One-way systems to keep patients separate

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Eastern Dispensary, Bath Photo: William Rogers, britishlistedbuildings.co.uk

The Corona virus pandemic prevention measures were not the first one-way system in British health care, as William Evans explains.

One feature of the measures imposed or encouraged by the UK government to stop Corona virus spreading was one-way systems for human traffic. In premises such as doctor’s surgeries, one-way systems aimed to reduce close contact between people and avoid transmission of the virus.

One-way systems are not new. We are familiar with them in the management of road traffic. Although fewer accidents and a reduction in personal injuries are some results, the main aims are to relieve traffic congestion and reduce conflict among road users. Another example comes from the household goods sector. The retailer Ikea makes customers follow a prescribed route through its stores. In this case, the aim is not safety, but more sales by bringing to customers’ attention all the goods offered, not just those the customer may be interested in.

There is a historic precedent for a one-way system in a medical context from the Eastern Dispensary in Cleveland Place East, Bath. Opened in 1845, it was designed by the local architect, Henry Edmund Goodridge (1797-1864). The external design is neo-classical: the entrance at the front through a portico with columns and a pediment. Inside, the design was innovative. On entering, patients were directed into one of two waiting rooms at either side of the building (one for women, one for men?). In each waiting room, the patients sat on, and moved along, benches. The first bench was attached to the left side wall, the next one to the right, and so on.

As a result, patients moved along the benches in queue until they were summoned to rooms at the back of the building where they were seen by an apothecary or surgeon or went into a dressing room. They then left the building by a back door from the room where they were seen or treated.

Plan of the dispensary The Builder, (1849) 160

The purpose of that layout may have had much to do with keeping order in what could otherwise have been a melee, but no doubt it also helped to limit the transmission of infectious or contagious diseases. Goodridge’s radical design was commended by The Builder magazine as a model for future dispensaries. It would be interesting to know whether his Bath layout was followed elsewhere.

After it ceased being used as a dispensary, the building housed various activities: in the 1910s, for example, colleges and pharmacies. It is now a bistro.

References

Plan of the dispensary: Bath & NE Somerset Council Archives, 0033

The Builder, (1849) 160; https://archive.org/details/gri_33125006201806/page/160/mode/2up?view=theater

Michael Forsyth, Bath, in the Pevsner Architectural Guides series, Yale UP 2003

For Goodridge: HM Colvin, A biographical dictionary of British architects 1600-1840, Yale UP 1997

For dispensaries: Michael Whitfield, The dispensaries: healthcare for the poor before the NHS, Author House 2006

William Evans is treasurer of Avon Local History & Archaeology, the umbrella group for local history in the Bristol and Bath area.

Recycling Penicillin from Urine in Post-War Germany

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Limited supplies of penicillin and Allied restrictions on German access to the drug in the immediate aftermath of World War II led to its recovery from the urine of treated patients. Susanne Krejsa MacManus explains.

German research on penicillin started only in 1942 and then on a very small scale.[1]  Gerhard Domagk (1895-1964), the German scientist who in 1935 had developed sulfonamides, had advised the Nazi government to concentrate on improving of “his” type of antibiotics instead of trying to get its own penicillin production going.

It took Germany till the end of 1943 to really understand the importance of penicillin, but because of the efforts of the Allies to restrict information and materials,[2] German scientists were not able to learn about the right mould, nor could they develop the process to get a good supply.

From autumn 1945, British and American forces increased the amount of penicillin flown into hospitals in Berlin – mostly for their own soldiers as a treatment for sexually transmitted diseases. But the occupying forces faced a dilemma: on one hand, they had to look after the health of the population of the occupied areas; on the other hand, there was a hostile atmosphere against the German population – at least in the first months after the end of the war. Germany was categorised as a “defeated enemy” – in contrast to Austria which was categorised as a “victim”.

There was even a third aspect. The German pharmaceutical industry was known as being innovative and effective. The occupying forces hoped for “penicillin made in Germany” and encouraged companies like I.G. Farben, Hoechst and Chemie-Grünenthal to start such an undertaking.

The USSR did not have penicillin production of its own, although they claimed two of their scientists had invented the antibiotic long before Alexander Fleming. As early as early May 1945, Soviet forces who were eager to get penicillin as part of German reparations were pushing the German company Schering .[3]

Since one of Schering’s production sites lay in British territory, the company got support from the British element of the occupation forces for building laboratories and getting raw material (as this ad shows.).[4] 

Salzburger Nachrichten, 9/1/1946  Schering AG produces penicillin Berlin,  As the British broadcast has reported, the Germany pharmaceutical company Schering AG in Berlin will manufacture penicillin for Germany. The British military government has promised its support to the company in procuring the laboratory and the necessary material, so far as it is available in Germany.

But sufficient output was not available before the end of 1946/the beginning of 1947.

Two-thirds excreted

During their struggle to set up a production site, scientists at Schering recalled that two- thirds of penicillin given by injection left the body very quickly, so quickly that injections had to be repeated every few hours.[5] “If we could get the urine of patients treated with penicillin”, the scientists speculated, “we might be able to reclaim and concentrate this substance.”

The British and American forces permitted them to collect the urine from their hospitals on the condition that they got their share of the recycled substance. From March 1946, Schering’s scientists organised milk-churns and bicycles and went from hospital to hospital to collect patients’ urine. The recycling process was successful, and in spring 1947 it was extended into American and British areas of West Germany. In April 1949, nearly 5000 liters of urine from 3153 patients were collected from hospitals. This activity lasted till 1950, when the manufacturers’ penicillin production was sufficient to meet demand.

Recycling penicillin from urine was not a new idea, but its use on this scale was was exceptional. It showed that the German researchers had clearly understood the character of penicillin being excreted from the organism so quickly. Secondly, the process of recycling penicillin purified the substance, which at the initial injection had produced sharp and unpleasant feelings for the patient. And third, it shows how Schering’s researchers could act on their own initiative, without having to ask boards and committees for permission as they would have to do today.

Susanne Krejsa MacManus PhD is an independent journalist, author and archivist in Vienna. She is a member of the History of Medicine/Medical Humanities working group of the Commission for History and Philosophy of the Sciences at the Austrian Academy of Sciences (ÖAW).

References

[1] I. Pieroth: Penicillinherstellung – Von den Anfängen bis zur Großproduktion, Heidelberger Schriften, 1992, p. 103.

[2] P. Rostock: Die Wunde, Berlin: De Gruyter, 1950, p. 290.

[3] J.-P. Gaudillière, B. Gausemeier: Molding National Research Systems, OSIRIS 2005, 20:180-202.

[4] Schering A.G. Berlin produziert Penizillin, Salzburger Nachrichten, 9. 1. 1946, p. 2.

[5] J.H. Humphrey: Excretion of Penicillin in Man, Nature 3920, 1944, 765.

 

 

Illustrations of the History of Medicine from the Art of Barbara Hepworth

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Consultant orthopaedic surgeon, Norman Capener had a considerable effect on the work of sculptor Barbara Hepworth (1903-1975), as James Scott explains.

 In 1944, Barbara Hepworth’s daughter Sarah developed osteomyelitis of her proximal femur, – a much feared condition with a mortality of about 30% at the time. I was able to discover that she was treated with an infusion of penicillin directly into her thigh, which she recalled to me was “quite painful’. She, thus, would have been among the very first patients to receive penicillin for infection of the bone.

Initially in hospital for about nine month, Sarah underwent many local procedures. Norman Capener was her surgeon. He had a strong interest in sculpture, and he and Hepworth became friends.

With his help, Hepworth attended many operations about which she wrote: “I became completely absorbed by two things: first the extraordinary beauty of purpose and co-ordination between human beings all dedicated to the saving of life…and secondly by the way this special grace of mind and body induced a spontaneous space composition and articulated an animated kind of abstract sculpture very close to what I had been seeking in my own work.” This resulted in an iconic series of painted drawings of operations, and informed much of her subsequent sculpture. (Drawing by Barbara Hepworth © Bowness) 

A little more than 25 years ago, I founded the Arts Project at the Chelsea and Westminster Hospital, which was shortly to open. There were a great many works of art in the six hospitals which were to close as a result, including a ‘Resurrection’ by Veronese in the chapel of the old Westminster Hospital.

The architects were very encouraging, and during the first few years of the life of the new hospital, we were able to introduce about 1500 new works of art and incorporate many from the previous hospitals. One of the works we borrowed for the Dermatology Department was a sculpture by Barbara Hepworth.

We also created a flourishing program of music, dance, poetry etc., followed later by opera. The great value of this endeavour for everyone — staff, patients and visitors — was clear from the outset.  The project has since grown enormously in scope and flourished.

Where were the women?

When I was a medical student at the Middlesex Hospital in London in the mid-1960s, (with wonderful murals by Cayley Robinson in the front hall), I had seen some sculptures in Battersea Park by the sculptor Kenneth Armitage. I particularly remember a piece by him called Pandarus. Many years later, I discovered that he had a studio 

in Olympia, West London, and we became friends. After an exhibition to celebrate his 80th birthday at the Yorkshire Sculpture Park, he lent me four sculptures for the hospital, – including Pandarus (right). 

Researching a book about him for the publishers Lund Humphries, I noted that a woman called Lillian Somerville had successfully promoted his career and those of many more Modern British Artists internationally for the British Council through the Venice Biennales over a period of 15 years. Little was known about her.  Some further research revealed many other women who had promoted all aspects of modern art in this country at that time, again about whom little was known.

A couple of years ago I contributed towards a book for Unicorn Press, describing the work of the arts project and the Chelsea and Westminster Hospital. During lockdown, I prepared a further book for them, simply telling the stories of many of the women to whom my attention had been drawn, including a description of Barbara Hepworth’s connection with Norman Capener. 

James Scott is a retired orthopaedic surgeon and emeritus editor of the Bone and Joint Journal. He is the author of The Women who Shaped Modern Art in Britain and a co-author of The Healing Arts: The Arts Project at Chelsea and Westminster Hospital. Both are published by Unicorn Publishing Group.

References

Norman Capener obituary. British Medical Journal, 19 April 1975, p 145

Read, Herbert, Barbara Hepworth, Carvings and Drawings, Section 5. Lund Humphries, 1952

The Third Man was true – Penicillin in Post-War Austria

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The 1949 black and white film, The Third Man, about the black market in Austria after the end of World War II, is still the most frequent association made between the two key words Vienna and penicillin, says Susanne Krejsa MacManus.

Advertisement for penicillin production from Life magazine, Science Museum, London

In 1999, when the British Film Institute surveyed 1,000 people from the world of British film and television to list the greatest British films of the 20th century, The Third Man (1949) after Graham Greene’s book became No 1. It tells the story of an American writer, Holly Martins, who arrives in Vienna to accept a job with his friend Harry Lime, only to learn that Lime has died. Suspicious, Martins stays in Vienna to investigate and discovers the black market in penicillin.

Why was Vienna’s black market so active after the war? From 1941 onwards, British and American scientists and companies developed penicillin into the medical Wunderwaffe (wonder weapon) following its discovery by the Scottish bacteriologist Alexander Fleming (1881-1955). As soon as reasonable amounts of penicillin could be produced, some countries outside Britain and the United States began receiving donations of supplies or some support in starting their own production.

As a war enemy Germany did not receive any such help, nor did Austria, which had become part of the Third Reich in 1938. To block their scientists from learning about penicillin, British and American scientists were not permitted to publish their results on penicillin internationally.[1]

Post-war relief

However, after the war, Austria was deemed a liberated country and therefore entitled to help.[2] Virtually everything was needed. The country could not survive on its own, nor would it have been able to feed and help the vast numbers of displaced persons stranded there. The occupying forces had to organise and oversee the first months. Help also came from Red Cross organisations, religious groups and private initiatives.

The United Nations Relief and Rehabilitation Administration (UNRRA) had been founded in November 1943 to help nations after the end of World War II. In March 1946, UNRRA’s first train with provisions and goods arrived in Austria. A few weeks later medical supplies came, including penicillin, but sufficient only for 20 patients, and its distribution and assignment tightly controlled by a penicillin committee. To teach doctors in Austria how to use previously unknown materials, drugs and medical equipment, the British Council provided books, lecturers and contacts.[3]

With such limited supplies of penicillin, some illnesses were excluded from treatment, sexually transmitted diseases being one of them. To prevent fraud, the vials had to be returned after usage. Even so, the black market flourished. Newspapers from the years 1945 to 1949 reported thefts from American hospitals, counterfeiting, dilution with even dangerous substances and blackmail.

One in such scam an alleged Miss Austria, Norberta Grimm, had apparently turned the heads of two members of the American occupation forces in Vienna. In order to buy her a large diamond ring, the two of them stole penicillin from army stocks, which the girl was then supposed to sell or exchange on the black market.

Only, there was no Miss Austria in 1928,[4] Likewise, no one of her name ever appears in the list of winners for the other years.[5] The men were caught by police when one of them handed over ten bottles of penicillin to Grimm, worth a black-market price of $10,000 per bottle.

What lends the story a certain punch, though, is that it coincided with a lecture given by the famous British penicillin expert Prof. Ronald V. Christie in Vienna on the “miracle drug penicillin” – reported in the same newspaper edition, just a page further on.[6]

Susanne Krejsa MacManus PhD is an independent journalist, author and archivist in Vienna. She is a member of the History of Medicine/Medical Humanities working group of the Commission for History and Philosophy of the Sciences at the Austrian Academy of Sciences (ÖAW).

[1] Paul Rostock, Die Wunde, Berlin 1950, p. 290.

[2] Resolution No. 74: A Resolution relating to Operations of the Administration in Austria, https://www.parlament.gv.at/PAKT/VHG/V/I/I_00086/imfname_337149.pdf, p. 15.

[3] Englische medizinische Fachliteratur für Wien (British Medical Books for Vienna) in: Weltpresse, Feburary 9, 1946, p. 2

[4] Two Captains Convicted – New Yorkers Said to Have Sold Penicillin Stolen from Army, in: New York Times, May 27, 1946

[5] Two Captains Convicted in Penicillin Sale, in: The Stars and Stripes, May 26, 1946, p. 4.

[6] Wiener Kurier, June 21, 1946, page 3 (Norberta Grimm), page 4 (report on Prof. Christie’s lecture)

 

Being right is not enough

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Scientific debate can be soured by the tendency for evangelical pioneers to see any questioning as opposition bordering on evil.   Their aggressive attitude can delay innovation, a lesson perhaps for our own times and a reason for studying history, says Mike Davidson.  

Ignaz Semmelweis

My wife and I saw the production “Dr Semmelweis” at the Bristol Old Vic. At last, a chance to experience live theatre with a full audience; it also fulfilled my interest in the history of medicine. The writers, Mark Rylance and Stephen Brown, were influenced by the 1952 biography Semmelweis (1818-1865) by Louis-Ferdinand Céline, a work I am unfamiliar with.

Their play is a dramatic interpretation of the work of Ignaz Semmelweis (1818–1865) on puerperal sepsis and his failure to convince his contemporaries of the need for ward hygiene to control the disease. This was in no small part a result of his uncompromising personality and ability to alienate even his strongest supporters and allies.

Semmelweis proposed the practice of washing hands with chlorinated lime solutions in 1847 while working in Vienna General Hospital’s First Obstetrical Clinic, where doctors’ wards had three times the mortality of midwives’ wards. His observations brought him into conflict with many within the contemporary scientific and medical establishment.

The play records Semmelweis’s descent into madness, haunted by the ghosts of the women he has not saved. The ghosts are portrayed as dancers and musicians on stage and within the audience, as he recollects events. Much of the narrative takes the form of flashbacks acted out for his wife. The opportunities for engagement squandered by Semmelweis due to his lack of understanding of human nature are highlighted.

Rylance’s performance as Semmelweis was central and powerful and the cast provided strong support. I found two female performances poignant, Thalissa Teixeira, as his wife Maria, and Jackie Clune, as nurse Muller. The female characters provide a more balanced view of history than concentrating on male pioneers.

Muller is a senior midwife who helps Semmelweis with his introduction of hygiene methods and provides clinical data to support his thesis. His lack of empathy for her guilt in accidentally causing an outbreak of sepsis that contributed to her ultimate suicide speaks volumes of the single-mindedness and unforgiving attitude of Semmelweis.

There is a very pertinent observation by Rylance in an interview published in the Financial Times on 12 January 2022: “He wasn’t just a victim. He was also a very difficult person: someone who got very angry about people not understanding him and became his own worst enemy. Which maybe a lot of pioneers are — they’re people who cut through and are not the most polite or politically savvy people.”

The production at Bristol has now ended but given the enthusiastic reception it got there, it may be staged again.

I recommend the play not only for a medical history enthusiast but for anyone who wants to experience a thought-provoking performance by a talented cast, playwrights, dancers and musicians.

Mike Davidson is President of the British Society for the History of Medicine.