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.

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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

Brian

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

Blog Oct 26th 2013

The whole of Afifah’s blog can be found on:

http://rosemarycottageclinic.wordpress.com

West Sussex History of Medicine Society

Lectures October 26th 2013

by Afifah

World War 1 and the birth of Maxillo-Facial Surgery

by Colonel Michael Williams FDSRCPS FRCS FRCS(OFMS) L/RAMC

I don’t think I can do justice to this subject as it was pretty traumatic to be part of the audience for this intimately informed lecture. Colonel Williams has my sincere respect for his endeavours toward putting right all those desperately terrible wounds he has worked on, all those beautiful faces upon which havoc has been wrought by metal flung by fire.

Colonel Williams began his lecture with some of the historic background of the political causes of the First World War, and how come we ended up with thousands of men in trenches across France, putting up with the hellish conditions that rent a psychological gash through the people of England, and probably all Europe and beyond. He didn’t mention the fact that WW1 was all about oil (well I never!) which is why the first battalion that Britain sent anywhere in that war was to Basra, Iraq, no less. I recommend watching the funny yet deadly serious version of this aspect of our rarely told history in Robert Newman’s ‘History of Oil’ here in a 45 minute youtube presentation:

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We learned about the various ways missiles of different sorts cause their damage, and whether they are high or low velocity and which injuries are likely to result and why. The fact that facial injuries were so commonly seen in photos of soldiers returning home is due to the fact that the faces of the soldiers were always the most vulnerable parts, and still are today. It is very difficult to devise protection that still permits all the essential senses, which are mostly located in the head, to function fully. We were introduced to the remarkable surgeon Harold Gillies, the New Zealander who developed new techniques in jaw surgery following his training under the dentist Valadier. Amazingly we were shown a painting of a surgical theatre with Gillies and his team, followed by a photo of the same elegantly practical chamber some decades later, looking exactly the same.

The images we were shown of the poor men with parts of their faces missing, and then the same men post surgery were remarkable, but horrible. Whether brought about in WW1 or Helmand Province, the awefulness is the same. Life can never be the same for these individuals, nor their families, and even though brilliant and dedicated surgeons such as Col Williams learn their incredible skills through these men’s tragedies, he was at pains to say that each generation of such surgeons has to learn almost from scratch, as it seems so hard to maintain this level of expertise when not at war. This is because the sort of damage done by blast injuries are unlike those produced through ‘normal’ accidents, such as falls, car crashes and fisticuffs. The term used for this state of affairs was ‘loss of institutional memory’. I guess the only way round this is for professionals such as Michael Williams to write detailed descriptions and directions with copious photographic and video records of each and every case he and his colleagues deals with, enabling someone in 20 years time, for example, to pick up where he left off, and put some unfortunate soul back together.

Did the President of the Royal College of Physicians help Churchill win the war?

By Dr Anthony Eisinger FRCP

This presentation was all about the life and rôles of Dr Charles McMoran Wilson, the First Baron Moran, or Lord Moran as he was more generally known. We learned of the rather remarkable life of this clever, ambitious and influential man, who was not only one of the founding fathers of the NHS but also a BBC correspondent and one of the witnesses at the Nuremberg Trials, though this aspect of his life was not discussed today.

As Winston Churchill’s private physician he clearly saw many things that others did not, and was privy to some of the thoughts and problems that Churchill worked with that others would not have been aware of, but I saw a funny quote on the Wikipedia page on Lord Moran which was attributed to Churchill’s private secretary, Sir John Colville. He said ”Lord Moran was never present when history was made, but he was invited to luncheon afterwards”. This waspish put-down probably came about because patient confidentiality was felt by many to have been broken by Moran when he wrote his book ‘The Struggle For Survival’ about Winston Churchill, and this was an attempt by Colville to water down some of his more disturbing observations, after the fact.

Seeing the famous portrait of Churchill by Graham Sutherland was a highlight of this lecture for me as I had not seen it before. I knew of its existence of course, and that Winston’s wife, Clementine, destroyed it, disliking the final work vehemently. I had no idea any photos of it existed so was very pleased to have the opportunity of gazing on it and remembering the excellent play I heard about the whole story on Radio 4 a year or two ago. I thought it a very fine painting, but I have no interest in whether Churchill looked old, ill or tired, as she did.

Another gem from this talk was the detail that others may have known but which was news to me, and that is the full name of one of the Mitford sisters, Unity, the one who admired Adolf Hitler. I don’t recall why she was mentioned in this talk in particular but I will never forget her name now as it was quite unexpected: Unity Valkyrie Mitford! Who would call their daughter the name of the female entity that, in a battle, decides which soldiers will die and go to Valhalla, and which will not? What were her parents thinking?

Lord Moran managed to rub the GP world up the wrong way when he described them as the least able doctors, saying that those more capable became consultants, and he was no fan of women in medicine. But we are all a product of our times, so I don’t hold either of these notions against him too much. The fact that he was at Churchill’s side, or near it – at luncheon anyway – through all sorts of pivotal moments of history, means his publishing of the maligned book was probably a reasonable act for the nation, even if certain personal medical information was divulged which ought not to have been. In Clementine’s place I too would have objected to the publication of such a book, but as a citizen I feel the truths about this historic man wins the day.

 

Blog Oct 19th 2013

The whole of Afifah’s blog can be found on:

http://rosemarycottageclinic.wordpress.com

West Sussex History of Medicine Society

Lectures October 19th 2013

by Afifah

 

The History of Human Movement

Professor Mike Whittle MB BS BSc MSc PhD gave an interesting lecture on, an area of research in which he has been deeply involved. We learned about some of the misconceptions about how humans and animals achieve their various modes of perambulation, and how hard it has been to pin down the many details that are involved. Leonardo da Vinci, of course, applied his genius to the subject and, understanding muscle arrangement as he did, probably had a pretty good idea of the mechanics of walking, and 1682 Borelli was able to show that the centre of gravity played a huge role in the process.

People questioned whether horses passed through a phase, in which all four hooves were off the ground while they galloped, and until Edweard Muybridge (yes, that’s the weird spelling he adopted rather than his original name, plain Edward Muggeridge) 1830 to 1904,         arranged twelve cameras and a series of trip wires around a track and proved that indeed horses did have all four feet off the ground when cantering or galloping, showing that our human eyes and brains are simply unable to see this fact. By proving this on film he won a bet and in the process appears to have invented the multi camera form of      photography. Similar to this, and yet different, was the work of Etienne-Jules Marey (also 1830 -1904) who found a way to capture various movements of an object, animal or person as a single image rather than a series of images as Muybridge had done.

There is an example of his work which readily demonstrates the adjustment to the centre of gravity that the body makes as it bends: He also produced chronophotgraphies of a man wearing black clothes with white lines stratigically place on them,      walking.

This work somehow distills, as an image, the process of walking, which is quite astonishing.

 Mike Whittle himself, our speaker, was involved in developing reflective markers which were placed on certain parts of people to identify their specific movements under strobe lighting, at Oxford University. Using this technique he was able to show, for example, that there is a difference in an individual’s gait when they walk on a flat pathway or on a motorised treadmill.

 We heard that gait analysis, though interesting and useful in some circumstances, such as in cerebral palsy, and forensic identification of crime scenes, is very expensive and is therefore hardly ever done these days. However, in the film industry the use of reflective markers on       actual actors has been used to produce fine quality computer           generated images (CGI) which have great impact, such as in the 2009 block buster film ‘Avatar’. So, where there’s money to spend and money to be made it is still done, but it is too expensive to use as part of a therapeutic process in most cases, as it does not generally diagnose faults but rather examines detail in order to plan treatment. This seemed rather a sad end to the lecture as it was such a fascinating subject, and it has spawned a great deal of skill, industry and artistry. And all about something we mostly take for granted, simply – moving.

The second lecture was something of a surprise:

Dracula, Doctors and Diagnosis’ 

by Fiona Subotsky MA FRCPsych.

This lecture was two days before Halloween, so I think we were being reminded of some of the wierd and wonderful concepts that have become part of that annual tradition.

Not being a lover of the horror genre in books or film, or vampires, or anything ‘gothic’ I am probably not the best person to report on such matters, but it seems that Bram Stoker, author of Dracula, based most of his characters on his rather dodgy relatives and friends, many of whom were actual doctors. Indeed one of the characters in the book, a Dr Seward, was named after a real Dr Seward who presided over the real Colney Hatch Asylum, a dread place if ever there was one. The vague medical terms, concepts and attempts to sound knowledgable about matters of health in this tale are, generally, laughable. The pseudo psychiatry that is expressed throughout is also bizarre and, some might say, silly.

 Our lecturer, a retired child and adolescent psychiatrist, considered what could be wrong with Dracula. A difficult task indeed! Could he have had clinical lycanthropy (the ability to appear in many forms), or multiple phobias, OCD, or even rabies we wonder (rabies was my idea, not the speaker’s, but I think she said that Dracula was afraid of water, am I right?).

Finding actors to play some of these parts must have posed a challenge. One that fitted the role rather well was Max Shreck, who our lecturer suspects had Marfan’s syndrome (though I think those fingers in the 1922 photo below are prostheses). Klaus Kinsky, known for his    ex treme volatility and unsavoury nature, certainly looked the part when the  director, Werner Hertzog, cast him as Nosferatu in 1977.

Blog Oct 12th 2013

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The first blog for the new season has arrived from Afifah.

The whole blog can be found on

Rosemarycottageclinic.wordpress.com

WSHoMSoc lectures Oct 12th

by Afifah

Hooray, the West Sussex History of Medicine Society autumn lecture season has begun! I am looking forward to reporting on these gems combining as they do knowledgeable speakers, historical topics and academic investigation.

 

On Saturday 12th Oct we launched the term with

Professor Ken Shaw MA MD FRCP, the endocrinology specialist. The talk was titled “A Glass of Wine Before Visiting the Sick: The Clinical Sense of James Lind, Haslar Physician 1758 – 1783”.

At first I thought James Lind must have been one of those brilliant people who achieve a great deal in a tragically short life, but the dates above do not refer to Lind’s birth and death but to his time atHaslar Hospital. In fact he only went to Haslar when already an established medical practitioner, at the age of 42, and lived a further eleven years after his tenure at that place of physic.

Lind is chiefly famed for his attempts to understand and successfully treat scurvy, that desperate disease that we now know as due to vitamin C deficiency. Sadly, he didn’t solve the problem, but came tantalisingly close to doing so, searching and researching, as he did, all the possible causesand cures that occurred to him and others of his day. Indeed he conducted some pretty good clinical studies on the subject. I particularly like his trial method of pairing up scorbutic patients and observing the effect of each pair being prescribed a different treatment.

The vastness of the scurvy problem can hardly be overstated. The fact that 90% of the crew of HMS Salisbury, the Channel Fleet ship to which Lind was appointed Surgeon, died of the scurvy illustrates the devastation it wreaked. Hindsight, being the wonderful gift that it is, makes uswonder at the failure of those working to solve this problem, especially when there appeared to be a correct focus on food stuffs and yet not quite the right food stuffs, despite the solution having been stumbled upon on more than one occasion prior to Lind. Indeed we heard that in 1699Everard Manwaring identified citrus fruits as a cure. Clearly, his realisation failed to catch on as the problem of scurvy continued well into the next two centuries! In fact the expedition to the Antarctic by Captain Scott and his band of tough adventurers failed partly due to scurvy as they failed to take any citrus fruit with them, and that was as recently as 1910! One would have thought that this particular nutritional blunder could have been avoided.

Lind’s suggestion that physicians should wine and dine before visiting the sick is eminently sensible. Only when one is fully nourished can one’s immunological resistance be great enough to defend one from those lurking microbes that can assail from any quarter. Fully functioning organs of all types in our bodies depend on the regular through flow of fats, proteins, minerals, vitamins and water, and surely no one would deny that wine is a bit more antiseptic than water!

The second of our lectures was on ‘Beethoven: His Life and His Music’ written and presented by Dr Winston Leigh BA MB ChB MRCGP.

Dr Leigh’s interest in and knowledge of the arts is legendary, so to have Beethoven given the Leigh treatment was eagerly anticipated, and it did not disappoint. Although my childhood was spent surrounded by classical music, due to my father being a piano teacher, there is much that I learnt about our Ludwig that I did not previously know. I didn’t know he was born in a caul, for instance!The family into which Ludwig was born and his early years although influenced by music were also influenced by alcohol as his grandfather was a wine merchant and certain relatives died of alcohol poisoning. Indeed at one time it was considered that our man Beethoven may have had cirrhosis of his liver due to alcohol poisoning, and I am not sure where the theories stand on this now. What we do know is that he suffered from an array of other persistent complaints right through his teens and beyond, well before his hearing began to fail, and these conditions interest me greatly. Abdominal cramps, constipation, diarrhoea, headaches, and pulmonary infections all plagued the poor young man.

Beethoven had to endure a series of extremes throughout his life, it seems, from enormous highs (e.g. Mozart found that the musical variations on a theme he asked the young Ludwig to compose were so complex and brilliant that he stated to the world that they must “Watch out for this one!”) to dreadful lows (his father suffering a mental breakdown when his mother died, leaving Ludwig to care for his two younger brothers as Dad was unable to cope), back up again (being tutored by the great composers of the time Joseph Haydn and Salieri) and back down again (severe, troubling tinnitus), right back up, due to falling madly in love (with the 17-year-old Josephine Von Brunsvik, his pupil, and probably the love of his life) only to be dashed back down as her widowed mother needed her to marry a man of wealth and aristocratic status, which our man could not claim. This was followed by another lift from love (this time to another pupil, Giulietta Guiccardi, to whom he proposed marriage, and was accepted, only to be rejected by her father as an inappropriate suitor but to whom he dedicated the immortal piece Piano Sonata No.14, a.k.a. the “Moonlight Sonata”). Following this blow to his hopes the poor man admitted to thoughts of suicide, so he was clearly profoundly depressed by this time, with only his vast musical creativity keeping him going! In hismid 40s Ludwig spent a lot of money trying to help his younger brother Carl who had developed TB and when he died a major legal battle ensued as Ludwig attempted to gain custody of Carl’s young son, even though the poor kid’s mother was still living. All rather bizarre.

And through it all, with gaps for getting embroiled in other things, Beethoven produced works of utter genius, even though his hearing continued to deteriorate, eventually resulting in total deafness. His bowels continued to malfunction too, and at the age of 56 following some months of illness so severe he kept to his bed, with jaundice, swollen ankles, ascites, a fever and with foetid breath, he died, during a thunder-storm. A doctor had drained the ascitic fluid in his abdomen,some time earlier, to no avail. Apparently when his body was examined in an autopsy his spleen was black, his pancreas was hard and both auditory nerves were shrivelled, accounting very well for the deafness.

Following an amazing trail of leads and discoveries of letters in secret drawers, and a snippet of his hair taken by a pupil and found in a locket, handed from collector to collector, arriving for auction at Sotherby’s in 1994 (all 582 strands) Beethoven’s hair has now been analysed in an attempt to discover the cause of his poor health. Initially William Walsh checked for the presence of mercury and other heavy metals, and then Walter McCrone (the forensic chemist of Turin Shroud fame) identified an excess of lead in the hair. 42 times the normal level, no less! It is well-known that lead poisoning effects nerve development and function, and can cause unpredictable behaviour and outbursts. It can also cause digestive system pain and malfunction, but can it cause the liver to fail and the spleen and pancreas to be so harmed?

So, between a possible alcohol story, the lead poisoning from the lead pipes of the day, the extreme emotional roller coaster that this man experienced, and what looks to me very much like coeliac disease with extra gastrointestinal manifestations, this genius did extraordinarily well to produce the sublime and lasting works that we know and love so well. Thank you Winston Leigh for bringing so much of this story together, with music (I forgot to mention that) for our delight.

Blog Dec 8th 2012

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WSHOMSoc lectures Dec 8th 2012

Well, another term of fantastic lectures is over. I will miss them. The format is so good: the fortnightly event, the pair of lectures, the local lunch, the elevated conversation… What could be better?

We ended on a very strong note and I for one am agog with anticipation, awaiting the programme of 2013 speakers. Let’s see if I can do justice to both speakers in this, my humble blog version of todays event. Apologies for any mistakes or unintended omissions.

First off I learned about a luminary of the neurology world of whom I had never heard (at least, I had, but without realising it) – Samuel Alexander Kinnier-Wilson.

Our speaker, Dr Edward Reynolds MD FRCP FRCPsych, is a renowned and much published neurologist with a special interest in psychology. His subject was S A Kinnier Wilson of the eponymous Wilson’s Disease, who was one of the greatest neurologists of his era, the early part of the twentieth century. The reason for Dr Reynolds coming to Chichester to give this talk was, I believe, the recent unearthing of a film that he intended to show us, but which could not be induced to play on the CMEC computer system due to ‘incompatibility’, but we were not disappointed as the film was well described and commented upon and I am sure we all felt familiar with it by the end of the talk.

Kinnier Wilson worked at the ‘National Hospital for the Paralysed and Epileptic’, a great name for what was surely a great institution. These days it is known as the National Hospital for Neurology & Neurosurgery in Queen Square which is a more fitting name, less like a side-show. (It tends to be called just Queen Square to medics, for brevity.) Wilson was the first person to carry the title ‘Consultant Neurologist’ and had a great influence on the psychiatric aspects of neurology through his work in asylums.

Wilson’s Disease is a rare and pretty obscure disorder and I have not seen a case yet (though I had to ask the neurologist for a ceruloplasmin test recently as I diagnosed an early onset Parkinson’s patient who could have had Wilson’s Disease, which can present with similar symptoms) and one can see why it interested Kinnier Wilson. Patients have both neurological and psychological symptoms as copper accumulates in their brain and liver. Symptoms such as confusion, seizures, migraine, crazy impulsivity, apathy, dementia and psychosis may be the result of the aberrant metabolism which is due to the absence of the enzyme that breaks down copper. (Please Dr Reynolds, send me a comment and let me know if I have got this roughly right, correcting me if not).

But, interestingly, Kinnier Wilson appears to have had a connection with the great Charlie Chaplin! Who would have thought it? The theory was posited that they may have met when Chaplin’s mother was in a lunatic asylum, and it is through this connection with Chaplin that it is thought that the film (which in our case we have not got) of neurological diseases featuring Kinnier Wilson and patient examples of neurological defects of many types, came to be made, as Charlie Chaplin would have had the cinematic skills and kit to make such a film. We were shown a photograph of Charlie Chaplin standing with Kinnier Wilson’s wife Muriel (nee Bruce) at his large Californian home, and we suspect that Wilson himself is taking the picture, but we dont know who owned the camera, Wilson or Chaplin. It was suggested that the famous walk adopted by Chaplin in his portrayal of the penniless unfortunate that became his alter ego, was developed through his observation of patients in Kinnier Wilson’s neurology wards.

 

I was extremely touched by the letter we were shown, written so elegantly by Charles Sherringham to Kinnier Wilson telling him that he and Edgar Adrian had proposed Wilson for the honour of Fellow of the Royal Society. The letter was filled with gentility, savoir faire and Edwardian courtesy. The handwriting alone was a delight. I loved the way Sherringham entirely down-played the fact that he and Edgar Adrian had just got home from receiving their Nobel Prize for Medicine by writing something like: ‘Adrian seems no worse for wear after his trip to Stockholm’. How very tangentially put! That was the era when blowing ones own trumpet was simply vulgar. These men were anything but vulgar.

The second of this last pair of lectures was by our very own Winston Leigh BA MB ChB MRCGP. I say ‘our very own’ because this doughty gentleman has now given no less than eight lectures to members of the West Sussex History of Medicine Society. He certainly gets the prize for persistent curiosity. (I hope I get one of those when I grow up too).

Winston Leigh must be an artist, or a musician, or both. I have only been at two of his lectures so far (I have only been a member of the society for a couple of seasons) and both have been about artists and had music playing as we went back into the lecture hall after our tea. (Thank you to the elves that make the tea and coffee appear as if by magic, by the way!) This time the strains of a Robert Schumann piece met me as I found my seat and I am afraid to say I mis-guessed the composer.

The subject of the lecture was Artists’s Eyes: Oscar Claude Monet and Vincent van Gogh. We were lead through the various theories and their probable accuracy about the distinct artistic styles that these great painters are famed for and whether their eyes, their brains, or simply their painterly idiosyncrasies were the source of their genius.

It seems that there is a new sport which medical minds spend considerable time and effort on. It involves trying to diagnose the illnesses of historical figures in today’s terms. Eyewitness accounts, records of one sort or another as well as things like CT scans, bone analysis where possible or tissue sampling can lead to a more accurate appraisal of their diseases, so it is a rich and fascinating seam indeed, there being a great many historical figures to investigate! (For example: Fredrick Chopin may not have died from TB, as has been generally assumed, but actually have had cystic fibrosis? That was the subject of a previous lecture by Dr Leigh last year and very convincing it was too).

Seeing a picture painted in 1867, then one in 1890 and another in 1922 was a wonderful way to witness the marked change in Monet’s style, as it did indeed become more and more ‘impressionistic’. But was there a cause, per se? Indeed there may well have been: we learned that Monet certainly developed cataracts, in both eyes. By the time he was 53 and living at Giverny, enjoying his fabled garden, his colour differentiation was definitely impaired, which must have been a cause of great anxiety to him, though great pleasure to those of us who love his water lily works. He very sensibly rejected the idea of surgery for many years, but eventually did risk it in 1923, when it had to be done in two stages as he apparently became aggressive and uncooperative with the surgeon. Poor man! He must have been terrified, and not without reason. I know it is a very common operation these days, but most people still balk at the idea of letting anyone near their eyes with a sharp implement. I learned the word ‘aphakic’, (thank you Dr Leigh) as he had to use aphakic glasses once his cloudy lens was removed.

Vincent Van Gogh is quite a different case. It seems that his physical and mental health were the main problems, mostly brought on by poverty and subsequent poor living conditions, and he was known to have had epilepsy which still leaves many at a social and financial disadvantage. However he smoked a pipe and drank heavily too. It seems too that he was acquainted with the Green Fairy (absinthe) which was a common drink amongst the bohemians of the era. As a Medical Herbalist I have prescribed tincture of wormwood (Artemisia absinthium) on many occasions and can honestly say I have never seen anything but excellent effects when used for its vermifuge and anthelmintic properties with no wacky side-effects in the least, so my belief is that the virtually hallucinogenic properties ascribed to the drink absinthe were exaggerated and played upon by users and detractors alike. He also had gonorrhoea and suspected syphilis too, possibly from the alcoholic prostitute he shacked up with for a couple of years. So he was not a well man.

However, our speaker was interested in the artistic style, use of colour, especially the famous yellows, and the halos he painted around lights and stars and whether all this added up to a quirk of the visual cortex or other apparatus, or some other discernible pathology. However, in the final analysis it did not. His eye was fine, and no sight issues have been revealed. He seems to have had a particular affinity for a mustardy yellow colour, using various shades intensively in a great number of paintings. One amazing piece called Still Life With Grapes, Pears and Lemons is painted virtually entirely in hues of yellow. He lived in a house called The Yellow House, whether by design or co-incidence, but none of his use of colour can reasonably be considered pathological anymore, but rather part of his artistic genius.

Apart from the extremely interesting thoughts about Van Gogh’s health the culmination of Dr Leigh’s talk was, for me, the wonderful news that Van Gogh probably did not die due to an unsuccessful suicide attempt using a gun as we have been lead to believe. We were reminded that the original story goes like this: on July 27th 1890 Vincent was in a wheat field in Auvers-sur-Oise with his easel and paints, working away, when his poor mental health got the better of him and he shot himself. Regaining consciousness and with a chest wound he struggled back to the hotel in which he lived. Two doctors were called, and word was sent to his brother Theo, but the doctors did not have the skill to remove the bullet which miraculously had missed his vital organ but was lodged towards his spine. Vincent stated that he had pulled the trigger himself and that no one else was involved. However, it was known that he had taken to hanging out with two young chaps, brothers, perhaps in their late teens or early twenties, and together they would drink and get sozzled and have good time (presumably). These brothers had a revolver and it is now believed that on this fateful day the three of them were in the field together, considerably the worse for wear due to alcohol, and one of the brothers accidentally discharged the gun inadvertently wounding Vincent! They probably scarpered, with the gun (which was never found) assuming him dead and terrified of the consequences, but he was only unconscious. Once back at the hotel he clearly stated that it was a stupid attack on himself by himself and that no one else should be considered, and he smoked his pipe and waited for Theo to come and sort him out (again). Overnight however, the wound became septic, which is to be expected in an emaciated, thoroughly malnourished body, so the next day he died! But the wonderful news is that some thirty-odd years later a middle aged man identified himself as one of the two brothers who had been with him on that drunken day, and that he had indeed been the one to have actually pulled the trigger of the dratted gun, by accident! What a hero it makes Vincent! He made sure that the young chap was not hounded as a murderer, as it had all been a stupid, idiotic, clumsy accident, and nothing would be gained by blaming the lad. He certainly does not sound insane now does he? More like an entirely decent if intensely foolish genius artist, sick in body like so many other impoverished folk, but which the world would have been so much the poorer without.

So all those possible diagnoses that Winston Leigh offered up, but discarded, such as bipolar disorder (apparently his sister ‘had’ it), Meniere’s disease (which could explain the ear incident, by the way it was definitely his LEFT ear – don’t be fooled by the self portrait wherein it appears to be his right ear – he was looking in a mirror while painting it, duh..), closed-angle glaucoma (the halos round the stars and candles in his works, but in a man not yet 40 this would be unusual), or neurosyphilis (again, he would have been rather young for it to have manifested neurologically), nor Digitalis toxicity (though this could have been the cause of the xanthopsia – seeing excessive yellowness – as Dr Gachet of the eponymous painting by Van Gogh did prescribe foxglove frequently and is painted holding a sprig of it, but there is no evidence that Vincent had a heart arrhythmia nor was the recipient of that particular herbal drug). So we are left with simply the wonderful, rich, vibrant, startling and vivid painterly intention, rather than any ill health ‘causing’ Van Goghs colour choices.

 

 

Blog Nov 24th 2012

IMG_2377WSHoMSoc lectures Nov 24th 2012

There can be nobody who isn’t fascinated by the Ancient Egyptians. Clearly the first of todays lecturers was so riveted by the ancestral treasure trove of Egypt that she made it her life’s work.

By tentatively approaching their iconic and yet pretty alien culture we discover something of ourselves. The gradual peeling away, like layers of an onion (or maybe a bandage?) by all sorts of means, from shovels to high-tech land imaging and everything in between, secrets that have been hidden for thousands of years are revealing what extraordinary things we humans have achieved in terms of intelligence, maths, engineering and mega architecture, and, of particular interest to me, medicine. Surely that is enough to keep anyone fully occupied for decades.

Professor Rosalie David OBE of Manchester University must have been hard pushed to pack a lifetime’s research into one 50 minute presentation, but she managed it, just for us. Disease and Everyday Life in Ancient Egypt took us on a voyage into a different time with different realities and different rules. We learned how naturally mummified bodies were found in pits in the sandy hot parts, and that those buried in early carefully devised tombs called Mastabe had not survived in tact as the natural drying out process had been prevented by the very desire to preserve the bodies buried in them. Things around these dead are, of course, of great interest, the pots, the artefacts etc, but those bodies didn’t preserve well at all. There was clearly a great interest in these people to get funerary systems right, and hence they devised the full-blown mummification techniques with which we are familiar.

With every mummy we, of course, want to know what was the cause of death? These are tricky questions to answer, not only because of the passage of time, and the desire to keep the mummy in tact, but also because their viscera have been removed, leaving us fewer clues. However more than one of those discussed this morning were known to be infested with worms of one sort or another. Guinea worms in in one case and filarial worms in another. Since the mosquito is one of the carriers for this parasite, which can lead to elephantiasis, it seems our mummy was most probably miserable at his death. Although filariasis is still going strong it looks as though guinea worm infestation is on its way out as it only bothers the people of about four countries in Africa these days. Schistosomiasis was also found in two mummies back in 1910 and they think that the ‘ah, ah, ah’ disease may well have been this. Poor people. Drat those snails!

What I wanted to know is what these people ate. Clearly we are well into the period known as Neolithic, but it appears that hunter-gatherers and grain users were over-lapping as climate and peoples changed and adapted for some thousands of years. No neat delineation can be determined. From my perspective I was hoping to hear from Prof David that evidence of bone anomalies, tooth structure insufficiencies and smaller stature could be clearly stated once the use of grain had developed. Although severe dental wear has been found it is considered due to grit in the grain, i.e. external factors, rather than the internal mineral deficiencies which we now know are brought about through the chelation of minerals by phytates in grains. Clearly, I need to consider evidence from further back still if I am to find out about the effects of eating grains on those people right on the cusp of their hunter-gatherer forebears and the later regular gramineae (grass seed) eating folk.

I was, however, very heartened to hear the results of research into the prescriptions those ancient doctors left. A full 64% of the herbal mixtures have been shown to have a therapeutic value on a par with modern drugs. To me, as a Medical Herbalist, this is not at all surprising, but it may have been to others present. A great many plants have potent pharmaceutical application, and of course all people in all eras in all parts of the world relied upon such plants as grew in their vicinity, for their medicine, and according to the WHO 80% of the worlds people still do.

The second lecture was very different, although it too involved inanimate bodies. These, however, never had internal organs, so canopic jars were not needed to retain them, nor has an afterlife ever been considered in relation to these ‘bodies’. I am speaking about ‘Resusci Anne’ who was the subject of the lecture: The Most Kissed Woman In The World.

To the uninitiated Resusci Anne is the human-like model on which doctors, nurses, and herbalists, learn to perform cardio-pulmonary-resuscitation (CPR). Our lecturer, David Wilkinson, Consultant Anaesthetist St Bartholomew’s Hospital and Honorary Senior Clinical Lecturer at University of Oxford lead us through the surprising and sometimes surreal story of the origin and form of this ubiquitous ‘doll’.

Attempting to bring people back to life after drowning or collapsing for whatever reason, seems to only have occurred to people in the 1700s. Maybe before that they just took unconsciousness to be a sign of death, rather than the small window of opportunity to retrieve life as we now see it. I won’t regale you with the astonishing, and disturbing methods that were employed once the idea of recovery did dawn in the collective minds of our ancestors, suffice to say that they were bonkers for the most part.

At last one Norwegian chap, Mr Laerdal, who began as a publisher of encyclopaedias, started making toys. His toys were made of a new kind of plastic which proved useful in making not only dolls but toy cars too, Tomte cars were the result, and they are now collectors items. You may well recognise the style as they were all the range for boys in the middle of the 20th century. His knowledge of moulding plastic lead to a request for him to make fake wounds out of the same sort of plastic for medical training and thence to devising a doll for medical training of mouth to mouth resuscitation after his son nearly drowned. This was no easy task, as real bodies are actually very unlike plastic dolls. All sorts of density issues, springy ribs, throat structures etc had to be considered. And then the troublesome question of what the face should be like!

The solution to the face is poignant and bizarre, in equal measure. The body of a young woman who had drowned had been pulled from The Seine in Paris and her body lay unclaimed in the mortuary. Even though the media of the time was used to find the family of this sad individual, no one came forward, and her unknown, unloved and probably desolate life became a disturbing reproof to the Parisians of that time. So a death mask was made of her lovely and innocent face with no name, and it was this that became, and still is, the face of Resusi Anne. And so her life goes on. Although she was perhaps unloved, lonely and unknown in her life, she has become the most kissed woman in the world as a result of her demise and the conscience that her tragedy stirred in her countrymen.

Over 300 million people have now kissed Anne. One can only hope that in some way, to some small degree, this undoes the sadness that she probably had while alive.