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

Posted on 27th July 202327th July 2023 by Lee Coppack | Leave a comment

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.

Tracing Britain’s early hospital ships

Posted on 20th May 202320th May 2023 by Lee Coppack | Leave a comment

Ships’ muster and pay book records provide valuable information about hospital ships in the Royal Navy starting in the 17^th 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 17^th 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 18^th 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 18^th 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 19^th 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

Posted on 23rd February 202323rd February 2023 by Lee Coppack | 1 Comment

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.

German doctors in British exile

Posted on 6th January 20236th January 2023 by Lee Coppack | 1 Comment

Susanne Krejsa MacManus describes how the German Society for Gastroenterology, Digestive and Metabolic Diseases is recovering the stories of its members expelled under the Nazis. She explains how one of them, Ernest Maurice Fraenkel, found exile in Britain.

The German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) was founded in 1913 by the famous Professor Ismar Boas. In 1933, it had a membership of 430 professors, lecturers, scientists, physicians, surgeons, pharmacologists and researchers, many of them eminent in their field. Approximately one-quarter of them were classified as Jews or non-Aryans under the Nazi regime, including Professor Boas.

The official boycott had started a few weeks after Adolf Hitler became Reichskanzler of Germany in 1933, and in March 1938 in Austria after the so-called Anschluss. Every institution/organisation/association, including the DGVS, had to exclude and disenfranchise their Jewish members. The lives of approximately 8500 medical doctors in Germany and 3500 medical doctors in Austria were at risk. They lost their jobs. They were persecuted, forced to flee Germany or deported to concentration camps.

At least 20 DGVS members came to Britain. Dr. Ernest Maurice Fraenkel (1886-1948) was the first to arrive. A professor of medicine at the University of Berlin, he was on the staff of the University Clinic, the Charité Hospital and the Rudolf Virchow Hospital there. In 1933, he escaped to London via Paris and got a job as a research worker at Westminster Hospital, where he continued his work on the Rous sarcoma virus and the filterability of the tubercle bacillus.

In 1936, he took the Licentiate in Medicine and Surgery of the Society of Apothecaries (LMSSA) in London, and shortly afterwards began working at the London Country Council (LCC) laboratories on the significance of moulds in certain cases of asthma. Naturalised in 1940, he practiced in Buxton in Derbyshire during the war.

On his return to London in 1945, Fraenkel was made consulting allergist to the LCC and published papers on allergy, bronchial asthma and related subjects. After his death in 1948, British Medical Journal described him as “a physician with a philosophic outlook, and some of his ideas were held to be in advance of his time”.

We remember

In 2013, while preparing for its 100 year anniversary, the DGVS found the members’ list from 1932/1933. They saw crossed out in red pencil were the names of their former Jewish members.

“We Remember”, now available in English, is the DGVS initiative to commemorate them. Their aim is to get their former members back, restore their reputations, honour their contributions to the discipline and remind themselves of the roles their former colleagues had for the scientific society. So far, about 90 biographies, including that of Professor Boas, are available online. Another 25 are in the process of research and production.

Why is this interesting for members of the BSHM? A lot of facts and knowledge have been lost: connections, details of their lives, often even the place and date of their birth, are not known. So, one of the main goals of DGVS archivist Harro Jenss MD, is to find colleagues, family members and others to learn more about these doctors’ lives in Britain. “We would also be grateful to receive hints and corrections or even new sources which help us to fill gaps,” he says.

Here are the names of members of the DGVS who made it to Britain: Abraham Adler (1891 – 1948), Alfred John Alexander (1880 – 1950), Erwin Cohnreich (1889 – 1943), Heinrich Davidsohn /Henry J. Davidson (1884 – 1963), Georg Eisner (1885 – 1947), Ernest Maurice Fraenkel /Ernst Moritz Fränkel (1886 – 1948), Robert Goldschmidt (1878 – 1970), Simon Isaac (1881 – 1942), Walter Kaufmann (1877 – 1949), Otto Kestner (1873 – 1953), Johann Lewinski (1878 – 1940), Greta Noah (1902 – 1984), Leo Pollak (1878 – 1946), Erwin Pulay (1889 – 1950), Ernst Rachwalsky (1889 – 1962), Berthold Stein (1874 – 1947), Ludwig Weil (1874 – 1961), Erich Kurt Wolffenstein (1899 – 1976), Walter Zweig (1872 – 1953).

Today, the DGVS unites more than 6500 doctors.

Susanne Krejsa MacManus is an independent journalist, author and archivist in Vienna. She is a member of the History of Medicine and Medical/Health Humanities working group of the Commission for History and Philosophy of the Sciences at the Austrian Academy of Sciences (ÖAW).

blogeditor@bshm.org.uk

Long life in Georgian asylums

Posted on 29th November 202229th November 2022 by Lee Coppack | Leave a comment

John Rendall was 104 when he was buried at Box, Wiltshire, on 21 January 1821. This great age is even more striking because he had been confined to an asylum for more than 60 years. Peter Carpenter asks if there were other exceptionally long lived residents of early asylums.

There are few surviving records of patients in Georgian asylums for mentally ill patients. There are registers for Bethlem and St Luke’s available online, but provincial “madhouses” of the time were relatively rare, and little documentation survives. The main early entries regarding patients are in other records, such as parish churchwardens’ accounts and relate to admitted paupers.

“Box Mad House” shown in Andrews & Drury’s map of 1773 (courtesy Wilts History Centre).

Kingsdown House Lunatic Asylum at Box, Wiltshire, six miles to the east of Bath, has claim to be the longest running private asylum in the country.[i] It was operating by 1687[ii] and was closed in 1946 by its proprietor Gerald McBryan, in between his own psychiatric admissions and attempts to rule Sarawak and Brunei.[iii]

As part of my study of Kingsdown House, I explored a surviving folder of correspondence between its proprietor and the churchwardens of Trowbridge[iv] a substantial market town about 9 miles from Box. This together with the Trowbridge accounts[v] and newspaper records throw light on the case of John Rundell/ Rundle/Randal.[vi]

In November 1758, the churchwardens’ accounts note payment for: “Horsehire & Turnpikes Dr Jefferys at Kingsdown relating to John Rundall junr of Studley 1/9d”.[vii] James Jeffery, a surgeon, is the first well documented operator of the asylum.

And the next month:

“Expence of sending John Rundle weaver to ye Madhouse under the Care of Dr Jefferys at Kingsdown. Viz: 26^th Dec [1758]: Two guards all night and part of ye next day with expenses 6/10d

27^th: 2 guards and hire of two Horses to Kingsdown 8/6d [viii]

Jeffery then charges 7/- a week reducing to 5/- over 6 months. He does not charge for the period 18 -22 August 1760. The reason is revealed in the account entry: “Expence on account of John Rundle discharged from ye madhouse upon trial, but attempting to drown himself sent again under a guard.” 9/1d

In 1763 Jefferys writes: “altho’ Rendall is not so bad as in time past yet he still persists in surprising odd Whyms & Fancys which undoubtedly might end in some bad consequence was he not under proper care.”

In 1775 the churchwardens negotiated a much reduced fee as John, who though still disordered in his senses, was able to work around the asylum. His delusions probably lasted most of his life, as he would have otherwise returned to the cheaper Trowbridge poorhouse. Overseers of the poor were not famed for their financial benevolence.

Rendall’s death clearly made the newspapers take notice: [Died] 7 Feb at Dr Langworthy’s Asylum, Kingsdown house, Box, … John Randall, aged 104 years, upwards of 69 of which he had been a patient at that institution, enjoying good health, and working regularly in the garden until a few weeks prior to his death. He was an early riser, and was confined to his bed but a few days, in possession of his retentive powers to the last.[ix]

If the age is correct, then John Rundle was born about 1717 and admitted at the age of 40.

The only other long lived asylum inmate I know of is an 1806 reference to: “The poor inoffensive idiot whom the passenger may have seen for nearly half a century past sitting at the door of the Magdalen Hospital in Holloway [Bath], died last week, aged 92. He has been for some years the only patient supported in that institution”[x]

In fact, the hospital’s later evidence in a charity inquiry states he was aged 95 and had been 75 years in the house but gives no other information.[xi] Are these the only long lived inmates known before the 1830s? I welcome evidence of others.

Two of John Rundell’s letters . A letter with a similar list of clothing refers to Mr James Jefferies suggesting it is from the early period of his illness.

Peter Carpenter is a retired psychiatrist in intellectual disability who has researched the history of mental health institutions in Bristol.

References

[i] See http://www.boxpeopleandplaces.co.uk/inside-box-mad-house.html for a short description. See also Leonard Smith: Private madhouses in England, 1640-1815. Palgrave MacMillan. 2020

[ii] Minute Book of the Men’s Meeting of the Society of Friends in Bristol 1667-1686. Bristol Record Society vol XXVI.

[iii] See for example accounts of him in Philip Eade: Sylvia, Queen of the Headhunters. London, Weidenfeld & Nicolson. 2007

[iv] Wiltshire & Swindon History Centre, Ref.No. 206/93

[v] Wiltshire & Swindon History Centre Ref No: 206/ 60-73

[vi] Rundle’s letters are briefly described in William Ll. Parry-Jones The Trade in Lunacy. London: Routledge & Kegan Paul,1972 p168-9

[vii] Wiltshire & Swindon History Centre 206/64 Trowbridge churchwarden accounts 5 Nov – 3 Dec 1758.

[viii] Wiltshire & Swindon History Centre 206/64 accounts 3-31 Dec 1758

[ix] Taunton Courier and Western Advertiser 21 Feb 1821: deaths.

[x] Bath Journal Monday 28 July 1806 page 3e.

[xi] Sixth report of the Commissioners of Inquiry concerning certain Charities in England and Wales (British Parliamentary Paper 1822 (12) IX 1) page 737.