An unflattering view of English medical education in the 1840s

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

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.

 

 

Widowhood and Bereavement during and after the English Civil Wars

Recent estimates suggest that more than 3 per cent of the population of England and Wales died as a direct result of the Civil Wars of 1642–1651. Andrew Hopper describes his work on the widowhood and bereavement of the more than 180,000 women who had lost a male relative.

Deaths in Britain and Ireland during their mid-seventeenth-century Civil Wars represent a greater proportional loss of population than Britain suffered during World War One. On a free website, The Civil War Petitions Project publishes details of subsequent petitions to the state from veterans and their families for welfare payments as a result of injuries and bereavement sustained during those wars.

This image shows mounted troops at the Battle of Nasby but also a dead soldier in armour - many men died.

The Battle of Nasby was fought on 14 June 1645 during the First British Civil War. It was an important victory for the Parliamentarians. National Army Museum collection

I am currently analysing the findings of this project for a book that will illuminate the experiences of those bereaved by the civil war, with a particular focus on war widows, orphans and bereaved families, based on the petitions.

This is possible because soon after the outbreak of civil war, Parliament’s ordinance of 24 October 1642 confirmed that not just Parliament’s wounded soldiers, but also the widows and orphans of those who gave their lives for the parliamentary cause would be entitled to apply for monetary relief. A series of further ordinances followed in 1647 that prompted women to petition for state pensions in their thousands.

Securing such provision became more difficult after the Restoration in 1660 when most royalist war widows who were granted relief received one-off gratuities rather than regular pensions. The right to state pensions for all British war widows was not restored until 1901. The records of the 1640s and 1650s therefore represent a unique opportunity to investigate attitudes towards war-related welfare at a time when at least some within the governing regimes considered such women to be part of the political nation.

A first national study

This will be the first national study of seventeenth-century military welfare, drawing on the project team’s research conducted in nearly all the county record offices in England and Wales. It will measure the success of women, children and families in obtaining relief and subsisting compared with that of their fellow petitioners among wounded servicemen.

The book will begin with a social profile of civil-war widowhood and then develop into a wider cultural history of widowhood and bereavement. It will compare the variety of experiences of the war widows of the middling and poorer sorts such as Elizabeth Alkin, nicknamed ‘Parliament Joan’, with those of much higher social status such as Katherine, Lady Brooke.

I will also examine how war widows remembered the conflict, and how this may have differed from more ‘official’ or state-sanctioned memories found in proclamations, thanksgivings, sermons and anniversaries. By looking beyond 1660 and embracing the twin themes of welfare and memory, the book will show how the consequences of the Civil Wars persisted for generations after armed hostilities had come to an end.

Andrew Hopper Professor of Local and Social History at the University of Oxford Department of Continuing Education and the author of Widowhood and Bereavement during and after the English Civil Wars. He and his colleague, Departmental Lecturer Dr Ismini Pells, will present Medical Care and Military Surgery during the British Civil Wars: The Civil War Petitions Project at the BSHM Congress taking place from 13-16 September in Cardiff.

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

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.

Consulting the past to understand the future: a military surgery perspective

Evidence suggests that far from being quacks and uneducated butchers, early modern surgeons were capable and undertook effective procedures, according to Stephen Rutherford.

In January 1699, the General Quarter Sessions at Doncaster heard the petition of James Moore of Letwell, West Riding of Yorkshire. James was nearly 80 and reported that while fighting for the King in the Civil Wars, he had “received many wounds in his head, especially one by a pistoll shott w[hi]ch bullet doth sitt in his neck, w[hi]ch is very apparent to be seene w[hi]ch is both painefull & very troublesome”.

These wounds dated from the battle of Marston Moor, 55 years earlier, yet James had survived not only the battle, but also had lived a further five decades with his injuries. Another petition presented to the Trinity Quarter Sessions of Northamptonshire in 1674, referred to the battlefield injuries of William Sudbury of Woodnewton, who had received “13 wounds in his head & body very dangerous, but also the fingers of one of his hands cut [off]”. Again, the petitioner had survived extreme wounds and ill-health, to bring his petition, over 25 years later. Even more extreme examples have been recorded.

Battle of Marston Moor 2 July 1644, John Barker (1811-1886) – Cheltenham Art Gallery and; Museums, Glos.

These examples show the extent to which severe wounds could be survived and suggest that early modern surgical practices were potentially successful against even quite extreme injuries. This is my main area of interest: investigating, and assessing the biomedical validity of, early modern surgical techniques – especially those of military surgeons. Many of the approaches these surgeons used are still in use in surgical practice, with remarkably little change.

Early modern surgeons had no understanding of (among others) germ theory, immunology, homeostasis, biochemistry and pharmacology, but through trial and error, these surgeons had an appreciation of what procedures minimised infection, gangrene, shock and sepsis, and how to promote recovery. It is possible to see the origins of many modern procedures in the published practices of these professionals. (Picture: 17th century flintlock pistol, Royal Armoury collection)

Medicine in war and conflict

The tagline of this year’s BSHM Congress, ‘Consult the past to understand the future’, is therefore particularly relevant to these studies. I am particularly excited by the programme of this year’s Congress, the organisation of which I have the privilege of supporting, as it will be held at my home institution, Cardiff University.

One of the three themes of the congress, Medicine in War and Conflict, is of particular interest to me. The examples mentioned above come from petitions identified by the Civil War Petitions Project , and two lead researchers of the project, Prof. Andrew Hopper and Dr Ismini Pells, will be the keynote speakers for the first day of the congress. The Civil War Petitions project provides an exceptional example of the value of consulting the past to understand the future.

The work of the project to identify, transcribe and share petitions from wounded soldiers and war widows across the British isles, has led to a better understanding of the experience of the general population after the civil wars. The project has also led to better understanding of medical procedures, the prevalence and survivability of wound types (including psychological trauma), the structure of local and county-level poor relief, court procedures, and even patterns of allegiance and civic memory within local communities.

Also of importance to the project’s findings are parallels between centralised support for soldiers and their families, compared to the experiences of military veterans and their families, and people with disabilities, today. Many of these outcomes were unintended consequences of scrutinising the petitions and show how consulting the past can lead to unexpected, yet valuable, new insights and understandings.

Steve Rutherford is Professor of Bioscience Education at the School of Biosciences, Cardiff University.

Further reading:

Three blogs of interest

  1. The physical impact of gunshot wounds in the British Civil Wars https://www.civilwarpetitions.ac.uk/blog/manie-dangerous-woundes-and-shotts-the-physical-impact-of-gunshot-wounds-in-the-british-civil-wars/
  2. Wounds, battlefield trauma, and their survivability in the British Civil Wars https://www.civilwarpetitions.ac.uk/blog/wounds-battlefield-trauma-and-their-survivability-in-the-british-civil-wars/
  3. The personal cost of war: injuries from firearms and their treatment during the Civil Wars https://www.civilwarpetitions.ac.uk/blog/the-personal-cost-of-war-injuries-from-firearms-and-their-treatment-during-the-civil-wars/

Rutherford, S.M. (2016) Ground-breaking pioneers or dangerous amateurs? Did early-modern surgery have any basis in medical science? In: Pells, Ismini, ed. New Approaches to the Military History of the English Civil War – Proceedings of the First Helion & Co. ‘Century of the Soldier’ Conference. Solihull: Helion and Co, 2016; pp. 151-183. https://orca.cardiff.ac.uk/id/eprint/101352/