Category Archives: medical history

Robert Drane – a leader of pharmaceutical education in Wales, antiquarian and naturalist

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Having never visited Wales before, 22 year old Robert Drane moved to Cardiff on 8 February 1856, and the history of pharmacy – and pharmacy education – in Cardiff are very much tied up with him.  Briony Hudson explains.

A contemporary described Drane as “a young man with a charming manner, a striking appearance and a vocabulary and diction that are the possession of but a few of the world’s geniuses.” He had, however, departed abruptly from the respected London firm of Allen & Hanburys after breaking house rules in the respected Quaker-run establishment by staying out after 11 pm and going to the theatre.

Drane first became assistant to the apothecary Griffith Phillips on Duke Street, Cardiff, but two years later, he moved to his own pharmacy at 11 Bute Street, Cardiff. In 1867, aged 34, he opened new, purpose built premises at Crockherbtown (renamed Queen Street in 1886), close to Cardiff Castle.

At that time, those wanting to make or sell medicines usually undertook an apprenticeship with an established chemist, as Drane had done. The Pharmaceutical Society, founded in London in 1841, had established a register of members, but it was voluntary. The Society also opened its School of Pharmacy, the first in the country, at its Bloomsbury Square, London, headquarters in 1842.

There were no pharmacy schools in Wales, although the Pharmaceutical Society and its London school had a Welsh presence from the start in the person of Theophilus Redwood from Boverton, Glamorgan, as the first professor of pharmacy, a post he held until 1885.

The Pharmacy and Poisons Act

Robert Drane as an older man- a photo from the Cardiff Naturalists' Society

In 1868, Parliament passed The Pharmacy and Poisons Act that required those wanting to practise as pharmacists to register with the Pharmaceutical Society in order to be able to dispense particular scheduled drugs, such as opium and strychnine. This Pharmaceutical Society register was then only open to those that had passed its minor or qualifying examination. Pharmacists, like Drane, who had been in business before 1868, were able to join the register without jumping this educational hurdle.

Drane called on the three other pharmacists in Cardiff in an attempt to produce some formal training in chemistry, pharmacy and botany for their assistants. His cooperative scheme intended that there would be nothing to pay, and the assistants would meet two nights a week to learn chemistry and pharmacy. They would also join Drane in Sophia Gardens, Cardiff’s first public park, adjacent to Cardiff Castle, at 7am on two mornings a week to learn botany, a class that he had already instituted soon after settling in Cardiff.

According to Drane’s later account, the scheme fell through because of the “indolence of the assistants” and “the ignorance of the pharmacists.” Despite this, his efforts had laid the foundation for pharmaceutical education in South Wales.

Aspiring pharmacists in South Wales had to wait for local technical education to provide what was missing. Cardiff Borough Council had begun running science and art classes in 1866, but it seems that formal pharmaceutical education in South Wales was unavailable until the establishment of a College of Pharmacy in Cardiff in 1919, five years after Drane’s death in 1914.

In addition to pharmacy, Drane had a strong interest in ceramics and co-wrote a history of the ceramic factories of Swansea and Nantgarw. He is also considered to be the founding father of the Cardiff Naturalists’ Society, which was established in his shop at 16 Queen Street, in 1867, according to many documented sources.

In 1927, the Cardiff Naturalists’ Society unveiled a plaque in his memory on the front of Drane’s shop in Queen Street (below).

The plaque commemorating Robet Drane as a naturalist, antiquary and connoisseur.

Briony Hudson, director of Amersham Museum, is a pharmacy historian, Honorary Lecturer at the Cardiff University School of Pharmacy and Pharmaceutical Sciences, and author of the publication that marked its centenary in 2019. This article is based on her presentation on the history of pharmacy education in Cardiff to the History of Medicine Society of Wales summer meeting on 29 June 2023.

With thanks to the Cardiff Naturalists’ Society for the photographs. See the Society’s web site for more information on Drane’s many interests.

Tracing Britain’s early hospital ships

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Ships’ muster and pay book records provide valuable information about hospital ships in the Royal Navy starting in the 17th century, say Edward Wawrzynczak and Jane Wickenden.

Hospital ships carrying surgeons and medical supplies became a regular feature of Royal Naval operations in times of conflict during the second half of the 17th century. The vessels initially employed were typically old merchant ships hired for a specified period which underwent minimal alterations for their special role.

The Royal Navy deployed hospital ships for the first time during the Second Anglo-Dutch War (1665-1667) Four Days Battle, Abraham Storck, National Maritime Museum with aid from the Art Fund

Improvements were introduced early in the 18th century: the gun-deck was reserved for the sick and wounded, bulkheads were removed and canvas screens used to separate infectious cases. From this time, naval hospital ships were built in naval dockyards or purchased outright and modified for the purpose when required.

Many of the ship muster and pay book records have survived in remarkably complete form in naval archives. They provide valuable information about these hospital ships, especially where, when and how they were used, who was responsible for the care of seamen and what kind of patients were brought on board.

During the long 18th century, sea-going hospital ships were employed wherever in the world the fleet was engaged: in the English Channel, the Mediterranean, Caribbean and Baltic, North America and the East Indies. Hospital ships were also stationed at major home ports before the construction of naval hospitals and continued as additional accommodation for the sick.

The nominal surgeon’s complement of a hospital ship included mates, assistants, helpers or nurses, and laundresses/washerwomen or washermen. Their actual number depended on the vessel’s size and function and probably reflected changing naval needs, the availability of suitable staff and the surgeons’ preferences.

The use of laundresses was recorded on the sea-going hospital ship Looe in 1718. In the 1740s, women nurses were often found on hospital ships stationed in port, such as the Blenheim at Portsmouth, with six nurses allocated to every 100 men. Five nurses formed part of the surgeon’s company on the Apollo hospital ship which sailed to the East Indies in 1747.

The records of two hospital ships that served in the Caribbean in 1741-44, Princess Royal and Scarborough, reflect the high incidence of sickness which affected some ships of the line and the high mortality associated with tropical diseases, notably yellow fever, which severely reduced manpower.

Such ships took sick or wounded men from ships of the fleet, cared for them until they were fit to return to their own ships, or conveyed them to a naval hospital. They relieved shore hospitals to facilitate the convalescence of patients, and returned invalided seamen home where they could continue their recovery.

The hospital ship to the fleet also housed the squadron’s physician. At the turn of the 19th century, hospital ships such as Thomas Trotter’s Charon and Medusa carried, as well as the usual medical necessities, essential foodstuffs to minimise the risk of scurvy. They kept the surgeons of the fleet regularly supplied and helped to ensure that their charges remained fighting-fit at sea.

Thomas Trotter (1766-1832), Physician to the Fleet, engraving by Daniel Orme, public domain

Edward is currently BSHM Vice-President and President Elect. Jane Wickenden was the Historic Collections Librarian to the Royal Naval Medical Service at the Institute of Naval Medicine from 2001 to 2021.

Wawrzynczak EJ & Wickenden JVS. From ‘Sick Comforts’ to ‘Doctor’s Garden’: British Naval Hospital Ships, 1620 to 1815. British Journal for Military History. 2023; 9(1): 24-48. https://journals.gold.ac.uk/index.php/bjmh/article/view/1687/1792

‘Wilson’s balls’: TB treatment in the 1940s-1950s

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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

Dr David A Wilson                      Kind permission of Dr Robert Wilson

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.

A Nichols propelling pencil Author’s own photo

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.

 

 

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.

 

 

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.