Emil Kraepelin, the little known guru of British psychiatry

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Emil Kraepelin (1856-1926) is one of the psychiatrists who have shaped world psychiatry. His views have had more lasting influence on psychiatry than Freud, yet he is little known by the public, explains Peter Carpenter. 

Kraepelin arguably is the most significant figure in the development of the ideas of British psychiatry. The impending centenary of his death has prompted a two-day conference at the Royal Society of Medicine in London: After Kraepelin: Ambitions, Images, Practices and the History of Psychiatry 1926-2026 on 6-7 March.

Bearded older man in oval format

Emil Kraepelin

His comparative obscurity is probably because he was a German by birth, spent his entire life within Germany and wrote in German. He left others to translate. But he wrote at a time when British psychiatry was looking for evidence to develop the profession. His great work Compendium der Psychiatrie: Zum Gebrauche für Studirende und Aerzte (Compendium of Psychiatry: For the Use of Students and Physicians) was first printed in 1883, and he wrote nine editions of the work during his life.

He first stressed the biological basis of mental illness and the need to collect observations over time. He started the advance from concepts of mental illness from classifications that still depended on 18th century and earlier ideas that named mental conditions by how they presented in the here and now. A patient, therefore, could have series of names given to their condition over a period of ill-health. As part of this, in his 1893 edition he separated major affective disorders – mania and melancholia – from dementia praecox (later called schizophrenia) – rather than grouping them on whether they were violent or inactive when seen.

With his detailed case records and search for physical causes, Kraepelin turned psychiatry and the treatment of mental illness from a philosophical argument into a science and psychiatrists from quacks to doctors. His ideas were practically useful to psychiatrists dealing with major mental illness, and whilst Freud later held the public’s imagination, Kraepelin (and his views of the biological basis of major mental illness) continued and determined much of modern psychiatric thinking and treatment.

Kraepelin actively rejected the ideas of Freud on childhood experiences being a cause of illness. He studied speech in dreams as a means of understanding psychotic speech. He campaigned for better treatment of the mentally ill but also supported the ideas of eugenicists and taught that homosexuality was a vice.

The conference After Kraepelin: Ambitions, images, Practices and the History of Psychiatry 1926-2026 has a programme that covers both his history and his ideas and how biological research and social and political changes have altered how his ideas are now seen. It will take place on 6-7 March and is open to all. Further details: https://www.rsm.ac.uk/events/psychiatry/2024-25/pyt02/.

Peter Carpenter is a retired psychiatrist, now co-chair of the history of psychiatry group in the Royal College of Psychiatrists and a fellow of the RSM.

The Royal Lancaster Infirmary Collecting Barrel 

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Soon after its opening in 1896, the general committee of the Royal Lancaster Infirmary (RLI) discovered that they needed an additional £4200 for essential items. Bryan Rhodes describes an object used to raise funds.

Late 19th century stone building

Royal Lancaster Infirmary original building https://commons.wikimedia.org/wiki/User:The_wub

Building work on the new Lancaster Infirmary began in 1893, and by 1896 this ‘state of the art’ new hospital was ready to be opened. The Duke and Duchess of York arrived in Lancaster for the official opening of the hospital in March 1896. The Duke, later crowned George V, opened the hospital using a golden key presented by the architects, Paley and Austin, on Tuesday 24 March, and announced that from that moment onwards, the infirmary would become the ‘Royal Lancaster Infirmary’, courtesy of his grandmother, Queen Victoria.

Despite various fundraising events and multiple donations at the opening ceremony, the general committee needed to raise the additional funds, and this collecting barrel was probably one method to do so.

Wooden collecting barrel with plaque dating from 1896

The RLI Collecting Barrel. Photo courtesy Bryan Rhodes

Object of the month

The barrel is the first in the series of ‘Object of the Month’ on the new website of the Lancaster Health and Medical Museum Collection and is one of the museums’ most recent donations, received in October 2024 from Mrs J. Parker

Mrs. Parker discovered the collecting barrel, measuring 22.5 cm long  (just under 9 inches), in the cellar of her late father’s house. Her father, Kenneth Townson, had moved to Lancaster in 1961 to work in the Bay View Hospital (the last name for the Lancaster workhouse hospital). By coincidence, I had arranged to meet her to collect the barrel in the Bay View Garden Centre café.

When the Bay View Hospital closed in 1962, Mr. Townson moved to the RLI where he worked until 1984 as the manager of the general office, close to the main entrance. We don’t know how the barrel came to be in his possession, but we are grateful to Mrs. Parker both for photos of her father and the barrel.

Collecting barrels of this design were quite common in the late 1800s. Our example is beautifully coopered with narrow wooden staves and four brass hoops. At one end there is a small wooden door with a lock. The key for the lock is missing.

After collecting the barrel, I discovered that Mrs. Parker’s husband also has a connection to Lancaster’s medical history. He is a direct descendant of Agnes Oxley, who worked as one of two cleaners for the notorious Dr Buck Ruxton in September 1935. She was scheduled to clean his house and surgery the day after he murdered his common law wife and the housemaid and was surprised to have a very early visit from the doctor asking her not to come that day!

Bryan Rhodes is the chair of the Lancaster Health and Medical Museum Collection and guest editor of the 5th edition of Topics in the History of Medicine, to be published later this year by the British Society for the History of Medicine.  He is a retired orthopaedic surgeon.

Further Reading: ‘In Times of Need, The History of the Royal Lancaster Infirmary’  by J.G. Blacktop

 

 

Plague Houses and Pandemics – Some comparisons between 1665 and 2020

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Charles ll issued an edict in 1665 that every parish should identify a shed, a tent or a house to accommodate those identified with the plague. Alison Wall looks at the role of such isolation in times of pandemic.

19th century lithograph of old plague houses in bleak setting

Pest houses Tothill Fields, Westminster, London, lithograph 1840, Wellcome Collection

Plague, pest or pestilence houses – the terms can be used interchangeably – were buildings set apart as places to isolate those suffering plague and smallpox. It seems that there was often a favourable outcome and people survived.

There were five pest houses in London, accommodating about 600 sufferers, and there are houses still standing across the country, some Grade ll listed.

Was there a degree of restraint for those confined to the pest house? There may well have been if we look at Samuel Pepys’s comments, in his diary of 1665: “A mayde having run away was taken back to the pest house in the pest coach.”

What was the pest coach? It was a special sedan chair painted black, with black curtains, so it was clear what its function was.

Then and now, the most important difference between the 21st and the 17th centuries was the realisation in the 17th century it was wrong to admit plague and smallpox sufferers into the general hospitals or hospitiums, as they were initially called. The latter were there to serve the poor and suffering and give general shelter and care.

Charles II looked back in history and understood the importance of isolation and care in the pest houses. Sadly, our equivalent Nightingale hospitals were erected in a very reactive and uncoordinated fashion. In our time, how many people were admitted into the general hospitals with some acute or chronic condition, unrelated to Covid but caught Covid in hospital and died? Many health professionals also died in the early days of Covid.

Another, if less significant contrast, is that in the time of the Great Plague in 1665, thousands of stray cats and dogs were slaughtered, as people believed they carried dirt and fleas. The cat population could have helped reduce the numbers of black rats that were carrying the plague carrying fleas. Conversely, during the Covid lockdown many people homed cats and dogs for companionship.

The spread of Covid across the world has had a massive impact. The isolation that plague victims must have experienced – and sometimes tried to escape – has echoes in that endured during lockdown in the period of Covid. Isolation causes huge psychological and emotional impacts, with greater understanding of this post Covid.

Inevitably there will be future pandemics. We need to reflect and plan for the future, remembering the value of those parish pest houses.

Alison Wall is a retired nurse, midwife and health visitor. She is the author of “Plague Houses and Pandemics”. Before her retirement she worked in Camden and Islington as a public health strategist.

Woman in pink dress with figure in red cloak and plague masque.

Alison Ward with a figure wearing plague masque

References and further reading

  1. https://www.nationalarchives.gov.uk/education/resources/great-plague/
  2. Byrne, J. Encyclopedia of the Black Death. Bloomsbury. 2024. p.217
  3. https://onlinelibrary.wiley.com/doi/abs/10.1111/nuf.12001
  4. Latham, R.C. & Matthews, W. (ed) 1885. The Diary of Samuel Pepys, Vol. Vl. p.120
  5. Boyd, D. Plagues and Pandemics. Pen and Sword. 2021. p. 67

Snake oil charms of popular medical history

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The mention of ‘snake oil charms’ in the King’s speech at the opening of Parliament in July reminded me of one of the most unusual cases I encountered in my final years as a consultant surgeon, writes Bryan Rhodes.

European adder in dried grass next to a log.

Adder photo by Illuvis, Pixabay

A middle-aged man had gone for a stroll close to Fell Foot Park in the Lake District and sat down on a flattened patch of long grass. Suddenly, an adder appeared between his legs, and as he lifted his arm in self-defence, it bit him on the right hand. Despite the administration of two different types of anti-venom in A&E, by the following day swelling and discolouration was spreading up his arm, and I was beginning to consider whether an amputation could become necessary.

The adder is Britain’s only venomous snake, so mortality from snake bites is quite rare in the UK, roughly one a decade. Worldwide however, snakebite envenoming kills about 100,000 people a year, so it is perhaps surprising that the snake has become such a widespread symbol of health and healing. Certainly, our patient survived, and fortunately, no surgical intervention was required.

Indeed, the coat of arms of the British Orthopaedic Association features the Greek demi-god of healing Asclepius, pictured as usual with a large snake winding its way up his staff, the snake’s head perilously close to the demi-god’s abdomen. There are many theories about the ‘Rod of Asclepius’ and associated snake including one that the snake’s ability to shed its old skin and generate a new healthy skin explains its presence. Another theory links it to the Old Testament story in which God tells Moses to ‘make a bronze snake, put it on a pole, and place it where people can see it; anyone who is bitten by a snake can look at it and live’.

White marble statue of Asclepius, Greek demi-god of healing, with his staff and serpent.

Greek demi-god of healing Asclepius Photo by Michael F. Mehnert, Museum of Epidaurus Theatre, via Wikimedia Commons

 

Folklore

In English folklore, adders were thought to be deaf, and oil derived from adders was considered a valuable treatment for deafness and earache. To obtain the oil an adder was caught and killed, its skin was lacerated multiple times, and it was hung in a warm location with a container placed below it to catch the viscous liquid dripping from its carcass. The Oxford Dictionary of English Folklore indicates that provincial chemists would purchase this snake oil from snake-catchers, presumably for onward sale to their customers.

The adder’s shed skin was also thought to have healing power: able to help extract thorns and splinters from a person’s hand. Traditional cures for an adder bite included oil from the offending snake, wrapping the victim in a fresh sheepskin, or applying a flat ‘snakestone’ to the site. Of all the strange historical treatments provided for adder bites in the centuries before anti-venoms, perhaps the most bizarre was that discovered in Wiltshire by the notable antiquary and natural historian, John Aubrey FRS (1626 – 1697) which involved fastening a succession of live pigeons to the site of the snake bite.

Norman Morrison, a retired Scottish police officer who developed a fascination for adders and published ‘The Life Cycle of the Adder’ in 1924 was himself bitten on the right hand by an adder and wrote about the experience and some of the traditional Hebridean ‘cures’ in his later publication ‘My Story’.

Snake oil salesman

The term ‘snake oil salesman’ now means the archetypal charlatan: the fast-talking seller of quack or fake cure-all remedies. The term has also spread more widely such that it is often applied to politicians, businessmen and anyone offering false hope or dubious treatments. The poor reputation of snake oil salesmen appears to be largely attributable to a Texan called Clark Stanley (b. 1854). In the late 1880s, Chinese itinerant railway workers commonly used a Chinese liniment derived from water snake oil.

Stanley produced an American alternative which he claimed to contain rattlesnake oil, which was sold widely across the US. The Pure Food and Drug Act of 1906 brought in a new era of scrutiny for all American products claiming medicinal properties, and Stanley’s Snake oil liniment was analysed in 1916. The product was found to be almost entirely mineral oil and didn’t contain any snake oil at all. Stanley was found guilty of ‘misbranding’ his product and fined $20.

Since the release of Captopril in 1980, an ACE inhibitor and anti-hypertensive drug developed following research by John Vane and Sergio Ferreira on a component of Brazilian pit viper venom, there has been increasing interest in the therapeutic possibilities of snake venom. There seems to be much less enthusiasm for the charms of snake oil!

Bryan Rhodes is a retired consultant orthopaedic surgeon. He is the book review editor of BSHM and the chair of the Lancaster Health and Medical Museum Collection.

References and further reading:

  1. A Dictionary of English Folklore, Editors: Jaqueline Simpson and Steve Roud, 2003, OUP
  2. Oliveira, A.L. al.  The chemistry of snake venom and its medicinal potential, Nature Reviews Chemistry, 6, 2022, pp451-469
  3. Morrison, N., My Story, 1937 Published in Inverness

 

 

 

 

The Bulletin: A meaning making mechanism for British polio disabled people

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Polio is highly culturally evocative – vaccines on sugar lumps, children in callipers and lifetimes in iron-lung respirators. The Bulletin, published by The British Polio Fellowship, provides an additional perspective. It gives an insight into how polio-disabled people understood and wished to represent themselves. Charlotte Stobart explains.

In 1939, Patricia Carey, who contracted polio in India as a child, and Frederic Morena, a stage actor who contracted polio at 42 and was subsequently wheelchair bound, founded the Infantile Paralysis Fellowship as an advocacy and self-help society.

This organisation, which became the British Polio Fellowship, initially attempted to address both the physical and social limitations of polio-disability, focusing on mutual support and personal development.  From its inception, the Fellowship published a bimonthly newsletter for members.

The first major British polio epidemic came in 1947, and outbreaks of polio (nicknamed the ‘summer scourge’) occurred regularly until the 1956 advent of the Salk Vaccine. The number of cases came down, but the disease left many people with lifelong disabilities. Many developed post-polio syndrome, sometimes as much as 40 years after the original infection.

Young men with polio disability are part of a regional water polo team

A regional water polo team. Young men with characteristic polio-disability. The Bulletin, May 1969, p. 8, The British Polio Fellowship Archive

By 1965, the fellowship had around 12,000 members to whom it circulated the newsletter, called the Bulletin. This was a bottom-up, collective project, and the polio-disabled readership provided the bulk of copy and photographs (including of sports days, holidays and weddings). Similarly, patients at the Spinal Injuries Unit at Stoke Mandeville Hospital in Buckinghamshire, wrote and edited their own community building publication, The Cord, from 1947.

Active and positive

The Bulletin consciously and consistently portrayed polio-disabled people enjoying a range of experiences, triumphing over polio and over societal assumptions about the limitations of disabled people. It challenged dominant sociocultural narratives of loss and trauma, and provided polio-disabled people with representational agency and a positive sense of identity and community.

The iconic ‘Action for the Crippled Child’ charity collection boxes of the 1960s showed a young boy with his crutches and callipers. He is despondent, evoking charitable pity (and hopefully, donations). Conversely, editions of The Bulletin from the 1960s used pictures of a group of young men on crutches playing football, a team of water polo players with characteristic signs of polio paralysis in their asymmetric legs and a man in a wheelchair being lifted (somewhat inexplicably) by crane onto a ship.

Through the 1960s, understandings of polio shifted as the public health threat waned. As their numbers and cultural purchase naturally decreased, polio-disabled people were increasingly overlooked by mass-media, and polio itself became increasingly regarded as a phenomenon of the past or other global regions.

Thanks in no small part to the work of the British Polio Fellowship and The Bulletin, the polio-disabled identity developed positive connotations: determination, hard-work and tenacity. The Bulletin allowed British polio-disabled people to continue to assert their presence and identity and raise funds for assistive technologies, activities and residential homes for their ageing cohort. The British Polio Fellowship continues to publish The Bulletin to this day, advocating for the 47,000 people in Britian still living with the late effects of polio.

Charlotte Stobart is an MA student of History of Technology, Science, and Medicine at the University of Manchester.

References and further reading

The British Polio Fellowship: https://www.britishpolio.org.uk/

The Bulletin Archive- stored at the British Polio Fellowship Office in CP House, Otterspool Way, Watford WD25 8HR.

Brady, Sam, The Cord, https://www.paralympicheritage.org.uk/blog/the-cord-journal-for-paraplegics, National Paralympic Heritage Trust, 20 July, 2020.

Couser, Thomas, “Disability, Life Narrative, and Representation.” PMLA 120:2 (2005): 602–6

Williams, Gareth, Paralysed with Fear: The Story of Polio. London: Palgrave MacMillan, 2013