Category Archives: medical history

“The forgotten man of Africa”

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Standing on the deck of the exploring vessel Pleiad in July 1854, Edinburgh trained doctor William Balfour Baikie was about to lead an expedition into the interior of Africa to test the validity of a cure for malaria, writes Wendell McConnaha.

B&W photo of bearded man, formally dress, 19th century

William Faulkner Baikie at the time of his first voyage, Orkney Library

Baikie had been seconded to the mission sponsored by the merchant Macgregor Laird and the Royal Geographical Society, which would leave from Fernando Po, an island in Equatorial Guinea, now called Bioko. Baikie was initially to serve as naturalist and assistant surgeon, but a series of events had elevated him to the expedition’s leader.

For years, men had attempted to explore the path of this great river and, although they encountered natural barriers and local hostility, it was malaria that threatened to cut short the life of any European who ventured inland, and the Bight of Benin was referred to as the Whiteman’s Grave. As the anonymous rhyme said: “Beware and take care of the Bight of Benin. There’s one comes out for forty goes in.”

Although the death rate among Europeans traveling into the interior in this part of Africa often exceeded 70 percent, the focus up to the time of Baikie’s voyage was curing the disease rather than looking for a prevention, and even the preferred method for treating those contracting the disease remained in doubt.

Sailed 19th century exploring vessel
The exploring vessel Pleaid, Frank Cass & Co.

As early as 1630, Jesuit Brothers working in Peru had observed the Quechua Indians using bark from the cinchona tree in treating malaria. The bark was collected, dried, ground into a fine powder and mixed with water to form a strong tea. The treatment had quickly been adopted by the crews of slave ships traveling between Europe, Africa and South America. Royal Naval surgeons soon began utilizing the treatment for sailors who had contracted malarial fever. In 1817, two French chemists isolated the crystals within the bark naming their extract quinine. However, bloodletting and purgatives remained the standard methods of treating malaria within the general medical establishment.

Not just treating

In 1847 Dr Alexander Bryson, an Assistant Surgeon in the West Africa Squadron, presented the Admiralty with a report in which he announced the use of quinine had cut the mortality rate in half, and proposed quinine might also be used as a prophylactic. Baikie was convinced that Bryson was correct in his assumption.  Although the purpose of his mission was to explore the Niger and Benue rivers and establish trading sites, Baikie would also use his command position to conduct the first clinical trial testing Bryson’s theory.

Each crew member would be given two-thirds of a glass of wine containing five grains of quinine each morning and a second glass before retiring in the evening. Baikie was staking his reputation and the lives of those under his command on this untested theory. If he were correct, the centre of Africa would be opened to outside exploration.  If wrong, he could lose his life and the lives of all those entrusted to him.

On 7 November the Pleiad returned to Fernando Po. They had been on the river for 118 days, explored and charted over 600 miles, and established a series of trading sites. Most importantly, for the first time in the history of African exploration, they had completed the mission without the loss of a single life.

Baikie travelled to England, published the journal of his exploring voyage and then returned to the Niger, where he spent his last five years living alone among the Igbo. His enlightened approach in working with the indigenous people earned him such respect that to this day the Igbo word for “white man” is “Beke.” Baikie died at age 39 of tropical fever. Revered in Africa, his role in establishing a prevention for malaria is largely forgotten by the rest of the world.

Memorial to William Balfour Baikie
Memorial tomb to William Balfour Baikie (1825-1864),
St Magnus Cathedral, Kirkwall, Orkney Library and Archives

Professor Wendell McConnaha is a retired university professor in education who has worked around the world. When in Nigeria, he first learned of William Baikie and resolved to write his story, which he has now done in The King of Lokoja: William Balfour Baikie the Forgotten Man of Africa. 

References and further reading

Christopher Lloyd, The Search for the Niger, (London, Collins, 1973), pp. 21-22

C. M. Posser and G. W. Bruyn, An illustrated history of malaria, (New York, NY:

Alexander Bryson, Report on the Climate and Principal Diseases of the African Station, Printed by order of the Lords Commissioners of the Admiralty, (London, W. Clowes and Sons, 1847)

An unflattering view of English medical education in the 1840s

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In about 1841, Belgian doctor Constantin Pierre Crommelinck toured various psychiatric institutions in England, France, and Germany. His report reviewed not just various English asylums and also the training of English doctors. Peter Carpenter recounts his none too flattering findings.  

Constantin Pierre Crommelinck (1814-1884) was the son of a Belgium surgeon who trained as a doctor and became a teacher of anatomy at the École de Médecine in Bruges. He initially had some success as a surgeon, but then turned to psychology and psychiatry. There is no official biography for Crommelinck, but his entry in Dutch in Wikipedia indicates he was not an easy colleague.

In about 1841, he toured various psychiatric institutions in Belgium, France, England and Germany and also investigated the training of English doctors. The following year, he reported his findings to the Belgian Minister of the Interior Jean-Baptiste Nothomb: Rapport sur les hospices d’aliénés de l’Angleterre, de la France, et de l’Allemagne. (A report on asylums of England, France and Germany, 1842).

In this report, he made recommendation for the design and therapeutic organisation of future Belgian asylums. His descriptions of various asylums in England are little known in the UK, other than that of Gloucester Asylum, which appears in several biographies of Samuel Hitch, the founder of the first British psychiatric association in 1841.

Hunterian anatomy school, London, 1839 by R. B. Schnebbelie, Wellcome Collection

Hunterian anatomy school, London, 1839 by R. B. Schnebbelie, Wellcome Collection

English medical education mocked

In the same report, Crommelinck took the opportunity to make very pointed remarks on the English medical profession and medical education. While commenting on the richness of England’s material resources, he mocked the surgeons’ habit of having an apprenticeship and then attending a selection of classes in London. He wrote:

“At the end of three years’ training with a physician or surgeon, where the pupil has learned (and how else?) physiology before anatomy, therapeutics before pathology, and practice before anything else, he goes back to school, … spends two years there, and qualifies as a physician or surgeon-apothecary. These two years pass like the other three, with the only difference that all the branches are no longer taught by one and the same individual, but by five or six, all teaching pell-mell, without troubling themselves about each other or prescribing to their disciple any order to follow. …Thus the pupil begins, and attends pell-mell, lessons in physiology, anatomy, therapeutics, pathology, medical and surgical clinics, childbirth, etc.

Having attended lessons from each teacher, Crommelinck then went on to describe the anatomy lesson as the most absurd, ridiculous and contrary to common sense. “I will cite among others the one that Mr. Macmurdson gave at St. Thomas Hospital. It was the tenth since the opening of his course; it related to the mucous membranes: all the students, with two or three exceptions, were true beginners. Fifty jars containing different pathological or monstrous alterations of the mucous membranes were placed on the table.

“Mr. Macmurdson took a notebook from his pocket and, using his finger to mark his place, began to read very fast a long, profound and learned dissertation on the past, present and future, healthy and sick, natural and monstrous state of the mucous membranes in man as in other animals. The most scabrous questions of theory and practice were discussed in this reading; he talked about typhus, inflammation, cancer, tumours haemorrhage, bleeding, leeches, calluses, strictures, astringents, styptics, molluscs, pachyderms, mammals, Peyer’s glands, Brunner’s glands – do I know what a jumble of absurdities did not come out of his mouth, while seriously begging his students to pay scrupulous attention to the elementary principles that were going to develop before them?”

[Pages 69-71, Peter Carpenter’s translation]

Rather than pretending to listen and understand, wrote Crommelinck, the students had fun cutting figures in the benches, whispering among themselves and kicking each other. They “ended the farce by applauding excessively when the hour of freedom arrived.”

The lecturer compared with Molière’s comedic doctor from the play Le malade imaginaire, was probably Gilbert MacMurdo, a surgeon at St Thomas’s in the 1846 Medical Directory. It is surprising that Crommelinck named an individual, but the early signs of irascibility seem to have ripened into vitriol later in his career.

Peter Carpenter is a retired psychiatrist who researches the history of UK mental health institutions.

Further reading:

Rapport sur les hospices d’aliénés de l’Angleterre, de la France, et de l’Allemagne is available at the Wellcome Library and the library of the Royal College of Psychiatrists. Digital copies can be found by internet search.

https://nl.wikipedia.org/wiki/Constantin_Crommelinck

Bringing X-rays to the front

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Edwin Aird describes how Marie Curie created radiological cars to take X-rays to the battlefront in Word War I.

In 1914 at the beginning of the First World War, Paris was under threat of invasion from Germany. The situation was sufficiently alarming that the French Government moved to Bordeaux. And Marie Curie moved the precious 1 gm of radium that she had isolated to deposit in a bank in Bordeaux in a very heavy lead pot.

Once the radium was safe, Curie returned to Paris, where one of her daughters took her to visit a hospital to see the war wounded. Curie quickly realised the potential value of having X-rays near the battle front for surgeons to use. As her daughter Eve Curie wrote: “A luxury, the magic arrangement whereby a rifle bullet or fragment of shell could at once be discovered and localized in the wound.”

 She already understood the properties of X-rays, but taught herself their application, production and development, fluoroscopy (not so called at the time), and the components of X-ray systems, generators, transformers etc. To get the X-ray machines to the front, however, meant mobile units or radiological cars. And they did not yet exist. So she created them.

Les Petites Curies

Founding director of the Red Cross Radiology Service, Curie built her first radiological car from a large Renault. She persuaded wealthy acquaintances and the Union of Women of France to help her build a fleet of 20 radiological cars. They became known as Petites Curies. Her daughter Irene, (who later received a military medal and won a Novel prize herself with her husband, F. Joliot) assisted in the field.

The image shows Marie Curie's level of involvement with the mobile X-ray machines.

Marie Curie at the wheel of one the Petites Curies, the mobile X-ray machines she created

The conditions under which Curie worked must have been horrendous, but she played down the overall impact of the noise/smells/dangers. Eve Curie said: “She was never to speak of the hardships and dangers to which she exposed herself during those four years… She showed her working companions a careless and even gay face…The war was to teach her that good humour is the finest mask of courage”.

 According to Marie Curie herself, during these years it had been possible to X-ray approximately 900,000 injured people. She wrote: “Towards the end of 1918 there were more than 500 fixed and semi-fixed radiological stations in service in the hospitals of the territory and in the armies with a further 300 mobile devices on cars, on sterilisation trucks and motor surgical ambulances. Approximately 400 radiologists served these devices, aided and partly replaced by auxiliary personnel, including manipulators trained at the Institute Curie.”

Marie Curie died in July 1934 from pernicious anaemia, which she attributed to the high X-ray exposures she received during the war.

She remains one of the few people to receive two Nobel Prizes and the only woman to do so. The French Academy of Sciences rejected her membership in January 1911 – only months before her second Nobel Prize. It never elected her. Otherwise, her brilliance, drive and public service were widely acknowledged. In total, she received 8 major prizes, 16 medals, 104 titles and authored 483 papers.

Marie Curie and her daughter Irene

References and further reading

  • Curie, Maria, “La Radiologie et la Guerre” (in French) : Marie Curie. Librairie Felix Alcan 1921
  • Curie, Eve, “Marie Curie”: (1938, Windmill Press Surrey)
  • Van Tiggelen, Rene (Brussels), “La Grande Guerre 1914-1918”
  • Simthsonian Magazine Oct 2017
  • Jogensen, TJ BJR Papers: “Marie Curie and Pierre Curie and the discovery of radium” by Eve Curie BJR July 1950;” Marie Sklodowska Curie 1867-1934” by Claud Regaud BJR, Sept 1934
  • Thomas, Adrien, “The first 50 years of military radiology 1895-1945” European J Radiology 2007; 63: 214-219
  • https://www.pbs.org/newshour/science/the-day-marie-curie-got-snubbed-by-the-french-science-world

Edwin Aird is retired Director of Medical Physics at Mount Vernon Hospital, Northwood with more than 40 years in NHS as  researcher, teacher and examiner.

 

 

How a pregnancy test saved the lives of a family in Nazi times

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Susanne Krejsa MacManus explains how pregnancy testing saved the life of a refugee woman biochemist and her family in the run-up to World War II.

In the 1930s, the Institute of Animal Genetics at Edinburgh University was the only UK laboratory that ran pregnancy tests. Although the Aschheim-Zondek method invented in Berlin in the late 1920s had been seen as a great step forward, the result took more than 100 hours. It also required testing on female mice. No wonder that the scientific community was excited by a new method that took four hours.

Austrian biochemist Regina Kapeller-Adler had developed a method for detecting the amino acid histidine in the urine of pregnant women in 1933. As the Vienna Daily reported on 30 May 1933 under the heading “Eine neue Schwangerschafts-Reaktion” (a new pregnancy test): “The great advantage of this new chemical pregnancy test lies in the fact that it can be carried out in four hours, whereas the tool that has been most ideal for early diagnostics up until now […] requires a hundred hours until it can be read.”

The second advantage was that it employed a chemical instead of a biological reaction, and no mice had to be killed.

After Hitler occupied Austria (Anschluss) in March 1938, Regina, her medical doctor husband Ernst Adler and their young daughter Liselotte were in severe danger because they were Jewish. The Nazis persecuted Ernst Adler, and he escaped deportation to the Dachau concentration camp only at the very last moment. Regina lost her post at the Institute of Medical Chemistry at the University of Vienna; before that, she had also not been able to get her postdoctoral qualification – as a woman and a Jew.

When Francis Crew, Professor of Genetics at Edinburgh University, learned about the danger Regina and her family were in, he offered her a job in his laboratory, with support of The Society for the Protection of Science and Learning (formed in 1933 in help refugee scientists and other academics).

There was still a problem to be solved: Britain only permitted entry for foreigners if there was a mandatory “guarantor” to vouch for them. Fortunately, Napoleon and Henrietta Ryder deposited the considerable amount of £50 for the Adler family whom they did not know personally, and little is known about this couple. Regina together with husband and daughter could leave Austria, even taking their furniture and his medical equipment with them.

In Britain

In January 1939, they reached London and journeyed on to Edinburgh. Within two months of their arrival in Scotland, she was demonstrating her pregnancy test at the Eleventh British Congress of Obstetrics and Gynaecology. After the German invasion of Norway in 1940, most female foreign citizens were ordered to leave the east coast of Britain. Regina unusually received permission to remain in Edinburgh to continue her research since it was categorised as being of national importance. Ernst was interned on the Isle of Man from May to September 1940. After his release and re-qualification, he started a medical practice in Edinburgh in 1942.

In July 1941, Regina received her Doctor of Science degree from Edinburgh University. From the end of the war, she spent fruitful years in the Pharmacology Department of the university, and in 1952 she got her first university position as lecturer in the Department of Clinical Chemistry. From that time, she meticulously trained and encouraged a series of Ph.D. students, to whom she acted as mentor.

Regina gained recognition, grants and awards. She was internationally acclaimed as a major authority on histamine, which is made in the body and derived from histidine, and gallantly titled “The Histamine Queen” by her exclusively male colleagues in the field, an allusion to her forename. In June 1973, she was presented with the University of Vienna’s Golden Honorary Diploma. She died in Edinburgh on 31 July 1991 at the age of 91.

Kapeller-Adler’s method was an important step towards the modern pregnancy test, but it was not yet the final breakthrough. Not fully reliable on its own, it was used as an additional test or pre-test when standard tests did not give a clear yes-or-no answer.  Today, pregnancy tests detect the hormone human chorionic gonadotropin (hCG), which starts to be produced around 6 days after fertilisation. The results are available in a few minutes.

Acknowledgement and references

Information from this blog came direct from Liselotte Adler-Kastner, daughter of Regina Kappler-Adler and Ernst Adler. In addition, it refers to two articles that she wrote about her parents in “Visa to Freedom 1939 thanks to a Pregnancy Test”, Edinburgh Star 62, March 2009, 9-11, and “From personae non gratae in Vienna 1938 to respected citizens of Edinburgh: a vignette of my parents Dr Ernst Adler and Dr Regina Kapeller-Adler”, Wiener Klinische Wochenschrift (1998) 110/4-5: 174-180 (Viennese Clinical Weekly)

Further reading:

Interview with Liselotte Adler-Kastner at Refugee Voices.

Museum of Contraception and Abortion (MUVS)

Susanne Krejsa MacManus is an independent journalist, author and archivist in Vienna. She does research for the Museum of Contraception and Abortion (MUVS). Thanks go to Liselotte Adler-Kastner, Regina’s daughter.

 

 

Poor law but better care

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Graham Kyle explains that a surprising benefit of the harsh Poor Law Amendment Act 1834 was that paupers in the workhouse received free medical care. Perhaps even more unexpectedly, the care had to come from qualified medical practitioners.

Near where I live near Llanfyllin in North Wales, there is a fairly well preserved workhouse that was established under the Poor Law Amendment Act 1834.  A group of volunteers who worked hard to save it from dereliction also assisted the National Archives transposing the correspondence between the local Board of Governors in Llanfyllin and the Poor Law Commissioners in London.

These records are now online and give a wonderful insight into human interactions between ‘the poor’ and those charged with looking after them, as well as the relationships between the central and local governing bodies.

Before 1834, the poor were the responsibility of each parish. The 1834 Act encouraged parishes to amalgamate so that they could afford to build workhouses where people would be sent to undertake menial and boring tasks, such as oakum picking, stone breaking or bone crushing, in return for food and shelter.

This aerial view of  Llanfyllin Workhouse or Y Dolydd, as it became, shows the four separate yards for men, women, boys and girls, each overlooked by the central master’s house, so that any misbehaviour could be quickly checked.

Medical care from medical men

It was policy to make these workhouses uninviting to encourage people to be self-sufficient and avoid them. The food was plain and monotonous, and the accommodation was intentionally made “less amenable than a labourer’s cottage.” Another harsh part of the regime was that families were split up.

A benefit that paupers did gain from the 1834 Act was free medical care, which previously would have been well beyond their means. The local Board(s) of Guardians, being keen to keep costs down, initially appointed men of doubtful skill or training – “lads who had worked in a druggists’ shop for a short while” to provide the health care. However, the Poor Law Commission quickly insisted that only qualified “medical men” could act as medical officers, and in 1842 further stipulated that Poor Law medical officers should have qualifications in both medicine and surgery.

Why they insisted on the dual qualification in medicine and surgery is not clear, although their report stated the reason was that “skill in one branch does not guarantee skill in the other.”  This preceded a similar requirement for admission to the Medical Register by decades. Thus, the pauper had the potential for a higher standard of medical care than the general public, albeit effective therapies were few at the start.

Effectiveness of treatments generally changed especially with the introduction of vaccination for smallpox. When the Government made this mandatory in 1853, they used the Poor Law Medical System as the basis for the roll out of the programme…to use a modern idiom.

An end to the Poor Law

The Poor Law continued until 1930 when the Poor Law Board became the Local Government Board, which took over responsibility for welfare. The Llanfyllin Workhouse had become formally known as the Llanfyllin Public Assistance Institution, although a decade earlier the name had been changed to “Y Dolydd”, Welsh for “The Meadows” in an effort to soften its image. It became essentially an old people’s home, with the former workhouse infirmary providing beds for local general practitioners until the late 20th century.

 

When the Local Government Board took over responsibility for welfare, workhouses were often adapted for use in other care settings.

Other workhouses became part of hospitals, such as Kensington Workhouse (above), which was eventually incorporated into St Mary Abbot’s Hospital.   Lezan, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons

 

Further reading

https://www.workhouses.org.uk/

https://www.llanfyllinworkhouse.org.uk/history/

Hodgkinson, R. G., Poor Law Medical Officers of England: 1834-1871. Journal of the History of Medicine and Allied Sciences, 11 (3) 1956 pp. 299-338

 

Graham Kyle is the President of the History of Medicine Society of Wales and a retired ophthalmic surgeon.