The Worshipful Society of Apothecaries

This blog is all about the Worshipful Society of Apothecaries and their recent 3-day history of medicine course which ran from 1st-3rdMay. This fascinating course comprised a series of interesting lectures, spanning the history of medicine over two thousand years in Europe and beyond.

 

Image 1: Worshipful Society of Apothecaries Coat of Arms

 

The Worshipful Society of Apothecaries is quite simply an historical gem nestled in central London, a stone’s throw from St Paul’s Cathedral. Like many of the other London livery companies, the Society of Apothecaries looks rather unassuming from the street. But, walk into the courtyard, and then through the main entrance up a beautiful seventeenth-century staircase into the court room or parlour, and prepare to be met by gorgeous wood paneling, impressive life-size portraits of various Society benefactors and lots of rhinos – the Society’s emblem for over 400 years! The origins of the Grocers and Apothecaries of London can be traced back to 1180. In 1617, the Apothecaries separated from the Grocers to form the Worshipful Society of Apothecaries of London.

 

Image 2: The Court Room

The delegates that were attending the course were of varying backgrounds – medical students, practising doctors, pharmacists, historians, nurses, museum curators and those with a general interest in the history of medicine. Such an eclectic group of people made for probing questions and stimulating discussion at the end of each lecture.

The talks during the course covered a broad range of themes and topics – there really was something for everyone! Day one featured art and surgery, the history of the coroner, the founding of voluntary hospitals and disease and medicine in ancient Egypt. Day two brought talks focused on medicine in Scotland and Japan as well as women in medicine and a broad overview of Britain and world medicine. On the final day, we were treated to the history of pharmacy, the history of X-rays and a talk on the archaeological findings from Salisbury Plain as well as a general overview of the history of clinical medicine. All in all, a satisfying and fulfilling course that provided a comprehensive overview of the history of medicine.

Anyone interested in attending the History of Medicine course or applying for the Diploma in the History of Medicine (DHMSA) at the Worshipful Society of Apothecaries should consult the following website for the most up-to-date information:

 

https://www.apothecaries.org/diploma-in-the-history-of-medicine/

 

Image 3: Dürer’s Rhinoceros – emblem of the Worshipful Society of Apothecaries

 

Lucy Havard.

Now Walks Like Others

How were poor crippled children treated in England during the late 19th and early 20th centuries before the advent of free healthcare through the NHS and the Welfare State?

A group of  Northampton children – all very keen on medical history – believe that if medical history is to be truly relevant it must live. So one day, while happening to sit in an outpatient clinic they decided to answer the above question using the extensive historical archive held at Northampton General Hospital. They give their answers with a short film (20 mins, link at end of post).

 

        

Image 1: CC BY Credit: Science Museum, London

The Northampton Crippled Children’s Fund (NCCF, 1893-1925) provided medical care for ‘poor crippled children in straightened circumstances under 17 years of age’ initially in Northampton and eventually county-wide. It also gave long term dietary supplementation and summer seaside holidays. It had wide community support. In its final year before the opening of the Manfield Orthopaedic Hospital it treated 3000 children. Crippled Children’s Funds were widespread in the UK before the establishment of the National Health Service (NHS) but there are few surviving records and research has been limited in this area.

My day job is as a consultant community paediatrician. This film is a way of introducing medical history to my patients, keeping my day job interesting and giving something back to the community where I work.

The children involved in the film are my patients, their siblings and members of Theze Guyz Theatre Company, Northampton. Together, working with healthcare professionals and historians they relate, recreate and assess the work of the Northampton Crippled Children’s Fund within its historical context. The film includes full medical and dietetic reconstructions, and some cartoons. You can view it using the following link:

https://www.youtube.com/watch?v=vvU8suIPTiU

The film credits acknowledge the funders who made this film happen.

The film was written and directed by Professor Andrew N Williams PhD FRHistS consultant community paediatrician and curator of Archive, Northampton General Hospital.

 

Andrew Williams

A Breath of Life in the Archives

Laboratory (? at Sudbury), Credit: Wellcome Collection

 

A young man, an assistant in the laboratory, poses for the camera. The surroundings and his attire flag a bygone era. What stories might he tell us of that time?

The photograph is undated, and the location not precisely specified [1]. The time and place can, however, be established with some certainty. The lab is part of the Serum Department of the Lister Institute of Preventive Medicine at Elstree, Hertfordshire. The year is 1903, or as near as matters, when this new establishment was unveiled to the press [2]. Another version of this image, artistically faded at the corners, appeared in a promotional pamphlet soon after [3].

In the archives of the Lister Institute, tucked away under ‘historical items’, sits a remarkable memoir [4]. Albert Riggs was 17 years old, and had been out of work for 4 weeks, when a neighbour working as a builder on the Elstree site suggested he apply for a vacancy. Riggs passed the interview and started as a lab assistant on 3 September 1903 on a weekly wage of 12 shillings. He was appointed Head Assistant at the beginning of World War I and remained an employee of the Institute for 48 years. He put down his memories in a 100-page annotated typescript illustrated with hand-drawn diagrams. Riggs’ first impressions of the Elstree Laboratories were drawn upon by the best-known history of the Lister Institute:

 

At six o’clock on a lovely August morning in 1903, I first saw the Lister Institute, or as it was then known locally “Queensberry Lodge”, and now whenever it comes to my mind, I see it as I saw it then, the lovely tree lined drive, the green fields, the trim hedges, the old house with its rustic porch in front, the stables with their eighteen horses and whistling stablemen, and the calm peace which reigned over everything. [5]

 

In considerable detail, Riggs describes the labs, animal houses and stables. He covers the routines involved in making a variety of serum products and the role of lab assistants immediately prior to 1914, and he offers a first-hand insight to the work of the Institute during the war when it supplied tetanus antitoxin and other antisera to the Army [6]. Most engagingly, Albert touches on aspects of his life, candidly recalls many of his colleagues, and describes – warts and all – some of the ‘characters’ under whom he worked.

With its authentic voice – a rare counterweight to the large volume of ‘official’ documents typical of institutional archives – this lab assistant’s memoir breathes life into history.

 

 

References

[1] Image of laboratory at Sudbury (?), Lister Institute, Wellcome Library Archives, SA/LIS/R.163.

[2] British Medical Journal1 [2217], 1513-15 (1903); The Lancet, 2 [4167], 120-1 (1903).

[3] A Laboratory at Queensberry Lodge, The Lister Institute of Preventive Medicine – with notes on serum therapeutics by members of the staff of the Institute, 1904, SA/LIS/P.13, facing p. 10.

[4] Albert Riggs’ Memoirs of the Lister Institute of Preventive Medicine, Elstree, Hertfordshire, c. 1951, SA/LIS/M.6.

[5] Chick, H, Hume, M. & Macfarlane, M. (1971) War on Disease: A History of the Lister Institute, London: Andre Deutsch, p. 80.

[6] Wawrzynczak, E.J. (2018) Making serum, saving soldiers: the Lister Institute during World War I, VesaliusJournal of the International Society for the History of Medicine,Vol. XXIV, No. 2, 40-48.

 

 

Edward Wawrzynczak

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

 

50 Years of Fibre-optic Colonoscopy

2019 marks 50 years since the advent of fibre-optic colonoscopy. This blog discusses the development of this widely used technique and associated technology, and its impact on modern medicine.

Colonoscopy is a technique that allows direct visualisation of part of the large intestine (the colon). A flexible tube (endoscope) with a light source is inserted into the anus and images from the inside of the colon are projected onto a monitor. As well as being used for diagnostic purposes, colonoscopy can also be therapeutic, for example allowing for the removal of pre-cancerous growths.

The technique of modern colonoscopy is largely thanks to the work of several doctors in the 1960s and 1970s. The fibre-optic colonoscope was developed by Dr Niwa and Dr Yamagata at Tokyo University. Two physicians based in America, Dr William Wolff and Dr Hiromi Shinya, then pioneered its use, performing the first modern colonoscopies in June 1969. They described ‘over 1000 successful and totally uncomplicated endoscopic examinations’. The colonoscope, unlike the flexible sigmoidoscope, allowed for visualisation of the complete colon. Wolff and Shinya later developed and started using an electrosurgical polypectomy ‘snare’ to remove polyps. They published a seminal paper in 1973 demonstrating the utility, safety and cost-effectiveness of colonoscopy. The practice of colonoscopy increased during the 1970s and 80s, facilitated by the associated public exposure when President Ronald Regan underwent several colonoscopies to remove polyps in the mid-1980s. The New York Times quoted the advice given by Ronald Reagan’s surgeon who stated that the president should ‘undergo an examination of his intestines, a colonoscopy, within six months and every year after that, as well as periodic blood tests to check for possible colon malignancy’.

So how has colonoscopy changed over the past few decades? Well, to be truthful, not much! The technique is very much the same. However, the instruments used today are more flexible, making them easier to manipulate. This allows for better visualisation of the colon and reduces the amount of time needed to perform a colonoscopy.

Colonoscopy is essential in the diagnosis of bowel cancer which is the fourth most common cause of cancer in the UK. It is used for both the surveillance of patients with previous bowel cancer or significant risk factors, and in screening for bowel cancer. Colonoscopy can also be therapeutic. It can facilitate the removal of lesions and the cessation of bleeding in the bowel, through electrocoagulation, injection therapy and the use of special clips secured over bleeding blood vessels.

 

Endoscopic examination of a patient’s gut by Dr A.I. Morris, Royal Liverpool University Hospital. Drawing by Julia Midgley, 1998. Wellcome Images.

 

Improvements in optical imaging have already increased the quality of the images seen on the monitor as a colonoscopy is being performed. Higher definition images mean more subtle lesions and even small polyps can be visualised. Less invasive imaging modalities, such as virtual colonoscopy (computed tomography colonography) and capsule endoscopy, have been developed as potential options for those who are unable to undergo a complete colonoscopy.

Many believe that colonoscopy will grow to play a bigger therapeutic role in the future. Watch this space…

 

 

Further Reading

William Wolff and Hiromi Shinya, ‘Polypectomy via the Fiberoptic Colonoscope,’ New England Journal of Medicine, 288, No.7, February 15 1973, pp. 329-331.

Bernard Weinraub, ‘Reagan’s Doctors Find Cancer In Tumor But Report Removal Leaves His Chances Excellent,’ The New York Times, July 16, 1985. Available at: https://www.nytimes.com/1985/07/16/us/reagan-s-doctors-find-cancer-tumor-but-report-removal-leaves-hischances.html

 

Lucy Havard