Some Aspects of  Health

                                                   Aspasia - Physician, Surgeon

In 2016 Gregory Tsoucalas and Marcos Sgantzos published an article in the Journal of Universal Surgery on two 'majestic' female physician surgeons - one of them was Aspasia, a Greek who lived circa the 4th century AD.
Using the Thesaurus Linguae Graecae and searches in electronic databases such as Google Scholar, Scopus and PubMed, the authors discovered descriptions of procedures that were similar to those used today.
Above: Greek and Roman forceps.
With thanks to the Wellcome Collection https://wellcomecollection.org


Aspasia, who wrote prolifically, influenced medical giants such as Aetius of Amida, who considered her a  genius, and Paul of Aegina. Her main field was that of midwifery and gynaecology, advising pregnant women not to exercise violently, go on chariot rides over rough roads, eat spicy foods or carry heavy loads.
If the mother's life was in danger Aspasia would perform abortions, using either abortion inducing drugs, or, if the mother was already in labour, by surgical procedures.
Other operations that Aspasia discussed included surgery for haemorrhoids of the uterus, and for varicose hernia of the labia. Her triumph is not only that she performed medicine in a culture dominated by men, but that she introduced new and successful procedures, establishing them by writing medical texts.

Gregory T, Markos S. Aspasia and Cleopatra Metrodora, Two Majestic Female Physician – Surgeons in the Early Byzantine Era. J Univer Surg. 2016, 4:3
See the full article and references at http://www.jusurgery.com/universalsurgery/aspasia-and-cleopatra-metrodora-twomajestic-female-physician--surgeons-in-theearly-byzantine-era.pdf
See also Forgotten Women - The Scientists, Zing Tsjeng, 2018
                                                                                                 
                                                        The Economics of Teeth
Dentistry has been performed throughout history and throughout the world. Teeth that have been drilled (and possibly filled with bitumen) have been found in a human being 13000 years old
Study published online March 27 2017 in the American Journal of Physical Anthropology.

The earliest recorded replacement teeth were made by the Etruscans in the 7th century BC.

Right: Etruscan teeth around 2000 years old.
Credit: Royal College of Surgeons Museum in Edinburgh

The oldest pair of confirmed wooden dentures were reportedly created from Japanese boxwood for a 16th century Buddhist priestess by the name of Nakaoka Tei.
In 2008 the Japan Times reported that some 18th century wooden dentures had been found in a ditch at Yokkaichi, Mie Prefecture. Commenting on the find, Haruhisa Yamaguchi, former head of a museum of teeth in Nagoya, said that these would have been an expensive item, and would have been lost, not thrown away. 'Only high class samurai and rich merchants could afford artificial teeth,' he said.
http://www.internationaltimber.com/news/timber/5-unusual-uses-for-timber-products
https://www.japantimes.co.jp/news/2008/11/25/national/george-washington-not-only-one-with-wood-choppers/#.WdI1LNFrw2w

In the west from mediaeval times onwards, teeth got worse, and the culprit was...
 
                                       ...Sugar

P J Holloway PhD, BDSW and J Moore BDS, MBChB, PhD, DSc, The role of sugar in the aetiology of dental caries, Journal of Dentistry, vol 11, issue 3, Sept 1983, p189-190

From Anglo-Saxon times until 1900 there is a clear correlation between sugar consumption and the rate of caries.
Dr Jo Buckberry, using 1978 data from Moore and Corbett, article on dental disease.
http://www.leeds.ac.uk/yawya/bioarchaeology/Dental%20disease.html - Accessed 02-10-2017


Right: Still life with bread and confectionery, Georg Flegel, first half of the 17th century.
Georg Flegel [Public domain], via Wikimedia Commons

Sugar was initially expensive, and only the wealthy could indulge in it. Consequently it was the rich whose teeth suffered the most.

A report on Elizabeth 1 from the German traveller Paul Hentzner : 'Next came the Queen...Her Face oblong, fair but wrinkled; her Eyes small, yet black and pleasant; her Nose a little hooked; her Lips narrow and her Teeth black...'
Paul Hentzner's Travels in England 1797 edition, p34, available via https://archive.org/details/paulhentznerstr00hentgoog

                                                                   What to do with decaying teeth?

1530. The Little Medicinal Book for All Kinds of Diseases and Infirmities of the Teeth (Artzney Buchlein), the first book devoted entirely to dentistry, is published in Germany. Written for barbers and surgeons who treat the mouth, it covers practical topics such as oral hygiene, tooth extraction, drilling teeth, and placement of gold fillings.
For most people extraction of rotting teeth by, for example, the barber surgeon, was probably the only option. For many years the roles of barbers and surgeons overlapped. An Act of Parliament in 1540 created the Company of Barbers and Surgeons of London. The Act decreed that no surgeon was to perform the tasks of a barber, and vice versa, but both could continue to draw teeth.
http://barbercompany.org/history-of-the-company/


                                                                    His pole, with pewter basins hung,
                                                                    Black, rotten teeth in order strung,
                                                                    Rang'd cups that in the window stood,
                                                                    Lin'd with red rags, to look like blood,
                                                                    Did well his threefold trade explain,
                                                                    Who shav'd, drew teeth, and breath'd a vein.
                                                                             John Gay 1727



Right:
Another option in France for having your teeth extracted - a travelling tooth-drawer.
G Gostiaux, born 1838.

Courtesy The Wellcome Trust. This file is licensed under the Creative Commons Attribution 4.0 International (CC by 4.0)

By the 18th century (and possibly before) teeth were being replaced in England.

'We can actually transplant a tooth from one person to another, without great difficulty, nature assisting the operation, if it is done in such a way that she can assist, and the only way in which nature can assist, with respect either to size or shape, is by having the fang of the transplanted tooth rather smaller than the socket.'

'The scion tooth, or that which is to be transplanted, should be a full-grown young tooth; young, because the principle of life and union is much stronger in such than in old ones. It will be scarcely necessary to observe, that the new teeth should always be perfectly sound, and taken from a mouth which has the appearance of that of a person sound and healthy...'
John Hunter, The Natural History of the Human Teeth, London 1778, Part 1, p126ff
The Surgical Works of John Hunter, ed James F Palmer, London 1835, Vol 2, p99

Above: Thomas Rowland, 1787. Teeth being extracted from the poor to be inserted into the wealthy.
Courtesy The Wellcome Trust. This file is licensed under the Creative Commons Attribution 4.0 International (CC by 4.0)


M Dubois de Chémant (see below) called this practice 'as dangerous as it is immoral'
M Dubois de Chémant, A Dissertation on Artificial Teeth in General, exposing the Defects and Injurious Consequences of all teeth made of Animal Substances, London 1797, p14ff

                                                                                            Dentures

                                                                            A famous denture wearer
George Washington 1732 - 1799
'Throughout his life Washington employed numerous full and partial dentures that were constructed of materials including human, and probably cow and horse teeth, ivory (possibly elephant), lead-tin alloy, copper alloy (possibly brass), and silver alloy.'
http://www.mountvernon.org/george-washington/the-man-the-myth/a-history-of-washingtons-dental-troubles/

                                                                                           ***
M Dubois de Chémant promoted artificial teeth.

'To restore to man all the advantages of which he finds himself deprived by the loss of teeth, and to remedy the inconveniences which this loss brings along with it recourse has been made to artificial teeth, but since human industry has contrived to make up this deficiency, this art has always been limited to the choice of animal substances: for this purpose sea-horses*, elephant's, ox's and calf's teeth, teeth extracted from dead human bodies etc. etc. have been made use of, and even teeth from living persons. All these substances, though very good in appearance, soon rotted, became black and caused [a] pernicious smell...'
M Dubois de
Chémant, A Dissertation on Artificial Teeth in General, exposing the Defects and Injurious Consequences of all teeth made of Animal Substances, London 1797, p9
*Sea-horse - a hippopotamus.

He made artificial teeth from porcelain paste, supplied by Wedgwood.
http:/www.bda.org/museum/collections/dental-art/porcelain-teeth.aspx

                                                                                                   ***

However, human teeth continued to be used for dentures - and the battlefield of Waterloo provided a ready supply. In 1819 Magistrates asked a prisoner how he made his living, and he answered that he was a useful member of society. He used to supply dead bodies to hospitals*, but lately had taken to extracting the teeth, 'which he served most of the eminent men in the profession with, by this he could earn a considerable sum of money.'
The court was given to understand that the prisoner 'along with several other persons [was] at the Battle of Waterloo, for the purpose of extracting teeth from the dead bodies.'
Kentish Weekly Post, 15 January 1819
*This would have been for dissection



Above: 'Waterloo teeth'.
Victoria Gallery & Museum, University of Liverpool. Photography Relic Imaging Ltd.


Right:
Watchtower at St Cuthbert's, Edinburgh
Built to deter those who wished to disinter bodies - for whatever reason.
Photograph 2017, Anne Bligh collection

In 1848 Edward Truman was granted a patent for artificial teeth using gutta percha*.
The American Journal of Dental Science, ed Harris, Blandy and Piggot, Philadelphia And London, 1855, Vol 5, p42
* Gutta percha - a natural latex from trees native to south east Asia. It is still used in root canal procedures.
A Concise Guide to Endodontic Procedures, Peter Murray, New York 2015, p169


Dentures from the 1850s onwards were also made of Vulcanite, a form of hardened rubber into which porcelain teeth were set.
https://bda.org/museum/collections/teeth-and-dentures/vulcanite-dentures

                                                                            Stuck for a Wedding Gift?

'I can recall that, in certain parts of the country, one of the most popular gifts to a young woman intending marriage was to enable her to have her teeth extracted and dentures fitted. Thus the dread of toothache was removed and the future partner spared any trouble and expense.'
Address in 1980 by D G E Roberts, President of the British Dental Association. Quoted in Evidence-Based Women's Oral Health, ed Halpern and Kaste, April 2013, Vol 57, no.2

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                                                A Quick Question about Eyes

Did medieval people have glasses? The question arose because in Ann Swinfen's novel 'The Huntsman's Tale', set in the mid 1300s, a character does not use glasses because he does not trust them.


 'It is not yet twenty years since there was found the art of making spectacles. (Italian: occhiali)  I have seen the man who first invented and created it and I have talked to him'.

Fra Giordano da Rivalto, sermon in February 1305. Manuscripts are held by the sisters of St Catherine at San Gaggio.
https://www.college-optometrists.org/the-college/museum/online-exhibitions/virtual-spectacles-gallery/the-invention-of-spectacles.html


Right: Detail of portrait of Hugh of Saint-Cher, 1352
Public domain, via Wikimedia Commons

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                                                            Call The Midwife
Midwife - 'Woman who is with' [the birth]. From middle English mid (with) + wif (woman).
https://www.etymonline.com/word/midwife

In many cases throughout history a handwoman or handywoman assisted women giving birth - uncertified and untrained, these women were finally outlawed by the 1902 Midwives Act.
https://academic.oup.com/shm/article/25/2/380/1735509/Birth-Attendants-and-Midwifery-Practice-in-Early

From an early date the Church of England had the responsibility for licensing midwives in the UK. Eleanor Pead took an oath in front of the Archbishop of Canterbury in 1567, and this 'has generally been accepted by historians as the earliest proof of the licensing of midwives'.
Why the involvement of the church? There may be several reasons, including concerns about witchcraft; but it seems likely that the prime reason was that the authorities were anxious to ensure that newborns were baptised into what they saw as the true faith.
Doreen Evenden, The Midwives of 17th Century London, Mount Saint Vincent University, Cambridge, 2000, p23ff


Those seeking a licence had to acquire testimonials from members of the community such as clergy, doctors and neighbours, and six women also had to swear to the candidate's ability.
ibid p34

Above: Midwife on her way to labour, 1811
Image courtesy of the Wellcome Library, London        
                                        


Male midwifery started in the early 1700s - man-midwives were also known as he-midwives, or accoucheurs. One of the most significant male midwives was William Smellie (1697-1763), who established procedures for the safe use of obstetrical forceps.
http://broughttolife.sciencemuseum.org.uk/broughttolife/people/manmidwives
http://broughttolife.sciencemuseum.org.uk/broughttolife/people/williamsmellie


Sarah Stone wrote a book in 1737: 'A complete practice of midwifery: consisting of upwards of forty cases or observations in that valuable art, selected from many others, in the course of a very extensive practice: and interspersed with many necessary cautions and useful instructions, propler to be observed in the most dangerous and critical exigencies, as well when the delivery is difficult in its own nature, as when it becomes so by the rashness or ignorance of unexperienc'd pretenders: recommended to all female practitioners in an art so important to the lives and well-being of the sex.'
According to another article written by the Science Museum the 'pretenders' she speaks of were men who claimed the credit when childbirth went well, but blamed women when things went wrong.
http://broughttolife.sciencemuseum.org.uk/broughttolife/themes/birthanddeath/childbirthandmedicine
Above: A caricature of a male midwife, 1793
Image courtesy of the Wellcome Library, London


In 1881 Zepherina Veitch and colleagues founded the Matron's Aid or Trained Midwives Registration Society, with the aim of regulating the profession and improving the status of midwives. Shortly afterwards it changed its name to the Midwives' Institute.
In the 1920s it produced its own advanced course for teachers.
In 1941 the institute became the College of Midwives, and received a Royal Charter in 1947.
https://www.rcm.org.uk/sites/default/files/History%20of%20the%20RCM.pdf

                                                                       Childbirth in the 20th Century

Births were usually at home (or sometimes in nursing homes) until the creation of the NHS in 1948.

Billie Hunter and Nicky Leap interviewed dozens of mothers and retired midwives about their experiences of childbirth from the 1910s to the 1950s. The result was The Midwife's Tale, an oral history from handywoman to professional midwife, published in 1993. Many midwives worked privately  - one, Mary W, delivered an average of 80 babies a year. In the 1930s Mary charged 30s (£1.50) per delivery, but during the Depression accepted payment by installments.
Quoted by
Dr Sara Read in an article, My Ancestor was a Midwife, in Who Do You Think You Are? June 2017
Above: A midwife starting on her rounds, 1949.
Image courtesy of the Wellcome Library, London
Between the late-1940s and mid-1960s roughly two-thirds of births in England and Wales took place in hospital and one-third at home.
Jennifer Worth's books, including Call the Midwife: a true story of the East End in the 1950s, were the basis for the television series of the same name. Jennifer worked for a scheme run by an Anglican nunnery, the Community of St John the Divine, which was set up in 1848; her books detail some of the challenges of working in an impoverished area.

http://www.historyandpolicy.org/policy-papers/papers/choice-policy-and-practice-in-maternity-care-since-1948

'When I was having my first two children, home confinements seemed so old-fashioned that I did not even consider the idea. By the time my third baby was due, however, nursing home accommodation had become more expensive than ever, and being an older and tireder mother I felt I simply could not face the rigours of a hospital ward. It seemed that the only way I could get a room of my own, and the peace I needed, was to have the baby at home - not in the old-fashioned way with a maid and a nurse, but in the modern way with a Home Help and a District Nurse - and a helpful husband...'
Article in the magazine Housewife, May 1950, p90


In 2015 the percentage of women giving birth at home was 2.3%.
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthcharacteristicsinenglandandwales/2015

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                                                                             Bedchamber Surgeries

'Up until the 19th century, it was very common for upper and middle class individuals to have surgical procedures done by private practitioners at their residences. In fact, it was overwhelmingly preferred...even though the hospitals had more skilled and experienced surgeons than private practices, due to their heavy case loads and wide range of medical knowledge.
Surgical procedures done at home were, on average, far more successful than those done in hospitals due to the high probability of infection. Additionally, surgery done at home was appealing because it included psychological and physical comfort.'
https://bhatmanjim.weebly.com/the-operating-room.html

                                                         19th Century Anaesthetics

"Before the 19th century operations were horrific procedures,and most patients died from post-operative shock, infection or loss of blood. In some London hospitals the death rate after operations was over 80%."
http://www.bbc.co.uk/schools/gcsebitesize/history/shp/modern/indrevsurgeryrev1.shtml

Until the mid 19th century surgery was both dangerous and painful, so major operations were not possible. Patients would be given a drug like opium, or surgeons would try to get them drunk before surgery.In 1799 Humphrey Davy discovered that laughing gas - nitrous oxide - could dull pain, almost most surgeons ignored his pamphlet brought out to promote the gas.
Ether was pioneered in the USA by Dr Crawford Long in 1842, and by the end of 1846 several successful operations in Britain had been performed using it, the first being performed by Sir Robert Liston.
Unfotunately, Ether did have its side effects - not only was it highly flammable but it could also cause coughing and vomiting in some patients.

Above: One of the first operations with the use of ether as an anaesthetic agent performed at the Massachussetts General Hospital. From a  daguerrotype reproduced in the Transactions of the American Surgical Association.
Image courtesy of the Wellcome Collection


In 1847 James Simpson, the Professor of Midwifery at Edinburgh University discovered chloroform, which was quicker acting than ether and didn't appear to have any side effects.

By November chloroform was being used in Derby, when dentist Mr Murphy received a bottle from London. Mr Murphy, with other 'medical gentlemen'  found that within minutes, or even seconds, a deep sleep was induced. 'Upon recovery, the patient exhibited none of the depressing effects so often the result of ether inhalation.'
Derby Mercury 24 November 1847, p2 col7


Left: An anaesthetic inhaler for chloroform, France, 1840 - 1860.
Image courtesy the Science Museum, London
Early operations (date span unknown) were opposed by some religious people. For example, they regarded it as God's intention for women to feel pain during childbirth (! A male view perhaps?)
Other people feared that doctors were not experienced in giving the required doses of anaesthesia. In fact a number of people did die from overdoses of ether and chloroform. Some also worried that they wouldn't know what the doctor was doing to them whilst they were unconscious.
However, little objection remained after Queen Victoria opted to have choloroform for the birth of her eighth and ninth children - Prince Leopold in 1853 and Princess Beatrice in 1857.

Chloroform remained the most popular anaesthetic until the 1900s when it was discovered that it could cause heart and liver damage. From then on, surgeons returned to using ether. Today surgeons use a complex mix of drugs administered by a qualified anaesthetist.
https://www.slideshare.net/wal147/anaesthetics-in-surgery-notes
 
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                                                                                       Mastectomy

The BMJ online states that: 'The rage for breast surgery attained manic proportions in the late 19th century in the United States and in Europe. But the trend was driven by surgeons, not women, and the results were far from aesthetic.'
http://www.bmj.com/content/344/bmj.e834

The first recorded attempt at a mastectomy is attributed to the surgeon Leonides of Alexandria in about the 2nd century AD but caution remained the watchword. By the 1600s prints in northern Europe showed women stoically undergoing surgery.
In 1882 William Stewart Halsted, a 30 year old American surgeon, introduced a radical mastectomy which proved to be a milestone in the development of the treatment of breast cancer.
Mukherjee, Siddhartha, The Emperor of All Maladies: a Biography of Cancer, Simon and Schuster, 2010, p23
Rankin J., William Stewart Halsted: a lecture by Dr Peter D. Olch. Ann Surg. 2006; 243(3): 418-25, quoted in http://www.amsj.org/archives/3019

For Sarah Morley (below) , the surgery must have been carried out by a surgeon with skills likely to have been ahead of their day in London in the year 1886.

                                                                                       
                                                                      The Story of Sarah Morley

In 1886, Sarah underwent a mastectomy on the dining table of her London home. It is not known why this was performed at home, nor whether it was carried out by a member of the family such as by either of her two medical sons.
Alfred and Sarah had ten children, all of whom survived to maturity.
Above: The Fletcher family, circa 1895
Vanessa Griffith collection
Above: Sarah Morley, 1836 - 1926
Vanessa Griffith collection
                                                                                          
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                                                                               Military Hospitals
Above: 'When I Join the Ranks - What to do and how to do it'
Stephen Isitt collection
During WW1 a booklet, 'When I join the ranks', was produced for new recruits to the Army. Covering topics such as 'The first day', 'Where I shall live', 'How I shall be paid, fed, clothed and equipped', it also had a section on hospitals.
'The Major' had this to say: 'The greatest care is taken in the Army to keep the soldier in good health, but when he does fall sick he receives, perhaps, even greater care than he would in civilian life, and the modern military hospitals are magnificently conducted institutions, and unwilling as Mr Thomas Atkins* is to enter them, once he has got there he is very often loath to come out. The nurses of Queen Alexandra's Imperial Military Nursing Service, with their gray cloaks and scarlet facings, are a familiar figure in every garrison town. These ladies, after passing a course of hospital nursing, are admitted into the Army, and there have to undergo another probationary period. At the present time their work is being largely supplemented by the work of the various voluntary aid detachments, composed of ladies who are giving up their time to nursing the wounded soldier.


Sick parade in the Army is held early each morning, when those who are able are marched under the orderly-corporal to the doctor, and are marked according to their ailments or non-ailments as (1) duty, (2) light duty, (3) no duty, (4) hospital.
An important part of the training of a soldier is sanitation and the prevention of disease, and this is a subject on which he is being constantly lectured by the R.A.M.C. officers. It must be remembered that the sick soldier is not only of no use to the country, but he is also what is known as "a useless mouth" and consequently it is up to him to keep himself as fit as he possibly can.'
When I Join the Ranks, The Major, London, Aldershot and Portsmouth, 1916, p27,28
* Thomas, or Tommy Atkins, is a slang name for a British soldier. Various accounts for its origin are given.
Above right: A Sister of Queen Alexandra’s Imperial Military Nursing Service and a Matron of the Territorial Nursing Service.
This image is from The First World War Poetry Digital Archive, University of Oxford (www.oucs.ox.ac.uk/ww1lit); © The Imperial War Museum


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                                                                    Smoking
A 1931 advertisement for Camels cigarettes.
Image courtesy
bbc.co.uk – © copyright 2015 BBC

                                                                A Brief 20th and 21st Century Timeline

Children's Act 1908. No-one under the age of 16 could be sold tobacco.

https://www.doctorfox.co.uk/news/the-history-of-cigarette-advertising-in-the-uk/

WWI Tobacco was included in army rations
ibid

Above: Princess Mary's 1914 Christmas gift
Image courtesy http://gallery.nen.gov.uk/gallery0-.html
In November 1914 Princess Mary created a fund to provide a 'gift from the nation' for those serving overseas, the wounded at home, nurses, and the widows or parents of those killed. An embossed brass box, 5" x 3¼", and 1¼" deep was sent, containing a variety of items, depending on the recipient. Servicemen at the front or at sea recieved a pipe, an ounce of tobacco, a packet of 20 cigarettes and a tinder lighter. There were different contents for non-smokers, Indian troops, nurses and servicemen not in the first category.

https://www.yorkcastlemuseum.org.uk/collections/collections-highlights/princess-marys-1914-christmas-gift/


1950 Richard Doll published research in the British Medical Journal linking smoking and lung cancer
Doll, R.; Hill, A. B. (1 September 1950). "Smoking and Carcinoma of the Lung". British Medical Journal.

Above: A page from the British Medical Journal, May 1952. Promotion for a weaning food is alongside an advertisment for Player's No. 3 cigarettes.
Vanessa Griffith collection

1954 The British Doctors' Study, studying 40,000 doctors over a two and a half year period, confirmed the link
Doll, R.; Hill, B. (Jun 2004). "The mortality of doctors in relation to their smoking habits: a preliminary report: (Reprinted from Br Med J 1954:ii;1451-5)

Sweet cigarettes - candy sticks with a red tip - were widely available in the mid 20th century. They can still be bought today (a conversation about their desirability appeared on https://www.mumsnet.com in 2009) although they are banned in some countries

Right:
Sweet cigarettes came in all sorts of packaging in the mid 20th century.

Image courtesy bbc.co.uk – © copyright 2018 BBC
                                                         
1964 US Surgeon General Luther Terry announced at a news conference that smoking caused lung cancer. The report was released on a Saturday because of concern over the effect on tobacco industry stocks.
https://www.popsci.com/article/science/100-years-smoking-studies-popular-science

1st August 1965 UK. All television advertisements for cigarettes were banned
https://www.doctorfox.co.uk/news/the-history-of-cigarette-advertising-in-the-uk/

1971
“WARNING by H.M. Government, SMOKING CAN DAMAGE YOUR HEALTH” added to cigarette packets
ibid

2005 The Hungarian Grand Prix was the last race in an EU country to feature tobacco advertising
http://news.bbc.co.uk/1/hi/uk/4732047.stm

1st July 2007 UK. It became illegal to smoke in public places such as restaurants and shopping centres.

https://www.doctorfox.co.uk/news/the-history-of-cigarette-advertising-in-the-uk/

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                                                              Mental Illness

                                                                            The Bethlehem Hospital

Above: The hospital at Bethlem, 1817
Image courtesy the Wellcome Trust at https://wellcomecollection.org
                                                           
In the 13th century Simon Fitzmary donated an area of land in the Bishopsgate ward of the City of London to found a charitable hospital.
The Priory of St Mary of Bethlehem was built on the land in 1247, with the purpose of healing poor people who were sick. It became known as Bethlehem Hospital, often abbreviated to Bethlem or Bedlam: the site of the single storey building is now covered by Liverpool Street Station.

https://historicengland.org.uk/research/inclusive-heritage/disability-history/1050-1485/from-bethlehem-to-bedlam/

There are various documents concerning the hospital in the National Archives. They include one from 1279 which describes the jurisdiction of the Dean and Chapter (of St. Paul's Cathedral ?) over various properties, including the St Mary of Bethlehem Hospital, 'novus hospitalis extra Bissopesgate.'

Ref
CCA-DCc-ChAnt/L/77, http://discovery.nationalarchives.gov.uk

At some stage the hospital began concentrating on patients who exhibited the symptoms of mental illness rather than physical disease, and these 'lunatic' patients were in the majority by 1403. This term covered not only those with mental illness, but also those suffering from dementia, epilepsy, or who had learning disabilities.

https://historicengland.org.uk/research/inclusive-heritage/disability-history/1050-1485/from-bethlehem-to-bedlam/

Circa 1538-1544 there was a case involving Peter Mewtis, master of Bethlehem Hospital, London, (the plaintiff) and William Kyngstone of Foleshill, (the defendant) over the embezzlement of money collected for the inmates of the hospital.

ref
C 1/1033/23-24, http://discovery.nationalarchives.gov.uk

'Bedlam Hospital' London is the subject of another legal case 1558-1579
Ref
C 3/42/81, http://discovery.nationalarchives.gov.uk

In 1676 the hospital moved to Moorfields in the City of London.

https://historicengland.org.uk/research/inclusive-heritage/disability-history/1050-1485/from-bethlehem-to-bedlam/

1694 Alexander Hosea left part of his estate to St Bartholomew's Hospital, the lunatics at Bethlehem, and the poor of the Weavers' Company.
Ref
ADM 106/445/16, http://discovery.nationalarchives.gov.uk

'In 1728, the election of Doctor James Monro as physician saw the inception of a 125-year rule by the Monro family which controlled the asylum for four generations of fathers and sons'.

https://blog.findmypast.com/the-masters-of-madness-how-the-monro-family-ruled-bedlam-1406117236.html

The Monros, hugely influential and consulted by the upper echelons of society, (two were asked for their opinion on King George III's illness) were refined patrons of the arts. 'Yet their management was marked by treatment regimens which were regarded as outmoded and barbaric even by the standards of the day.'
The Monro dynasty and their treatment of madness in London, I. Macintyre, A. Munro,

Neurosciences and History 2015; 3(3): 116-124

Treatments included bloodletting, purging, vomiting and bathing. Chains and manacles were used for restraint, 20 years after their use had ceased in Paris, and the public were allowed inside to watch the inmates' behaviour.

ibid p 121ff

Visitors had to pay a penny each to view the inmates - it was free on the first Tuesday of the month.
96,000 visitors were recorded in 1814.
https://www.princeton.edu/~graphicarts/2010/01/an_insane_american.html



Left:
Etching by George Cruikshank, after a sketch by George Arnald. 'William [James] Norris: An insane American. Rivetted alive in iron & for Many Years Confined, in that State, by Chains 12 Inches Long to an Upright Massive Bar in a cell in Bethlem.'

Quaker Edward Wakefield gave evidence at an enquiry into conditions at Bedlam in 1814. He testified that William (or James) Norris, an American, had been chained to his bed for 12 years.
https://cambridgelibrarycollection.wordpress.com/2014/05/15/the-restraint-of-the-insane/
Image courtesy the Wellcome Trust at https://wellcomecollection.org


1815 The report of the Commons Committee into Madhouses in England can be read at https://archive.org/stream/b21291792#page/n1/mode/2up

In 1851 the Lunacy Commissioners were allowed in to inspect Bethlem, and their critical report resulted in the dismissal of Edward Thomas Monro, the current physician.

A report of the interrogation of Dr Monro can be found in The London Daily News, 10 November 1852, p2 col 1-4


                                                                             Health and Nutrition

How healthy was the Workhouse diet?
See https://www.youtube.com/watch?v=S7JOAtF9CIg, a video made by the British Medical Journal.
Mentioned in the video is a Treatise on Food and Diet by Jonathan Pereira, London 1843. 'An account of the dietaries for some of the principal metropolitan and other establishments for paupers, lunatics, criminals, children, the sick etc.'
It can be accessed here: https://books.google.co.uk/books?id=bn4EAAAAQAAJ&printsec=frontcover&dq=Pereira+Food+and+diet&hl=en&sa=X&ved=0ahUKEwjU-Irt6M3ZAhWSa8AKHcZnBbkQ6AEIJzAA#v=onepage&q=Pereira%20Food%20and%20diet&f=false

                                                                                    Invalid cookery

'Much greater variety is permitted nowadays in invalid dietary than used to be the case when beef tea and chicken broth were the nurse's main standby. Fresh foods containing vitamins are of much more value in building up strength ...than foods which have lost all their "goodness" through long cooking.'
Cookery Illustrated and Household Management,  Elizabeth Craig (ed), 1936, p549

Some recipes we would recognize today: chicken soup, scrambled egg, grilled chops. Others have disappeared.

Gruel
Mix a dessertspoonful of patent groats or fine oatmeal with a little cold milk. Pour on half a pint of boiling milk, then put it into the saucepan and boil for 10 minutes, stirring well. Add sugar or salt as may be preferred, and, if needed, a tablespoon of brandy can be mixed in.
ibid, p559

Lamb's head broth.
1 lamb's head
1 oz rice or pearl barley
1 carrot
1 onion
1 turnip
1 teaspoonful parsley
3 pints cold water
Have the head chopped in half, then tie it together with tape. Put it into a saucepan with the water and half a teaspoon of salt. Bring to the boil, remove the scum, then add the vegetables cut into small dice, and the rice or barley. Simmer for about 3 hours,then lift out the head, skim well, pour the broth on to a teaspoonful of chopped parsley, and serve.
ibid, p563

Boiled lettuce.
[Directions pretty much as you would expect]
ibid, p576

                                                                                                 ***

                                                                    Diabetes

c 1550BCE. An Egyptian manuscript, the Ebers papyrus, mentions 'too great emptying of the urine'.
Leonid Poretsky, ed, Principles of diabetes mellitus, 2nd ed, New York, 2009, p3

See:  https://bxscience.edu/ourpages/auto/2008/11/10/43216077/egypt%20medicine.pdf

for possible sections of the papyrus to do with Diabetes Mellitus
- Accessed 30-03-2018

Left:
the Ebers Papyrus
By PEbers_c41.jpg: Einsamer Schützederivative work: Photohound (talk) - This file was derived fromPEbers c41.jpg:, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18511551


At about the same date Indian physicians classified the disease as madhumeha or honey urine, noting that ants were attracted to the urine of these patients.
Leonid Poretsky, ed, Principles of diabetes mellitus, 2nd ed, New York, 2009, p3

Image from WikiClipArt

The Persian philosopher Avicenna (980 -1037) describes diabetes mellitus in his Canon of Medicine, 1025. The symptoms include sweet urine,
abnormal appetite, diabetic gangrene and sexual dysfunction.
https://www.diabetes.co.uk/diabetes-history.html - Accessed 25-03-2018

'The odour may be fruity, or like newmown hay'
The Canon of Medicine of Avicenna, AMS reprint from 1930 edition, New York, 1973, p338

The full text of Avicenna's Canon of Medicine can be accessed here: https://archive.org/stream/AvicennasCanonOfMedicine/9670940-Canon-of-Medicine_djvu.txt
- Accessed 25-03-2018

                                       Uroscopy

Medieval medicine put a lot of reliance on uroscopy - examining the colour and odour of urine, together with any sediment. This came from a 'not unreasonable assumption that what came out of the body reflected what was happening within...'
The Henry Daniel Project, http://henrydaniel.utoronto.ca/urines/uroscopy/
- Accessed 25-03-2018



Right:
De Piskijker by Jan Steen
 [Public domain], via Wikimedia Commons

Left:
Attacks such as this one, by Thomas Brian, led to the decline of uroscopy after the 17th century.

'The irony was that, in the case of diabetes, the pisse-prophets may have had a point: the answer did lie in the urine.'
http://blog.wellcomelibrary.org/2013/11/diagnosing-diabetes-a-wee-taste-of-honey/
Thanks to the Wellcome library for this image


Some doctors went further that examining the appearance and smell of urine - they tasted it.
In the 1700s Matthew Dobson identified that the sweet taste indicated excess sugar in the urine and blood. He also noticed that some patients died rapidly, whilst others lived much longer - this observation led to the distinction between types 1 and 2 diabetes.

https://www.diabetes.co.uk/diabetes-history.html - Accessed 25-03-2018

In the 1800s a French physician, Apollinaire Bouchardat, was amongst the first to suggest that the pancreas had a role in diabetes. He noticed that restricted calories helped his diabetic patients, and encouraged them to decrease starchy foods and sugar, and to exercise. He also advocated  patients monitoring for themselves the levels of  glucose in their urine.
https://www.diabetes.co.uk/pioneers/apollinaire-bouchardat.html

Restricting the carbohydrate intake of patients became a treatment for diabetes - the only one known - with the diets sometimes so extreme that patients died of starvation.
https://www.diabetes.co.uk/diabetes-history.html
http://diabetesstopshere.org/2012/08/21/the-history-of-a-wonderful-thing-we-call-insulin/

See: Lewis Webb Hill and Rena S Eckamn, The Starvation Treatment of Diabetes, Boston, Mass., 1916. Available through Project Gutenberg eBooks at https://www.gutenberg.org/files/26058/26058-h/26058-h.htm - Accessed 31-03-2018

In 1869 German medical student Paul Langerhans discovered that there were clusters of cells in the pancreas.

https://beyondtype1.org/brief-history-insulin/ - Accessed 29-03-2018

In 1889 dogs had their pancreases removed in experiments studying digestion. It was discovered that these dogs developed the symptoms of diabetes.
https://www.diapedia.org/management/8104098119/a-short-history-of-insulin

1895 Edward Shafer (later Sir Edward Sharpey-Shafer) suggested that a pancreatic substance controlled glucose; he thought that the substance originated in the cells discovered by Langerhan. He was one of the early adopters of the term  'insuline' for the hormone.
https://www.diapedia.org/introduction-to-diabetes-mellitus/1104098115/edward-sharpey-schafer-1850-1935#fnref:8

In the 1920s Canadians Frederick Banting and assistant Charles Best wanted to test the hypothesis that if insulin could be extracted and isolated, it could be used to treat diabetes.
They devised experiments showing that transferring material from dogs with healthy pancreases to dogs without pancreases decreased the high sugar levels.

https://www.diabetes.co.uk/diabetes-history.html - Accessed 25-03-2018
https://beyondtype1.org/brief-history-insulin/ - Accessed 29-03-2018
Above: Leonard Thompson, before and after treatment.
© 2004 Wijeya Newspapers Ltd.


The researchers were keen to try this substance - insulin - on a human being.
Leonard Thompson, aged 14 and a diabetic for three years, was admited to Toronto General Hospital in 1921. Weighing 65 pounds and in danger of slipping into a diabetic coma, he was close to death.
Leonard's father allowed the hospital to administer pancreatic extract to his son, and in January 1922 Leonard became the first person to receive insulin injections.



The impurity of the insulin caused an allergic reaction, but James Collip had developed a purer form, and when this was tried Leonard's symptoms began to improve, with his blood sugar levels returning to normal.
https://www.diabetes.co.uk/diabetes-history.html - Accessed 25-03-2018
http://broughttolife.sciencemuseum.org.uk/broughttolife/people/leonardthompson - Accessed 31-03-2018


'With the relief of the symptoms of his disease, and with the increased strength and vigor resulting from the increased diet, the pessimistic, melancholy diabetic becomes optimistic and cheerful. Insulin is not a cure for diabetes; it is a treatment.'
Dr (later Sir) Frederick Banting, Nobel Prize Lecture 1923

'Banting and Best did not seek a patent for their discovery, instead selling the rights to the University of Toronto for $1, as a means of ensuring that insulin could be available to all those who needed it.'

http://banting.fellowships-bourses.gc.ca/en/about-a_propos_banting.html

Leonard's patient records are held in Toronto General Hospital - one page of them can be seen here: https://insulin.library.utoronto.ca/islandora/object/insulin%3AM10015

In 1923 Eli Lilly and Company began to mass produce insulin from the pancreases of pigs and cows.

Up until this time patients diagnosed with diabetes might live only weeks or months - a year if they were lucky.
Leonard lived until he was 27.
https://beyondtype1.org/brief-history-insulin/ - Accessed 29-03-2018

'A relative was a volunteer in a camp for diabetics and became engaged to someone she had met there. My grandmother and mother were both horrified, since they were sure he had a very low life expectancy. This was the 1970s! I pointed out that this was no longer the case, but their information and presumably experience came from the days when diabetes was a death sentence for a child.'
Barbara Rowland

                                                                                                              ***

                                                                    Smallpox

Smallpox is caused by the variola virus, and has existed for at least 300o years. There is no cure, but vaccination is very effective if conducted early enough.
http://www.who.int/csr/disease/smallpox/faq/en/

It is spread by contact with an infected person, via respiratory droplets or the sores that appear on the body. Contaminated bedding or clothing can also spread the virus.
https://www.historyofvaccines.org/content/articles/history-smallpox

'Smallpox was probably the single most lethal disease of eighteenth century Britain.'
Davenport, Newton, Satchell, Shaw-Taylor, Smallpox transmission and control in Britain before vaccination,  https://www.geog.cam.ac.uk/research/projects/migrationmortalitymedicalisation/pdf4.pdf

Variolation - introducing material from smallpox pustules into scratches in the skin, resulted in people contracting  a milder form of the disease with a lower fatality rate. However, people who had been so treated could still pass on not only smallpox, but other diseases such as hepatitis and syphilis.
https://www.sciencedirect.com/topics/immunology-and-microbiology/variolation


A Gloucestershire doctor, Edward Jenner, was intrigued by the idea, current in the countryside, that people who caught cowpox - a mild viral infection that originated in cows but could transfer to humans - did not catch smallpox.
In 1796 he diagnosed cowpox in a dairymaid, Sarah Nelmes, and decided to test if the disease could protect another person from smallpox. James Phipps, the eight year old son of his gardener, became his guinea-pig. Material from Sarah's pustules was rubbed into scratches on James' arm: he became mildly ill but had recovered a week later. A few weeks later Jenner variolated James with smallpox material  - he did not develop the disease.
This was the first of many experiments.
Above: Edward Jenner's lancets, London. Although mainly used for bloodletting, they could also have been used for vaccinating.
Image courtesy the Science Museum and the Wellcome Trust


In 1798 he published his research in a book, An Enquiry into the Causes and Effects of the Variolae Vaccinae; a Disease Discovered in some of the Western Counties of England, particularly Gloucestshire, and Known by the Name of the Cow Pox.
The technique of introducing material under the skin became known as vaccination, derived from vacca, the Latin for cow.
http://www.jenner.ac.uk/edward-jenner

Above: Benjamin Jesty's memorial at Worth Matravers Church, Dorset.
http://www.wikiwand.com/en/Worth_Matravers, credit Charlesdrakew

Although Jenner's research became famous, credit should also be given to Benjamin Jesty, who also noticed that those who had been infected with coxpox seemed immune to smallpox. In 1774, twenty-two years before Jenner's experiments, he transferred coxpox material to his wife and two young sons - using his wife's knitting needle - and none of them caught smallpox, even though the sons were exposed to the disease on several occasions.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2279376/pdf/tacca00099-0087.pdf

Cardiff 1962. 'My dad worked long and unsociable hours, so it was a complete surprise to come home from school one day and find him there. We all bundled into the car and went straight to a local GP's practice. Dad had pulled strings to get the three of us inoculated against smallpox, because an epidemic was spreading rapidly from the docks through the city.'
Frances Berry

In 1962 there were smallpox outbreaks in Britain, particularly in Wales. The following website documents the story, and records people's memories of the outbreak: https://smallpox1962.wordpress.com/

This website is a personal account for the Bradford area, told by a pathologist:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079469/

Mr Arthur Tiley, Bradford West, made a statement to the House of Commons in February. His analysis of the epidemic included the effects on trade in the city:
'Our main hospitals were closed. Our shops were empty. The large stores tell me that their turnovers dropped by 50 per cent. The cafes had no business. The cinemas closed and our famous Bradford pantomime is coming to an end a month before it should....Our trade was injured. We have this world famous textile export trade, and people abroad, and especially in Italy, were refusing to receive our goods because of this epidemic. Bradford is famous, too, for its mail-order businesses, but catalogues were being refused.'
Hansard 15 February 1962 vol 653 cc1655-66

In December 1979, smallpox was officially certified as eradicated throughout the world.
http://www.who.int/csr/disease/smallpox/faq/en/

                                                                                                               ***

                                                             Spanish Influenza

                                                                                     I had a little bird,
                                                                                   Its name was Enza,
                                                                                 I opened the window,
                                                                                      And in-flu-enza
Children's rhyme, 1918

'Paris, Sunday. For some time past Spanish Influenza has been reported. This is ordinary influenza, but has spread with the rapidity of an epidemic. Dr. Legroux...."It is not a serious malady. It began at the front early in May, From Dunkirk to the Vosges most of the soldiers were attacked by it, and the Germans were not immune.
It is very infectious. The infection spread to Paris, then to Spain. The Spaniards made a great fuss about it. But for that it would not be noticed today." '
The Scotsman, 24 June 1918, p3, col7

The influenza pandemic of 1918 and 1919 killed more people - between 20 and 40 million* - than had died in WWI. A fifth of the world's population was affected, and, unusually,  20 - 40 year olds as much at risk as more vulnerable age groups.
*Estimates vary
https://virus.stanford.edu/uda/

Called Spanish flu (although the first recorded cases were in the United States), the pandemic was caused by an influenza A virus, H1N1. Symptoms included feverishness and shortness of breath, haemorrhaging resulting in nose-bleeds and blood-filled lungs, and vomiting. The disease developed at an unprecedented speed within individuals, and there were many stories of people dying within hours.
In places so many people died that mass graves had to be dug to accommodate the dead.
https://www.nationalgeographic.com/archaeology-and-history/magazine/2018/03-04/history-spanish-flu-pandemic/

Above: Advice from the Illustrated Current News, New Haven, Conn.
Image courtesy of the US National Library of Medicine

                                           More advice on avoiding influenza, and caring for those who have it
Householders:
Keep out of the sick room unless attendance is necessary
Do not handle articles coming from the sick room until they are boiled
Allow no visitors, and do not go visiting
Call a doctor for all inmates who show signs of beginning sickness
The usual symptoms are: inflamed and watery eyes, discharging nose, backache, headache, muscular pain, and fever
Keep away from crowded places, such as "movies", theatres, streetcars
See to it that your children are kept warm and dry, both night and day
Have sufficient fire in your home to disperse the dampness
Open your windows at night. If cool weather prevails, add extra bed clothing

Poster Indiana State Board of Health https://eu.indystar.com/story/news/history/retroindy/2018/01/31/retroindy-1918-spanish-influenza-swift-and-deadly/1075458001/

Image courtesy of the National Museum of Health and Medicine
Four year old José Ameal had the curtains closed beside his bed, 'So I wouldn't see the funeral processions.'
http://www.bbc.co.uk/news/world-europe-43866250

'People were dying so fast in our parish...they could not bury them fast enough.'
http://edition.cnn.com/2009/HEALTH/05/04/flu.antibodies/index.html

Other stories from the pandemic can be found here:
https://nzhistory.govt.nz/media/sound/one-familys-story-1918-flu-pandemic (New Zealand)
http://www.rtdouse.com/SpanishInfluenza.html (US)
http://www.rense.com/general85/span.htm (Canada)