Showing posts with label syphilis. Show all posts
Showing posts with label syphilis. Show all posts

Tuesday, November 2, 2010

Gimme some skin, man

Last week I attended as invited commentator a fascinating and thought-provoking conference, ‘Scratching the Surface: the history of skin, its diseases, and their treatment’, held at the University of Birmingham Medical School under the auspices of the History of Medicine Unit at Birmingham and Trent University (Ontario), with support from the Wellcome Trust and the Society for the Social History of Medicine. Many of the speakers were familiar faces from their researches in the Wellcome Library.

With twenty papers packed into the course of two days, this conference was both dense and wide-ranging. The periods and places under discussion ranged from eighteenth-century London, Italy and Quebec to 1980s San Francisco, via Mexico City in the 1790s, the nineteenth century Maghreb under French colonialism, Hong Kong and its New Territories under British rule before the Second World War, and mid-twentieth century Uganda. The conference was kicked off to an excellent start by Philip Wilson’s keynote, ‘Reading the Skin, Discerning the Landscape: Geohistorical Depictions of the Human Surface’.

Among the rich spread of topics discussed were the apparently new disease of pellagra in eighteenth century Italy (already associated with maize-eating, in the form of polenta, at that early date); Admiral Francis Beaufort (of wind-scale fame)’s skin disease and its diagnoses both contemporary and more recent; outbreaks of skin conditions believed to be specific to a particular area (St Paul’s Bay Disease in Quebec, ‘Radesygge’ in Norway, the lesions observed among the indigenous population of the Mahgreb); Percival Pott and his colleagues treating wounds at Barts in the eighteenth century; scrotal cancer in chimney-sweeps; vaccination, tattooing and ‘dermographia’; light therapy for lupus in the early twentieth century.

A theme that pervaded the conference was the important of visual depictions of skin diseases and the quest for accurate reproduction of various dermatological phenomena, through water-colour paintings, wax modelling and the preservation of specimens, and the important role these played both in teaching medical students and in health education. Another theme was the common perception that manifestations on the skin signified deeper problems within the bodily system. While many papers dealt with this question of what was false within appearing on the surface, others dealt with the penetration of the skin by outside forces, whether this was the wound treated by the surgeon, the surgeon’s own penetrating knife or scalpel wounding to heal, the soot ingrained in the skin of climbing boys, the lancet of the vaccinator, the needles of the tattooist, or the entry into the system of woolsorters of the anthrax bacillus.

The wider cultural concerns which, as it were, were perceived as writing themselves on the skin or explored through dermatological issues were strongly represented. To take just one example, the ‘Itch’ in early modern London was not merely associated generally with the more degraded social elements, it was particularly associated with the Scots who, following the Act of Union, were seen as that era’s flood of undesirable immigrants to the metropolis.

The presence of the particularly stigmatised ailments of leprosy and syphilis was prevalent: one redolent of Biblical horror and the other of God’s punishment for immorality. The attitudes they created towards sores and lesions on the skin seem to have become intricately imbricated in attitudes towards other diseases which manifested similarly.

As may be imagined, providing a few summary concluding remarks was a far from easy task with so many excellent papers and such a variety of topics, but some attempt was made to draw out common themes and resonances, including the need for caution in, so to speak, deciphering the messages written on the skin and not turning these into simplistic dramatic or moralistic narratives.

It is anticipated that a publication will ensue from this stimulating event.

Wednesday, April 29, 2009

One hundred years since the ‘Magic Bullet’

In 1909 Paul Ehrlich, working with his Japanese student Sahachiro Hata at the National Institute for Experimental Therapeutics in Frankfurt, discovered that the 606th substance tested in their attempts to discover a specific chemotherapeutic agent to cure syphilis, the arsphenamine compound named ‘Salvarsan’ did in fact destroy the spirochaete, treponema pallidum, which caused syphilis.

In the early years of the twentieth century this sexually-transmitted disease was a major public health problem: it had long-term lingering effects on the infected individual, and was also the cause of much disability in their offspring.

The discovery of Salvarsan was also an important breakthrough in the development of specifically targeted chemotherapeutic agents. It was rapidly taken up by the medical profession, replacing the previous much less efficacious treatment with mercury.

Its history is reflected in a number of archival collections in the Wellcome Library: the Paul Ehrlich transcripts include his work on arsphenamine, case-notes among the papers of Surgeon-General Knapp, RN (GC/85) show the early use of salvarsan trreatment in the Royal Navy, while Sir Bernard Spilsbury’s index cards of autopsies include some early deaths from toxic side-effects while dosage levels were still being worked out. These are also documented (with other material on Salvarsan) in the papers of Frederick Parkes Weber.

At the outbreak of the First World War in 1914 the supply of Salvarsan (and the later developed Neosalvarsan) was cut off since they were produced in Germany. Substitutes – Kharsivan and Neokharsivan - were developed and manufactured by Burroughs Wellcome and Co Ltd. Further information can be found in the company records.

Contemporaneously, the Royal Commission on Venereal Diseases (1913-1916) was hearing evidence on the best and most effective ways to bring this radical new treatment and sufferers together. Its reports and minutes of evidence are held in the Library.

Other items of relevance in the Wellcome Library, besides numerous printed works, include the 1974 BBC educational film The Search for the Magic Bullet as well as the famous Hollywood movie, starring Edward G Robinson (better known his gangster roles) as Ehrlich, Dr Ehrlich’s Magic Bullet (1940).

Although it was replaced in the 1940s by penicillin, a treatment which took much less time and had far fewer dangerous side-effects, Salvarsan and its clones played a major role in the reduction of syphilitic infection in the UK between the two world wars.

Tuesday, April 28, 2009

Centenary: Stacey Hopper, born 28 April 1909

The artist Stacey Hopper was born exactly 100 years ago, at Aberaman, now part of the town of Aberdare, South Wales, on 28 April 1909. Thousands of people will have seen his work without knowing his name. His claim to fame is that, in the role of cartoonist and illustrator, he saved many Allied soldiers in World War II from the horrors of such diseases as malaria and syphilis, and thereby played a part in the Allied victory.
Left: Mussolini and Hitler. Wellcome Library no. 583972i

The Wellcome Library has two collections of Stacey Hopper's works, one from the Royal Army Medical Corps and one from Stacey Hopper himself; the latter was acquired from his family in 2003, together with valuable contextual information about his life and work. Other works by him are in the Imperial War Museum and the National Army Museum in London.

Before the war, Stacey Hopper taught art in Ealing and was an accomplished caricaturist. In 1934 he published a caricature "The origin of the Nazi salute" which was reproduced in newspapers at home and abroad: it showed the Nazi salute evolving from the action of Hitler holding up a paintbrush when painting. Stacey Hopper was called up and joined the Royal Corps of Signals in August 1941, and was initially posted to Prestatyn, North Wales. In November 1942 he was among the troops sent to Algeria. There his artistic ability and sense of humour brought him to the attention of Major General Ernest Cowell, who asked him to help with health promotion for the Army Medical Department (the initials "AMD" appear on many of his works).

In Algeria the main problem was malaria. The disease was attacked in several ways. In the first place it was necessary to get into the minds of soldiers that mosquitoes were vectors of disease. As the Australian hygiene expert Neil Hamilton Fairley impressed on General Wavell, there was a danger of losing more men through malaria than through military casualties at the hands of Hitler and Mussolini.



These mosquitoes (right) discuss sucking blood from the troops as if they were ladies discussing tea at the Ritz.
Wellcome Library no. 584189i





Practical measures included blocking off the mosquitoes' breeding grounds, for example by excluding them from the latrines …

Wellcome Library no. 584263i

Another method was to spray everything in sight with "Paris Green" (copper (II) acetoarsenite), a toxic substance used as an insecticide …

"But he distinctly said - spray every drop of water and all the female adults".

Above: Wellcome Library no. 584264i

The medicine of choice against malaria was Atebrin, which was strongly supported by Hamilton Fairley and eventually replaced quinine as the main prophylactic against malaria. However, compliance was so difficult to enforce that eventually officers were ordered to place the pills in the men's mouths themselves. This exercise (below) in the style of H.M. Bateman refers to Atebrin.

"Tablet day -- the man who forgot". Wellcome Library no. 584428i


In November 1943 Stacey Hopper was promoted to Second Lieutenant and took part in the invasion of mainland Italy. Some wash drawings by him in the Wellcome Library record the bringing of casualties by air from the Anzio campaign in Lazio to Capodichino airport near Naples. This example, dated Naples 1944, shows the wounded being carried by stretcher-bearers into a tent where they are served with mugs of tea by the Red Cross. A lot of casualties are anticipated, for the first arrivals are being laid down at the back of the tent, and the tea urn and a quantity of mugs are on a table near the front. After tea, they were taken by ambulance to military hospitals for treatment. Above left: Wellcome Library no. 583973i

As the troops fought their way northwards towards Rome, Stacey Hopper's artistic skills were again called on to protect the troops, no longer from malaria but from typhus and dysentery.


Left, Wellcome Library no. 585129i. Above, a detail from it.







Right: Wellcome Library no. 585148i







And as Italians went over to the Allies in the areas liberated from the Axis, thought was given to Italian women who were infected with sexually transmitted diseases by Allied soldiers. Right: Wellcome Library no. 585150i





It was also now in the Allies' interest to make sure that Italian cooks recruited to serve the troops obeyed the stricter hygiene regulations that were required when catering for large numbers. Left: Wellcome Library no. 585122i


Having returned safely from the war Stacey Hopper returned to his pre-War profession as a teacher of art, at first in Ealing in West London and later in Somerset. He also continued to produce caricatures for publication, especially of popular entertainers and of actors in the West End theatres: his work was published in the Musical Express. He died in Bristol on 6 February 1996.

Works by Stacey Hopper are in copyright and are reproduced here under a licence granted to the Wellcome Library.

Saturday, March 14, 2009

Happy birthday, Paul Ehrlich!

Paul Ehrlich (1854-1915) was a leading medical researcher of the late nineteenth and early twentieth centuries particularly famed for his work in bacteriology and immunology. He won the Nobel Prize for Medicine in 1908. He is best remembered for 'Dr Ehrlich's Magic Bullet', Compound 606, the arsephanemine drug salvarsan discovered in 1909, which provided a cure for syphilis,.

Shortly after the Second World War, Gunther Schwerin, one of his grandsons, located Ehrlich's copybooks in Germany, and sent them, along with other material, to the Wellcome Historical Medical Museum in London for safekeeping. While they were there, his former secretary Martha Marquardt, who was also his biographer, and the co-editor of the four volumes of his collected papers, one of the few people able to read his handwriting, prepared seven sets of typewritten transcripts. These carbons are the 3rd set (of 4) copies, formerly in the possession of Sir Henry Dale, and presented by him to the Library early in 1958. The originals, and 3 sets of copies, are now held with the Paul Ehrlich archive in the Rockefeller Archive Center, New York, by whose kind permission this particular set of copies is made available in the Wellcome Library

There are 6 series, representing both copies of letters sent by him, and experimental notebooks. There are not complete sets of transcripts for all of these: in some cases the originals themselves appear to no longer exist. According to a letter from Dr E A Underwood, Director of the Wellcome Historical Medical Museum, to Gunther Schwerin, 25 Mar 1963 (WA/HMM/CO/Eau/13), there are some misreadings by Marquardt of scientific terms in the originals, as, although she was capable of deciphering Ehrlich's writing, she was not herself a scientist.

Ehrlich's name is one of those on the frieze of names of the most distinguished figures in medical science, created in 1913 for the Wellcome Historical Medical Museum when it was based in Wigmore Street. The frieze is now viewable around the gallery of the Wellcome Library Reading Room at 183 Euston Road