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The Editor’s Eye

December 5, 2014

Final issue: focusing on the stories of the medical humanities – by Elizabeth T Hurren

The stonemason discovered the vermilion carving when cleaning the back wall of my cottage for repointing this summer:

Sharp frost

May 29th 1914 

Still, in a building dated 1654 it was a surprise to find a weather report carved just before the eve of World War I. Lime plaster has to be frost-free when repairing stonework, so the young mason must have been anxious about the inclement ground frost as war threatened on the village horizon in the summer 1914. In a hurry perhaps to get the delayed job done, soon he – and all the young men in Rutland, the smallest county in England – would be packing up for France. It was touching to feel the carving with my fingers, to reconnect to village tradesmen who became unknown soldiers in 1914 on the Western Front.

Royal Army Medical Corps stretcher-bearers lifting a wounded man out of a trench. By Gilbert Rogers. Wellcome Images

Royal Army Medical Corps stretcher-bearers lifting a wounded man out of a trench. By Gilbert Rogers. Wellcome Images

This 2014 winter issue of Wellcome History features those that should never be forgotten in this World War I centenary year. It touches on themes often associated with wartime medicine: plastic surgery, mental ill-health, suicidal tendencies, force-feeding of conscious objectors, and those dislocated across the British Empire.

This is also the final issue of Wellcome History. In future, the Wellcome Trust will be sharing research in the medical humanities online, to make faster connections across the world in a digital age. Would Henry Wellcome like the e-revamp? Well, he always had a pioneering spirit and was a supreme self-publicist, so it seems very likely that, as a business entrepreneur with a passion for medical history, Henry would have been at the forefront of using the web to engaging the public wherever he could. I hope therefore that contributors will continue to uphold his pioneering spirit by sending in new ideas and ways of thinking to meet whatever human challenges the future of medicine and science holds.

In 2014 the Trust launched Mosaic, publishing weekly stories on any aspect of biology, medicine, public health, history or ethics that in some way touches on human or animal health, or the human condition. Articles with a historical aspect so far have included Hungary’s struggle with polio in the Cold War, Alan Turing’s contribution to developmental biology, and the many decades of efforts to understand blood groups, Alzheimer’s disease and the dangers of asbestos. The editorial team is always looking for new contributions (find out how to contribute).

Meanwhile, the Wellcome Trust blog features news about work the Trust supports, in the medical humanities and public engagement as well as in science, and the Wellcome Library blog showcases historical research activities and resources.

As the closing editor of this final printed issue, I would like to thank everyone who has contacted me from around the world. It has been a privilege to engage with your cutting-edge research, and I shall continue to follow debates and discussions online as our future innovations give voice to the medical humanities of Henry Wellcome’s extraordinary legacy.

My kindest regards,

Elizabeth Hurren

Dr Elizabeth Hurren is Reader in Medical Humanities, University of Leicester (eh140@le.ac.uk).

Beautifully hideous

December 4, 2014

Pioneering plastic surgery in World War I – by Jennifer Summers and Max Browne

A man's face repaired using a Gillies pedicle tube. From Gillies’s Plastic Surgery of the Face, 1920. archive.org

A man’s face repaired using a Gillies pedicle tube. From Gillies’s Plastic Surgery of the Face, 1920. archive.org

The sight of “men burned and maimed to the condition of animals” returning from the trenches motivated a visionary volunteer surgeon, Harold Delf Gillies (1882–1960), to transform the field of maxillofacial reconstructive surgery. The techniques Gillies employed, such as the ‘tubed pedicle’, are the first pioneering examples of modern plastic surgery from World War I.

Facial and head injuries were common in the trenches. Around 15 per cent of those who survived and were evacuated back to Britain for treatment had some form of facial trauma. The typical Tommies’ training did not prepare them, either physically or psychologically, for the horrific conditions of the trenches or the aftermath. An American surgeon in France, Dr Fred Albee, noted that the soldiers “seemed to think they could pop their heads up over a trench and move quickly enough to dodge the hail of bullets”. Read more…

Norfolk in World War I

December 4, 2014

Celebrating the workhouse war effort – by Stephen Pope


Civil servants responsible for the UK’s public health provision at the start of World War I coordinated a huge logistical task. They offered to work with the Ministry of Defence to find accommodation to house and train all the new army recruits required to fight a major land war against Germany in Europe. Their inspired solution was to ask the Local Government Board in London to make available any spare workhouse capacity that it had in towns, cities and rural areas like Norfolk. The granting of Old Age Pensions to those over 70 years of age in 1908 meant that by 1914 many of the elderly could afford to live at home. Fewer people in the workhouse created spare capacity that could be used for the war effort. This ensured that medical and healthcare provision for recruits could be managed in practical terms, and it secured the humane treatment of prisoners of war too.

Postcard photograph of Aylsham Workhouse, Norfolk, in World War I. Author’s personal collection

Postcard photograph of Aylsham Workhouse, Norfolk, in World War I. Author’s personal collection

From the start of the war the Local Government Board supported the military by sending out circulars urging workhouse guardians to make arrangements to admit troops into public buildings. Some 20,000 troops were in training camps in Norfolk by the end of 1914, ensuring that local guardians felt obligated to assist. At first, most were accommodated in tents. As winter approached, wooden huts were being built, but the military realised that workhouses could provide weather-proof accommodation for the troops.  Read more…

In Flanders fields

December 3, 2014

Casualties of war at Essex Farm, near Ypres – by Jonathan Swan

In early 1917, the British Army front line ran in a rough semi-circle about two to three miles around the east of the town of Ypres in Belgium. On the night of 9 April the men of C Company of the 15th Battalion of the Royal Welsh Fusiliers were struggling to keep warm in their trenches to the north of the town. There had been sporadic artillery and machine-gun fire all day, and a gas alert or two, but nothing out of the ordinary. Then, at about 11.30pm, the Germans fired a salvo of rifle grenades at trench post 9, and five men were wounded. Their next destination, Essex Farm Advanced Dressing Station (ADS), was an important part of a medical evacuation chain that is today little appreciated.

An advance dressing station, WWI. By Ugo Matania. Wellcome Images

An advance dressing station, WWI. By Ugo Matania. Wellcome Images

During the early hours of 10 April, even as a counter-barrage was being called down, stretcher-bearers collected the casualties and took them back through the maze of trenches to an aid post about 800 yards away, near the battalion headquarters. From there they were taken to Essex Farm, another 1,500 yards away across the Yser canal. This is where they had their wounds initially dressed. It was the sort of place where so many injured men waited until they could be evacuated further back from the front line to safety and medical treatment. Essex Farm still stands today and is one of the most visited – but most poorly understood – battle sites in Belgium. For many it is closely associated with John McCrae’s poem ‘In Flanders Fields’, the lines of which are on a bronze plate at the top of the path down to the bunker. Visitors peer into the gloom of the seven chambers inside the low ADS concrete structure, but it is hard to imagine the scenes of wounded soldiers and their medical experiences.  Read more…

The near-death of the novelist

December 2, 2014

Virginia Woolf’s Veronal overdose, 1913 – by Ian Franklin

Two men rushed out of a front door and hailed a taxi outside 38 Brunswick Square in Bloomsbury, central London, on 9 September 1913. They were on a medical emergency. It was essential to collect and return with a stomach pump from St Bartholomew’s Hospital about half a mile away. Their patient, Virginia Woolf, was at death’s door. She was not yet the famous novelist, but this was her first serious suicide attempt and it required an urgent medical intervention.

Virginia Woolf, age 20. Wikimedia

Virginia Woolf, age 20. Wikimedia

Dr Geoffrey Keynes, house surgeon at St Bartholomew’s, accompanied Leonard Woolf, Virginia’s distraught husband. Virginia was a gifted individual who had only started her writing career, completing but not yet publishing The Voyage Out. Already, though, she was disturbed by mood swings that sometimes felt overwhelming; on this particular night, she needed urgent professional help to prevent the risk of a fatal outcome. Had she not received it, the rest of her famous novels might never have been written. In later life, Keynes liked to think that he had saved her future masterpieces for posterity. Sadly, these mental ill-health episodes would continue, culminating in her death by suicide during World War II. Virginia’s medical case notes illuminate how well strong barbiturates were understood on the eve of World War I, before the mental traumas of the trenches.  Read more…

Force-feeding and medical ethics

December 2, 2014

Prison medicine’s roles in therapy and discipline, 1909–80 – by Ian Miller

Mural of Bobby Sands – IRA prisoner and hunger striker – on Falls Road, Belfast. PPCC Antifa on Flickr

Mural of Bobby Sands – IRA prisoner and hunger striker – on Falls Road, Belfast. PPCC Antifa on Flickr

Should hunger strikers be force-fed? How should prison doctors care for starving prisoners? And in what ways does hunger striking impact upon prison medical activity? Medical professionals first posed these ethically driven questions in 1909 when prison doctors began to force-feed imprisoned suffragettes in Winson Street Gaol, Birmingham. Throughout the 20th century, the medical-ethical dimensions of hunger-strike management continued to pose problems when Irish republicans, World War I conscientious objectors, IRA members and other prisoner groups staged protests involving food refusal. More recently, the force-feeding of detainees in Guantánamo Bay and African-American prisoners in California has brought the issue once again to the fore of international public debate. Read more…

Hopes, fears and frustrated dreams

December 1, 2014

Infertility in early modern England – by Jennifer Evans

A physician examining urine brought by a woman. Wellcome Images

A physician examining urine brought by a woman. Wellcome Images

IVF has helped many infertile couples have children since 1978. Yet, as the historian Professor Lisa Jardine recently highlighted, people seldom talk about the times when IVF treatments fail. Soon after her public statement, BBC Magazine published an article entitled ‘I wish IVF had never been invented’, which featured testimonies of people who had struggled with infertility and IVF treatments. These testimonies showed people’s hopes, fears and frustrated dreams of fertility: some spoke of being given nothing but false hope, others spoke of their devastation when the treatment failed. Several spoke of the sense of being in a raffle with no sense of how many times they should buy a ticket. This frustration was echoed by those who lamented the ‘postcode lottery’ system that means couples in one NHS area may get treatment for free, while others nearby have to pay. The search for treatments and the feelings of helplessness and frustration experienced by these couples is part of a long history of fertility medicine, and we can see that early modern men and women expressed the very same hopes and fears. Read more…

Dysfunctional diasporas?

November 30, 2014

Migration and mental illness – by Marjory Harper

Migrants about to set sail, saying goodbye at the Glasgow docks. After Henry O’Neil, 1891. Wellcome Images

Migrants about to set sail, saying goodbye at the Glasgow docks. After Henry O’Neil, 1891. Wellcome Images

When 31-year-old Malcolm was admitted to the Royal Asylum at Gartnavel in Glasgow in October 1859, on the petition of his mother, his previous occupations were listed as “seaman, gold-digger, merchant, and clerk”. At the time of admission he was declared to be “of unsound mind, and suffering under a severe attack of brain disorder” which manifested itself in incoherence and delusions. He was, moreover, the asylum register warned, “very dangerous”. Eight months later, however, Malcolm was discharged, “recovered”, and left almost immediately for Australia, “with the intent of advancing himself in life, but without any settled plan”. It was not his first experience overseas: during an earlier sojourn in America he had first received private psychiatric treatment, before returning to Glasgow to the care of his family and subsequently the custody of the Royal Asylum. Shortly after arriving in Melbourne in 1860, Malcolm corresponded briefly with his brother, a bush missionary, and the two arranged to meet. That rendezvous did not take place, and Malcolm was never heard of again. Read more…

What’s in a name?

November 28, 2014

Shifting local definitions of epilepsy and its care, 1870–1913 – by Rebecca Wynter

Imagine, if you will, a time 
when Britain was reeling from international economic changes; when charity and welfare were struggling with rising numbers of 
poor and unemployed; when voices openly demanded the separation of
 the deserving from the undeserving; when tensions arose from defining disabled people as a financial burden and as capable; when the very boundaries of disability were being redrawn. The time in question was between around 1870 and 1913.

The National Hospital for the Paralysed and Epileptic, Queen Square, Holborn. After J W Simpson, 1884. Wellcome Library

The National Hospital for the Paralysed and Epileptic, Queen Square, Holborn. After J W Simpson, 1884. Wellcome Library

What happened then helped form
 a public language to describe those with neurological and developmental conditions, which redefined people and even prompted compulsory detention. In the city of Birmingham, for example, lived Annie. She was 16, described as
 “a great trouble to her mother, who [was] unable to look after her properly and [had] little control over her” and “easily led into moral trouble”. Annie was termed “feeble-minded” and recommended for indefinite forcible detention at an institution called a colony. It was this Birmingham facility that formed the subject of my pilot study for a larger research project on what were known as epileptic colonies. Read more…

The Editor’s Eye

July 15, 2014

Focusing on the stories of the medical humanities – by Elizabeth T Hurren

Elizabeth Hurren.

Elizabeth Hurren.

“It’s marvellous the workings of a wheelbarrow.” This was my Irish Grannie’s favourite piece of homespun wisdom – it covered everything that life could throw at you and a lot of surprises that made life really worth living. A district nurse and midwife, married to a man originally born in India, she knew all about the amazing uses a wheelbarrow could be put to in modern medicine: taking clean laundry deliveries to surgical wards, wheeling pregnant women to theatre, carrying clean water from village wells and food from the fields to nourish countless millions – in a global health economy the wheelbarrow has surely been one of the most versatile and underrated pieces of medical equipment. Did I mention that it covered sex education too? My Grannie would whisper that with the birds and the bees, “so much depends on the wheelbarrow”. I never worked out the precise mechanics of wheelbarrow reproduction, but I did learn that for many of the poorest a wheelbarrow was their mobile home – a pram for precious babies – a trusted family heirloom. In this summer 2014 issue all our contributors invite us to see human creativity and medical diversity in humdrum things and outwardly familiar predicaments. Read more…

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