Author Archives: Lee Coppack

Illustrations of the History of Medicine from the Art of Barbara Hepworth

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Consultant orthopaedic surgeon, Norman Capener had a considerable effect on the work of sculptor Barbara Hepworth (1903-1975), as James Scott explains.

 In 1944, Barbara Hepworth’s daughter Sarah developed osteomyelitis of her proximal femur, – a much feared condition with a mortality of about 30% at the time. I was able to discover that she was treated with an infusion of penicillin directly into her thigh, which she recalled to me was “quite painful’. She, thus, would have been among the very first patients to receive penicillin for infection of the bone.

Initially in hospital for about nine month, Sarah underwent many local procedures. Norman Capener was her surgeon. He had a strong interest in sculpture, and he and Hepworth became friends.

With his help, Hepworth attended many operations about which she wrote: “I became completely absorbed by two things: first the extraordinary beauty of purpose and co-ordination between human beings all dedicated to the saving of life…and secondly by the way this special grace of mind and body induced a spontaneous space composition and articulated an animated kind of abstract sculpture very close to what I had been seeking in my own work.” This resulted in an iconic series of painted drawings of operations, and informed much of her subsequent sculpture. (Drawing by Barbara Hepworth © Bowness) 

A little more than 25 years ago, I founded the Arts Project at the Chelsea and Westminster Hospital, which was shortly to open. There were a great many works of art in the six hospitals which were to close as a result, including a ‘Resurrection’ by Veronese in the chapel of the old Westminster Hospital.

The architects were very encouraging, and during the first few years of the life of the new hospital, we were able to introduce about 1500 new works of art and incorporate many from the previous hospitals. One of the works we borrowed for the Dermatology Department was a sculpture by Barbara Hepworth.

We also created a flourishing program of music, dance, poetry etc., followed later by opera. The great value of this endeavour for everyone — staff, patients and visitors — was clear from the outset.  The project has since grown enormously in scope and flourished.

Where were the women?

When I was a medical student at the Middlesex Hospital in London in the mid-1960s, (with wonderful murals by Cayley Robinson in the front hall), I had seen some sculptures in Battersea Park by the sculptor Kenneth Armitage. I particularly remember a piece by him called Pandarus. Many years later, I discovered that he had a studio 

in Olympia, West London, and we became friends. After an exhibition to celebrate his 80th birthday at the Yorkshire Sculpture Park, he lent me four sculptures for the hospital, – including Pandarus (right). 

Researching a book about him for the publishers Lund Humphries, I noted that a woman called Lillian Somerville had successfully promoted his career and those of many more Modern British Artists internationally for the British Council through the Venice Biennales over a period of 15 years. Little was known about her.  Some further research revealed many other women who had promoted all aspects of modern art in this country at that time, again about whom little was known.

A couple of years ago I contributed towards a book for Unicorn Press, describing the work of the arts project and the Chelsea and Westminster Hospital. During lockdown, I prepared a further book for them, simply telling the stories of many of the women to whom my attention had been drawn, including a description of Barbara Hepworth’s connection with Norman Capener. 

James Scott is a retired orthopaedic surgeon and emeritus editor of the Bone and Joint Journal. He is the author of The Women who Shaped Modern Art in Britain and a co-author of The Healing Arts: The Arts Project at Chelsea and Westminster Hospital. Both are published by Unicorn Publishing Group.

References

Norman Capener obituary. British Medical Journal, 19 April 1975, p 145

Read, Herbert, Barbara Hepworth, Carvings and Drawings, Section 5. Lund Humphries, 1952

The Third Man was true – Penicillin in Post-War Austria

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The 1949 black and white film, The Third Man, about the black market in Austria after the end of World War II, is still the most frequent association made between the two key words Vienna and penicillin, says Susanne Krejsa MacManus.

Advertisement for penicillin production from Life magazine, Science Museum, London

In 1999, when the British Film Institute surveyed 1,000 people from the world of British film and television to list the greatest British films of the 20th century, The Third Man (1949) after Graham Greene’s book became No 1. It tells the story of an American writer, Holly Martins, who arrives in Vienna to accept a job with his friend Harry Lime, only to learn that Lime has died. Suspicious, Martins stays in Vienna to investigate and discovers the black market in penicillin.

Why was Vienna’s black market so active after the war? From 1941 onwards, British and American scientists and companies developed penicillin into the medical Wunderwaffe (wonder weapon) following its discovery by the Scottish bacteriologist Alexander Fleming (1881-1955). As soon as reasonable amounts of penicillin could be produced, some countries outside Britain and the United States began receiving donations of supplies or some support in starting their own production.

As a war enemy Germany did not receive any such help, nor did Austria, which had become part of the Third Reich in 1938. To block their scientists from learning about penicillin, British and American scientists were not permitted to publish their results on penicillin internationally.[1]

Post-war relief

However, after the war, Austria was deemed a liberated country and therefore entitled to help.[2] Virtually everything was needed. The country could not survive on its own, nor would it have been able to feed and help the vast numbers of displaced persons stranded there. The occupying forces had to organise and oversee the first months. Help also came from Red Cross organisations, religious groups and private initiatives.

The United Nations Relief and Rehabilitation Administration (UNRRA) had been founded in November 1943 to help nations after the end of World War II. In March 1946, UNRRA’s first train with provisions and goods arrived in Austria. A few weeks later medical supplies came, including penicillin, but sufficient only for 20 patients, and its distribution and assignment tightly controlled by a penicillin committee. To teach doctors in Austria how to use previously unknown materials, drugs and medical equipment, the British Council provided books, lecturers and contacts.[3]

With such limited supplies of penicillin, some illnesses were excluded from treatment, sexually transmitted diseases being one of them. To prevent fraud, the vials had to be returned after usage. Even so, the black market flourished. Newspapers from the years 1945 to 1949 reported thefts from American hospitals, counterfeiting, dilution with even dangerous substances and blackmail.

One in such scam an alleged Miss Austria, Norberta Grimm, had apparently turned the heads of two members of the American occupation forces in Vienna. In order to buy her a large diamond ring, the two of them stole penicillin from army stocks, which the girl was then supposed to sell or exchange on the black market.

Only, there was no Miss Austria in 1928,[4] Likewise, no one of her name ever appears in the list of winners for the other years.[5] The men were caught by police when one of them handed over ten bottles of penicillin to Grimm, worth a black-market price of $10,000 per bottle.

What lends the story a certain punch, though, is that it coincided with a lecture given by the famous British penicillin expert Prof. Ronald V. Christie in Vienna on the “miracle drug penicillin” – reported in the same newspaper edition, just a page further on.[6]

Susanne Krejsa MacManus PhD is an independent journalist, author and archivist in Vienna. She is a member of the History of Medicine/Medical Humanities working group of the Commission for History and Philosophy of the Sciences at the Austrian Academy of Sciences (ÖAW).

[1] Paul Rostock, Die Wunde, Berlin 1950, p. 290.

[2] Resolution No. 74: A Resolution relating to Operations of the Administration in Austria, https://www.parlament.gv.at/PAKT/VHG/V/I/I_00086/imfname_337149.pdf, p. 15.

[3] Englische medizinische Fachliteratur für Wien (British Medical Books for Vienna) in: Weltpresse, Feburary 9, 1946, p. 2

[4] Two Captains Convicted – New Yorkers Said to Have Sold Penicillin Stolen from Army, in: New York Times, May 27, 1946

[5] Two Captains Convicted in Penicillin Sale, in: The Stars and Stripes, May 26, 1946, p. 4.

[6] Wiener Kurier, June 21, 1946, page 3 (Norberta Grimm), page 4 (report on Prof. Christie’s lecture)

 

Being right is not enough

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Scientific debate can be soured by the tendency for evangelical pioneers to see any questioning as opposition bordering on evil.   Their aggressive attitude can delay innovation, a lesson perhaps for our own times and a reason for studying history, says Mike Davidson.  

Ignaz Semmelweis

My wife and I saw the production “Dr Semmelweis” at the Bristol Old Vic. At last, a chance to experience live theatre with a full audience; it also fulfilled my interest in the history of medicine. The writers, Mark Rylance and Stephen Brown, were influenced by the 1952 biography Semmelweis (1818-1865) by Louis-Ferdinand Céline, a work I am unfamiliar with.

Their play is a dramatic interpretation of the work of Ignaz Semmelweis (1818–1865) on puerperal sepsis and his failure to convince his contemporaries of the need for ward hygiene to control the disease. This was in no small part a result of his uncompromising personality and ability to alienate even his strongest supporters and allies.

Semmelweis proposed the practice of washing hands with chlorinated lime solutions in 1847 while working in Vienna General Hospital’s First Obstetrical Clinic, where doctors’ wards had three times the mortality of midwives’ wards. His observations brought him into conflict with many within the contemporary scientific and medical establishment.

The play records Semmelweis’s descent into madness, haunted by the ghosts of the women he has not saved. The ghosts are portrayed as dancers and musicians on stage and within the audience, as he recollects events. Much of the narrative takes the form of flashbacks acted out for his wife. The opportunities for engagement squandered by Semmelweis due to his lack of understanding of human nature are highlighted.

Rylance’s performance as Semmelweis was central and powerful and the cast provided strong support. I found two female performances poignant, Thalissa Teixeira, as his wife Maria, and Jackie Clune, as nurse Muller. The female characters provide a more balanced view of history than concentrating on male pioneers.

Muller is a senior midwife who helps Semmelweis with his introduction of hygiene methods and provides clinical data to support his thesis. His lack of empathy for her guilt in accidentally causing an outbreak of sepsis that contributed to her ultimate suicide speaks volumes of the single-mindedness and unforgiving attitude of Semmelweis.

There is a very pertinent observation by Rylance in an interview published in the Financial Times on 12 January 2022: “He wasn’t just a victim. He was also a very difficult person: someone who got very angry about people not understanding him and became his own worst enemy. Which maybe a lot of pioneers are — they’re people who cut through and are not the most polite or politically savvy people.”

The production at Bristol has now ended but given the enthusiastic reception it got there, it may be staged again.

I recommend the play not only for a medical history enthusiast but for anyone who wants to experience a thought-provoking performance by a talented cast, playwrights, dancers and musicians.

Mike Davidson is President of the British Society for the History of Medicine.

Leprosy has a fascinating history and a rich philatelic documentation

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Leprosy is a disease of stigma, because of the potential late stage disfigurement which may involve the face and extremities, Bill Dibb explains.

At the same time, it awakens a morbid fascination and dread, as shown by early 20th century postcards of  ‘leper colonies’ and ‘lepers’ with severe disease. (Today, the term ‘persons afflicted with leprosy’ is used.)

Religion has always been closely tied to leprosy. The disease is mentioned in religious texts and, through the centuries; people with leprosy, rejected by society, have received care from, in particular, Christian organisations. They ran Lazar Houses or lazarettes, named after the Biblical parable of Lazarus, for the afflicted. 

The work of religious orders, particularly nuns, in these communities is illustrated in black and white postcards, usually showing matriarchal European nuns standing over the patients. Fortunately, effective community treatment and tracing regimes in most jurisdictions have largely, although not completely, replaced such centres nowadays.

Mycobacterium leprae
Many commemorative postage stamps hail Gerhard Armauer Hansen of Bergen, Norway who discovered the leprosy bacillus, Mycobacterium leprae, in 1873 with hagiographic imagery.

Gerhard Hansen

Hansen’s disease is a synonym for leprosy. Typically, few illustrate the field workers around the world who have devoted their careers to treatment of leprosy.

Philatelic items often helped to raise income for leprosy work in affluent countries, through money raised from charity stamps and picture postcards. Nowadays, letters and postage stamps are superseded by emails. Leprosy charities are struggling as new diseases attract attention, but the need for research funding of this complex, partially understood disease and affected patients remains. Historically, there is much fertile ground for further study.

I have collected philatelic items related to infection for many years and didn’t regard it as a particularly esoteric interest until an avid collector of Asian snuff boxes thought that my area was far more unusual than his!

Similarly, in medicine, we see doctors can become obsessed with a rare syndrome and start to see it everywhere, potentially overlooking more common diagnoses. Dare I say that preoccupation with Covid and its control, eclipsing everything else in healthcare, may have a parallel?

Leprosy control and eradication have been significantly set back by the stringent lockdown measures imposed during the pandemic. Much leprosy work is field-based, visiting remote villages to detect cases in the face of stigma and poverty. Leprosy programmes desperately need support now to avoid increasing case numbers and delayed treatment. The dream of eradication is still in the future.

Chapel for sufferers at Cambridge

Bill Dibb is a retired microbiologist and infection control doctor. dr.dibb@gmail.com

Control and the therapeutic trial: the influence of insulin

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How do we decide whether a drug, or other treatment, actually works? Martin Edwards describes the rhetorical strategy adopted by the Medical Research Council to establish its authority.

Patients’ variations in response to disease and treatment can render it fiendishly difficult to know whether a therapy is benefitting a particular individual. For centuries, the gold standard was the assessment of a wise and experienced clinician but during the first half of the twentieth century, new methodologies arising from the laboratory, hospital and statistical theory challenged this traditional model.

The stakes were high, no less than the moral authority to adjudicate how the therapeutic efficacy should properly be ascertained. Between the wars, the debate in Britain was frequently vitriolic – particularly between the Royal College of Physicians, which prioritised clinical acumen, and the Medical Research Council (MRC) which advocated newer methodologies.

The University of Toronto in 1921 granted British patent rights over insulin to the MRC and thus offered the MRC control, not only over insulin manufacture and supply, but also how to assess its effects and proper usage.

In fact, the MRC’s approach to testing was, as with other drugs at that time, highly eclectic; it sent samples of insulin to trusted clinicians in prestigious hospitals without any protocol or scheme for investigation – the clinicians were simply asked to report their experiences with the drug.

An unanticipated consequence of the MRC’s control of insulin supply was that it was on the receiving end of public clamour for the drug. Heartrending letters to the MRC described young people, typically in their teens or early twenties, dying slowly and horribly from diabetes, and pleaded for supplies of life-saving insulin.

Patients even turned up at the MRC, supported by loved ones. Landsborough Thomson, MRC Council Secretary, recalled the MRC administration being swamped by these requests and unable to fulfil its normal functions.

Reserved for controlled studies

In response, the MRC under the direction of its chairman Walter Morley Fletcher adopted a standard response to such requests, stressing that insulin was a new drug which needed to be reserved for ‘controlled studies’. The meaning of ‘controlled’ was not defined nor did it refer to the presence of a comparison group – none of the MRC insulin trials used one – but rather vaguely implied proper conduct, regulation and scrutiny.

So successful was this rhetorical strategy that the MRC repeated it when restricting supplies of penicillin in the 1930s and streptomycin and influenza vaccine in the 1940s. In each case, it stated that the drug should be reserved for ‘controlled trials’.

Control is a powerful word with implications of authority, power, regulation and order. Without defining it, the MRC appended the word to their own studies in the interwar years, using it as a rhetorical device in the battle for authority to adjudicate therapeutic efficacy.

By the time the MRC’s trial of streptomycin in tuberculosis – reckoned by many trial historians to be the first randomised controlled trial – was published in 1948, the MRC had successfully co-opted the word as applying exclusively to its own studies. It offered the streptomycin trial as an exemplar of how therapeutic trials should be conducted, describing the methodology as ‘the controlled trial’. By then, ‘controlled’ referred technically to the presence of a control group, though the other powerful associations of the word continued to resonate.

We have depended on the ‘controlled trial’ ever since. The MRC’s adoption of the potent word ‘control’ arguably began with insulin. Had it not been for MRC control of British insulin supply, might we simply refer nowadays to a ‘randomised trial’?

This text is an abstract of a talk given to a session of the Apothecaries’ History of Medicine Fellows 8/12/2021 to commemorate the 100th anniversary of the discovery of insulin.

References/further reading:

  1. A Landsborough Thomson, Half a Century of Medical Research vol. 2: The Programme of the Medical Research Council (UK) (London: HMSO 1975) pp 40, 230
  2. Liebenau, ‘The MRC and the Pharmaceutical Industry: The Model of Insulin’, in J, Austoker and L. Bryder (eds), Historical Perspectives on the Role of the MRC (Oxford: Oxford University Press, 1989) 163-80
  3. Edwards, Control and the Therapeutic Trial: Rhetoric and Experimentation in Britain 1918-48 (Amsterdam: Rodopi Publishing, 2007)