The 'Orphans' go for a short walk

In 2009 the Wellcome Library acquired four large paintings known as the Acts of Mercy. They had been painted by Frederick Cayley Robinson between 1915 and 1920 for display in the Middlesex Hospital, in the Fitzrovia district of central London. The Middlesex Hospital building was demolished in 2005 (except for its chapel, which still stands), and its assets, archives and responsibilities passed to the University College London Hospitals NHS Foundation Trust. The paintings, being homeless, were then acquired by the Wellcome Library. From the Wellcome Library they were lent in 2010 to the National Gallery for a temporary exhibition focused on them and their painter. More information about the paintings is available in several postings on this blog.

University College London Hospitals NHS Foundation Trust is now constructing a new cancer hospital, the UCH Macmillan Cancer Centre, in Huntley Street, London, south of the present University College Hospital and not far east of the site of the demolished Middlesex Hospital. 'The Orphans', one of the two pairs of paintings by Cayley Robinson that make up the Acts of Mercy, is being lent to the new cancer hospital, which will open next month, in April 2012. There is a certain appropriateness in the loan because the former Middlesex Hospital had a longstanding interest in, and reputation for, the treatment of cancer. [1]

That tradition went back to 1791 when a surgeon called John Howard sent a letter to "the medical gentlemen of the Middlesex Hospital" proposing that a ward be opened for "paupers afflicted with the disease called cancer". The purpose of this initiative was twofold: to afford relief to the patients and to investigate the causes of cancer. For the relief of patients, an out-patient as well as an in-patient service was suggested. For the purposes of investigation, Howard suggested that notes on cases be kept carefully and made available "to any intelligent or scientific person".

Howard was invited to put his proposals to the Middlesex Hospital Board: he not only did so but also produced an anonymous sponsor who was prepared to pay 3,000 guineas towards the costs. The hospital governors accepted the offer, and the ward opened in 1792. A few years later the sponsor was revealed to be the (by now deceased) Samuel Whitbread (1720–1796), the Bedfordshire brewer whose brewery was based in Chiswell Street in the City of London.

Whitbread's funds created the Cancer Charity, which has been described as "the centre and inspiration of the researches into malignant disease which have flowed from the Middlesex Hospital ever since." In 1914 the Barnato-Joel trustees endowed it with funds to build a new research laboratory. It was absorbed into the Middlesex Hospital's radiotherapy department in 1937. Both before and long after that date, many distinguished researchers, surgeons and physicians carried out at the Middlesex Hospital work towards the two objectives of the charity, relief of cancer patients and advancement of understanding of cancer.

It is that tradition of the Middlesex Hospital that will be continued in the new UCH Macmillan Cancer Centre in Huntley Street. It is remarkable that three specific features of John Howard's proposal to the Middlesex in 1791 are retained in the new building: out-patient treatments, in-patient facilities, and (in collaboration with the UCL Cancer Institute on the other side of the road), making the results of research available by open access publishing. As in the former Middlesex Hospital entrance hall, Cayley Robinson's 'Orphans' will be watching over patients in the atrium of the new building.

The other pair of paintings that makes up Acts of Mercy will remain in the Wellcome Library, and after 8 March 2012 will be redisplayed on facing walls, as Cayley Robinson originally intended. However, anyone wishing to see the four paintings together should revisit the Wellcome Library before that date for a last view of the quartet.

[1] R.S. Handley, 'Gordon-Taylor, breast cancer and the Middlesex Hospital', Annals of the Royal College of Surgeons of England, 1971, 49: 151-164

Images: 'Orphans', by Frederick Cayley Robinson. Wellcome Library nos. 672831i and 672832i

The Great Drag Race

Getting ready for the great drag race. Men in dresses and lots of makeup ran 10.2 km all in aid of raising funds and public awareness of prostate cancer.




Stop Raining Please!






And they're Off!

Race for Life - Hampstead

All over the country women are racing for life to raise money for cancer research. Last Saturday's race was on Hampstead Health. Congratulations to these women who ran a great race.
Find out how you can support on the race for life website.

You can also support the cause through one of our City Daily Photo Bloggers (CDP), Ham of London. You can read his story here.

Go ask Alice

During the final decades of the twentieth century, a leading go-to person for evidence on the deleterious effects of low-dose radiation was Alice Stewart, FRCP (1906-2002), then well past retirement age. Throughout her eighties and well into her nineties she remained active in her research into the effects of lose-dose radiation, in spite of establishment resistance to her findings and inadequate facilities and funding, and travelled extensively all over the world to speak at conferences, at hearings and inquiries on the implications of her work for environmental issues and occupational hazards, and in legal cases for compensation.

Stewart’s copious papers were presented to the Wellcome Library shortly after her death and have now been catalogued and are available, subject to issues of Data Protection for some material, under the usual conditions of access to material in Archives and Manuscripts.

This is an important and wide-ranging collection, and a major addition to our holdings concerning radiation, among many other topics. Although the majority of the material dates from after Stewart’s retirement from the University of Oxford, when she became an Honorary Research Fellow at the University of Birmingham, the papers do include material on her earlier career, as well as some personal and family material, including correspondence with the poet and literary critic William Empson, with whom she had a relationship enduring over decades.

She was the daughter of two doctors, Arthur and Lucy Naish, who worked in Sheffield and were particularly concerned with issues of child health and welfare. An unpublished lightly fictionalised biography of Lucy Naish by her daughter-in-law, the novelist Nora Naish, ‘Dr Lucy’ is held in Archives and Manuscripts. As one of four medical students at Cambridge in her year, Alice was the target of hostility from her male peers, but made friends in other fields. She continued her clinical training at the Royal Free Hospital, qualifying in 1932.

After some years in practice in London, she was invited to Oxford by Professor L J Witts, and it was there that she joined John Ryle’s Institute of Social Medicine. She undertook various important surveys into occupational health during the Second World War, and in 1946 became only the ninth woman (and the only one under 40) to be elected a Fellow of the Royal College of Physicians. Following Ryle’s early death, she succeeded him as Director of the Institute of Social Medicine, but the post was downgraded from a professorship to a readership, on account of her gender.

She devised better ways of recording and interpreting data in an era during which computers were still not common, in a method she called ‘visible tape’ which enabled the data to be read in several different ways.

In 1955 the Institute commenced the Oxford Childhood Cancer Survey. One of the early findings that came out of this study (which went on for many years) was Stewart’s discovery of the role of x-rays in pregnancy to the development of leukaemia in the offspring, which although initially derided, led fairly quickly to the development of stricter protocols for the x-raying of women either pregnant or likely to be so and the move towards other forms of imaging.

In 1974, on her retirement, finding the ambience in Oxford deeply uncongenial to her and the work she was doing, she moved to Birmingham, expecting to finish off the work on Childhood Cancer Survey. However, a few months later, Thomas Mancuso, an American epidemiologist who had been commissioned by the Atomic Energy Commission to undertake research on the effects of low-level radiation on workers in nuclear facilities, contacted her about some anomalous findings in his study of workers at Hanford, which manufactured plutonium for the Manhattan Project.

This led her into a second, late-blossoming career of research into and activism around the effects of low-dose radiation, i.e. at levels below those which had been deemed harmful in setting guidelines for practice within nuclear facilities or in considering wider environmental impacts. In spite of the hostility her findings evoked in many places, she also gained recognition and honours, including the ‘Alternative Nobel’, the Right Livelihood Award, in 1986.

The collection includes substantial amounts of correspondence between Stewart and colleagues and institutions worldwide, as well as 36 boxes of research materials. There are files relating to the numerous legal cases in which she was approached to give evidence. Her involvement with anti-nuclear and environmental activists is well-documented, including her support for the Greenham Common Women’s Peace Camp, which extended to (well into her 80s) helping to organise a Women’s Rock Concert to raise funds. As well as material relating to disseminating her findings through the usual academic channels of conferences and learned journals, the papers also reveal her assisting broadcasters and journalists in more popular media.

A biography of Stewart, The woman who knew too much : Alice Stewart and the secrets of radiation was published by Gayle Greene in 1999. Further unpublished biographical accounts can be found in the collection at PP/AMS/A.5. There were many obituaries on her death in 2002, including in The Guardian, The Independent and the Journal of Radiological Protection. The entry in the Oxford Dictionary of National Biography was, rather oddly, compiled by her long-time adversary, Sir Richard Doll (whose papers are also held in the Wellcome Library). A video interview of her by Max Blythe in 1985 is held in the Wellcome Moving Image and Sound collection along with other audiovisual records of her.

Graphic Medicine

I’m not a great aficionado of comics or graphic novels. I know who Alan Moore and Stan Lee are; various (male) friends and family have raised my awareness of Marvel and DC Comics; I’ve read the odd issue of Swamp Thing, but the term graphic medicine was new to me. I came across it when a list of recommendations for the Library’s Medicine & Society Collection landed on my desk. They all came from the Graphic Medicine website created by Dr Ian Williams. This excellent website identifies and reviews graphic novels relating to all aspects of health and medical culture. Since the Medicine & Society Collection is all about exploring key medical and health themes in contemporary society, graphic medicine seemed like a perfect fit.

Definitions
A quick aside here: The distinction between graphic novels and comic books is imprecise, but graphic novels tend to come in bound book format and are usually a single continuous narrative, they can be fiction, biography or non-fiction. The term ‘comic books’ is generally used for single unbound pamphlets that serialise a story in weekly issues traditionally bought from newsagents. The Wellcome Library also has a selection of comic books, most of which are public health information pamphlets.

Variety
Having had a chance to examine some of the graphic novels in more detail, I’ve been impressed by the range of topics covered and by the diversity of authors working in this relatively small field:

There are patient accounts of illness and treatment, such as Cancer made me a shallower person by Miriam Engelberg and Spiral Cage, Al Davison’s autobiographical account of living with spina bifida.




There are views from inside the health care system such as Psychiatric Tales by Darryl Cunningham who worked as a health care assistant in an acute psychiatric ward, and Couch Fiction, an account of a therapy session from the points of view of both the patient and the therapist.



Perhaps surprisingly, there were quite a few accounts of carers and family members’ experiences of living with a sick person, such as Epileptic, a memoir of growing up with a brother who has epilepsy, and Blue Pills, a love story about a man’s relationship with a woman and her son, both of whom have HIV.



There are also more traditional comic formats such as the manga style Monster, a thriller about a hospital doctor tracking down a serial killer. The manga novels offer an extra challenge to readers in English because, although they are translated from the original Japanese, they still read from right to left, which can take some getting used to.



The authors are a mix of ages and sexes, and come from Japan, the United States, France and the UK, and there are almost as many different and styles and techniques as there are authors.

Medical education
Along with the development of medical humanities, literature and arts are proving to be useful tools in medical education and patient care. Patient narratives can give health care professionals a valuable insight into the patient’s point of view, but a recent BMJ article on graphic medicine suggested that by using techniques such manipulation of scale, text and image, graphic novels have “the ability to convey visceral understanding in ways that conventional texts cannot” [i]. Their ‘unreal’ quality can also make it easier for trainee health practitioners to discuss difficult or complex issues of ethics or interpersonal communication. In the increasingly global field of public health, they can be particularly useful for reaching young people or non-native speakers.

Pay attention here’s the library bit...
All the titles can be found at the same location in the Library, a specially created classification for graphic novels in the Medicine & Society Collection: HHLC. This allows readers to see the variety of themes amongst the graphic novels and directly compare their different styles. Library catalogue users can also search by genre for ‘graphic novels’ to see what is available across the collections.

As an emerging genre, graphic medicine offers a vivid representation of how illness, disability and health issues can touch people in so many different ways: personally, professionally, directly and indirectly. They are an exciting addition to the Library collections, and one that I look forward to expanding in the future.

[i] Green, Michael J. and Myers, Kimberly R.; Graphic medicine: use of comics in medical education and patient care in BMJ Vol. 340 Iss. 7746, 13 March 2010

Author: Lalita Kaplish

A novelist's bicentenary

Elizabeth Gaskell, the novelist, was born 200 years ago today, on 29th September 1810.

The huge success of the BBC’s version of Cranford (which added several of her other short stories to the adaptation) and, a few years before that, a high-quality version of North and South, have made her name a familiar one to a modern audience. For many years, however, she seemed destined to be treated as a footnote to other people’s stories. For much of the nineteenth and early twentieth centuries, she was known as a novelist basically for Cranford: for all its charm, this is perhaps one of her minor works and certainly made it possible to see her as a milder, more demure figure than the reality. In addition, as feminist critics rightly pointed out, the tendency during this time to refer to her as “Mrs Gaskell”, without a forename, tended to reduce her individuality (it also made it hard to distinguish her from similarly-named lesser writers such as Mrs Oliphant or Mrs Humphrey Ward). During her years of neglect, the other one of her works to enjoy continued currency was her biography of Charlotte Brontë: again, this gave her prominence but only as the friend and biographer of Brontë (whose biography, being first in the field, would often be attacked ritually by anyone seeking to justify the need for their own subsequent work).

From the 1950s onwards, her novels exploring the social consequences of the industrialisation she saw around her in Manchester – Mary Barton and North and South – were given more and more prominence, but again at the cost of lumping her into a literary-historical moment, treating these works as part of a collective whole called “The Condition of England novel”, in which Gaskell, Kingsley, Disraeli and others formed a rather undifferentiated supporting cast to Dickens’ Hard Times. It has taken the determined rediscovery and re-excavation of women’s writing from the 1970s and 1980s onwards to bring her to prominence on her own merits as an accomplished and varied writer: not as someone else’s wife or biographer, or a bit-part player in literary history, but as Elizabeth Cleghorn Gaskell (née Stephenson), novelist.

We might not think of her instantly as a writer who explores medical themes (although anyone who saw the TV adaptation of Cranford will have vivid memories, maybe too vivid, of Philip Glennister as Mr Carter having a leg amputated without anaesthetic). However – as any visitor to the Wellcome Library can vouch – what is “medical” can be defined very broadly, and many broad social or scientific issues turn out to be grist to the medical-historical mill. The industrial revolution involved huge social and scientific changes, very many of which had medical implications, and Gaskell’s works demonstrate a vivid eye for this changing world around her. Science and industry impinge on her novels frequently, even in those not explicitly to do with “the condition of England”: the rural idyll of Cranford, for example, is invaded by the newly-invented railway, and in her last novel Wives and Daughters the central male character, Roger Hamley, is a naturalist whose commitment to scientific rigour and clarity mirrors his personal qualities of honesty and uprightness. Most notably, of course, it is in those novels that explore the social consequences of industrialisation, and take the reader into the same Manchester slums that Engels described, that the public-health consequences of the Industrial Revolution are all around us, the ill-lit and ill-drained slums where the poor sleep surrounded by filth. The presentation of Gaskell as a meek, dove-like figure whose works were limited to a female world of charm and manners, which predominated in the early twentieth century, is a long way from the truth.

With that in mind, it should perhaps come as no surprise that Elizabeth Gaskell is represented in the archives collection of the Wellcome Library. Our MS.7141 comprises a letter from Gaskell to a friend named Ann Scott (the wife of the principal of Owens’ College, which would evolve into Manchester University), written around 1854, in which she discusses the medical case of a Mrs Glover of Bury. Mrs Glover is suffering from a uterine cancer and, it is clear, her prognosis is not good. Gaskell explains that there is a possibility of her being operated upon by Dr Protheroe Smith at the Women's Hospital in London; however, she makes it clear that she thinks that this is unlikely to heal her and that there might be no point in subjecting Mrs Glover to the pain and stress of unnecessary surgery. (Dr Smith, she indicates, has a track record of pressing ahead in such circumstances to an extent that she feels might amount to positive cruelty.) The alternative, she suggests, might be to experiment with reducing pain by using mesmerism: a concept that had been around since the start of the century, and which - despite the lack of an agreed model explaining it – had been used to perform pain-free operations in the place of anaesthetic. (Coincidentally, active in Manchester at the same time as Gaskell was the general practitioner James Braid, whose work on these phenomena was to explain them in terms of actions upon the mind of the subject rather than the nebulous physical explanations centring on a “magnetic fluid” that had been favoured by mesmerism’s inventor Franz Anton Mesmer: it was Braid who gave these phenomena their modern name, “hypnotism”.)

It is a suggestive vignette, pointing us in various directions: demonstrating Gaskell’s interest in medical issues and a willingness to think beyond the box of orthodoxy in looking at therapies, opening discussions on male practitioners’ treatment of the female body and of women’s illness, echoing modern concerns about medical invasiveness versus palliative care for the terminally ill. The letter is discussed in detail in an article in Medical History (Christopher Hilton, "Elizabeth Gaskell and Mesmerism: An Unpublished Letter", Medical History, 1995, 39: 219-235), published not long after the Library acquired it; the article - including a transcript of the letter - is freely available here. Although it is our only Elizabeth Gaskell item, it fully earns its place in our holdings: it links to all sorts of issues discussed elsewhere in the collection and demonstrates another way in which this intelligent, aware woman engaged with the changing world around her. Two hundred years on from her birth, we salute her: Elizabeth Gaskell, nobody’s footnote.

Images, from top:
1/ Elizabeth Gaskell, c.1851, from Wikimedia Commons.
2/ Manchester soup kitchen, mid-19th century, from Wellcome Images (image number L0004800).
3/ Manchester workers' dwellings, mid-19th century, from Wellcome Images (image number L0004801).
Images made available under Creative Commons licence.

Banana Warm-Up

Warming up with lots of laughs for the 5k banana run. Part of the campaign by the world cancer research organisation to get people to increase their regular physical activity.
Learn more here.

Race for Life

Breast Cancer affects millions of women around the world. In the UK more than 50,000 each year. Funding for research will help us, our daughters, grandaughters and girls not yet born.

What can you do to help?

Have some fun!

RUN. Join the nearest race for life event in your area.

• its a 5k course
• you can run, walk, jog or even dance
• it's for women only (men you can support the women in your life)
• check out the website for more details or call 0871 641 1111

Also don't forget to go for a breast screen test.

Henrietta Lacks and HeLa

59 years ago today, Henrietta Lacks was diagnosed with cervical cancer. Few would have guessed the impact the cells taken from her tumour would have on cancer research, drug testing, and the discovery of vaccines.

Until 1951, no researcher had been able to grow human cells in culture for more than a few weeks. But Dr George Otto Gey of Johns Hopkins Hospital, Baltimore, USA, found that cells taken from Henrietta’s tumour grew outside of her body indefinitely, no doubt due to the aggressive nature of the tumour from which they came. He named these cells HeLa, after Henrietta, and sent them to his colleagues. HeLa was seen as a breakthrough, possibly even the cure for human cancer. Within two years of their initial discovery, 600,000 cultures were shipped for use in research.

One of the first applications of HeLa cells was in the discovery of the polio vaccine. The polio virus could grow in HeLa cells, which enabled the growth of the large amounts virus required to produce the polio vaccine, subsequently developed by Jonas Salk.

HeLa cells are an immortal cell line – they can be split and proliferated as many times as required without the quality of the cells deteriorating over time. They have an active version the enzyme telomerase during cell division, which prevents the shortening of telomeres that is thought to result in eventual cell death. This results in an endless supply of cells.

HeLa is still the most widely used human cancer cell line and it is estimated that the total number of HeLa cells that have been propagated in cell culture far exceeds the total number of cells that were in Henrietta Lacks's body. Henrietta died eight months after her cells were taken, never knowing the contribution she made to scientific research, or how she indirectly saved many lives.

(Wellcome Images holds a range of HeLa images. Shown above are HeLa cancer cells undergoing mitosis: click on the image for more information).

Author: Louise Crane

Miracle rat?

Recent research has discovered that the naked mole rat (Heterocephalus glaber) has some interesting genetic characteristics that may lead to a cure for cancer. The fact they can live longer than any other rodent, combined with their inability to contract cancer, has piqued the interest of geneticists, and resulted in one discovery in particular that could be used to inhibit the growth of tumors.

The Wellcome Library holds a wide range of literature on genetic research and the history of cancer treatments and cancer care, including a number of films and videos on genetics and inheritance, as well as cancer, from the 1930s to the present day. The following video, Book of Life, from 2001 highlights the Sanger Institute and some of the genetic research carried out there. This video has been digitised as part of the Wellcome Film project (to watch, see below), and a transcription (PDF) is also available.

And the naked mole rat? Well, the Wellcome Trust featured a naked mole rat in its cine magazine Looking Around (1952) with an enthusiastic narrative by Gerard Hoffnung on its physical appearance and habits (to watch see segment 2). In 1952, of course, scientists were unaware of how significant this "extraordinary little animal" might prove to be in developing genetic therapies for cancer.