Elizabeth Garrett Anderson: a modern woman 100 years ahead of her time

Posted on 7th December 20188th December 2018 by Edward Wawrzynczak | Leave a comment

As a junior doctor possessing two X chromosomes, it is easy to applaud the achievements of Elizabeth Garrett Anderson (1836-1917), widely revered as the first British female doctor. It is infinitely harder to establish exactly how she succeeded and to quantify the relevance of this extraordinary woman who died just over 100 years ago. Can we still learn from her example, or has too much time passed to draw significant parallels in today’s modern world?

Image 1: Elizabeth Garrett as a young woman, Wellcome Images

Elizabeth Garrett Anderson wrote to a friend in 1864: ‘My strength lies in the extra amount of daring which I have as a family endowment. All Garretts have it.’ EGA did have ‘daring’, and she wasn’t scared to do things differently. She is frequently referred to as ‘a pioneer’, and with just cause: EGA was the first woman to qualify in Britain to practice medicine, the first woman to qualify as a doctor of medicine in France, the founder of the first hospital staffed by women, the first female member of the British Medical Association (BMA), the first female Dean of a British medical school, the first female mayor in Britain; the list goes on. EGA’s nature as ‘the first’ engendered two conditions: one, that the medical profession as a whole had not expected, nor prepared, for the possibility of a female attempting admission to their ranks; and two, that any doors that remained open within the medical profession were swiftly slammed shut soon after EGA had passed through them. The permission for women to take the Licentiate of the Society of Apothecaries (LSA) examinations to obtain a medical degree, and admission of females to the BMA may be cited as examples here. Consequently, EGA’s nature as a ‘pioneer’ conferred a significant advantage, and it was initially harder, as opposed to easier, for women to qualify as doctors after Elizabeth Garrett Anderson had succeeded.

Image 2: Elizabeth Garrett Anderson, Wellcome Images

Not only did EGA have an unwavering belief in herself and her ability to become a doctor but she put her career first: this was unprecedented in mid-Victorian Britain. She married comparatively late, at the age of 34, despite the average age of contemporary females entering matrimony being just 23 years in 1871. Importantly, marriage took place only after she had successfully completed her studies to become a fully qualified doctor. She had previously declined an offer of marriage in 1865 from her sister Millicent’s future husband, the MP Henry Fawcett. Even after becoming engaged to James Skelton Anderson, she worried that this might jeopardise her career as a doctor and her fight for women’s suffrage: ‘I believe I should almost die of the sense of something akin to guilt, if I found myself, three years hence, really out of the medical field’. This excerpt clearly demonstrates an immense sense of duty. EGA felt herself carrying the weight of the future of women’s rights on her shoulders, and this was constantly in the forefront of her mind.

Elizabeth Garrett Anderson changed the course of women in medicine indefinitely, and more broadly, had an integral role in promoting the women’s suffrage movement on a national scale. Women today can identify with EGA given that she mastered the ability of the ‘modern woman’ to ‘have it all’ – with both a successful career and a fulfilling family life. In 1871, The Lancet proposed ‘if [Elizabeth Garrett Anderson] succeeds in combining the two functions of mistress of a household and medical practitioner, she will have performed a feat unprecedented in professional history, and added another notable incident to this annus mirabilis’.

Quod erat demonstrandum.

The Gripe Water

Posted on 21st November 201821st November 2018 by Edward Wawrzynczak | Leave a comment

Early modern receipt books may be defined as collections of food recipes, medicinal remedies and household tips. These handwritten manuscripts were generally compiled by the housewife; she would use the receipt book as a means to record her own recipes as well as those borrowed from friends, neighbours, family, and even doctors and surgeons. Receipt books were highly valued and were often passed down through the generations; they were even formally bequeathed in wills. These manuscripts provide intriguing evidence of the homemade medicinal remedies in use in the early modern period. This blog is focused on a recipe for ‘Gripe Water’ from a receipt book attributed to Mary Chantrell, dated 1690. The manuscript can be found at the Wellcome Library in London and it is also available in a digitised format online via their website.

Wellcome Library MS.1548, 53.r-v

The layout of this recipe is interesting: it is written in prose, and there are no separate lists of ingredients or utensils as is often the case in modern-day recipes. It must have been rather difficult for early moderns to make sure they had all the ingredients required before starting to make the recipe!

One of the most striking things about this particular recipe is the number of individual ingredients used: ‘gilley flowers’, ‘rosemary flowers’, ‘borage flowers’, ‘blacke cheryes’, ‘strawberyes’, ‘rasberyes’, ‘mint’, ‘balme’, ‘angellicoe’, ‘rue’, ‘morella cheryes’ ‘coriander seeds’, ‘caraway seeds’, aneseeds’, ‘nutmeg’, ‘cloves’, ‘mace’, ‘cinamon’, ‘ginger’, ‘pennyroyall’, ‘brandy’, ‘sherye’ and ‘white wine’. Some of these herbs and spices were difficult to cultivate in seventeenth-century English gardens necessitating their purchase from specialist suppliers. Exotic spices, such as ginger, mace, cinnamon and nutmeg often had to be imported. The housewife would need to know where to obtain these individual items as well as how to judge their quality in the making of this remedy.

The quantities of ingredients is notable: a gallon each of strawberries and raspberries, 12 pounds of cherries, three gallons of brandy, a gallon of white wine and a gallon of sherry! Such quantities would have made the recipe expensive. Perhaps the large amounts used were due to the recipe being made for a large household, or maybe the intention was to share or exchange the final product amongst others in the local community. Perhaps the ‘Gripe water’ would be made once and then kept and stored for future use over the coming months or even years.

Finally, the equipment used is interesting. The recipe mentions the use of a ‘Limbeck such as the Apothecaryes use’. This ‘Limbeck’ (more commonly termed an ‘alembic’), was an apparatus used for the purposes of distillation. Using this kind of equipment supports the notion that activities commonly associated with the history of science might be performed in the home, and encourages us to consider the domestic environment as an ‘experimntal space’.

Early modern receipt books, like this one, raise many questions. But they also provide us with a tantalising window through which to view early modern domestic medicine.

Louisa Aldrich-Blake’s Casebook

Posted on 9th November 20189th November 2018 by Edward Wawrzynczak | Leave a comment

On 25^thApril, 1891, five-year-old Beatrice Saunders, drowsy and delirious, was brought to London’s Royal Free Hospital by her mother. Louisa Aldrich-Blake, a 25-year-old medical student, later to become an eminent surgeon, spent the next 10 days patiently documenting the progression of the little girl’s illness in her casebook (shown below). Beatrice died of tuberculous meningitis on 4^thMay 1891. Aldrich-Blake’s casebook provides us with a valuable lens through which to view the education of a nineteenth-century female medical student.

Aldrich-Blake’s casebook, Wellcome Library, MS 5794.

This casebook is part of a collection of Louisa Aldrich-Blake’s clinical notes, written between 1887 and 1908, presented to the Wellcome Library in 1926. It documents a number of patient cases that Aldrich-Blake observed as a student on the wards.

Much of Aldrich-Blake’s documentation is in keeping with Nicholas Jewson’s concept of late nineteenth century ‘Hospital Medicine’. This can be appreciated in Aldrich-Blake’s record of a complete medical examination on admission of the patient to hospital. She adopts a logical systems-based approach: ‘nervous system’, ‘alimentary system’, respiratory system’ and ‘circulatory system’ are all examined thoroughly.

There is an overwhelming preoccupation with statistical analysis by way of patient observations in Aldrich-Blake’s account. Numerical data features strongly – the number of respirations, the heart rate and the temperature being specified several times. This is further emphasised through the inclusion of the patient’s observation chart (see below). In one sense, this renders the text obsolete: the account of the deteriorating child is distilled down to numbers on a graph, an objective depiction of life and death.

Observation chart, Wellcome Library, MS 5794.

30 hours after the patient’s death, an autopsy was performed, and the findings described in great detail. Of the seven pages that Aldrich-Blake used in her casebook to record this admission, a significant proportion (one-and-a-half pages) was dedicated to the post-mortem examination. This is in keeping with Jewson’s view of pathological anatomy as integral to Hospital Medicine.

However, elements of Aldrich-Blake’s documentation also correspond with Jewson’s notion of ‘Laboratory Medicine’, for example in the testing and analysing of bodily substances. Aldrich-Blake recorded the results of Beatrice’s urine analysis in her casebook: ‘Urine: acid. No alb. No sugar. Abundant urates’.

Despite these unquestionable features of ‘Laboratory Medicine’, Aldrich-Blake’s account also contains some aspects of ‘Bedside Medicine’, notably a diagnosis achieved via the patient’s self-report of their illness. Given that the focus of this case is a five-year-old child, clearly the patient would not be expected to provide a history herself. However, the mother does give such a report, and Aldrich-Blake’s inclusion of this highlights its significance:

Quite well up till April 22^nd, no previous alteration in temperament. In the evening after coming home from school complained of headache and shivered. Early next morning had a severe fit of coughing of a peculiar character. After this she vomited and continued to do so after food or medicine until admission to R.F.H on April 25^th.

Aldrich-Blake’s casebook entry demonstrates co-existing elements of ‘Bedside’, ‘Hospital’ and ‘Laboratory Medicine’ as described by Jewson. This casebook is a rich resource for helping us understand the practices of nineteenth-century medical professionals. It also provides us with some insight into the somewhat nuanced transition from bedside to hospital medicine.

Wellcome Library, MS 5794, 5.r.

Collecting “stuff”

Posted on 28th October 201828th October 2018 by Edward Wawrzynczak | Leave a comment

Recently my wife and I have been trying to declutter our home; an emotional process that threatens domestic harmony and generates both relief and bereavement in equal measure. A lifetime of collected material artefacts and documents entombed in draws, cupboards or cardboard boxes are finally being subjected to the “William Morris test”: is it useful, is it beautiful? If not, where should it go? Relatives, friends, the sale room, eBay, charity shops, the municipal tip, or a car-boot sale are places where “stuff” can be deposited. In this way, collections become fractured, and objects might lose both their identity and meaning.

This year the BSHM has celebrated collections and collectors through an excellent Poynter lecture “the Doctor as Collector ” by Simon Chaplin which is now available on this website at https://BSHM.org.uk/poynter-lecture/ and by our recent symposium “In Sickness and in Health ” with abstracts and lecture images at https://bshm.org.uk/events/collections-symposium/

When James Parkinson (1755-1824), of eponymous disease fame, died, his collection of fossils, regarded as one of the finest in the UK, was inherited by his unappreciative wife. Sadly, she allowed the collection to be broken up and disposed of at a public sale. No catalogue exists and very few of the specimens can now be traced. A similar fate befell many other note-worthy “cabinets of curiosity” in the 18th an 19th centuries.

‘Cabinet of Curiosities’, by Domenico Remps, c. 1689

Readers of this blog may, like me, be reviewing their accumulated stuff. If you have collections or archives that could be of interest to other medical historians please take steps to deposit these in an appropriate repository – archives, libraries or museums – where they can be properly conserved, catalogued and made available to others.

Chris Derrett

The “Spanish” Influenza Pandemic of 1918-19

Posted on 11th October 201811th October 2018 by Edward Wawrzynczak | Leave a comment

In this centenary year there have been several new books, articles and television programmes about the pandemic which killed between 50 and 100 million people worldwide. Much of this writing, however, has been very America-centric, and has ignored the influenza that had been spreading in Europe from the autumn of 1916. Although this version of influenza had a low penetrance, it had a high mortality due to the fact that 25% suffered what we now know to be a cytokine storm, so 20% died a very unpleasant death. At the time it was not known what was happening – was it an infection, or some new poison gas produced by the other side? Amongst the British it almost exclusively affected soldiers, but when they discovered that German and Austrian soldiers and civilians were badly affected, the conspiratory theory was discarded. In UK there was a small outbreak in Aldershot, but it did not spread. The bacteriologists could find no common organism and labelled it “purulent bronchitis”. It was not until the 1918 pandemic, when it was noted that survivors of purulent bronchitis were immune to the influenza, that they realised they were looking at the same disease. Sadly, no tissues or samples remain of this early manifestation.

By definition “Spanish” Flu started in the USA in March 1918. This behaved in quite the opposite way to the purulent bronchitis. The mortality of the first wave (March-early September) was no higher than normal influenza epidemics, but it was extremely infectious. In the worst week, in July 1918, 46,275 British soldiers in France reported sick – they nearly overwhelmed the medical system. It was during this time that the infection got its misnomer. The warring nations did not wish to give any information to the enemy that might suggest that they had an increased rate of sickness, but Spain, which was neutral, had no such compunction. This meant that our press was able to report an epidemic in Spain, and the name stuck. The incorrect fact that it had started in Spain was believed to such a degree that when exploring the National Archives in Malta I came across the draft of a telegram from the Governor to the British Ambassador in Madrid demanding medical information. This was sent in cypher.

National Archives of Malta, CSG 01 – 1033/1918

In September 1918 it appears that the two expressions of the influenza met and mutated in Étaples near Boulogne and created the deadly 2^nd wave which caused a huge death rate as it still had the high penetrance of the American 1^st wave, but about 10% suffered the haemorrhagic cytokine storms. The figures are frightening. 17 million died in India alone, Samoa lost 20% of its population. In London 13,000 died of influenza (in 1912 the influenza deaths has been 535).

It must have been a horrendous time to be a doctor, struggling to understand why so many previously healthy young people were dying, and struggling to find places to nurse them. Many factory buildings had to be converted into makeshift hospitals. Let us all pray that we are able to contain the next severe pandemic.

Jane Orr