Laughter is the best medicine

Anyone who has read doctor-turned-comedian Adam Kay’s best-selling ‘This Is Going to Hurt’ about his experiences on the obstetrics wards will be aware that medicine provides rich pickings for humour and satire.

But Kay is not the first person to draw on medical experiences to amuse his audiences. For as long as modern medicine has existed, medics and patients have been finding the humour in their experiences, helping to inform on attitudes and experiences from that time.

One such example is this excerpt from the October 1869 magazine, Punch. Written by Francis Cowley Burnand, a nineteenth century comic writer and playwright whose popular column ‘Happy Thoughts’ describes the difficulties and distractions of everyday life.

In this excerpt, Burnand turns his attentions to the doctor’s waiting room, in a scenario that will be very familiar to anyone who has ever made an appointment to see their General Practitioner. The narrator’s attempts to catch the doctor’s eye and jump to the front of the queue are ultimately dashed and he is forced to wait his turn like everyone else. The incident ends in embarrassment when he misplaces the doctor’s fee inside the lining of his coat.

The gentle observational humour illustrated in this column gives insight into the type of medical treatment available to the upper classes, while also demonstrating how little doctor’s waiting rooms have changed in the last 150 years.

The working relationship between doctors and nurses is also very neatly satirised in the following engraving from 1891. The Doctor asks the Nurse: “How is the patient this morning?” To which she replies, “Well – he has been wandering a good deal in his mind. Early this morning I heard him say ‘What an old woman that doctor is!’ – and I think that was about the last really rational remark he made.”‘

This comedic interchange about a delirious patient could just have easily occurred on one of today’s NHS medical wards.

As well as providing entertainment, humour and satire have also been used to highlight public health and social issues. In the following satirical cartoon from an 1893 issue off Punch, ‘Mr Punch’ remonstrates with a policeman about a quack doctor selling his ‘remedies’ on the streets of London. Saying, ‘And if Punch’s ready bâton lays its thwacks on any back with special zest, it is on charlatans and quacks.’

The cartoon highlights the movement against quackery towards the end of the nineteenth century, with a higher degree of ‘outcry’ against quacks that promoted false and unproven health claims for financial gain. While we are less likely to see ‘cure-alls’ pedalled on street corners, ‘quackery’ in the form of misinformation regarding vaccination and cancer treatments still exists as a scourge in modern medicine.

 

Flora Malein

The October 1869 Happy Thoughts article in full:

Image courtesy of Peter Burke

Sources used:

Chisholm, Hugh, ed. (1911). “Burnand, Sir Francis Cowley” . Encyclopædia Britannica. 4 (11th ed.). Cambridge University Press. p. 848.

The Wellcome Library

Tuberculosis, Philately and the history of the ‘Christmas seal’

Paris: Comité National de Défense contre la Tuberculose; Quimper: Comité d’Hygiène Sociale du Finistère, [between 1930 and 1939?]. Image Credit: Wellcome Collection, CC BY.

Christmas has long been recognised as a time of charity and fundraising. Perhaps familiar to some is the ‘Christmas seal’ – a label placed on post over the Christmas period – to raise awareness and funds for charitable organisations.

Christmas seals fall into a category known as ‘cinderella stamps’: items that resemble stamps but cannot be used in payment for postage

While the Christmas seal concept has been adopted to raise funds for many different types of charitable organisations, they have most closely been allied to raising awareness of tuberculosis. According to a New York Times article, the concept originated in Denmark in 1904, when a Danish postal worker called Einar Holbøll came up with the idea to sell the penny seals to raise money for children with tuberculosis.

Other countries quickly followed suit with fundraising seals being produced to support tuberculosis causes in Sweden, Iceland and Argentina.

At the time, tuberculosis was still one of the major causes of death globally. And despite the discovery of the M. tuberculosis bacillus by Robert Koch in 1882, no effective treatment had been found. Organised national efforts to combat the disease were looking for means to raise awareness and financial support for the disease. These campaigns can be seen as some of the very first public health initiatives, in which the financial contributions of ordinary people were used to fund treatment of a disease.

Picture credit: W. Dibb Private Collection.

The first American Christmas seals were produced in 1907 by a Red Cross volunteer called Emily Bissell, who adopted the idea to help raise money for a tuberculosis sanatorium in Delaware that was under the threat of closure if a sum of $300 was not raised.

Although she could not get permission to have the U.S. national postal service to print and distribute the seals, as they had in Denmark, she was allowed to privately sell the seals in the post office lobbies. The seals were such a success they raised over ten times the amount needed and became an annual tradition that raised major funds for The National Tuberculosis Association (now known as the ‘American Lung Association’). The American Lung Association continues to sell their Christmas Seals™. Selling tuberculosis Christmas seals has also funded major disease prevention programmes in countries, such as Canada, through chest X-ray screening or tuberculin tests.

The Cross of Lorraine

National Tuberculosis Association, 1940. Image Credit: Wellcome Collection, CC BY.

Many examples of the Christmas seals created to raise funds for tuberculosis charities contain the symbol of the double-barred cross. Symbolically known as the ‘Cross of Lorraine’, it was adopted as the symbol of the fight against tuberculosis at the International Conference on tuberculosis held in Berlin, 1902.

A French doctor – Gilbert Sersiron – proposed the emblem which had been the banner of Godfrey of Bouillon, one of the leaders of the first Crusades who successfully laid siege to Jerusalem and became it first ruler. In adopting this Crusader symbol, the cross became a symbol of the new, organised anti-tuberculosis ‘crusade’.

 

Flora Malein

 

 

 

 

 

You can read more about postal items and infectious disease in a previous post, here

Sources used:

The New York Times: https://www.nytimes.com/1989/12/24/style/pastimes-stamps.html

The American Lung Association: https://www.lung.org/get-involved/ways-to-give/christmas-seals/history.html

The Canadian Lung Association: https://web.archive.org/web/20111115234620/http://lung.ca/involved-impliquez/christmas-noel/history-histoire/index_e.php

TB Alert: https://web.archive.org/web/20090302074617/http://www.tbalert.org/about/cross.php

John, Simon (2017). Godfrey of Bouillon: Duke of Lower Lotharingia, Ruler of Latin Jerusalem, c.1060-1100. Taylor & Francis. ISBN 978-1-317-126300.

https://wellcomecollection.org/works/msbjucxs

https://wellcomecollection.org/works/hdh9a7xw

Andreas Vesalius (1514-1564) – the greatest anatomist that ever was?

For me, any mention of anatomy conjures up memories of the hours spent during medical school in the Dissection Room, overpowered by the smell of formaldehyde, trying in vain to orientate myself with more than a little help from Gray’s Anatomy for Students. I remember being constantly told that whole-body dissection was a privilege, and not something that was offered by all medical schools. But sometimes I wondered, when did anatomy become such a fundamental component of a medical education, and why?

The answer I feel, lies with a certain character from the sixteenth century: Andreas Vesalius (1514-1564).

 

Born in Brussels in the early sixteenth century, Vesalius was the son of the apothecary to the Holy Roman Emperor. He became influenced by medicine at an early age and chose to pursue a career as a physician. Vesalius is renowned both for his skill as an anatomist and for his crucial role in elevating the status of the discipline of anatomy: he, more than any other individual, established it as an elementary component of a medical education.

Investigation into the field of anatomy before Vesalius was limited. There had been plenty of animal dissection: Aristotle’s extensive work on the classification of living things from the fourth century B.C. is probably the best example here. However, evidence of human dissection before the sixteenth century is sparse. There was a brief period in the third century B.C. when Herophilus of Chalcedon and Erasistratsus of Cos had carried out human dissections but enthusiasm for this practice was short-lived and it was soon prohibited due to the pressure of public opinion – Egyptians believed in the need of an intact body for the afterlife.

It was not until the twelfth century that there was a revival in interest in the field of human anatomy. At this time, ancient Greek physician and philosopher Claudius Galen was still regarded as the reference point in terms of human anatomy. However, Galen did many of his studies on animals and consequently some of his observations relating to the ‘human’ body were in fact false. Despite this, Galen’s writings had been accepted as scripture and had not been questioned… until Vesalius came along.

Vesalius’ greatest achievement in my mind was his book, De humani corporis Fabrica (‘On the Fabric of the Human Body’): the first complete account of human anatomy. This work was impressive in its content – it corrected many of Galen’s previous mistakes and errors – but more importantly, in what it represented in the wider field of medicine and medical education.

The Fabrica took Vesalius four years to complete but he was an absolute perfectionist. Extensive correspondence between Vesalius and his publisher demonstrates how he stipulated exactly how the Fabrica was to be set out, which drawings were to be included and how the various parts of the anatomy should be labelled. The Fabrica is beautifully illustrated and enormously detailed: a salute to Vesalius’ meticulous care and attention.

The Fabrica generated an anatomical revolution. Anatomy used to be stigmatised as the poor relation of surgery, but the Fabrica helped assert it as an integral component of medicine. Finally, anatomy was being recognised as a great skill, and the humble anatomist was being duly applauded.

Something that Vesalius emphasised in the Fabrica is the importance of observation and ‘seeing for oneself’. He was adamant that medical students learnt best by picking up a scalpel themselves rather than just reading a book or learning by rote. Vesalius himself refused to have a ‘cutter’ – an assistant who would perform the dissection for him. Instead, Vesalius did the dissection himself, surrounded by mesmerised students, and lectured as he went. This is wonderfully illustrated on the frontispiece of the Fabrica: on the left hand side of the exposed cadaver is Vesalius, pointing out the various abdominal contents, getting his hands dirty! Students surround Vesalius, clamouring to get to the front, eager to see the great anatomist at work.

Image 1: Frontispiece, Vesalius, De Humani corporis fabrica libri septem. Credit: Wellcome Collection. CC BY

 

Ultimately, by the end of the sixteenth century, Vesalius had surpassed Galen as the primary anatomical authority. He is thought of as one of the great innovators of anatomy, not because he discovered anything radically new, but because he altered the way in which the medical community thought about and practised anatomy. Vesalius’ work inspired and influenced budding anatomists and there were rapid advances in practical anatomy after his death. Realdo Columbo’s work on the heartbeat and pulmonary transit is one such example, and this proved vital in William Harvey’s later work on the circulation of blood.

So, to all those medical students out there, when you are next in the DR at the end of a long morning, more concerned about your mounting hunger than the insertion point of iliopsoas, take a moment to remember Vesalius: the greatest anatomist that ever was.

 

Lucy Havard

 

 

Further Reading

  • ‘Andreas Vesalius’, Science Museum (online). Available at: http://broughttolife.sciencemuseum.org.uk/broughttolife/people/andreasvesalius
  • ‘Vesalius’ Renaissance anatomy lessons’, British Library (online). Available at: https://www.bl.uk/learning/cult/bodies/vesalius/renaissance.html
  • Vivian Nutton, Ancient Medicine. Routledge: London, 2012.

 

 

The Humble Toothbrush

This blog focuses on the humble toothbrush: that everyday object that we too easily take for granted. Although many may consider the toothbrush a fairly insignificant and disposable item, it actually has rather an interesting history…

Early forms of the toothbrush have been in existence since about 3000 BC. Some Egyptian tombs have been found to contain ‘toothsticks’ demonstrating that cleaning teeth was clearly considered an important activity thousands of years ago.

It wasn’t until 700 AD that bristle toothbrushes were invented in China. These toothbrushes comprised of handles made of bone or bamboo and while bristles were fashioned from the hairs from the back of a hog’s neck!

 

Image 1: Toothbrush with horsehair bristles, London, England,1870-1920. Credit: Science Museum, London, CC BY.

 

Image 1 shows two toothbrushes that are part of a collection from the Science Museum in London. Both are made by the firm Savory and Moore. Savory and Moore was actually a dispensing chemist, and was the only retail outlet allowed in the district of Belgravia at the time. It served the royal family so it would be reasonable to assume that the owner of these toothbrushes was fairly wealthy. The toothbrush handles are made of ivoride, whilst the bristles are horsehair.

Nylon bristles were first used for toothbrushes in 1938. This new form of toothbrush was rapidly adopted due to growing concerns about oral hygiene during the Second World War. Indeed, the first truly ‘electric’ toothbrush was invented at the end of the 1930s. However, it was deemed ineffective and so sales never really took off. 1954 saw the introduction of ‘Broxodent’, the first usable electric toothbrush. However, this toothbrush was fairly unsafe given its high voltage and the fact that it was typically used in the bathroom where the presence of water further enhanced its electrocution danger! It wasn’t until 1961 that a cordless and rechargeable model of electric toothbrush became available, manufactured by General Electric – this sold much better. The electric toothbrushes that we have today have come a long way: they run on a lower voltage, have improved battery life and are rechargeable.

And the history of toothpaste? Well that’s another story..!

 

 

Further reading

  • ‘The History of the Electric Toothbrush,’ accessed 4/8/19. Available at: https://www.electricteeth.co.uk/the-history-of-the-electric-toothbrush/
  • ‘Prison, Suicide, & the Cold-Climate Hog (the sordid history of the toothbrush,’ The Museum of Everyday Life, accessed 4/8/19. Available at: http://museumofeverydaylife.org/exhibitions-collections/previous-exhibitions/toothbrush-from-twig-to-bristle-in-all-its-expedient-beauty/a-visual-history-of-the-toothbrush

 

Lucy Havard

The Stagnant Practice of Clandestine Abortion

It is just over 50 years since the 1967 Abortion Act was passed. It therefore seems fitting to examine the history of abortion and consider how this practice has changed over time, from antiquity to the twentieth century. This blog uses evidence from ancient treatises and excerpts from a collection of personal accounts from the mid-twentieth century published by Marie Stopes International (see further reading). It argues that despite the transcendence of two millennia, there was little change in abortion practices as a result of the secretive and stigmatised nature of the act.

 

Physical exertion

Physical exertion was a traditional method used to try and induce an abortion. Although only successful in the most extreme of cases, it was a commonly held belief in antiquity that prevailed until the mid-twentieth century. The ancient Hippocratic Corpus describes the ‘Lacedaemonian Leap’ which involved jumping up and down, touching one’s buttocks with the heels at each leap, to try and induce a miscarriage.

This belief in the abortive properties of physical exertion is also evident in personal accounts from the mid-twentieth century. ‘Alice’ fell pregnant at just 16 in 1963. She describes how ashamed her parents were when they found out, and how her father physically abused her to try and achieve this aim: ‘We lived in a house in Clifton, which had very steep stairs. My dad was there and he literally punched me in the stomach and then pushed me down the stairs’.

 

Oral methods

A wide variety of oral abortifacients were employed in antiquity. These ranged from a concoction of common herbs and plants that could be grown in one’s own garden, to exotic substances more difficult to obtain. The popularity of purging oral substances, both diuretics and laxatives, for the purposes of abortion is evident in Soranus’ Gynaecology.

Returning to the case of sixteen-year-old ‘Alice’, she describes how she came home from school one day ‘to find this strange concoction brewing in the kitchen. It was a natural laxative my mother said. They thought it would bring on a miscarriage’. On another occasion, Alice reports that her father ‘produced some little black pills and told me to take them’.

An abortion method combining both physical and oral elements is found in the commonly held belief in the efficacy of hot baths and alcohol. This is particularly advocated by Soranus in the ancient period, who advises ‘lingering in the baths and drinking first a little wine and living on pungent food’ in order to induce an abortion.

Such methods are also evident in the mid-twentieth century. When ‘Isa’ was denied a recommendation for a termination in 1962, she describes ‘getting blind drunk on gin and taking hot baths and God knows what else’.

 

Douching methods

Douching was a popular abortion method in the mid-twentieth century. ‘Jane’ recounts her two experiences of backstreet abortion in the 1950s: ‘Both were done in the same way, by different backstreet abortionists, using a douche, Lux and Dettol’.

Interestingly, there is in fact evidence for the use of douching devices in antiquity, especially in Hippocratic times. However, douching tended to be used to promote conception, rather than to prevent or terminate a pregnancy. For example, Hippocrates’ Diseases of Women advises a solution of ‘mare’s milk’ to be injected into the womb using a douching device to help treat an ulcerated uterus that is preventing successful conception.

 

Surgical methods

Surgical methods were recognised as the most dangerous means of abortion in antiquity, and were only resorted to in the most desperate circumstances, typically when the fetus was fairly well-developed and other methods had failed. Celsus, writing in the first century AD, described the technique of surgical removal as ‘reckoned amongst the most difficult: for it both requires the highest prudence and tenderness, and is attended with the greatest danger’.

However, there is clear evidence to suggest that these procedures did occur. Celsus is particularly detailed in his medical account of the surgical removal of an already dead fetus that had not been intentionally aborted:

 

…if the head is nearest, a hook should be introduced, in every part smooth, with a short point, which is properly fixed either in the eye, or the ear, or the mouth sometimes even in the forehead; and then begin drawn outwards, brings away the child.


There is an argument that such instruments were only used in cases where the fetus had already expired and not as a means of procuring abortion. However, references to the instrument known as embruosphaktes (literally: ‘embryo-slayer’), suggests otherwise.

There is similar evidence for instrumental methods used in the mid-twentieth century. Again, it is generally accepted that such intervention would be resorted to only when other less invasive methods had failed. Given the potential for physical harm this is hardly surprising. ‘June’ shares her memories of backstreet abortion in 1959: ‘I knew that women had been damaged severely from abortions going wrong. Knitting needles. We’d all heard stories about knitting needles and coat hangers’.

The ‘crochet hook’ was another popular instrument used in attempted abortion, easily obtainable and a common household item like the knitting needle and the coat hanger. The similarities between the description of the hook-like instrument from antiquity and the mid-twentieth century crochet hook depicted below are striking:

 

Image 1: Crochet hook – a hooked instrument for removing an aborted fetus. Wellcome Images.

 

This blog has drawn attention to the significant parallels existing between abortion practices of antiquity and those of the mid-twentieth century, prior to the introduction of the 1967 Abortion Act. I suggest that it was the stigmatised culture of abortion that led to this stagnation in abortion practices.

 

 

Further reading

  • Soo Brookstone (Ed), Voices for Choice(London: Marie Stopes International, 1997).
  • Aulus Cornelius Celsus, Cornelius Celsus of medicine. In eight books. Translated by James Greive, (London, 1756).
  • Hippocrates, Hippocratic Writings, edited by G.E.R. Lloyd, (London: Penguin Books, 1983).
  • Soranus, Gynaecology, translated with an introduction by Owsei Temkin, (Baltimore: John Hopkins University Press, 1991).
  • Konstantinos Kapparis, Abortion in the Ancient World, (London: Duckworth Publishers, 2002)
  • John Riddle, Contraception and abortion from the ancient world to the Renaissance, (United States of America: Harvard University Press, 1992).

 

 

Lucy Havard