin’s indefatigable polymath brilliance. Fothergill is credited with such medical achievements as identifying the nature of trigeminal neuralgia, describing streptococcal throat infection and making the connection it has with scarlet fever, and, like many doctors in the past and the present, he incidentally poisoned people with the use of the toxic element antimony  in his ‘powders’. Oddly enough antimony is still used in medicine, but now mostly to treat leishmaniasis and schistosomiasis, rather than the rather vague applications it, and other noxious substances (like mercury) were put to in Fothergill’s day.

Dr John Coakley Lettsom MD FRS, another Quaker, became very wealthy, partly through inheriting a slave plantation in the British Virgin Islands from where he originated, partly through marriage, and partly through his hard work as a physician. One of the most incredible facts I learned about Lettsom is that not only did he have a twin brother, but his mother had given birth to seven sets of twin boys! I think that must be a record and she deserves some sort of medal, surely! Her one famous son established various institutions including The Medical Society of London in 1773 “for the advancement of the science of medicine, surgery and those branches of science connected there with”, and the beautifully named Sea-bathing Infirmary of Margate in 1791. I had never heard of this TB hospital but apparently it was still in existence in living memory, though only the chapel now stands. So intrigued was I about this hospital that I have sought out a really good photo of the place for my readers’ delight.

I rather think Bognor Regis should have a whip round and set up a similar Sea-bathing Hospital for the terminally bewildered, with me as Medical Herbalist and Dietician. That should sort them all out!

 

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Joseph Priestly, scientist, chemist, identifier of the element oxygen no less! (oh, and inventor of soda water!), and friend to the great French chemist Lavoisier, was another of these brave, vociferous, revolutionary thinkers, who simply refused to stifle their freedom-loving intellects. This brilliant man really shook up religious structures in his fearless critique of the many accepted teachings, causing great discomfort to the simple believers and the comfortable Church hierarchy alike, and in the process influenced many to think again, more logically, about such troublesome concepts as the Trinity for example. And yet he could also turn his mind to more prosaic subjects, such as ‘The Medicinal Uses of Tea’. Some of you will know that I, a practicing Medical Herbalist for over twenty years, have long proposed Tea as the most commonly used medicinal herb of all, and will know for yourselves just how gently effective are the restorative powers of this oft overlooked herb.

“Scrofula, Gout and Dropsy: Dr Samuel Johnson and his Physicians”.

The second lecture of today was dedicated to Samuel Johnson himself, that outstanding man of letters who wrote the first English Dictionary. We heard not about Johnson’s works but of the challenging medical conditions that he suffered on and off throughout his life. From the outset there were difficulties, including being born to parents who were not young (dad 50 and mum 40) and he was not expected to live, being born weak and feeble, but he rallied. Unfortunately he contracted scrofula at two years of age, which is usually caused by tuberculosis (in the lymph nodes), and I initially assumed he picked this up from his wet nurse, but, having looked up this method of transmission, the American CDC assures me that this does not happen, so he must have got it through a different mechanism. In that era the Monarch was assumed to have magic powers of healing this particular affliction (The King’s Evil) and baby Sam was taken to Queen Anne in 1712 for her Royal Touch and he was given a coin by her to wear always, but sadly it was to no avail. The tubercular glands were eventually surgically excised, leaving him scarred for life. (Presumably they tried a little antimony on it first, just that part of the story is not told)

Even with such a tough start in life he grew to be a tall man at 6 foot, and was sporty and active, but after a year at Oxford University his father’s money ran out and he had to curtail his student life and go home to Litchfield, where he sank into a deep depression. He adopted the habit of taking long walks to Birmingham and back (a 30 mile round trip) much as Dickens did, to clear his mind and feel better, but serious melancholia haunted him throughout his life. Along with this he developed a range of neurological quirks that persisted throughout his life, and included patterns suggestive of OCD and Tourette’s syndrome, which must have alarmed some of his many distinguished friends on first meeting. Apparently he clucked and chucked with his tongue and made squeaking sounds and whistles, and loud blowing noises after excited conversations, and he had strange hand gesticulations and awkward postures too. It must have been rather unnerving to have him in the room, and he was mistaken for an imbecile that had been taken in, on at least one occasion. Oops!

At the age of 73, with his health generally poor struggling as he was with breathlessness and dropsy (i.e. heart failure), and gout he suffered a stroke, probably in a specific area of the frontal cortex that is responsible for language (Broca’s area) as he was unable to speak or write properly for some weeks, though there was no muscle paralysis or mental fog, which apparently gave him comfort.

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Squill – Urginea maritime, 1806

He made a good recovery from the stroke, aided by the herb squill (Urginea maritime) which contains cardiac glycosides. These compounds slow the pace and increase the efficiency of each beat of the heart. It is a diuretic too, thus enabling relief from the oedematous lungs and ascites (abdominal fluid retention) which was also drained off mechanically. Squill was often used alongside foxglove leaf (Digitalis purpura or lanata) – from which the drug digoxin is derived – in the treatment of heart failure. Current Medical Herbalists, like myself, prefer to use lily of the valley (Convalleria majalis), with or without squill, for this purpose as the therapeutic dose is not so close to the toxic dose, and there is no cumulative toxicity risk from this gentler, yet no less effective medicine, making it a far safer medicine than foxglove ever was. In fact it is probable that Sam Johnson died after taking too high a dose of Digitalis given to him by the famous physician William Heberden, (he of the eponymous arthritic nodes) and he died on Dec 13th 1784, at the age of 75. Johnson’s death stimulated interest in how to get the dose of Digitalis right and one William Withering, another Staffordshire man, published a significant work just 10 months after this notable death, enabling a far more nuanced use of foxglove, an effective yet toxic herb.

It should be noted that Johnson had tried all sorts of other somewhat heroic means to improve his health including electricity, lancing and bleeding, and the rather worrying scarification approach, which sounds to me to be one of the crazier ideas of the past. I wonder what proportion of people developed bacterial infections following such ‘treatment’, or just wished they hadn’t as it must have been rather painful to say the least.

On his autopsy a large gall stone (the size of a pigeon’s egg) was found along with hydatids of testes, by which I think testicular cancer is to be interpreted. He was buried in Westminster Abbey and continues to be celebrated for his immensely influential works of literature, not least about the physicians of his era and of earlier times and how medicine, for all the endeavours and good intentions of its practitioners, cannot be considered complete.

 

Dr Nicholas Cambridge (right) re-enactment of Samuel Johnson’s walk to London

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I wish I had witnessed the walk of our speaker Dr Nicholas Cambridge and his friend Professor Peter Martin who walked from Litchfield to London (17 Gough Square, where Johnson lived for thirteen years), re-enacting the walk of Johnson and his friend David Garrick which took place in 1737, to commemorate the birth of this hero of the English language some 300 years earlier.

Here is a BBC report of the event, if you want to read a little more about it

http://news.bbc.co.uk/1/hi/england/london/7939244.stm