A chance encounter with a jam jar of what appeared to be old ping pong balls in the (currently closed) Bakelite Museum in Somerset, set Christine Gowing on a fascinating journey to discover their link to pulmonary tuberculosis.
In 1945, someone died every ten minutes from pulmonary tuberculosis (TB) in the United States. Nearly 50 years previously, French surgeon Théodore Tuffier had opined that not only collapsing the lung would help but that physically maintaining the collapse with a substance was crucial to resting the lung, so that it had a chance to recover from the tuberculous infection. The procedure became known as plombage.
In the intervening period, a range of procedures and cures was attempted, but a prolonged stay in a sanatorium became the best available therapy. Plombage experiments were performed with a variety of materials, but none really worked. That is, until plastics were introduced which coincided with the particularly enterprising spirit of a young American
David A Wilson was a member of the surgery house staff at Duke University Hospital, North Carolina in the 1940s. He had, himself, suffered with TB for a year during his medical training. Maybe that experience motivated him to persevere with researching ways to sustain the collapse of a TB-affected lung, following thoracotomy, in an attempt to treat the disease.
Lucite (polymethylmethacrylate) had recently been developed and, following trials with other materials, Wilson experimented with producing spheres made of the acrylic to pack into the patient’s chest cavity. As well as its strength, biocompatibility and resistance to water, Lucite’s ability to be shaped into complex curves made it an ideal material for plombage. Supporting Wilson’s pioneering procedure, the university laboratory technicians at Duke set to work developing one-inch spheres – and trials began.
The procedure was successful and its practice quickly spread, soon hitting the headlines as an effective TB treatment. A small firm in New Jersey, Nichols Products, which produced plastic novelties, took over production of the Lucite balls in 1946. Archived records show that the balls were despatched widely throughout the United States and overseas, as Lucite plombage became increasingly adopted worldwide as a treatment for TB, until it became eclipsed by the use of modern antibiotics.
This innovative and audacious procedure was not without occasional side effects, however, such as the migration of the Lucite balls. A BMJ report in 2011 described a 76-year old woman who ‘presented with axillary squeaking on moving her left arm which she noticed during a yoga class. Her chest radiograph showed multiple rounded left upper zone lucencies.’ One of the balls had escaped.
It may have been a short-lived therapeutic success, but many patients such as this lived into their old age, free of TB, with what had become known as ‘Wilson’s balls’ in their chests.
Moreover, the significance of this procedure is not only its focus on a mid-twentieth century intervention for tuberculosis, but an illustration of the intersection of healthcare, new plastic technology and industry as a feature of post-World War Two medicine.
My research journey took me from Somerset to the United States where I met Dr Wilson’s son, visited Duke University and the site of the factory in Moorestown, NJ, where Edgar Nichols, an inventor and multiple patent-holder, mass produced the Lucite balls. The building is now derelict, but in the 1940s and 1950s the factory had produced a range of early plastic novelties, such as the one in the photo above: a propelling pencil with, curiously, a Lucite ball at one end for use as a magnifier and telephone dialling tool.
Christine Gowing has an MA and a PhD in the history of medicine. A full article with more detail of this pioneering procedure, Lucite plombage, was originally published in the journal of the Plastics Historical Society, ‘Plastiquarian’, December 2022.