World Digital Preservation Day 2022

World Digital Preservation Day, organised by Digital Preservation Coalition, is an international event to highlight the importance of digital preservation. This blogpost has been written by St George’s Archivist Juulia Ahvensalmi, Research Data Support Manager Michelle Harricharan, and Records Manager Kirsten Hylan. You can engage with the day and find out more about our work on the Museum and Archives Twitter account using the hashtags #WDPD2022 and #SGULWDPD2022. If you are interested in learning more about digital preservation at St George’s, or would like to get involved, please contact digpres@sgul.ac.uk.

‘Data for All, For Good, Forever’ is the theme of this year’s World Digital Preservation Day, demonstrating how digital preservation allows ‘digits to flourish’. What an apt theme for a university that has been transforming health and medical care since 1733! Whether it is developing the earlier practices of variolation into vaccination (introduced by Edward Jenner in 1798) that eventually eradicated smallpox or transforming health practice though our pioneering work in infection and immunity, population health and molecular and clinical research, for St George’s data has always been for good, for all and, with proper care, forever. This post will consider how by preserving records and data regardless of format that are held in the archives and currently being developed by our staff, we are not only ensuring we maintain our history, but that St George’s continues to contribute to ground-breaking medical research by allowing digits to flourish.

Postmortem Examinations and Case Books

St George’s, University of London (SGUL), is a specialist health and medical sciences university in South-West London. The Archivist, Research Data Support Manager, and Records Manager work together to advocate for digital preservation, winning funds for a digital preservation system, and identifying areas that hold records that require a long-term storage solution. As a medical school we have created many unique datasets that contribute to scientific knowledge and the teaching of medicine.

The Postmortem Examinations and Case Books were created by St George’s, University of London and St George’s Hospital between 1841 – 1946. The records contain case notes including medical histories and pathological findings, and detail social and cultural changes, medical advances, and historical events, including epidemics and the development of anaesthesia and antiseptics. The postmortem books were an integral teaching tool for students of surgery and anatomy at St George’s. Through a project funded by Wellcome, the casebooks were conserved, digitised and catalogued in 2018 – 2021. They now have a life beyond teaching; they are a genealogical, sociological, and historical resource freely accessible online, enabling researchers to broaden their and our knowledge of diseases and treatments that act as building blocks for current and future researchers’ work.

St George’s Post Mortem and Case Book 1846, and a catalogue entry for the case of Thomas Roles, PM/1880/236 displayed on the SGUL Archives catalogue.

The Cambridge Cohort of Open Spina Bifida

Our research data repository holds several valuable research datasets. One such dataset is The Cambridge Cohort of Open Spina Bifida which comprises of 9 reviews of 117 individuals born between 1963 – 1971 with open spina bifida. Spina bifida occurs when a baby’s spine and spinal cord does not develop properly in the womb, causing a gap in the spine (NHS, 2020). Most babies born with spina bifida can have surgery to close the opening in the spine, however, their nervous system will have already been damaged which can lead to a range of health problems. Some may also have learning disabilities.

The Cambridge Cohort of Open Spina Bifida is a unique spina bifida data resource that provides detailed data on the health and quality of life of individuals born with spina bifida. The resource is rare in that it includes a detailed neurological examination at birth, and follows up on participants throughout their lives, with 99% follow-up to the mean age of 50 years. The earlier reviews were conducted at home and school at the mean ages of 4 and 9 years and included clinical examination. Later reviews were based mainly on questionnaires (completed by patients and/or carers) and clinical records. The Office for National Statistics provided information on deaths to August 2017.

The data provide a full, comprehensive picture of the lives of people who received surgery for open spina bifida within 24 hours of birth until either they died (which a third did before the age of 5) or the end of the study in 2017. With a 99% follow-up, it represents a remarkable achievement in research and contribution to an area where not much had previously been known. For each of the participants, and their carers, participation in the research was a means of sharing their experience for good, for all those living with spina bifida – present and future, with the hope of improving understanding and treatment of their disease.

For the researchers, the study was an ongoing endeavour of love, started by a clinician, researcher and mother who passed the work on to her daughter on her retirement. Her daughter painstakingly continued her mother’s work, treasuring the study and the research as much as her mother before her. The dataset was passed to St George’s to share and preserve for the future – for all, for good, forever.

Oakeshott, P., Reid, F. (2021) The Cambridge cohort of open spina bifida. Figshare. DOI 10.24376/rd.sgul.14438780. Available at https://doi.org/10.24376/rd.sgul.14438780

A podcast with Prof Pippa Oakeshott, where she discusses her 2019 paper based on this data ‘Walking and living independently with spina bifida: a 50‐year prospective cohort study’, can be viewed on the Developmental Medicine and Child Neurology YouTube account.

Exploration of Disease Past and Present

What do these two resources, one containing information dating back to 1841, the other published in 2021, have in common? Both are maintained in a digital format, both add to our knowledge of a specific subject, and both have purposes that will evolve over time.

However, the everchanging technical landscape means that digital records essential for medical research are at risk. The importance of our digital records means there is a need for digital preservation to ensure these records remain accessible in order to protect our knowledge and investment, and ensure that future generations of researchers have the opportunity to access the knowledge contained within.

The historical records also provide a link between the past and present, and show the medical advances made over time. In 1865, a seven-month-old baby called Harriet (or Elizabeth) Garton was admitted to St George’s Hospital with a congenital meningocele, a type of spina bifida in which a sac of fluid protrudes through a gap in the spine. The only treatment available at the time was injection with iodine; it was not until 1895 that the first successful surgical operation was described. Although the iodine initially appeared to decrease the size of the tumour, little Harriet developed bronchiolitis and died five days after her third admission to the hospital: the doctor treating her blamed the disease on the ‘inclement’ weather when the child’s mother brought her to the hospital. Although the treatment was ultimately unsuccessful, the trial was seen as significant enough to discuss at length in an article published in 1866.

Illustration of the case, published in St George’s Hospital Reports, Vol 1 (1866) by Timothy Holmes, SGHMS/6/1/1; and the digitised post mortem case notes of Harriet Garton, infant, 10 Apr 1865, PM/1865/107.

Capturing and preserving our digital data allows us to place formal research datasets like the Cambridge Cohort of Open Spina Bifida alongside our understanding and treatment of the disease in 1865. It allows us to compare perceptions and innovative treatments over time. In 1865 surgery for spina bifida was not possible; now, it is part of standard care, with some surgeries even happening while babies are still in the womb. Our post-mortem examinations and casebooks include a number of cases of spina bifida and meningocele in infants aged between 3 days and 1 year, demonstrating how quickly babies’ health deteriorated without surgery in the past. Opportunities for future research includes exploring the genetic basis of neural tube defects like spina bifida and the use of stem cell technology as potential therapies.

Data for All, for Good, Forever

By actively managing our records and data and applying preservation tools and activities we can maintain the record and data’s ongoing viability. Key to achieving our goals is St George’s information management professionals including the Archivist, Research Data Support Manager, and Records Manager advocating for, and working with the owners of records and data to identify and actively manage their outputs.

The steps we take now to protect our digital records will ensure their longevity and the ability for researchers of the future to continue to access the knowledge held within. St George’s, University of London’s mission is to pursue excellence in academic medicine, healthcare and science, informed by a global outlook by creating and sharing knowledge. By identifying records for digital preservation, we ensure their availability for good, forever, and that the data contained within is available to all.

An Assassination in the Archive

‘Opening Up the Body’ is a Wellcome-funded 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 1841-1921. This post was written by Project Archivist Natasha Shillingford.

While cataloguing the 1909 volume of post mortem case books of St George’s Hospital, we came across the post mortem examination of Cawas Lalcaca, a Medico. The cause of death was listed as ‘Bullet wound in back perforating lung, diaphragm, liver, mesentery, intestines and ilium. 2^nd bullet wound in right chest.’  The medical case notes record that the ‘Patient was murdered on July 1 at the same time as Sir William Curzon Wyllie at the Imperial Institute by an Indian fanatic named Dhingra, who was subsequently executed at Pentonville.’

PM/1909/223. Archives and Special Collections, St George’s, University of London

What happened on that fateful night to result in the murder of two men?

A reception had been given at the Imperial Institute on behalf of the National Indian Association. It was attended by Lieutenant-Colonel Sir William Hutt Curzon Wyllie, K.C.I.E, C.V.O, Political Aide-de-Camp to Viscount Morley, Secretary of State for India and his wife, Lady Wyllie.

The Globe newspaper reported on the 2^nd July that “The occasion passed without incident until the close of proceedings. Sir Curzon was descending the staircase prior to leaving, Lady Wyllie having, in the meantime, descended to the cloakroom to fetch her wraps. Descending the staircase near Sir Curzon was Dr. Cawas Lalcaca.

Then suddenly, in the twinkling of an eye as it were, and to the stupefaction of those around, shots rang out, and Sir Curzon fell on his back on the stairs. An Indian student was standing in front holding a smoking revolver. One bullet had shattered Sir Curzon’s right eye; another bullet had pierced his face just below the other eye. Dr. Cawas Lalcaca fell with a bullet through his chest.”

There were a number of doctors among the guests, and they attended the victims, but “it was at once seen, however, that Sir Curzon’s fate was sealed and life was certified to be extinct. In the case of Dr. Cawas Lalcaca hopes were entertained of his ultimate recovery, and he was conveyed to St George’s Hospital, but died almost immediately.”

An eyewitness at the scene said that Dr. Lalcaca had previously been speaking to Sir Curzon Wyllie, and he was “of the opinion that he must have noticed the actions of the assassin just as he was about to fire, and thrust himself before Sir Curzon Wyllie, and thus received his death wound.”

PM/1909/223. Archives and Special Collections, St George’s, University of London

The morbid appearances in the post mortem examination at St George’s Hospital reveal the extent of Dr. Lalcaca’s injuries. The external description of the body describes the locations and entry of the bullets.

Meanwhile, the assassin was apprehended at the scene and escorted to Walton Street Police Station. The Globe newspaper reported that “the prisoner, stated to be a Parsee, is apparently about 25 years of age. Not of powerful physique, but mild-mannered, cool and self-possessed, his hair black, he was wearing gold spectacles, and a turban, which in the enactment of the tragedy fell off.” The motive of the crime was believed to be political, and in addition to the revolver which he fired, he had a further revolver, a long knife and a dagger on his person. His name was given as Madan Lal Dhingra, a student in Engineering at University College.

The Globe newspaper reported that when asked if he had anything to say, the prisoner replied, “The only thing I want to say is there was no wilful murder in the case of Dr. Lalcaca. I did not know him at all. When he advanced to take me I only fired in self-defence.”

An inquest on the body of Dr. Lalcaca was held at Westminster Coroner’s Court and was reported in the London and China Express, 9^th July 1909.

It stated that Dr. Lalcaca was a native of Allahabad but resided in Bombay, later at Shanghai. He was a doctor of medicine and had been in England since June 8^th. A friend described him as a “fine looking Indian, slightly over medium height, with a handsome bronze countenance, of a genial bearing, and refined appearance.”

The Coroner stated that it was a clear case of wilful murder by Dhingra or Dr. Lalcaca. He said that it was true that Dhingra stated that his intentions were not against Dr. Lalcaca and it was an act of self-defence, but that was not an excuse for murder. The Jury returned a verdict of ‘Wilful Murder’.

So, what was Dhingra’s motive for the attack on Curzon? The Christchurch Times reported on 10^th July 1909 that a brother of Dhingra had written to Sir Curzon Wyllie asking if he would offer Dhingra some advice, as “the family feared he was getting into a dangerous circle.” Sir Curzon apparently did write to Dhingra, and advised him in a tactful manner, but Dhingra resented this advice and clearly indicated this in a letter sent to Sir Curzon.

It was also said that Dhingra had attempted to kill George Curzon, Viceroy of India and had planned to assassinate the ex-Governor of Bengal. Wyllie’s presence at events with Indian students, made him an easier target for assassination.

Dinghra was tried at the Old Bailey on 23^rd July. He stated that “Whatever I did was an act of patriotism and justice which was justified. The only thing I have to say is in the statement which I believe you have got,” and he pleaded not guilty to the indictment. The Bicester Herald published Dhingra’s statement on 20^th August 1909. He wished it to be read at the trial, but permission was refused. “I admit the other day I attempted to shed English blood as an humble revenger for the inhuman hangings and deportations of patriotic youths. In this attempt I have consulted none but my own conscience. I have conspired with none but my own duty.” He continued, “I believe that a nation held down by foreign bayonet is in a perpetual state of war, since open battle is rendered impossible to a disarmed race. I attacked by surprise; since guns were denied me I drew forth my pistol and fired…The only lesson required in India at present is to learn how to die, and the only way to teach it is by dying ourselves. Therefore I died, and glory in my martyrdom.”

For the murder of Sir Curzon Wyllie and Dr. Lalcaca, Madan Lal Dhingra was hanged at Pentonville prison on 17^th August 1909.

The funeral of Dr. Cawas Lalcaca took place at Brookwood Cemetery, the only Parsee burial place within the metropolitan district. The London and China Express described the ceremony at the graveside as ‘short, simple and impressive. The coffin was covered with floral tributes. It was placed on a bier and drawn to the Fire Temple of the Parsees. When the coffin was taken into the building a fire of sandalwood and frankincense was lighted on the altar, on either side of which burned also a candle. The interment took place in a plain grace, and after the body had been taken from the temple, most of those present placed a small piece of sandalwood in the flames on the altar.”

The British Medical Journal reported that the floral tributes were particularly beautiful, and “conspicuous among them was a wreath from Lady Wyllie inscribed: ‘These flowers are sent by the wife of Sir Curzon Wyllie, in ever grateful remembrance of the brave and noble man who lost his life on the night of July 1^st in trying to save her beloved husband and others, with deepest sympathy.’”

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A Railway Mystery

‘Opening Up the Body’ is a Wellcome-funded 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 1841-1921. This post was written by Project Archivist Natasha Shillingford.

Following on from the discovery of a post mortem case of a monkey on the railway we decided to explore other cases of railway mysteries in the post mortem collection of St George’s Hospital. We soon came across a case worthy of the great Hercule Poirot.

On 23^rd September 1886 Moritz Fischer was admitted to St George’s Hospital with a compound depressed fracture of the skull, with laceration of the dura mater and brain with meningitis.

PM/1886/292. Archives and Special Collections, St George’s, University of London

The case notes said that ‘The man was found in a 1^st class compartment of the Metrop[olitan] Railway with a fractured skull.’ He was conscious but did not speak. There was a scalp wound about eight inches in length which extended from the centre of the forehead. The external table of the skull was fractured and the internal table was driven through the dura mater into the brain, with the brain substance protruding. The fragments of the bone were picked out with forceps and the scalp was brought together with sutures. He went on well without any special symptoms for nine days when he passed his urine into the bed and became drowsy. His temperature slowly rose from 99 degrees to 106 degrees on the evening of the 3^rd October and he died on the 4^th.

The post mortem examination states that there was a wound 3 ¼ inches long over the frontal region. It started from a point 1 inch to the right of the middle line and passed obliquely forwards and to the left. The angles of the wound were infiltrated. Beneath it, part of the temporal bone was absent. Some soft greyish substance protruded which was examined microscopically and found to consist almost entirely of nerve fibres, blood and granular matter.

PM/1886/292. Archives and Special Collections, St George’s, University of London

What happened to Mr Fischer in the first-class compartment to cause such brutal and deadly injuries?

Lloyds Weekly London Newspaper reported on September 26^th 1886 that on the arrival of the train at Bayswater, ‘the attention of the newspaper boy attached to the bookstall on the platform was attracted to the last compartment by one of the first-class carriage fourth from the engine, there being a stream of blood on the outside of the carriage door, the window of which was open. On looking through into the compartment the lad observed a gentleman lying prostate on the floor, alone, and with his feet towards the door, there being a small quantity of blood on the carpet, and a much larger quantity on the cushion of the seat nearest the engine.’ The acting-inspector on duty opened the door and ‘saw that the unfortunate man was quite insensible, and that blood was flowing from a terrible wound on the forehead.’ The gentleman was ‘attired in a grey overcoat, the coat underneath being of black diagonal cloth, and his trousers were light-striped. His gold watch and chain were safe, as were also his rings, but not much money was found in his possession. A few papers were discovered, and they were all in German. A visiting card was found bearing the inscription, “Mr. Moritz Fischer,” and the police, as the result of subsequent inquiries, ascertained on Friday that the injured gentleman was Mr. Moritz Fischer, head of the firm of Mr. A. Fischer and Co., general foreign agents of 35 Carter-lane, and having residence in Westbourne-terrace.’ Thus it appears that none of Mr Fischer’s belongings were stolen so theft was unlikely to be a motive for an attack. However, ‘It was reported that despite the carriage being empty, they could not be quite certain on the point, owing to the confusion which prevailed.’ Therefore it is entirely possible that another individual was in the carriage with Mr Fischer and escaped during the turmoil.

The police, however, were of the opinion that Mr Fischer sustained his injuries by accident, and the following anecdote appeared to confirm this hypothesis:

‘A friend of the injured man says that about twelve months ago Mr. Fischer met with a curiously similar but by no means so serious an accident while travelling on the railway. He had put his head out of the carriage window when he was struck by some projection in the tunnel. He was severely cut, and had to wear a bandage for some time. The injury then sustained was just over the forehead, as now, but the skull was not fractured. The old accident subsequently formed a standing joke among his friends, and he was often rallied about putting his head out of carriage window and advised not to be of so inquisitive a turn of mind. Only a few nights ago the old joke was repeated to him, along with the question whether he had lately been putting his head out of the window. This may be an explanation of the mystery, or it may be only a striking coincidence; but it is a singular fact that most of the known facts appear to lend themselves to such an explanation of what at first appeared to be a very tragic crime.’

The newspaper paper continues by saying that ‘It is conjectured that Mr. Fischer had a propensity for watching the people who occupied the adjoining compartments, and while indulging in this habit he must have placed his feet on the carriage seat, and in his endeavour to place his body as far outside the window as possible, his head must have come in contact with the projection in the spring of the arch.’

However, at the inquest into the death of Moritz Fischer (reported in the London Evening Standard 08 October 1886), a friend of the deceased, Fritz Mercier, said that despite being aware of Mr Fischer previously having injured his head during a journey from Manchester, he refuted the claim that he was well known to have put his head out a carriage window. Despite this, the inquest further confirmed that there was no sign of a struggle, there was no derangement of the carriage and ‘On the night of the accident when the traffic had ceased, Witness went in a carriage and found at the very spot where it was supposed the gentleman met with his injury, that it was quite possible by leaning about 18 to 20 inches out of the window, to meet with a similar accident. At the same spot there was a continuous trail of blood on the wall.’ Furthermore, a witness spoke to picking up a pair of spectacles about twenty yards from where the blood was found on the wall, and another witness testified that Mr Fischer had never been known to be without his spectacles.

Based on the evidence, and despite conflicting testimonies from the friends of Mr Fischer, the jury returned a verdict of Accidental Death. Foul play or a case of curiosity killed the cat, either way please refrain from putting your head outside a carriage window on a moving train.

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St George’s Archives – View of the Dissecting Room of St George’s Hospital

‘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.

View of the Dissecting Room of St George’s Hospital, Archives and Special Collections, St George’s, University of London

“At the time of which I am writing, between the years 1858 and 1860, Mr Pollock and Mr Gray were Lecturers on Anatomy, Mr Athol Johnstone was Lecturer on Physiology, and Dr Noad, Lecturer on Chemistry; whilst Dr Dickinson and Dr Hastings were Demonstrators of Anatomy. All these appear in the photograph.”

‘The Men of my Time’, St George’s Hospital and Medical School Gazette, No. 3, Vol 1

George Pollock

Photo credit: St George’s, University of London

George David Pollock was born in India in 1817, the son of Field-Marshall Sir George Pollock and his wife Frances Webbe. Pollock was sent to England as a child and later apprenticed to a country practitioner. He then entered St George’s Hospital and became House Surgeon to Sir Benjamin Brodie. Due to Brodie’s influence, Pollock in 1843 gained the post of Resident Physician to Lord Metcalfe, Governor-General of Canada. Following Lord Metcalfe’s death, Pollock returned to England and in 1846 he was elected Assistant Surgeon to St George’s Hospital, where he served for thirty four years until his retirement in 1880

In 1869, the Swiss surgeon Jacques-Louis Reverdin developed a successful method for the allograft of human skin. Based upon Reverdin’s work, Pollock performed the first such successful operation in England in May 1870. This technique was known as the Pollock Graft and was adopted by many surgeons.

Pollock took over the care of ophthalmic cases at St George’s. He was also Demonstrator of Anatomy under Prescott Gardner Hewett, and succeeded him as Lecturer on Anatomy. In the Ophthalmic Department at St George’s Hospital, he was known for his cataract operations which led to his private practice in eye diseases. He was also appointed Surgeon on the founding of the Hospital for Sick Children in Great Ormond Street and took great interest in cleft palate operations.

Pollock also served as Examiner in Surgery to the Indian Medical Service where he was said to be a popular member of the teaching staff. He was also President of the Association of Fellows and headed a reform party at the Royal College of Surgeons. He was President of the Royal Medico-Chirurgical Society in 1886, and of the Pathological Society in 1875, and also Surgeon in Ordinary to the Prince of Wales.

He practiced at 36 Grosvenor Street until the last year of his life, when he moved to 35 Chester Square. He married Marianne, daughter of Robert Saunders, in 1850 by whom he had five children, three surviving him. He died on 14^th February 1897 after a short illness of pneumonia.

Henry Gray

Copyright expired. CC BY 4.0

Henry Gray was born in 1827, the son of a Private Messenger to George IV and William IV. He entered St George’s Hospital on 6^th May 1845 and he soon focussed his attention on the study of anatomy. In 1848, at the age of 21, he was awarded the Triennial Prize of the Royal College of Surgeons for his essay on ‘The Origin, Connection and Distribution of the Nerves of the Human Eye and its Appendages, illustrated by Comparative Dissections of the Eye in other Vertebrate Animals’. As a student he was described as a painstaking and methodical worker who learned anatomy by undertaking dissections himself.

In 1850 Gray was appointed House Surgeon under Robert Keate, Caesar Hawkins, Edward Cutler and Thomas Turner. On 3^rd June 1852 he was elected a Fellow of the Royal Society, a rare distinction at the age of 25. Gray devoted himself to the study of anatomy and the first edition of his ‘Anatomy, Descriptive and Surgical’ was published in 1858, with engravings by Dr Henry Vandyke Carter. The book, known as ‘Gray’s Anatomy’, had reached the 23^rd edition by 1928.

In 1861, Gray became a candidate for the post of Assistant Surgeon at St George’s Hospital. His election was viewed to be certain, but he contracted smallpox while looking after a nephew with the disease, and died after a short illness on 13^th June 1861. Upon his death, Sir Benjamin Brodie wrote ‘I am most grieved about poor Gray. His death, just as he was on the point of realizing the reward of his labours, is a sad event indeed…Gray is a great loss to the Hospital and the School. Who is there to take his place?’

Athol Archibald Wood Johnstone

Post Mortem examination book 1844 (Anne Thompson, PM/1844/64) Archive and Special Collections, St George’s, University of London

Athol Archibald Wood Johnstone was born in 1820, the youngest son of Dr James Johnson, Physician to King William IV, whose name was accidentally spelt Johnson instead of Johnstone. Athol Johnstone reverted to the original family name on the death of his father.

He studied at St George’s Hospital, where he became House Surgeon, Demonstrator of Anatomy and Lecturer on Physiology. He later succeeded George Pollock as Surgeon to the Hospital for Sick Children, Great Ormond Street. Johnstone was also Surgeon to the Royal Alexandra Hospital for Children with Hip Disease, and to St George’s and St James’s Dispensary. In 1861 he declined to stand for the vacancy of Assistant Surgeon to St George’s Hospital following the death of Henry Gray. In 1862 he moved to Brighton where he practiced as Surgeon to the Brighton and Sussex Throat and Ear Hospital, the Invalid Gentlewomen’s Home, and the Brighton Battery of the old Royal Naval Artillery.

He was twice married, his second wife surviving him. Johnstone died on 16^th March 1902 in Brighton.

Henry Minchin Noad

Henry Minchin Noad was born in 22^nd June 1815 at Shawford, Somerset, the son of Humprey Noad. He was educated at Frome Grammar School. He began the study of chemistry and electricity, and about 1836 he delivered lectures on both subjects at the literary and scientific institutions of Bath and Bristol. He joined the London Electrical Society in 1837.

In 1845 he began his studies under August Wilhelm Hofmann at the Royal College of Chemistry. He joined the medical school of St George’s Hospital in 1847 when he was appointed to the chair of Chemistry. He remained in this role until his death.

In 1849 Noad obtained his degree of doctor of Physics from the University of Giessen. In 1850-51 he conducted an inquiry into the composition and functions of the spleen with Henry Gray. In 1856 he was elected a Fellow of the Royal Society. He was appointed Consulting Chemist to the Ebbw Vale Iron Company, the Cwm Celyn, and Blaenau, the Aberdar and Plymouth, and other iron works in South Wales. In 1866 he became an examiner of malt liquors at the India Office. In 1872 he became an examiner in Chemistry and Physics at the Royal Military Academy in Woolwich.

Noad died at his home in Lower Norwood, London on 23^rd July 1877, survived by his wife Charlotte Jane.

William Howship Dickinson

Image in public domain

William Howship Dickinson was born on 9^th June 1832 in Brighton, the son of William Dickinson of Brockenhurst. He was educated at Caius College, Cambridge and at St George’s Hospital. After graduating in 1859, he became Curator of the Museum, Assistant Physician in 1866 and Physician in 1874. He was also Assistant Physician from 1861 to 1869 at the Hospital for Sick Children, and later physician from 1869 to 1874. He held the offices of Censor and Curator of the Museum at the Royal College of Physicians, delivered the Croonian Lectures in 1883 and the Harveian Oration in 1891. Dickinson was Examiner in medicine to the Royal College of Surgeons and to the Universities of Cambridge, London and Durham.

Thomas Pickering Pick recalled attending an anatomy demonstration by William Howship Dickinson. He said that ‘The first of these which I attended was on the kidney, and a specimen from the dead-house was exhibited. I ventured to ask, no doubt with all diffidence as a beginner, whether it was not a very large one, and was met by the remark: “By no means; perhaps you are thinking of the kidneys you have eaten for breakfast this morning.” At this there was a universal titter, and I felt extremely small. But undoubtedly the suggestion was a perfectly true one. It was the first time I had seen a human kidney, and my knowledge of that particular organ was entirely derived from the sheep’s kidney on the breakfast table.’ (‘The Men of my Time’, St George’s Hospital and Medical School Gazette, No. 3, Vol 1)

Dickinson was a general physician but he was known as an authority on diseases of the kidney and children’s diseases. He was known to be a meticulously careful observer who visited the wards of St George’s Hospital every day to observe his patients and take their medical histories. Dickinson was said to have ‘worshipped St George’s Hospital almost to the point of idolatry and received in return, during his long life, no small measure of its homage.’

In 1861 he married Laura, daughter of James Arthur Wilson, physician to St George’s Hospital. They had four daughters and two sons. Dickinson died on 9^th January 1913.

Cecil Hastings

Unfortunately not much is known about Dr Cecil William Hastings, Demonstrator of Anatomy at St George’s Hospital. The student registers of the medical school reveal that he was educated at the University of Oxford and became a Member of the Royal College of Physicians. He took the post of House Surgeon in 1853 and was also Physician at the Royal Pimlico Dispensary.

Search the Authority Records on the Archives and Special Collections catalogue to find out more about the Surgeons and Physicians of St. George’s Hospital (https://archives.sgul.ac.uk/).

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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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