Next stop is the John Snow Pub in Broadwick St, near the site of the Broad St Pump in Soho. My colleague gives a detailed account of the historical work of John Snow. In 1854, only a century before most of us were born to the exact year, our medical hero completed his historic work which gave rise to the specialty of epidemiology.
John Snow was born into a labourer's family on 15 March 1813 in York and at 14 was apprenticed to a surgeon. In 1836, he moved to London to start his formal medical education. At the time, it was assumed that cholera was airborne. However, Snow did not accept this 'miasma' (bad air) theory, arguing that in fact it entered the body through the mouth. He published his ideas in an essay 'On the Mode of Communication of Cholera' in 1849. A few years later, Snow was able to prove his theory in dramatic circumstances. In August 1854, a cholera outbreak occurred in Soho. After careful investigation, including plotting cases of cholera on a map of the area, Snow was able to identify a water pump in Broad (now Broadwick) Street as the source of the disease. He had the handle of the pump removed, and cases of cholera immediately began to diminish. However, Snow's 'germ' theory of disease was not widely accepted until the 1860s.
Snow was also a pioneer in the field of anaesthetics. By testing the effects of controlled doses of ether and chloroform on animals and on humans, he made those drugs safer and more effective. In April 1853, he was responsible for giving chloroform to Queen Victoria at the birth of her son Leopold, and performed the same task in April 1857 when her daughter Beatrice was born.
Snow died of a stroke on 16 June 1858, at the young age of 45, having accomplished so much. Again, we wonder if today he would have survived.
The pub has Sam Smith beers and wall charts with information about our hero. We meet some fellow enthusiasts from N America and thanks to them for taking our photo.
The next stop is Margaret Street near Cavendish Square, a short walk away. If you were walking along this street on the morning of the 25th July 1865, you may well have heard a loud scream. Doctor James Barry, the Inspector General of Military Hospitals was dead. Sophia Bishop, the Charwoman, who was sent to prepare his corpse, had no intention of complying with his final wish, which was that on no account should he be changed out of the clothes in which he had died. “It’s the Devil!” cried Sophie, as she pulled up his nightshirt and revealed a secret that the good doctor had concealed for almost all of his life. ' What was this secret?' I ask.
Our colleague from WA guesses corectly. Sophie exclaimed ' It's a woman' and noting what she took for stretch marks on his stomach, 'a woman that has had a child." This truth was so scandalous to Victorian Britain that for years it was hushed up.
Dr James Barry, aged 70, was one of the most highly respected surgeons of his day. He also left behind a remarkable record as a reformer. He performed one of the first successful Caesarean sections in medical history. He was also the first woman to practise medicine in Britain.
Despite "a most peculiar squeaky voice and mincing manner' his fierce temper ensured he was a force to be reckoned with. He even crossed swords with another leading medical figure of day, Florence Nightingale, who later described him as "a brute" and "the most hardened creature I ever met throughout the Army". I suspect he was over compensating.
HOW did he get away with it? There has been a lot of research and nothing has been found to indicate that he was transgender or intersex. The likely truth is that she was simply a woman born in Ireland as Margaret Ann Bulkley sometime in the 1790s. She was the daughter of a greengrocer, Jeremiah Bulkley from Cork. In 1803, Bulkley was sent to prison for debt and his wife turned to her brother, the famous artist James Barry, to help ease the family's financial troubles. Barry was part of a liberal, forward-thinking set who were keen believers in women's rights and education, and as Margaret proved an able pupil, before long an elaborate, plan had been hatched for her future.
Women were not permitted to enter university, so it was decided that she would masquerade as a man and train as a doctor. In 1809, Margaret, assuming her uncle's name enrolled in Edinburgh University. Mother and daughter isolated themselves from anyone who might not be trusted to keep this darkest of secrets. Margaret wore an overcoat to disguise her womanly curves, and fibbed about her age as a means of explaining her smooth chin and high voice. She graduated three years later, moved back to London for a six-month stint as an apprentice surgeon at St Thomas's Hospital and, in 1813, joined the Army.
The flamboyant styles of the day, in that men dressed effeminately as a fashion, not a sexual statement, worked in her favour. In 1816 she was posted to the colony on the Cape of Good Hope in South Africa and acquired a black manservant who would stay with her for the next 50 years, and whose trusted task it was to lay out six small towels each morning that she would use like bandages to disguise her curves and broaden her slender shoulders.
Barry instigated a sweeping series of reforms, campaigning against poor sanitation and overcrowding in the Cape's prisons. She also improved cicrumstances for the lepers as well as the soldiers it was her duty to look after.
Lord Somerset, the governor of the colony, became a close friend and, possibly, also a confidante and lover, and proved a powerful ally. Barry disappeared for about one year. It is postulated that she was pregnant and could have had a still born child.
When she returned she cemented her reputation as a master surgeon when, despite knowing that no woman in Britain had ever survived the procedure, she conducted an emergency Caesarean on one Mrs Munnik on her kitchen table and saved her life and that of the baby. After a career all over the world she retired along with her loyal servant to London where she developed dysentery and died. Mrs Bishop did not reveal her findings until after the funeral, and that is another story.
The next stop is the Grange Langham Court Hotel , 31–35, Langham Street. This is a gorgeous building in it's own right, with interesting medical connections.
In 1901 Architect Arthur E Thompson’s eye-catching building was constructed by the de Walden family who owned 92 acres of real estate in Marylebone and Fitzrovia. Funds were also made available by the Lady Howard de Walden estate to provide sick care and club facilities for members who had paid into a co-operative society benefit fund and a nurse’s cooperative subscribed some £7,500 to complete the amount required. Provided nurses had contributed £1 and a shilling to club funds they could reside at the home.
Before the pioneering days of Florence Nightingale, nurses had a very poor reputation. It was normal for women of low social class to look to a life of prostitution, alcoholism and nursing. Florences's middle class parents were scandalised when their daughter told them that she was determined to become a nurse. It is possible that Florence visited this very site in her later years.
In the 1970s this was a private abortion clinic. This era was shortly after the legalisation of abortion and some time before access became equitable. Indeed over my career I have seen a vast improvement in the accessibility, which has been of great benefit to women. In countries where abortion is still illegal, illicit termination is the second most common cause of maternal mortality.
The red brick building immediately to the left of the hotel is named after William Hogarth.
Our next stop is the statue of Lister's Bust, 1922, in Portland Place. Below is a portrait of the great man himself (This one actually is a man!)
The bust is the last work of Sir Joseph Brock, who died before it could be completed. It was finished by an assistant to his exact instructions.
Joseph Lister, was a very important surgeon responsible for huge advances in the use of sterile conditions for surgery, which have been of lasting benefit to public health. He was born in Essex into a prosperous Quaker family in 1827, and he died in 1912. He attended UCH, one of only a few institutions which accepted Quakers at that time. Thus, our theme of marginalised groups continues!
By applying Louis Pasteur's advances in microbiology, he promoted the idea of the sterile field, while working in Glasgow.
Lister successfully introduced carbolic acid to sterilise surgical instruments and to clean wounds.
As we have seen, the belief that chemical damage from exposure to bad air (miasma) was responsible for infections in wounds, was difficult to let go of. A surgeon was not required to wash his hands before seeing a patient because such practices were not considered necessary to avoid infection, despite the compelling work of two doctors who preceded Lister. Sadly, it is still the case that medical practices lag behind established fact.
Oliver Wendell Holmes, an American, was the first came to up with the controversial idea that doctors were capable of carrying puerperal fever (a post partum infection now known to be due to the streptococcus) from patient to patient.
Ignaz Semmelweis, a Hungarian physician noticed in 1847 that doctors' wards had three times the mortality of the midwife wards and thus realised that puerperal fever (common in the 19th century hospitals and with a mortality at 10%–35%) could be drastically cut by the use of hand disinfection.
Despite various publications of results where hand washing reduced mortality to below 1%, Semmelweis's observations conflicted with the established scientific and medical opinions of the time and his ideas were rejected by the medical community.
Such was, and maybe still is, the arrogance of doctors. Surgeons of the time referred to the "good old surgical stink' and took pride in the accumulated stains on their unwashed operating gowns as a display of their experience. Some were offended at the suggestion that they should wash their hands and Semmelweis could offer no acceptable scientific explanation for his findings.
Semmelweis's practice earned widespread acceptance only years after his death, when Pasteur confirmed the germ theory and Lister practiced and operated, using hygienic methods, with great success. In 1865, poor Semmelweis was committed to an asylum where he died aged 47 after being beaten by the guards, only fourteen days after he was committed.
Lister is considered by most in the medical field as "the father of modern surgery'. As we have seen, his path was paved by others.
On 24 August 1902 Edward VII came down with appendicitis two days before his scheduled coronation. Like all internal surgery at the time, the appendicectomy needed by the King still posed an extremely high risk of death by post-operative infection, and surgeons did not dare operate without consulting Lister who obligingly advised them in the latest antiseptic surgical methods. The King survived.
The Royal College of Physicians, St Andrew's Place, is our final stop. Our focus is on the medical properties of the plants of the garden, but our pupils are drawn to the building and it's architecture. Fair enough, it is a Grade I listed building, designed by architect Sir Denys Lasdun and opened in 1964. Considered a modernist masterpiece, it is one of London’s most important post-war buildings. There has been an RCP since 1518. In that year, Thomas Linacre, a humanist and physician became the founder and first President of the Royal College of Physicians and was also royal physician to Henry VIII. He approached the latter outlining the need for a RCP as he was concerned re quacks exploiting the market and damaging the reputation of qualified physicians who he wanted to have cudos.
The main functions of the College, as set down in the founding Charter, were to grant licenses to those qualified to practice and to punish unqualified practitioners and those engaging in malpractice.
Since its foundation in 1518, the RCP has had five different headquarters in London. You can find out more about the history and garden here
My friend starts her tour a little late and is later supported by one of the amazing official guides, a retired psychiatrist. My mind is boggling and in need of tea and perhaps I need some gingkho for my memory (though we are told it does not work well) but I do take in the history going back to Ancient Greece and the many modern uses. We talk about lignociane, podophyllotoxin and finally watch our new friend sample the opium poppy! Info about garden tours is at the website above.
Finally, it is our last stop: the cafe at The Wellcome Collection. http://wellcomecollection.org/
The cafe does great teas and cakes. The collection consists of artefacts and exhibitons relating to Medicine, it's history and it's wider cultural links. In the past I have seen super shows on drug use and dying, currently there is an exhibition about sexology, but only the Devizes couple have the energy left for the collection. Some of us go home and the hard core beer fans head to the Bree Louise, http://www.breelouise.pub/ for a well earned pint of Dark Star Hophead. There also seems to be a young intruder!
Thanks to Rob Woodford of http://discovermedicallondon.com/ for his help and inspiration.
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