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

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 story of Mary Mallon (1869-1938), reprehensibly branded ‘Typhoid Mary’ by the American press, provides an excellent example of how caricature and animation played an intrinsic role in the dissemination of information in relation to epidemic disease. ‘Typhoid Mary’ was the first healthy carrier of typhoid to be identified in the United States. An immigrant from the shores of Ireland, Mary was a cook by trade and had efficiently been serving up typhoid bacteria along with her food since she first set foot in an American kitchen in 1900. In 1907, the New York health authorities discovered her infective potential: as a result, she was isolated and quarantined for a total of 26 years. Mary Mallon was formally held responsible for infecting 53 people with typhoid fever, three fatally so. However, historian Richard Gordon clarifies that her casualty list was probably far larger than this, there is even speculation that she caused the 1903 epidemic at Ithaca, New York, which had a devastating 1,400 victims.

Image 1: ‘Typhoid Mary’, Wikimedia Commons. The image first appeared in The New York American on June 20, 1909.

The negative media portrayal that Mallon was subject to encouraged her forceful treatment by the health authorities. The papers delighted in depicting Mary as a devious cook, out to poison her employers. Mary Mallon was, as Roy Porter so aptly describes, “rapidly demonised”: by 1909, macabre cartoons in the popular press depicted her cracking egg-like skulls into a frying pan. The juxtaposition of such images of habitual domestication with deadly disease generated fear and panic amongst the American public. Mary herself was very aware of the bad reputation she was accruing, stating to the New York Times that she was “treated like a leper”. Mary’s description was not an exaggeration: she was banished to an island, destined to live the rest of her days in enforced solitude.

Mary Mallon’s story sparks social, moral and legal debate that has extensive contemporary societal relevance when considered within the context of epidemic disease. It is a mark of the infamous nature of this case that the phrase ‘Typhoid Mary’ still carries strong connotations, defined figuratively in the Oxford English Dictionary as “A person who… is the source of undesirable opinions, emotions, etc.; an unpopular or subversive person”. The power of caricature was instrumental in rendering ‘Typhoid Mary’ an inextricable part of American popular culture.

Further Reading

– Richard Gordon, An Alarming History of Famous and Difficult Patients, (United States of America: St Martin’s Press, 1997).

– Roy Porter, The Greatest Benefit to Mankind, (London: Harper Collins Publishers, 1997).

– “‘Typhoid Mary’ Must Stay: Court rejects her plea to quit riverside hospital”, New York Times, July 17, 1909, 3.

– “Typhoid Mary”, Oxford English Dictionary, www.oed.com.

Lucy Havard