An unflattering view of English medical education in the 1840s

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In about 1841, Belgian doctor Constantin Pierre Crommelinck toured various psychiatric institutions in England, France, and Germany. His report reviewed not just various English asylums and also the training of English doctors. Peter Carpenter recounts his none too flattering findings.  

Constantin Pierre Crommelinck (1814-1884) was the son of a Belgium surgeon who trained as a doctor and became a teacher of anatomy at the École de Médecine in Bruges. He initially had some success as a surgeon, but then turned to psychology and psychiatry. There is no official biography for Crommelinck, but his entry in Dutch in Wikipedia indicates he was not an easy colleague.

In about 1841, he toured various psychiatric institutions in Belgium, France, England and Germany and also investigated the training of English doctors. The following year, he reported his findings to the Belgian Minister of the Interior Jean-Baptiste Nothomb: Rapport sur les hospices d’aliénés de l’Angleterre, de la France, et de l’Allemagne. (A report on asylums of England, France and Germany, 1842).

In this report, he made recommendation for the design and therapeutic organisation of future Belgian asylums. His descriptions of various asylums in England are little known in the UK, other than that of Gloucester Asylum, which appears in several biographies of Samuel Hitch, the founder of the first British psychiatric association in 1841.

Hunterian anatomy school, London, 1839 by R. B. Schnebbelie, Wellcome Collection

Hunterian anatomy school, London, 1839 by R. B. Schnebbelie, Wellcome Collection

English medical education mocked

In the same report, Crommelinck took the opportunity to make very pointed remarks on the English medical profession and medical education. While commenting on the richness of England’s material resources, he mocked the surgeons’ habit of having an apprenticeship and then attending a selection of classes in London. He wrote:

“At the end of three years’ training with a physician or surgeon, where the pupil has learned (and how else?) physiology before anatomy, therapeutics before pathology, and practice before anything else, he goes back to school, … spends two years there, and qualifies as a physician or surgeon-apothecary. These two years pass like the other three, with the only difference that all the branches are no longer taught by one and the same individual, but by five or six, all teaching pell-mell, without troubling themselves about each other or prescribing to their disciple any order to follow. …Thus the pupil begins, and attends pell-mell, lessons in physiology, anatomy, therapeutics, pathology, medical and surgical clinics, childbirth, etc.

Having attended lessons from each teacher, Crommelinck then went on to describe the anatomy lesson as the most absurd, ridiculous and contrary to common sense. “I will cite among others the one that Mr. Macmurdson gave at St. Thomas Hospital. It was the tenth since the opening of his course; it related to the mucous membranes: all the students, with two or three exceptions, were true beginners. Fifty jars containing different pathological or monstrous alterations of the mucous membranes were placed on the table.

“Mr. Macmurdson took a notebook from his pocket and, using his finger to mark his place, began to read very fast a long, profound and learned dissertation on the past, present and future, healthy and sick, natural and monstrous state of the mucous membranes in man as in other animals. The most scabrous questions of theory and practice were discussed in this reading; he talked about typhus, inflammation, cancer, tumours haemorrhage, bleeding, leeches, calluses, strictures, astringents, styptics, molluscs, pachyderms, mammals, Peyer’s glands, Brunner’s glands – do I know what a jumble of absurdities did not come out of his mouth, while seriously begging his students to pay scrupulous attention to the elementary principles that were going to develop before them?”

[Pages 69-71, Peter Carpenter’s translation]

Rather than pretending to listen and understand, wrote Crommelinck, the students had fun cutting figures in the benches, whispering among themselves and kicking each other. They “ended the farce by applauding excessively when the hour of freedom arrived.”

The lecturer compared with Molière’s comedic doctor from the play Le malade imaginaire, was probably Gilbert MacMurdo, a surgeon at St Thomas’s in the 1846 Medical Directory. It is surprising that Crommelinck named an individual, but the early signs of irascibility seem to have ripened into vitriol later in his career.

Peter Carpenter is a retired psychiatrist who researches the history of UK mental health institutions.

Further reading:

Rapport sur les hospices d’aliénés de l’Angleterre, de la France, et de l’Allemagne is available at the Wellcome Library and the library of the Royal College of Psychiatrists. Digital copies can be found by internet search.

https://nl.wikipedia.org/wiki/Constantin_Crommelinck

Matthias Schleiden and the Genesis of Cell Theory

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Wallace Mendelson describes how an encounter between two scientists resulted in the creation of cell theory.

Matthias Jacob Schleiden (1804-1881), the son of a Hamburg physician, was trained in the law in Heidelberg, and in 1827 returned to his hometown and set up a practice. It was remarkably unsuccessful, and ultimately, he became depressed to the degree that in 1832 he shot himself. He survived, though marked by a scar on his forehead for the rest of his life, and he wisely determined that it might be time to pursue a different profession.

This image shows Mattias Schleiden, an important contributor to modern biology despite his bouts of depression.

Matthias Schleiden

With a lifelong interest in plants and the encouragement of his uncle Johann Horkel who was a botanist, in 1833 Schleiden began to study natural history in Göttingen, and then botany in Berlin. After fruitless applications to several universities, he once again became depressed. After another unsuccessful suicide attempt, his family aided him in finding a position at the University of Jena, where he took his degree in natural history and joined the philosophical faculty.

While in Berlin, Schleiden had been influenced by studies of cell nuclei performed by the Scottish botanist Robert Brown. It was Schleiden’s view that nuclei were essential to embryonic cell development. In 1838, he published a landmark paper asserting that cells were the basic unit of plant life, and that each plant was ultimately produced from a single embryonic cell. As such, he was challenging the notion of spontaneous generation, which held that life somehow appeared from inorganic matter.

Schleiden found himself engaged in a variety of conflicts exacerbated by his imperious manner, and he ran afoul of the church. Overwhelmed and feeling anxious and depressed, he determined that a break from academe was in order and that he might find relief in travel. While doing so, he went to Berlin, where he visited the physician and physiologist Theodor Schwann, whom he had known in his student days.

Schwann was interested in microscopic studies of the developmental relationship of various animal tissues. He was, however, hampered by the limits of the available technology, as the cell walls of animals were less clear than those of plants. It has been said that at a dinner, Schleiden described his work, and Schwann recognised a similarity to what he had seen in nervous system tissue and cartilage. The two began a collaboration, which resulted in an 1839 paper asserting that all plant and animal tissue is comprised of cells, which represent the fundamental building blocks of life.

This notion reached fruition when in 1855 the German pathologist Rudolph Virchow added that all cells are derived from pre-existing cells (‘Omnis cellula e cellula’), thus laying the cornerstone of modern biology.

Serendipity

One of the most important contributors to our understanding of the fundamental building blocks of life, Theodor Schwann

Theodor Schwann

In looking back at Schleiden’s career, two qualities are of note. One, of course, is his recurring depression, almost costing him his life, which led him both to change his interests to botany, and later to take leave from academe, leading to his fortuitous dinner with Schwann. The second is the casual nature of their encounter, which ultimately resulted in their formulation of cell theory. There were of course other such remarkable encounters.

One is reminded of David Waldie, a physician and chemist with the Liverpool Apothecaries Company. While on vacation in Scotland in 1847, Waldie mentioned to the obstetrician James Young Simpson that chloroform, a treatment for asthma, could cause patients to fall asleep, and that it might have potential as an anesthetic. Similarly, in 1889 there was the serendipitous meeting in a library between Joseph von Mering and Oskar Minkowski, who worked in different institutions inside the University of Strasbourg. Their subsequent studies concluded that the pancreas secretes a substance regulating glucose, later determined to be insulin. Such seemingly casual encounters appear to have germinated into some of the most remarkable contributions to biology and medicine.

Notes and further reading

de Herder, W.W1 and Klöppel, G.: One hundred years after the discovery of insulin and glucagon: the history of tumors and hyperplasias that hypersecrete these hormones, Endocrine Related Cancer 30 (2023), https://erc.bioscientifica.com/downloadpdf/journals/erc/30/9/ERC-23-0046.pdf

Guthrie, D.: David Waldie, a forgotten pioneer of chloroform anesthesia. British Medical Bulletin, Volume 4 (1946), Page 142, https://doi.org/10.1093/oxfordjournals.bmb.a072699

Jahn, L: “Schleiden, Matthias Jacob” in: Neue Deutsche Biographie 23 (2007), S. 52-54 [Online-Version]; URL: https://www.deutsche-biographie.de/pnd118852116.html#ndbcontent

Wallace Mendelson is a US psychiatrist and author, working primarily in the fields of sleep research and psychopharmacology. His most recent book is The Battle Over the Butterflies of the Soul: Camillo Golgi, Santiago Ramón y Cajal and The Birth of Neuroscience (2023). 

 

Bringing X-rays to the front

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Edwin Aird describes how Marie Curie created radiological cars to take X-rays to the battlefront in Word War I.

In 1914 at the beginning of the First World War, Paris was under threat of invasion from Germany. The situation was sufficiently alarming that the French Government moved to Bordeaux. And Marie Curie moved the precious 1 gm of radium that she had isolated to deposit in a bank in Bordeaux in a very heavy lead pot.

Once the radium was safe, Curie returned to Paris, where one of her daughters took her to visit a hospital to see the war wounded. Curie quickly realised the potential value of having X-rays near the battle front for surgeons to use. As her daughter Eve Curie wrote: “A luxury, the magic arrangement whereby a rifle bullet or fragment of shell could at once be discovered and localized in the wound.”

 She already understood the properties of X-rays, but taught herself their application, production and development, fluoroscopy (not so called at the time), and the components of X-ray systems, generators, transformers etc. To get the X-ray machines to the front, however, meant mobile units or radiological cars. And they did not yet exist. So she created them.

Les Petites Curies

Founding director of the Red Cross Radiology Service, Curie built her first radiological car from a large Renault. She persuaded wealthy acquaintances and the Union of Women of France to help her build a fleet of 20 radiological cars. They became known as Petites Curies. Her daughter Irene, (who later received a military medal and won a Novel prize herself with her husband, F. Joliot) assisted in the field.

The image shows Marie Curie's level of involvement with the mobile X-ray machines.

Marie Curie at the wheel of one the Petites Curies, the mobile X-ray machines she created

The conditions under which Curie worked must have been horrendous, but she played down the overall impact of the noise/smells/dangers. Eve Curie said: “She was never to speak of the hardships and dangers to which she exposed herself during those four years… She showed her working companions a careless and even gay face…The war was to teach her that good humour is the finest mask of courage”.

 According to Marie Curie herself, during these years it had been possible to X-ray approximately 900,000 injured people. She wrote: “Towards the end of 1918 there were more than 500 fixed and semi-fixed radiological stations in service in the hospitals of the territory and in the armies with a further 300 mobile devices on cars, on sterilisation trucks and motor surgical ambulances. Approximately 400 radiologists served these devices, aided and partly replaced by auxiliary personnel, including manipulators trained at the Institute Curie.”

Marie Curie died in July 1934 from pernicious anaemia, which she attributed to the high X-ray exposures she received during the war.

She remains one of the few people to receive two Nobel Prizes and the only woman to do so. The French Academy of Sciences rejected her membership in January 1911 – only months before her second Nobel Prize. It never elected her. Otherwise, her brilliance, drive and public service were widely acknowledged. In total, she received 8 major prizes, 16 medals, 104 titles and authored 483 papers.

Marie Curie and her daughter Irene

References and further reading

  • Curie, Maria, “La Radiologie et la Guerre” (in French) : Marie Curie. Librairie Felix Alcan 1921
  • Curie, Eve, “Marie Curie”: (1938, Windmill Press Surrey)
  • Van Tiggelen, Rene (Brussels), “La Grande Guerre 1914-1918”
  • Simthsonian Magazine Oct 2017
  • Jogensen, TJ BJR Papers: “Marie Curie and Pierre Curie and the discovery of radium” by Eve Curie BJR July 1950;” Marie Sklodowska Curie 1867-1934” by Claud Regaud BJR, Sept 1934
  • Thomas, Adrien, “The first 50 years of military radiology 1895-1945” European J Radiology 2007; 63: 214-219
  • https://www.pbs.org/newshour/science/the-day-marie-curie-got-snubbed-by-the-french-science-world

Edwin Aird is retired Director of Medical Physics at Mount Vernon Hospital, Northwood with more than 40 years in NHS as  researcher, teacher and examiner.

 

 

How a pregnancy test saved the lives of a family in Nazi times

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Susanne Krejsa MacManus explains how pregnancy testing saved the life of a refugee woman biochemist and her family in the run-up to World War II.

In the 1930s, the Institute of Animal Genetics at Edinburgh University was the only UK laboratory that ran pregnancy tests. Although the Aschheim-Zondek method invented in Berlin in the late 1920s had been seen as a great step forward, the result took more than 100 hours. It also required testing on female mice. No wonder that the scientific community was excited by a new method that took four hours.

Austrian biochemist Regina Kapeller-Adler had developed a method for detecting the amino acid histidine in the urine of pregnant women in 1933. As the Vienna Daily reported on 30 May 1933 under the heading “Eine neue Schwangerschafts-Reaktion” (a new pregnancy test): “The great advantage of this new chemical pregnancy test lies in the fact that it can be carried out in four hours, whereas the tool that has been most ideal for early diagnostics up until now […] requires a hundred hours until it can be read.”

The second advantage was that it employed a chemical instead of a biological reaction, and no mice had to be killed.

After Hitler occupied Austria (Anschluss) in March 1938, Regina, her medical doctor husband Ernst Adler and their young daughter Liselotte were in severe danger because they were Jewish. The Nazis persecuted Ernst Adler, and he escaped deportation to the Dachau concentration camp only at the very last moment. Regina lost her post at the Institute of Medical Chemistry at the University of Vienna; before that, she had also not been able to get her postdoctoral qualification – as a woman and a Jew.

When Francis Crew, Professor of Genetics at Edinburgh University, learned about the danger Regina and her family were in, he offered her a job in his laboratory, with support of The Society for the Protection of Science and Learning (formed in 1933 in help refugee scientists and other academics).

There was still a problem to be solved: Britain only permitted entry for foreigners if there was a mandatory “guarantor” to vouch for them. Fortunately, Napoleon and Henrietta Ryder deposited the considerable amount of £50 for the Adler family whom they did not know personally, and little is known about this couple. Regina together with husband and daughter could leave Austria, even taking their furniture and his medical equipment with them.

In Britain

In January 1939, they reached London and journeyed on to Edinburgh. Within two months of their arrival in Scotland, she was demonstrating her pregnancy test at the Eleventh British Congress of Obstetrics and Gynaecology. After the German invasion of Norway in 1940, most female foreign citizens were ordered to leave the east coast of Britain. Regina unusually received permission to remain in Edinburgh to continue her research since it was categorised as being of national importance. Ernst was interned on the Isle of Man from May to September 1940. After his release and re-qualification, he started a medical practice in Edinburgh in 1942.

In July 1941, Regina received her Doctor of Science degree from Edinburgh University. From the end of the war, she spent fruitful years in the Pharmacology Department of the university, and in 1952 she got her first university position as lecturer in the Department of Clinical Chemistry. From that time, she meticulously trained and encouraged a series of Ph.D. students, to whom she acted as mentor.

Regina gained recognition, grants and awards. She was internationally acclaimed as a major authority on histamine, which is made in the body and derived from histidine, and gallantly titled “The Histamine Queen” by her exclusively male colleagues in the field, an allusion to her forename. In June 1973, she was presented with the University of Vienna’s Golden Honorary Diploma. She died in Edinburgh on 31 July 1991 at the age of 91.

Kapeller-Adler’s method was an important step towards the modern pregnancy test, but it was not yet the final breakthrough. Not fully reliable on its own, it was used as an additional test or pre-test when standard tests did not give a clear yes-or-no answer.  Today, pregnancy tests detect the hormone human chorionic gonadotropin (hCG), which starts to be produced around 6 days after fertilisation. The results are available in a few minutes.

Acknowledgement and references

Information from this blog came direct from Liselotte Adler-Kastner, daughter of Regina Kappler-Adler and Ernst Adler. In addition, it refers to two articles that she wrote about her parents in “Visa to Freedom 1939 thanks to a Pregnancy Test”, Edinburgh Star 62, March 2009, 9-11, and “From personae non gratae in Vienna 1938 to respected citizens of Edinburgh: a vignette of my parents Dr Ernst Adler and Dr Regina Kapeller-Adler”, Wiener Klinische Wochenschrift (1998) 110/4-5: 174-180 (Viennese Clinical Weekly)

Further reading:

Interview with Liselotte Adler-Kastner at Refugee Voices.

Museum of Contraception and Abortion (MUVS)

Susanne Krejsa MacManus is an independent journalist, author and archivist in Vienna. She does research for the Museum of Contraception and Abortion (MUVS). Thanks go to Liselotte Adler-Kastner, Regina’s daughter.

 

 

Widowhood and Bereavement during and after the English Civil Wars

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Recent estimates suggest that more than 3 per cent of the population of England and Wales died as a direct result of the Civil Wars of 1642–1651. Andrew Hopper describes his work on the widowhood and bereavement of the more than 180,000 women who had lost a male relative.

Deaths in Britain and Ireland during their mid-seventeenth-century Civil Wars represent a greater proportional loss of population than Britain suffered during World War One. On a free website, The Civil War Petitions Project publishes details of subsequent petitions to the state from veterans and their families for welfare payments as a result of injuries and bereavement sustained during those wars.

This image shows mounted troops at the Battle of Nasby but also a dead soldier in armour - many men died.

The Battle of Nasby was fought on 14 June 1645 during the First British Civil War. It was an important victory for the Parliamentarians. National Army Museum collection

I am currently analysing the findings of this project for a book that will illuminate the experiences of those bereaved by the civil war, with a particular focus on war widows, orphans and bereaved families, based on the petitions.

This is possible because soon after the outbreak of civil war, Parliament’s ordinance of 24 October 1642 confirmed that not just Parliament’s wounded soldiers, but also the widows and orphans of those who gave their lives for the parliamentary cause would be entitled to apply for monetary relief. A series of further ordinances followed in 1647 that prompted women to petition for state pensions in their thousands.

Securing such provision became more difficult after the Restoration in 1660 when most royalist war widows who were granted relief received one-off gratuities rather than regular pensions. The right to state pensions for all British war widows was not restored until 1901. The records of the 1640s and 1650s therefore represent a unique opportunity to investigate attitudes towards war-related welfare at a time when at least some within the governing regimes considered such women to be part of the political nation.

A first national study

This will be the first national study of seventeenth-century military welfare, drawing on the project team’s research conducted in nearly all the county record offices in England and Wales. It will measure the success of women, children and families in obtaining relief and subsisting compared with that of their fellow petitioners among wounded servicemen.

The book will begin with a social profile of civil-war widowhood and then develop into a wider cultural history of widowhood and bereavement. It will compare the variety of experiences of the war widows of the middling and poorer sorts such as Elizabeth Alkin, nicknamed ‘Parliament Joan’, with those of much higher social status such as Katherine, Lady Brooke.

I will also examine how war widows remembered the conflict, and how this may have differed from more ‘official’ or state-sanctioned memories found in proclamations, thanksgivings, sermons and anniversaries. By looking beyond 1660 and embracing the twin themes of welfare and memory, the book will show how the consequences of the Civil Wars persisted for generations after armed hostilities had come to an end.

Andrew Hopper Professor of Local and Social History at the University of Oxford Department of Continuing Education and the author of Widowhood and Bereavement during and after the English Civil Wars. He and his colleague, Departmental Lecturer Dr Ismini Pells, will present Medical Care and Military Surgery during the British Civil Wars: The Civil War Petitions Project at the BSHM Congress taking place from 13-16 September in Cardiff.