1891)

Posted on 6th April 20196th April 2019 by Edward Wawrzynczak | Leave a comment

Thames Water, the authority responsible forLondon’s water and sewage system, is currently building a massive new ‘Super Sewer’ known as “Tideway”. Approximately 25km in length and due for completion in 2024, this project is being undertaken to prevent the release of thousands of tons of untreated sewage into the River Thames on a daily basis. This contemporary, complex and sometimes controversial civil engineering project is a reminder of the birth of London’s sewage system, designed by Joseph Bazalgette, born two centuries ago last month.

Portrait of Sir Joseph Bazalgette. Credit: Wellcome Collection. CC BY.

161 years ago Victorian MPs were busy arguing and prevaricating over the cost and necessity (or not) of building and funding a proper purpose-built sewer system, designed by Bazalgette. They rapidly ceased all opposition to the project during the long hot summer of 1858 when low tides meant that huge quantities of untreated sewage that normally ran into the Thames were deposited on the river’s foreshores. The resulting appalling smell became known as “The Great Stink”. Believing, as most did at that time, that bad smells spread disease, MPs had to hang sheets soaked in carbolic against the windows in the Palace of Westminster to stop the suffocating stench. Before finally leaving The House ‘en masse’ the MPs quickly voted in the necessary funding for Joseph Bazalgette’s brilliantly conceived sewer system. It consisted of “intercepting sewers”, pumping stations and treatment works that are still being used today thanks to the high quality brick-lined tunnels and the use of durable Portland cement.

Civil engineering: construction drawings for the Thames Embankment. Coloured drawing, 1865, after Sir J. Bazalgette. Credit: Wellcome Collection. CC BY.

Bazalgette was a brilliant engineer, who started his career working on various railway projects. He was responsible not only for the London Sewer System but also for the Thames Embankment, and numerous major roads in London such as Shaftesbury Avenue and Northumberland Avenue. He strengthened or rebuilt 12 bridges over the Thames and freed them from tolls. He also engineered the Blackwall Tunnel and the Woolwich Ferry, and important parks such as Clissold Park, Finsbury Park and Victoria Park “the green lung of East London”.

However, it is Bazalgette’s sewer system for which he is probably most famous. He designed it anticipating a population increase in London from 2 million to 4 million – extremely far-sighted for the time. Given that the current population of London is approximately 8.5 million, no wonder a ‘Super Sewer’ is needed to provide for the increased strain on the system. More important than saving Londoners from a further ‘Great Stink’, Bazalgette’s work played a critical role in saving the lives of many thousands from deadly water-borne infections such as cholera. For this, he deserves to be remembered.

Further Reading

Stephen Halliday,The Great Stink of London: Sir Joseph Bazalgette and the Cleansing of the Victorian Metropolis(Sutton Publishing: Gloucestershire, 1999).
‘Tideway – Reconnecting London with the River Thames,’ accessed 30/3/19, available at: https://www.tideway.london.
‘Thames Water,’ accessed 30/3/19, available at: https://www.thameswater.co.uk/

Hermione Pool

A Breath of Life in the Archives

Posted on 26th March 201926th March 2019 by Edward Wawrzynczak | Leave a comment

Laboratory (? at Sudbury), Credit: Wellcome Collection

A young man, an assistant in the laboratory, poses for the camera. The surroundings and his attire flag a bygone era. What stories might he tell us of that time?

The photograph is undated, and the location not precisely specified [1]. The time and place can, however, be established with some certainty. The lab is part of the Serum Department of the Lister Institute of Preventive Medicine at Elstree, Hertfordshire. The year is 1903, or as near as matters, when this new establishment was unveiled to the press [2]. Another version of this image, artistically faded at the corners, appeared in a promotional pamphlet soon after [3].

In the archives of the Lister Institute, tucked away under ‘historical items’, sits a remarkable memoir [4]. Albert Riggs was 17 years old, and had been out of work for 4 weeks, when a neighbour working as a builder on the Elstree site suggested he apply for a vacancy. Riggs passed the interview and started as a lab assistant on 3 September 1903 on a weekly wage of 12 shillings. He was appointed Head Assistant at the beginning of World War I and remained an employee of the Institute for 48 years. He put down his memories in a 100-page annotated typescript illustrated with hand-drawn diagrams. Riggs’ first impressions of the Elstree Laboratories were drawn upon by the best-known history of the Lister Institute:

At six o’clock on a lovely August morning in 1903, I first saw the Lister Institute, or as it was then known locally “Queensberry Lodge”, and now whenever it comes to my mind, I see it as I saw it then, the lovely tree lined drive, the green fields, the trim hedges, the old house with its rustic porch in front, the stables with their eighteen horses and whistling stablemen, and the calm peace which reigned over everything. [5]

In considerable detail, Riggs describes the labs, animal houses and stables. He covers the routines involved in making a variety of serum products and the role of lab assistants immediately prior to 1914, and he offers a first-hand insight to the work of the Institute during the war when it supplied tetanus antitoxin and other antisera to the Army [6]. Most engagingly, Albert touches on aspects of his life, candidly recalls many of his colleagues, and describes – warts and all – some of the ‘characters’ under whom he worked.

With its authentic voice – a rare counterweight to the large volume of ‘official’ documents typical of institutional archives – this lab assistant’s memoir breathes life into history.

References

[1] Image of laboratory at Sudbury (?), Lister Institute, Wellcome Library Archives, SA/LIS/R.163.

[2] British Medical Journal1 [2217], 1513-15 (1903); The Lancet, 2 [4167], 120-1 (1903).

[3] A Laboratory at Queensberry Lodge, The Lister Institute of Preventive Medicine – with notes on serum therapeutics by members of the staff of the Institute, 1904, SA/LIS/P.13, facing p. 10.

[4] Albert Riggs’ Memoirs of the Lister Institute of Preventive Medicine, Elstree, Hertfordshire, c. 1951, SA/LIS/M.6.

[5] Chick, H, Hume, M. & Macfarlane, M. (1971) War on Disease: A History of the Lister Institute, London: Andre Deutsch, p. 80.

[6] Wawrzynczak, E.J. (2018) Making serum, saving soldiers: the Lister Institute during World War I, Vesalius– Journal of the International Society for the History of Medicine,Vol. XXIV, No. 2, 40-48.

Edward Wawrzynczak

The Story of the Stethoscope

Posted on 12th March 201912th March 2019 by Edward Wawrzynczak | Leave a comment

One might not automatically recognise the image below as that of an early version of the medical stethoscope. It certainly looks very different today. This blog focuses on the invention of this instrument, synonymous with the medical profession, over 200 years ago.

Laennec-type monaural stethoscope, France, 1851-1900. Credit: Science Museum, London. CC BY.

Where did it all begin?

The story of the invention of the stethoscope begins with a young French physician in Paris, René Laennec. It was in 1816 that Laennec was called to see a rather fat and buxom young woman with a ‘diseased heart’. Feeling awkward, embarrassed and improper at putting his ear so close to this woman’s chest in an attempt to listen to her heart, Laennec sought to find an alternative method. He described his predicament and later actions in the medical text De l’Auscultation Médiate, published in August 1819:

I happened to recollect a simple and well-known fact in acoustics, … the great distinctness with which we hear the scratch of a pin at one end of a piece of wood on applying our ear to the other… I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised and pleased to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of my ear.’

Laennec modified this method of a rolled up piece of paper to make a wooden cylinder, measuring 25cm by 2.5cm. He called this piece of equipment a ‘stethoscope’, the name derived from the ancient Greek stethos meaning ‘chest’, and skopein meaning ‘look at’. The stethoscope became an essential item in Laennec’s medical bag and he utilised it to listen to both the heart and lungs of his patients.

Reception

Although a few physicians resisted the introduction of the stethoscope, maintaining that it was best to listen only with one’s ear, the vast majority of the medical profession embraced its use. The invention quickly spread over Europe in the early 1820s and the design was further developed and improved upon. By the end of the nineteenth century, this wooden instrument had morphed into something more akin to the modern-day stethoscope. Flexible tubing, first made out of rubber, and then plastic, made the stethoscope both easier to use and transport; whilst binaural earpieces improved the quality of the sound for the listener. The stethoscope works by transmitting acoustic pressure waves from the chest-piece through the hollow tubes to the listener’s ears. Today, there are even more advanced electronic stethoscopes which amplify body sounds improving further the sound transmitted.

A 19^thcentury stethoscope with a bell-shaped end. Credit: Wellcome Collection. CC BY.

The meaning of the stethoscope

The significance of a stethoscope in the twenty-first century cannot be under-estimated. It confers identity and, to a certain degree, status. Its wearer is automatically assured to be a member of the medical profession. It implies trust, understanding and knowledge. In this way, Laennec’s stethoscope is incredibly valuable, both from a diagnostic and symbolic perspective.

Further Reading

‘The story of Renee Laennec and the first stethoscope,’ Past Medical History. Available at: https://www.pastmedicalhistory.co.uk/the-story-of-rene-laennec-and-the-first-stethoscope/, accessed 9/3/19.

‘Stethoscope,’ Brought to Life – Exploring the History of Medicine. Available at: http://broughttolife.sciencemuseum.org.uk/broughttolife/techniques/stethoscope, accessed 9/3/19.

Lucy Havard

50 Years of Fibre-optic Colonoscopy

Posted on 16th February 201916th February 2019 by Edward Wawrzynczak | Leave a comment

2019 marks 50 years since the advent of fibre-optic colonoscopy. This blog discusses the development of this widely used technique and associated technology, and its impact on modern medicine.

Colonoscopy is a technique that allows direct visualisation of part of the large intestine (the colon). A flexible tube (endoscope) with a light source is inserted into the anus and images from the inside of the colon are projected onto a monitor. As well as being used for diagnostic purposes, colonoscopy can also be therapeutic, for example allowing for the removal of pre-cancerous growths.

The technique of modern colonoscopy is largely thanks to the work of several doctors in the 1960s and 1970s. The fibre-optic colonoscope was developed by Dr Niwa and Dr Yamagata at Tokyo University. Two physicians based in America, Dr William Wolff and Dr Hiromi Shinya, then pioneered its use, performing the first modern colonoscopies in June 1969. They described ‘over 1000 successful and totally uncomplicated endoscopic examinations’. The colonoscope, unlike the flexible sigmoidoscope, allowed for visualisation of the complete colon. Wolff and Shinya later developed and started using an electrosurgical polypectomy ‘snare’ to remove polyps. They published a seminal paper in 1973 demonstrating the utility, safety and cost-effectiveness of colonoscopy. The practice of colonoscopy increased during the 1970s and 80s, facilitated by the associated public exposure when President Ronald Regan underwent several colonoscopies to remove polyps in the mid-1980s. The New York Times quoted the advice given by Ronald Reagan’s surgeon who stated that the president should ‘undergo an examination of his intestines, a colonoscopy, within six months and every year after that, as well as periodic blood tests to check for possible colon malignancy’.

So how has colonoscopy changed over the past few decades? Well, to be truthful, not much! The technique is very much the same. However, the instruments used today are more flexible, making them easier to manipulate. This allows for better visualisation of the colon and reduces the amount of time needed to perform a colonoscopy.

Colonoscopy is essential in the diagnosis of bowel cancer which is the fourth most common cause of cancer in the UK. It is used for both the surveillance of patients with previous bowel cancer or significant risk factors, and in screening for bowel cancer. Colonoscopy can also be therapeutic. It can facilitate the removal of lesions and the cessation of bleeding in the bowel, through electrocoagulation, injection therapy and the use of special clips secured over bleeding blood vessels.

Endoscopic examination of a patient’s gut by Dr A.I. Morris, Royal Liverpool University Hospital. Drawing by Julia Midgley, 1998. Wellcome Images.

Improvements in optical imaging have already increased the quality of the images seen on the monitor as a colonoscopy is being performed. Higher definition images mean more subtle lesions and even small polyps can be visualised. Less invasive imaging modalities, such as virtual colonoscopy (computed tomography colonography) and capsule endoscopy, have been developed as potential options for those who are unable to undergo a complete colonoscopy.

Many believe that colonoscopy will grow to play a bigger therapeutic role in the future. Watch this space…

Further Reading

William Wolff and Hiromi Shinya, ‘Polypectomy via the Fiberoptic Colonoscope,’ New England Journal of Medicine, 288, No.7, February 15 1973, pp. 329-331.

Bernard Weinraub, ‘Reagan’s Doctors Find Cancer In Tumor But Report Removal Leaves His Chances Excellent,’ The New York Times, July 16, 1985. Available at: https://www.nytimes.com/1985/07/16/us/reagan-s-doctors-find-cancer-tumor-but-report-removal-leaves-hischances.html

Lucy Havard

The Flint Water Crisis: have lessons from history been forgotten (again)?

Posted on 26th January 201926th January 2019 by Edward Wawrzynczak | Leave a comment

‘That men do not learn very much from the lessons of history is the most important of all lessons that history has to teach’– Aldous Huxley

The Flint Water Crisis, which started in 2014 and is still on-going, is a contemporary example of where lessons from history have been ignored. Briefly, the authorities in Flint, Michigan, decided to replace the water supply from Lake Huron with the less expensive water from the Flint River. Unfortunately, the Flint River was heavily polluted and this led to Legionnaire’s disease and lead poisoning among residents using the water supplied by lead pipes. Of particular concern is the expert opinion that almost 9,000 Flint children are at risk of developmental difficulties and long-term conditions due to lead poisoning. The authorities have been heavily criticised for not testing the safety of the Flint river water in advance and for the delays in both accepting that there was a problem, and in implementing the changes necessary to supply safe water. The crisis has sparked intense political and media debate and several prosecutions are pending.

Image 1: Gums and tongue from a case of lead poisoning. Credit: St Bartholomew’s Hospital Archives & Museum, Wellcome Collection.

In the nineteenth century, several reports of lead poisoning secondary to lead pipes in Britain and the USA appeared in the medical literature and the popular press. The problem in Britain was widespread but particularly evident in Yorkshire, Lancashire and Scotland. In Sheffield, the problem was first reported in 1885 by the Medical Officer of Health and was traced to the water from one reservoir that corroded lead supply pipes and lead-lined cisterns, hence contaminating the domestic water supply. The resistant Sheffield Water Company only agreed to add lime to the water after a public inquiry in 1890. Of even greater concern is the shocking 120 year delay in accepting that lead poisoning in Glasgow was due to a combination of the water supply from Loch Katrine and lead supply pipes.

Could the Flint water crisis happen again? Yes, sadly it could, and the words of Huxley resonate strongly here. But, if we listen to the lessons of history, and learn from them, such needless harm can be prevented.

Further Reading

Anna Clark, ‘Nothing to worry about. The water is fine,’ The Guardian.17^thJuly 2018, accessed 24/1/19. Available at: https://www.theguardian.com/news/2018/jul/03/nothing-to-worry-about-the-water-is-fine-how-flint-michigan-poisoned-its-people.
Mona Hanna-Attisha et al, ‘Elevated Blood Lead Levels in Children Associated with the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response,’ Am J Public Health.Feb 2016.106(2): 283-90.

Mike Collins