A Case of Leprosy in the Archives

‘Opening Up the Body’ is a project to conserve the Post Mortem Examinations and Case Books of St George’s Hospital, 1841-1946. Our Archive team have been cataloguing and digitising records dating from 1841-1917 – that’s about 27,132 cases across 76 volumes. The comprehensive reports contained within these volumes reveal some fascinating stories, which we’ll be sharing with you via the Library blog. Today’s post comes from Natasha Shillingford, Project Archivist.

The post mortem record of Amy Bradshaw, Archives & Special Collections, St George’s, University of London, PM/1884/9

Amy Bradshaw, a seven-year-old girl, was admitted to St George’s Hospital on 24^th July 1883 and she later died on 10th January 1884. She was suffering from Leprosy.

The medical case notes record that ‘Her mother was a native of Oxfordshire, her father of Barbados, where his family had lived for three generations since leaving Scotland.’ Amy was one of six children, one of whom died in infancy of dysentery, and two had Leprosy. The sister next above her in age was four and a half years older, and she developed symptoms of Leprosy in 1875. Amy was said to have first developed symptoms herself in 1879, when her mother noticed raised spots ‘like blind boils’ on her back and thighs, which after a time turned brown and were succeeded by a fresh crop.

On admission she was described as ‘a dark intelligent child of characteristically leprous aspect. Over the face and hand the flattened tubercles, in parts red, in parts brown, are abundantly scattered: the nose enlarged, flattened at the tip, red and pigmented; the lower lip the same.’ On her arms, legs and feet were depressed cicatrices and scattered dark brown pigment.

On examination the larynx and epiglottis were found to be thickened and unnaturally white and a lumpy deposit was found. ‘The timbre of the voice is somewhat nasal and the vowel sounds slightly continental.’

Amy was treated with Chaulmoogra Oil in the form of an emulsion which was seen as a success and the child was happy as a rule, although she occasionally complained of soreness and aching in the leprous tubercles. On 17^th December her temperature rose rapidly ‘when an acute invasion of the new growth set in with much pain and suppuration.’ The medical case notes report that Amy’s elder sister who was suffering from the same symptoms, was allowed to leave the hospital on 23^rd December to spend Christmas at home. However, she developed pneumonia shortly after and died on 6^th January. Amy also gradually developed pneumonia in the hospital and ‘sank with great pain, and high fever, dying in Jan 10 1884.’ The post mortem report states ‘Face disfigured by leprosy cicatrices.’

Leprosy affects the nerves, respiratory tract, skin and eyes. It can cause loss of fingers and toes, gangrene, ulcerations, skin lesions and weakening of the skeleton. If left untreated, it can lead to a loss of sensation in the hands and feet. This lack of ability to feel pain can lead to the loss of extremities from repeated injuries or infection due to unnoticed wounds. Leprosy can also damage the nerves in the face which causes problems with blinking and eventual blindness. Other symptoms, which can be seen in the case of Amy Bradshaw, include flattening of the nose due to destruction of nasal cartilage, and phonation and resonation of sound during speech.

Credit: Elephantiasis graecorum, True Leprosy. Chromolithograph.
Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

The disease takes its name from the Greek word λέπρᾱ (léprā), from λεπῐ́ς (lepís; “scale”). Leprosy has a long and complicated history and for centuries has been associated with social stigma, which even in the modern day continues to be a barrier to self-reporting and early treatment.

The earliest possible account of a disease which is believed to be Leprosy appears in an Egyptian papyrus document written around 1500 BC. Indian texts from 600 BC also describe a disease that resembles Leprosy. The first account of the disease in Europe occurs in the records of Ancient Greece after the army of Alexander the Great came back from India, and then in Rome in 62BC which coincided with the return of troops from Asia Minor.

Leprosy had entered England by the 4^th century AD and was a common feature of life by 1050, although throughout its history it has been feared and misunderstood. It was often believed to be a hereditary disease, or some believed that it was a punishment or curse from God. Pope Gregory the Great (540-604) considered people with Leprosy to be heretics.

Others thought that the suffering of lepers echoed the suffering of Christ and they were enduring purgatory on earth and would go straight to heaven when they died. Therefore, they were considered closer to God than other people.

Leprosy patients were often stigmatised and shunned by the rest of society. During the middle ages people suffering from Leprosy were made to wear special clothing, ring bells to warn others of their presence, and walk on a different side of the road.

Credit: Manuscript showing leper. Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

A passage from Leviticus 13: 44-46 shows the biblical perception that people with leprosy were unclean and should be ostracised from society:

the man is diseased and is unclean. The priest shall pronounce him unclean because of the sore on his head.

Anyone with such a defiling disease must wear torn clothes, let their hair be unkempt, cover the lower part of their face and cry out, ‘Unclean! Unclean!’ As long as they have the disease they remain unclean. They must live alone; they must live outside the camp.

Credit: Two lepers receiving food through a wall. Etching by Gaitt after A. Decamps. Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

Even in more modern times, patients with Leprosy were often confined to colonies called Leprosariums because of the stigma of the disease. Some of these colonies were situated in remote lands or islands, such as the island of Spinalonga off the coast of Crete which was used as a leper colony from 1903 to 1957. The novel ‘The Island’ by Victoria Hislop tells the story of the leper colony on Spinalonga and its inhabitants.

In 1873 Dr Gerhard Henrik Armauer from Norway identified the germ that causes Leprosy. The discovery of Mycobacterium Leprae proved that leprosy was not a hereditary disease, or a punishment by God, but an infection caused by bacteria.

Patients with Leprosy were often treated, as can be seen in the case of Amy Bradshaw, with oil from the chaulmoogra nut. The treatment was said to be painful and its success was questionable, although some patients appeared to benefit. Leprosy is now curable with multidrug therapy (MDT) which was developed in the early 1980s

The last case of indigenous leprosy in the UK was diagnosed in 1798. Leprosy can no longer be contracted in this country, but there are around 12 new cases diagnosed each year. The World Health Organisation (WHO) (https://www.who.int/news-room/fact-sheets/detail/leprosy) figures state that in 2018 there were 208,619 new cases of leprosy diagnosed. This is approximately one every two minutes.

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Hysteria in the archives

‘Opening Up the Body’ is a project to conserve the Post Mortem Examinations and Case Books of St George’s Hospital, 1841-1946. Our Archive team have been cataloguing and digitising records dating from 1841-1917 – that’s about 27,132 cases across 76 volumes. The comprehensive reports contained within these volumes reveal some fascinating stories, which we’ll be sharing with you via the Library blog. Today’s post comes from Juulia Ahvensalmi, Project Archivist.

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Elizabeth Greed was 51 years old in 1888 when she was admitted to St George’s Hospital. Her medical case history, which survives in her post mortem record in the archives, tells us that she was married and had had five children; one of them had died. Another one was said to have tuberculosis, and one was said to be a ‘cripple’. When she was young she was said to have suffered from hysteria and scarlet fever.

Elizabeth herself said that about five years before, whilst walking in her garden, she had suddenly lost power in her legs. Although she recovered from this incident, she had been knocked down in the street the previous summer, and had struggled walking ever since. She also complained of various other ‘abnormal sensations’, including tingling in her limbs and a constricted feeling in her chest. She felt like she was floating in water when sat down, and when she walked, she could not feel the ground. She was also annoyed by a constant smell of sulphur.

She went to ask for treatment at Guy’s Hospital, but, feeling ill-treated there, took a cab to come to St George’s Hospital instead, then located at Hyde Park Corner. She was received by a young doctor called Richard Sisley, who in his notes describes her as ‘olive-skinned’ and her manner as ‘hysterical’. He says she only appeared to be able to walk supported, describing her movements resembling those of a marionette. He thought many of her symptoms pointed to hysteria, although the loss of power and the involuntary movements of her legs were suggestive of ataxic paraplegia – a condition that can be hereditary, or caused by damage to brain or the spinal cord, and is characterised by loss of motor function in the lower extremities.

The post mortem record of Elizabeth Greed, Archives & Special Collections, St George’s, University of London, PM/1888/132

Elizabeth was admitted as an in-patient to the hospital on 7 March 1888. Further examinations found no abnormalities in her heart or lungs, but she was becoming increasingly paranoid and delirious. She thought she was being poisoned by turpentine mixed in her food. She was worried she would be sent out of the hospital, but she also thought that the ward she was in was filled with paraffin and would be set on fire. She lost weight, becoming increasingly weak, until she was unable to stand. On 11 April 1888, ‘she died without first symptoms, quietly’. The cause of death was recorded as possible mania and dementia, and ataxic paraplegia.

The case notes in the post mortem record of Elizabeth Greed do not elaborate more on her alleged hysteria, but her case gives us a glimpse of how women’s health was approached: despite her symptoms pointing to a physical condition, her behaviour is labelled as hysteric. Life in the 1880s London was not easy, and this was particularly the case for the poorer part of the population. We can assume that Elizabeth was poor, as those able to pay would not have attended a charitable hospital such as St George’s – they would have had the doctors come to them, or visited them at their private practices instead. The census records reveal that Elizabeth was from Clapton, and her husband Robert had moved to London from Taunton in Somerset. They lived in Bermondsey, which in the 19^th century was a buzzing industrial hub, specialising in tanning, leather working, cotton work and food processing. All this industry meant that the population in Bermondsey was largely poor: the factories offered employment, but it was not particularly secure or well paid. Elizabeth is described as a ‘needlewoman’ (other related occupational terms include ‘dressmaker’ and ‘seamstress’). This was often work that could be done from home: sewing and mending clothes, making it easier for the women to care for their families. It was also, however, work that was very much underpaid, and the working conditions were likely to have been dire, with insufficient light and long hours, whether the work was done at home or in a factory.

But why was she labelled hysteric? Hysteria is no longer part of the medical vocabulary, but in the 19^th century it was a common way to describe and diagnose what was perceived as emotional excess, primarily of women (this usage of course still continues outside medical diagnoses). It was seen to affect women from all social classes. The term encompassed a variety of symptoms, including anxiety, nervousness, agitation and demonstrations of sexual desire. Sexuality was at the heart of the condition; the word hysteria comes to English via Latin hystericus, from Greek ὑστερικός (husterikós, “suffering in the uterus, hysterical”), from ὑστέρα (hustéra, “womb”). Hysterical symptoms were thought to originate in the womb, and a commonly cited method of treatment was said to involve using a vibrator in order to gain release in the form of orgasm – this, however, is a myth rather than a commonly employed treatment.

Brodie, Benjamin. 1837. Lectures Illustrative of Certain Local Nervous Affections. St George’s, University of London Archives. Credit: Juulia Ahvensalmi

St George’s also plays a part in the history of hysteria. Benjamin Brodie, one of the most eminent doctors of his time and physician to the royal family, examined cases of ‘nervous affections’ in 1837. In these cases, patients had suffered from articular pain and swelling, but there had been no deterioration of bone or cartilage in the post mortem examination. In Brodie’s view these cases were neurological disorders, perhaps following a minor injury or a strong emotional experience, which could lead to a ‘hysterical knee’, for instance.

Another St George’s doctor writing about hysteria was Robert Brudenell Carter, who worked as an ophthalmologist at St George’s in 1870-1883. In his 1853 book ‘On the Pathology and Treatment of Hysteria’, he (unlike most of his contemporaries) emphasized the effect of emotions on the nervous system, arguing that a strong emotion might lead to a hysteric attack even in otherwise healthy women, as well as men. The prevalence of hysteria among women could, in his view, be explained by women’s heightened emotions, but also due to their having to suppress their emotions more than men, who were allowed to be physically and sexually more active.

The association of hysteria with the nervous system rather than the uterus, and with psychological, rather than physical, causes became more widely accepted during the 19^th century. Jean-Martin Charcot was instrumental in re-defining hysteria in terms of neurological disorders, and his use of photography at the Salpêtrière asylum in Paris created controversial imagery of female hysteria.

Jean-Martin Charcot demonstrating hysteria in a patient at the Salpetriere. Lithograph after P.A.A. Brouillet, 1887. Credit: Wellcome Collection. CC BY

The American neurologist Silas Weir Mitchell advocated the so-called ‘rest-cure’ to calm the overstimulation of mind, which he believed was the cause of hysteria. This treatment was made infamous by Charlotte Perkins Gilman in her short story ‘The Yellow Wallpaper’ in 1891:

“John is a physician, and perhaps—(I would not say it to a living soul, of course, but this is dead paper and a great relief to my mind)—perhaps that is one reason I do not get well faster.

You see, he does not believe I am sick!

And what can one do?

If a physician of high standing, and one’s own husband, assures friends and relatives that there is really nothing the matter with one but temporary nervous depression—a slight hysterical tendency—what is one to do?

My brother is also a physician, and also of high standing, and he says the same thing.

So I take phosphates or phosphites—whichever it is, and tonics, and journeys, and air, and exercise, and am absolutely forbidden to “work” until I am well again.”

John W. Ogle, a physician at St George’s, discusses the case of Sarah G., 20, who was admitted to St George’s Hospital in 1869. She stated that she had been coughing and vomiting for about a year, and she had never menstruated until three weeks before her admission to the hospital. She had been treated previously at other hospitals for pain in the abdomen and vomiting. Ogle describes her as ‘rather delicate and interesting-looking’, and her manner as ‘somewhat sly and hysterical’.

Caption: John William Ogle (1824-1905), physician at St George’s Hospital. Credit: US National Library of Medicine

She was fed beef-tea and milk with limewater: beef broth was standard hospital fare, and the limewater was intended to relieve indigestion. Her constipation was treated with a ‘blue pill’ and the herbal remedies colocynth, senna draught and calumba; she was also given spirit of ammonia and bicarbonate of potassium. The so-called blue pill was (rather than Viagra!) a mercury-based medicine commonly used for this purpose, but also for treating a wide variety of other complaints, including syphilis, toothache and tuberculosis. Later various other medical concoctions were attempted, including calomel (mercury chloride), edemas made of castor oil and rue, belladonna (‘beautiful woman’ in Italian, from its cosmetic use for dilating pupils, the plant is also known as the deadly nightshade, and was used by the Roman empress Livia Drusilla to poison her husband emperor Augustus), brandy, prussic acid and morphine – it’s a wonder she was still alive at this stage, one might think!

Although her condition did not appear to be improving, she was seen to get up from her bed to watch Queen Victoria pass by the hospital on her way to open Blackfriars Bridge. This convinced Ogle that she must have been faking her illness. Despite her continued refusal to eat, she vomited and evacuated her bowels. Ogle quotes in his article a letter allegedly written by her to another patient, asking her to bring her a ‘nice peice [sic] of bread’ and to take care that she should not be seen to do so. She was further treated with faradisation (muscle stimulation by electric currents), and she was given daily baths until she got her period; she was also forced to do some exercise by walking her to the middle of the ward and then ‘leaving her to scramble back to her bed’. She appears to have got into disagreements both with the ward nurse and with Ogle, her doctor, until one day she suddenly walked out of the hospital.

Ogle diagnoses this case as ‘temper-disease’, suggesting that the original symptoms relating to her lungs may have been real enough to begin with, but that the attention received from exhibiting these symptoms had led the patient to feign further, imaginary, symptoms. He describes his patient as ‘by nature self-willed, with a ‘naughty’ disposition, badly trained, too well pleased to attract and receive attention, of an hysterical temperament’. Quoting Benjamin Brodie, he suggests that it is possible that even the cough was a hysterical symptom – a hysterical lung, if you will.

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Libraries Week 2019: Celebrating Archives

Libraries Week takes place between 7th – 12th October 2019. This year’s campaign is focused on celebrating the role of libraries in the digital world. Over the course of the week we’ll be introducing you to different teams within the Library and explore how they use technology to support our community.

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Today’s post comes from our Archives team, who have been involved in a large-scale digitisation project – so this year’s Libraries Week theme offered a perfect opportunity to provide an update! Click here for previous posts from our Archives.

Opening Up the Body: Digitising, cataloguing and visualising post mortem case books

Opening Up the Body is a project to conserve the Post Mortem Examinations and Case Books of St George’s Hospital, 1841-1946, and to catalogue and digitise those dating from 1841-1917 – that’s about 27,132 cases across 76 volumes. The catalogue data and digitised images will be made available on the St George’s, University of London website.

Post mortem of Caroline Parker, 42, from 1865.

The volumes contain manuscript case notes and detailed reports of the patients’ medical history, including details of treatments and medicines administered to patients. They also contain comprehensive reports of the pathological findings made during the detailed examination of the body after death. These rich and detailed post mortem records are a unique resource, which will contribute to our understanding of medical education, death practices, and the history of London’s hospitals and infectious diseases, amongst other things. Moreover, the volumes feature notable physicians and surgeons, including Henry Gray, who compiled his influential ‘Gray’s Anatomy’ whilst performing post mortems at St George’s.

Meet the team

Two Project Archivists have now started to catalogue the post mortem volumes and the project team consists of the University Archivist, Carly Manson, and two Project Archivists, Juulia Ahvensalmi and Natasha Shillingford.

How do we use technology to support our users?

AtoM (Access to Memory)

AtoM (Access to Memory) is a web-based, open source, standards-based application for archival description and access. AtoM was originally built with support from the International Council on Archives to encourage broader adoption of international standards for archival description across institutions. AtoM is a dynamic open source application with a broad user base who work together to continually improve and enhance the software to the benefit of the whole community.

Our catalogue is made available via the St George’s Archives & Special Collections website: https://archives.sgul.ac.uk/. AtoM allows users to type keywords into the search box located at the top of the banner, or they can explore the collections by browsing via collection, people and organisations, archival institutions, functions, subjects, places or digital objects. The catalogue homepage also displays the most popular items that have been searched for that week, which provides a glimpse into the interests of our researchers.

Each individual post mortem is being catalogued according to international standards and a summary of each will be produced, providing searchable keyword access. The information being captured in the catalogue includes the name of the patient, occupation, gender, date of admission, date of death, the physicians and surgeons who attended the case, a transcription of the diseases affecting the patient, and notes from the medical and post mortem examinations.

Example post mortem catalogue record

The catalogue data from the Opening Up the Body project will be imported from spreadsheets into AtoM.  The digitised images will be linked to the individual catalogue entry, allowing researchers to access the collection remotely and therefore increase access to the collection and also preserve the physical volumes.

Subject access points are being identified using the Medical Subject Headings (MeSH) database (https://meshb.nlm.nih.gov/search), which will allow researchers to search and identify cases by disease and anatomy group. For example, at the click of a button a researcher will be able to identify post mortems that were related to diseases of the respiratory system, or patients that were admitted to the hospital following an injury.

Name access points are also being created for every surgeon and physician of St George’s Hospital who treated the patients or undertook the post mortem examinations, and will be linked to their authority record in the catalogue. The authority record will list information such as dates of existence and a biographical history of the key figures in the history of St George’s.

Visualising the post-mortems

Word cloud of commonly found words in a post-mortem volume from 1887 using Wordclouds.com (https://www.wordclouds.com/)

As we catalogue the material, we are collecting a large amount of data. In order to be able to get the most out of this incredibly rich source, we’ve modified our cataloguing templates to structure the data so that we can both export it into AtoM in the required and easily readable format, and to make it easier to properly explore that data and gain new insights into the material.

This also requires standardising the data, especially when it comes to the names of diseases. These can change over time: tuberculosis, for instance, may be called tuberculosis or phthisis, and we want to make sure we can track these conditions, regardless of what they’re called (this of course is not always that simple, but that may be a subject for another blog post!).

Packed circles showing groups of diseases in 1864, using Flourish (https://app.flourish.studio/templates)

There are plenty of free, open-source tools available, many developed specifically for digital humanities. Visualisation tools are great for immediate visual effect, for telling stories and for drawing attention to details that might otherwise be missed, or might be worth more in-depth exploration – why does the word ‘India’ appear so frequently in the word cloud above, for instance? Why did so many people die of cardiovascular and respiratory diseases? Visualisations are nothing new, of course – John Snow (who at one time worked at St George’s) managed to figure out the cause of the 1854 cholera outbreak by mapping the cases.

Line graph showing instances of death from cholera during the 1854 cholera epidemic in London, using Flourish

Sankey diagram illustrating distribution of diseases by gender in 1864, using Flourish

As we continue cataloguing and collecting more data, we can begin to explore changes over time and ask more questions – did people live longer? How do their occupations change? How do medical advances affect the kind of diseases featured in the post mortems? How do the post mortems themselves change? Presenting the material like this not only allows our readers insights into the contents of the post mortem records, but it also gives us a chance to reflect on the details of our work, and on the ways in which we are dealing with the data as we go along. More importantly, though, we can use these visualisations to bring the material to life – so to say!

We are only just starting, so look out for more exciting visualisations as we delve deeper into the post mortems! And feel free to get in touch with us at archives@sgul.ac.uk – we’ll be happy to answer any questions you may have about the project and accessing the material.

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International Women’s Day 2019

 

Happy International Women’s Day!

There’s plenty of superb female writing talent in the Library, from our own St George’s academics, to classic and contemporary fiction writers. As we were celebrating reading for pleasure during World Book Day yesterday, we thought we’d mark #IWD2019 by pulling together a selection of female-authored fiction titles available in the Library.

You can find these and the rest of our fiction on the shelves at PN3353, but if you’d like to browse them online, click the image below. Each item is linked to its Hunter record, so you can check to see whether a copy is available to borrow. If it’s on loan, remember you can place a hold by signing in to Hunter:

 

International Women’s Day is all about celebrating women’s achievements, so there’s no better day to mark the accomplishments of our first four female medical students. Admitted in 1915 due to a shortage of men during the First World War, two of them are pictured below. Helen Ingleby (L) & Hetty Ethelberta Claremont (R) went on to have successful careers in the medical profession.

You can read more about ‘The First Women of St George’s’ in this interactive timeline. Click the image below for more details, or read our profile of pioneering female medics during the First World War.

The NHS in England at 70

To celebrate 70 years of the NHS, St George’s Library takes a look over its history

As the NHS marks its 70th year, a look over its history can help to draw into focus the achievements of its time so far, along with the changes that have taken place both within the service itself and in the society which it serves. Created on the basis that good quality healthcare should be available to all, the NHS rested upon three core principles: that it meet the needs of everyone; that it be free at the point of delivery; and that it be based on clinical need, not the ability to pay. These principles retain their importance 70 years on.

At its inauguration in 1948 the NHS was a three part system, with hospitals, general practice and local health authorities being run separately, though by the 1960s this model was increasingly seen to be ineffective. Numerous reports during the 1960s set out recommendations for the future development and structure of the service, but it was 1974 before the NHS was reorganised into regional authorities covering all three parts of the system. In the intervening period, authority for NHS services has continued to change, from 1991 when the first NHS Trusts were established, to 2002 with the introduction of Primary Care Trusts, and the current situation which gives authority and responsibility to Clinical Commisioning Groups (CCGs) and NHS Foundation Trusts, amongst others.

Amidst the 70 year history of the NHS, sit a number of innovations in treatment. The first kidney transplant was carried out in 1960, the first IVF baby was born in 1978, and the first successful gene therapy took place in 2002. In addition, changes to the approach to treatment have taken place, such as the Mental Health Act 1983, which introduced the issue of consent to treatment; under the prior Act of 1959, there was no requirement for patient consent.

Underpinning developments in healthcare services and practice all the while, has been the accessibility and use of relevant information and knowledge. As outlined by a blog post on The King’s Fund website, that organisation (when named King Edward’s Hospital Fund for London) provided an information service for hospitals and other organisations interested in hospital work even before the advent of the NHS. In November 1948 the service was formalised as the Division of Hospital Facilities, which included an Information Bureau and a Reference Library.

Today, Health Education England continues that commitment to enable NHS staff to access the information that can help shape good quality healthcare, and the library at St George’s is one of 215 NHS library services that supports NHS staff access and use of information resources for study, research and clinical practice. St George’s Library existed before the advent of the NHS as it supported St George’s Hospital and Medical School going back to the 1700s. Fortunately, developments in the provision of library services have also taken place over the years, meaning that current members no longer have to observe the following regulation:

11. A Member wishing to read a Book in the Reading Room must write the title of the Book, and his name on a piece of paper, and hand it to the Librarian, who alone is to take books from the shelves and replace them.

(Historic Regulations for the Library and Reading Room of St George’s Medical School)

The NHS70 website provides more on the history and the future of the National Health Service, as well as up to date news on celebrations of this milestone. The NHS England website also provides a decade by decade timeline of the service outlining more of the significant medical developments and innovations to have taken place in the NHS, alongside the key pieces of legislation and structural changes affecting the delivery of services by NHS staff throughout the past 70 years.

Stories from St George’s: The Gunpowder Mill Worker

This guest post is written by Dr Carol Shiels,
Museum Curator and Senior Lecturer at St George’s, University of London.

The anniversary of the failed Gunpowder plot is celebrated each year with fireworks and bonfires. If the plot had succeeded, the 36 barrels of gunpowder would have resulted in an explosion that would have destroyed Westminster. In this blog article we get an insight into the world of gunpowder production from an account of a patient at St George’s Hospital in 1850.

In London, a major site of gunpowder production was the Hounslow Powder mills, near Twickenham, in what is now Crane Park. In 1850 a large explosion occurred and a 21-year-old labourer was injured . He was only 5 metres away from the blast site and as a result of the explosion a beam fell on him and flames enveloped him as the loose gunpowder on his face and clothes caught fire. He was able to throw himself into one of the nearby rivers and was taken to St George’s Hospital at Hyde Park Corner. He was admitted to the hospital with his face black, his skin scorched and blistered and his hair and beard burnt away in places.  His major injury was a broken elbow joint; the pointed end of his elbow (part of the ulna) had broken off and the ulna was also fractured into three splinters.

Broken bones in the 19^th century were often a life-threatening injury. Caesar Hawkins, a senior surgeon at St George’s, decided to amputate the arm just above the elbow joint. A few years previously this would have been a severe and painful operation, but the recent use of chloroform as an anaesthetic during surgery meant he had a pain free operation. It went well with little blood loss and the patient had an uneventful but restless night. He was given opium to help with the pain and over the next few days his arm healed well with no swelling. Unrelated to the accident, the patient had a bad cough, producing dark coloured foamy sputum. When questioned by Caesar Hawkins, he described this as commonplace in the men working in the charcoal house at the mill. This is most likely to be due to the inhalation of carbon dust from charcoal production and, as the patient confirmed, led to the early death of many workers at the mill.

The elbow joint from the patient. It has been fixed in formaldehyde and displayed in a glass jar. This has been maintained in the Museum for 167 years.

Caesar Hawkins retained the patient’s elbow joint and added it to the collection of pathological specimens in St George’s Museum. He had discovered a piece of loose cartilage in the joint during the operation and described this as looking like a ‘bicuspid tooth from which the fangs had been removed’. Loose pieces of cartilage can be painful and can make movement of the affected joint difficult. Caesar Hawkins wrote an account of the case and it was published in a 1850 volume of the Lancet. Both the patient’s elbow joint and this early edition of the Lancet are still part of the St George’s Museums and Archives collections.

Such accidents were not uncommon and 55 explosions were reported at the same powder mill over its working life; some described as being like an earthquake.  It is likely that many workers ended up at St George’s as a result of these accidents and their stories will be uncovered with further exploration and research into our Museums and Archives collection.

 

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St George’s Library in 2016

As 2016 draws to an end, we bring to you the highlights for St George’s Library.

Supporting RAG Week

This year, the Library supported St George’s Students’ Union’s Raising and Giving Week by donating fines for a day and raised £137.45. The supported charities were Equip Africa, MACS and St George’s Hospital Charity.

App Swap

We’ve been continuing with our App Swap events. where staff and students get to talk about the apps that they have used, or have been involved with. Response has been great from student and staff who have attended, include Learning Advocate Ele Clancey. We aim to run more next year.

Supporting 10 Days of Wellbeing

June was the month for peace and relaxation in the Library, not least because it saw the St George’s Staff Development team launch its first “10 Days of Wellbeing” programme. We supported the new initiative by putting out a book swap trolley in the library foyer, where students and staff were encouraged to pick up or drop off books to share with others. We also added a selection of Mood-Boosting Books to the library collection.  To date, the most popular title of the Library’s 2016 Mood-Boosting collection is The President’s Hat by Antoine Laurain.

Library Refresh

Regular library users might have noticed a few changes to the look of the library, especially the main Quiet Study Group area; this year we replaced all our chairs, brought in round tables, and then brought back rectangular tables due to student demand. We also added screens to create a more flexible study space and help reduce noise. We’re always looking for ways that we can make the space work better for all our users and are open to feedback – let us know if you have any thoughts by speaking to staff or filling in a feedback form at the Library helpdesk.

Extended Opening Hours

In response to student feedback and after running some successful trials, this July we were pleased to announce that during the 2016/17 academic year we would once again be offering extended opening hours.

We’re now open longer than ever before; offering 24 hour access to the Library from 8am on Monday mornings to 9pm Saturday evenings and 9am-9pm on Sundays.

Library Treasure Hunt

The start of the new academic year is always very busy for library staff and this September/October was no different as we welcomed all our new undergraduate and postgraduate students – we hope you are all now well settled in to life at St George’s! Alongside our busy programme of induction sessions, we ran a Treasure Hunt featuring a number of clues and activities to help new students find their way around the Library and its resources.

Fresher’s Fayre Winners

Thank you to everyone who took part in our Social Media competition by liking our Facebook page and following us on Twitter. Our lucky prize draw winners went away with Honest Burger vouchers, Blossom tote bags and a St George’s teddy among other prizes. We also gave away a £20 Amazon voucher in our Treasure Hunt prize draw. Best of all, everyone who took part in the Social Media Competition can now get useful Library updates straight to their Twitter and Facebook feeds!

New Book Display

In September we introduced a book display to showcase various resources that we think you will find helpful.  Previous displays included our best books on study skills, and online resources recommended by the Learning Advocates.  Come and take a look to see what delights we have in store for the New Year!  You’ll find the display near the Library Helpdesk.

Children in Need

On 18th November we raised £100 for BBC Children in Need’s annual fundraiser by raising money through our staff sweepstake and donating fines. Pudsey was spotted all over the library waving hello.

Explore Archives

In November we also participated in and celebrated Explore Your Archive week, a campaign organised by the UK National Archives and the Archives and Records Association. We ran two handling sessions where selected objects were taken from the archives and displayed.  The history of each object was shared by the archivist Elisabeth. It was enlightening to find out more about our history and wonderful to share in the positive reactions and interest from staff and students at St George’s who attended.  The sessions were supported by a series of daily hashtags showcasing photos from our archives. We loved taking part in Explore Your Archives and learnt more about the fascinating history of St George’s’.

Christmas at St George’s

We end our blog with an original photograph from the archives showing St George’s Hospital at Hyde Park Corner at Christmas time in the mid-20th century.

In 2017 we are looking forward to working with all our users and the Students Union to continue to improve the study environment for everyone.

St George’s and the outbreak of the First World War.

This year marks the centenary of the outbreak of the First World War. The Library will be publishing four blog posts reflecting on the experiences of medical staff and patients during the conflict, not only at St George’s but within the wider medical community. The posts will be published at the beginning of each week during November starting from today. We hope you will find them interesting.

The outbreak of war in August 1914 was accompanied by a swell of patriotism in Britain and many appeared to accept the morale boosting suggestion that the War would not only be easily won, but that it would also be ‘over by Christmas’. Although confidence in the British Empire ran high, others were less sanguine and their outlook was epitomised by Viscount Grey’s famous comment of that same month:

‘The lamps are going out all over Europe, and we shall not see them lit again in our life-time’ (Spender, 1925, pp. 14-15).

At St George’s Hospital and Medical School however, both administration and staff appeared to share the  enthusiasm of the nation for war. A writer in the St George’s Hospital Gazette described the:

‘patriotism of the younger and (many of the older men)’. He continued to note that within a few days of the declaration of war ‘practically the entire resident and non-resident staff volunteered their services to the Admiralty or War Office ‘(St George’s Hospital Gazette, Oct 1914, p. 99).

The dark side of this burgeoning patriotism also revealed itself. Forty nurses were reported to have attempted to have a housekeeper with a German name removed from her position; she only survived by revealing she had changed her nationality (Bloomfield, 1933, p. 92).

Title plate from The St George’s Hospital Gazette, October 1914.

The first effect of the war upon St George’s was the loss of medical personnel to the Territorial regiments or the Royal Naval reserve. They were soon joined by professional nursing staff; in October 2014 alone twenty two joined the British Red Cross Society (St Georges Hospital Gazette, Oct 1914, p. 106). At the same time there was naturally no respite in the workload of a busy London hospital. Visiting staff and Registrars stepped in to take resident posts, retired employees returned to work and despite placing a hundred beds at the disposal of the War Office, the hospital coped. This was partially ascribed to:

‘… Certain rearrangements evolved in the depths of the brain of the Superintendent, who , fortunately, is an ex-Wrangler…’ (St Georges Hospital Gazette, Oct 1914, p. 100).

The first major engagement, The Battle of Mons, took place in August 1914 and St George’s staff who had volunteered saw service soon after signing up. A St George’s medic wrote of treating casualties who had arrived after a lengthy train journey at an unnamed military hospital in France:

‘Of the wounds I need not say much, except that taken on the whole they were more severe than one sees in England’ he continued ‘The more severe injuries however, especially those caused by shrapnel were generally very foul, with a certain amount of gangrene and cellulitis’ (St George’s Hospital Gazette, Oct 1914, pp. 97 – 98).

Walking wounded 1916 (photograph courtesy of the Imperial War Museum).

Most of the younger doctors who volunteered from St George’s and elsewhere had no experience of military medicine. Some of the senior medical staff however had held military rank and worked in theatres of war, particularly during the Boer War. A letter published by the Lancet in September 1915 reflected this:

‘I have looked up my old notebooks relating to my experiences of the Boer war and Zululand rebellion of 1906 in the hope that [they] may be of use to others who have not had the advantage of previously treated cases of rifle wounds’ ( The Lancet, 1914, pp. 642–44).

In hindsight this might seem naïve, but during the early stages of the conflict few comprehended that advances in medical science such as blood transfusions would be matched by advances in weaponry. Medical establishments had historically evolved from military and religious organisations. This was reflected by the hierarchical disciplined systems adopted by institutions such as St George’s. The organisation of nursing on the wards had developed from Florence Nightingale’s theories, which were themselves condensed from her experiences in the Scutari Military Hospital during the Crimean War (Nightingale, 1859). In that, and subsequent conflicts, the majority of deaths were caused by infection and disease rather than injury, so the importance of medical care in contributing to military success was understood. Moreover advances in medicine including an awareness of sepsis and disinfection had improved recovery rates from injury. The late Victorian and Edwardian eras had also witnessed a growth in interest in public health including sanitation, infection control and hygiene. Therefore it is not surprising that there was initially a degree of confidence in modern medicine’s ability to deal with the war wounded.

Interior of a military hospital ward in Cambridge (photograph courtesy of the Imperial War Museum).

As the war continued, the adoption of trench warfare meant the combination of wound and infection would become a major and recurrent challenge. The first shipment of wounded back to St George’s arrived on the King’s and Hope Wards in mid-October 1914. (St George’s Hospital Gazette, Oct 1914, p.100). John Lavery’s painting: The First Wounded, London Hospital, August 1914 although somewhat idealised suggests how the wards at St George’s might have looked. In the painting the wounds are probably not depicted in their full severity but the injuries and conditions prevalent amongst those admitted would have been similar to those treated at St George’s later that year. The most common problem was frostbite which continued to be the case throughout the war (Atenstaadt, 2006). Infections were also rife as was rheumatism, most probably caused by trench fever. Of the trauma cases upper limb injuries were more numerous (Park and Park, 2011). Although hospitals like St George’s were at this point staffed by professional medics and nurses used to treating infection and trauma, the scale and violence of the injuries must have profoundly affected the staff working with the first tranches of war casualties.

John Lavery. The First Wounded, London Hospital, August 14 (courtesy of Dundee Art Gallery).

This seems to have concentrated the minds of some medics, as a less grim consequence of the outbreak of war at St George’s was a rush to marry sweethearts, with the Gazette recording four such marriages (St Georges Hospital Gazette, Oct 1914, p. 108).

The effects of the War and the speed of its escalation in terms of manpower and effort can be detected within issues of the St George’s Hospital Gazette which appeared during its early months. As the war continued the numbers of St George’s staff involved increased and some were taken prisoner, injured, or killed in action. One of the first casualties was Septimus Hibbet, a House Physician at St George’s who was lost with the H.M.S Formidable in January 1915, one of the first battleships to be sunk during the war (St George’s Hospital Gazette, Oct 1914, p.102). In a surreal footnote a survivor of this sinking was reputed to have been resuscitated by a sheepdog called ‘Lassie’ who may have provided the inspiration for the famous Hollywood films (Clarke, 2008).

HMS Formidable (photograph courtesy of the Imperial War Museum)

BIBLIOGRAPHY

Atenstaadt, R. L. (2006) ‘Trench foot: the medical response in the First World War 1914 – 1918’, Wilderness and Environmental Medicine, 17(4), pp: 282 -289.

Blomfield , J. (1933) St George’s 1733 – 1933. London: The Medici Society.

Clarke, N. (2008) Shipwreck Guide to Dorset and South Devon. Charmouth: Nigel J. Clarke Publications

Ministry of Information First World War. (2014) Ward of the 1st Eastern General Hospital which stands on the grounds of Kings and Clare Cricket Fields, Cambridge. Available at: http://media.iwm.org.uk/iwm/mediaLib//290/media-290607/large.jpg (Accessed: 29 October 2014).

Lavery, J. (1915) The First Wounded, London Hospital, August 1914 [Oil on canvas]. Dundee Art Gallery, Dundee.

Nightingale, F. (1859) Notes on Nursing: What it is and What it is Not. London: Blackie & Son.

Park, M. P. and Park, R. H. R. (2011) ‘Art in wartime: The First Wounded, London Hospital, August 1914’, Medical Humanities, 17(1), pp: 23-26.

Spender, J. A. (1927) Life, Journalism and Politics. London: Cassell and Company Ltd.

(1913-1914) St Georges Hospital Gazette.

(1914-1919) St Georges Hospital Gazette (1914 – 1919), 22.

The Royal Navy 1914 – 1918. HMS Formidable. Available at: http://www.iwm.org.uk/collections/item/object/205319700 (Accessed: 29 October 2014).