Joseph Bazalgette (28/3/1819 – 15/3/1891)

Thames Water, the authority responsible forLondon’s water and sewage system, is currently building a massive new ‘Super Sewer’ known as “Tideway”. Approximately 25km in length and due for completion in 2024, this project is being undertaken to prevent the release of thousands of tons of untreated sewage into the River Thames on a daily basis. This contemporary, complex and sometimes controversial civil engineering project is a reminder of the birth of London’s sewage system, designed by Joseph Bazalgette, born two centuries ago last month.

 

Portrait of Sir Joseph Bazalgette. Credit: Wellcome Collection. CC BY.

 

161 years ago Victorian MPs were busy arguing and prevaricating over the cost and necessity (or not) of building and funding a proper purpose-built sewer system, designed by Bazalgette. They rapidly ceased all opposition to the project during the long hot summer of 1858 when low tides meant that huge quantities of untreated sewage that normally ran into the Thames were deposited on the river’s foreshores. The resulting appalling smell became known as “The Great Stink”. Believing, as most did at that time, that bad smells spread disease, MPs had to hang sheets soaked in carbolic against the windows in the Palace of Westminster to stop the suffocating stench. Before finally leaving The House ‘en masse’ the MPs quickly voted in the necessary funding for Joseph Bazalgette’s brilliantly conceived sewer system. It consisted of “intercepting sewers”, pumping stations and treatment works that are still being used today thanks to the high quality brick-lined tunnels and the use of durable Portland cement.

 

Civil engineering: construction drawings for the Thames Embankment. Coloured drawing, 1865, after Sir J. Bazalgette. Credit: Wellcome Collection. CC BY.

 

Bazalgette was a brilliant engineer, who started his career working on various railway projects. He was responsible not only for the London Sewer System but also for the Thames Embankment, and numerous major roads in London such as Shaftesbury Avenue and Northumberland Avenue. He strengthened or rebuilt 12 bridges over the Thames and freed them from tolls. He also engineered the Blackwall Tunnel and the Woolwich Ferry, and important parks such as Clissold Park, Finsbury Park and Victoria Park “the green lung of East London”.

 

However, it is Bazalgette’s sewer system for which he is probably most famous. He designed it anticipating a population increase in London from 2 million to 4 million – extremely far-sighted for the time. Given that the current population of London is approximately 8.5 million, no wonder a ‘Super Sewer’ is needed to provide for the increased strain on the system. More important than saving Londoners from a further ‘Great Stink’, Bazalgette’s work played a critical role in saving the lives of many thousands from deadly water-borne infections such as cholera. For this, he deserves to be remembered.

 

 

Further Reading

  • Stephen Halliday,The Great Stink of London: Sir Joseph Bazalgette and the Cleansing of the Victorian Metropolis(Sutton Publishing: Gloucestershire, 1999).
  • ‘Tideway – Reconnecting London with the River Thames,’ accessed 30/3/19, available at: https://www.tideway.london.
  • ‘Thames Water,’ accessed 30/3/19, available at: https://www.thameswater.co.uk/

 

 

Hermione Pool

 

The Story of the Stethoscope

One might not automatically recognise the image below as that of an early version of the medical stethoscope. It certainly looks very different today. This blog focuses on the invention of this instrument, synonymous with the medical profession, over 200 years ago.

 

Laennec-type monaural stethoscope, France, 1851-1900. Credit: Science Museum, London. CC BY.

 

Where did it all begin?

The story of the invention of the stethoscope begins with a young French physician in Paris, René Laennec. It was in 1816 that Laennec was called to see a rather fat and buxom young woman with a ‘diseased heart’. Feeling awkward, embarrassed and improper at putting his ear so close to this woman’s chest in an attempt to listen to her heart, Laennec sought to find an alternative method. He described his predicament and later actions in the medical text De l’Auscultation Médiate, published in August 1819:

I happened to recollect a simple and well-known fact in acoustics, … the great distinctness with which we hear the scratch of a pin at one end of a piece of wood on applying our ear to the other… I rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised and pleased to find that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of my ear.’

Laennec modified this method of a rolled up piece of paper to make a wooden cylinder, measuring 25cm by 2.5cm. He called this piece of equipment a ‘stethoscope’, the name derived from the ancient Greek stethos meaning ‘chest’, and skopein meaning ‘look at’. The stethoscope became an essential item in Laennec’s medical bag and he utilised it to listen to both the heart and lungs of his patients.

 

Reception

Although a few physicians resisted the introduction of the stethoscope, maintaining that it was best to listen only with one’s ear, the vast majority of the medical profession embraced its use. The invention quickly spread over Europe in the early 1820s and the design was further developed and improved upon. By the end of the nineteenth century, this wooden instrument had morphed into something more akin to the modern-day stethoscope. Flexible tubing, first made out of rubber, and then plastic, made the stethoscope both easier to use and transport; whilst binaural earpieces improved the quality of the sound for the listener. The stethoscope works by transmitting acoustic pressure waves from the chest-piece through the hollow tubes to the listener’s ears. Today, there are even more advanced electronic stethoscopes which amplify body sounds improving further the sound transmitted.

 

A 19thcentury stethoscope with a bell-shaped end. Credit: Wellcome Collection. CC BY.

 

The meaning of the stethoscope

The significance of a stethoscope in the twenty-first century cannot be under-estimated. It confers identity and, to a certain degree, status. Its wearer is automatically assured to be a member of the medical profession. It implies trust, understanding and knowledge. In this way, Laennec’s stethoscope is incredibly valuable, both from a diagnostic and symbolic perspective.

 

 

 

Further Reading

‘The story of Renee Laennec and the first stethoscope,’ Past Medical History. Available at: https://www.pastmedicalhistory.co.uk/the-story-of-rene-laennec-and-the-first-stethoscope/, accessed 9/3/19.

‘Stethoscope,’ Brought to Life – Exploring the History of Medicine. Available at: http://broughttolife.sciencemuseum.org.uk/broughttolife/techniques/stethoscope, accessed 9/3/19.

 

 

Lucy Havard

 

The Flint Water Crisis: have lessons from history been forgotten (again)?

‘That men do not learn very much from the lessons of history is the most important of all lessons that history has to teach’Aldous Huxley

The Flint Water Crisis, which started in 2014 and is still on-going, is a contemporary example of where lessons from history have been ignored.  Briefly, the authorities in Flint, Michigan, decided to replace the water supply from Lake Huron with the less expensive water from the Flint River. Unfortunately, the Flint River was heavily polluted and this led to Legionnaire’s disease and lead poisoning among residents using the water supplied by lead pipes. Of particular concern is the expert opinion that almost 9,000 Flint children are at risk of developmental difficulties and long-term conditions due to lead poisoning. The authorities have been heavily criticised for not testing the safety of the Flint river water in advance and for the delays in both accepting that there was a problem, and in implementing the changes necessary to supply safe water. The crisis has sparked intense political and media debate and several prosecutions are pending.

 

Image 1: Gums and tongue from a case of lead poisoning. Credit: St Bartholomew’s Hospital Archives & Museum, Wellcome Collection.

In the nineteenth century, several reports of lead poisoning secondary to lead pipes in Britain and the USA appeared in the medical literature and the popular press. The problem in Britain was widespread but particularly evident in Yorkshire, Lancashire and Scotland. In Sheffield, the problem was first reported in 1885 by the Medical Officer of Health and was traced to the water from one reservoir that corroded lead supply pipes and lead-lined cisterns, hence contaminating the domestic water supply. The resistant Sheffield Water Company only agreed to add lime to the water after a public inquiry in 1890. Of even greater concern is the shocking 120 year delay in accepting that lead poisoning in Glasgow was due to a combination of the water supply from Loch Katrine and lead supply pipes.

Could the Flint water crisis happen again? Yes, sadly it could, and the words of Huxley resonate strongly here. But, if we listen to the lessons of history, and learn from them, such needless harm can be prevented.

 

Further Reading

  • Anna Clark, ‘Nothing to worry about. The water is fine,’ The Guardian.17thJuly 2018, accessed 24/1/19. Available at: https://www.theguardian.com/news/2018/jul/03/nothing-to-worry-about-the-water-is-fine-how-flint-michigan-poisoned-its-people.
  • Mona Hanna-Attisha et al, ‘Elevated Blood Lead Levels in Children Associated with the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response,’ Am J Public Health.Feb 2016.106(2): 283-90.

 

Mike Collins

 

 

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

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.

 

Further reading:

  • Glynn, J. (2008). ‘The Pioneering Garretts – Breaking barriers for women’, Hambledon Continuum, London.
  • Garrett Anderson, L. (2016). ‘Elizabeth Garrett Anderson 1836-1917’, Cambridge University Press.

 

Lucy Havard

Louisa Aldrich-Blake’s Casebook

On 25thApril, 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 4thMay 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 22nd, 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 25th.

 

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.

 

Further reading

Foucault, Michel. The Birth of the Clinic. Translated from the French by A. M.Sheridan. London: Routledge, 2003.

Jewson, Nicholas. ‘The disappearance of the sick-man from medical cosmology, 1770-1870’, Sociology, 10, no. 2 (1976), 225-244.

Pickstone, John. ‘Ways of Knowing: Towards a Historical Sociology of Science,Technology and Medicine,’ The British Journal for the History of Science, 26, no. 4, (December 1993), 433-458.

 

Lucy Havard