A Medical Student in the Archives

Each year the Archives runs a module on the History of Medicine which allows students access to the collections to create a project around the sources they find. One student who participated this year was Nadya Ali Ebrahim Ali Alfardan, who researched the history of Syphilis using the records of the Ambrose King Centre. We are gateful to Nadya for taking time to contribute to our blog, here is what she wrote about the module and her research –

The Student Selected Component (SSC) modules are an integral part of the Barts and the London Medical School curriculum, where the medical student has the ability to choose medical topics of personal interest. As such, the first SSC I personally chose was an Introduction to the History of Medicine, within which I chose to research Syphilis at the London Hospital (now Royal London Hospital), in the early twentieth century.

There were different factors that drew me to this title. The first being the Royal London Hospital (RLH). The RLH, is not only the hospital which I will be spending 5 years of my education in, but also is a hospital with a rich history. It was the first voluntary hospital established to provided free medical care to the poor it in the east of London, serving the rapidly growing, and comparatively impoverished population there.

Another factor was the area, whose rich history only heightened my interest. Given the area neighbors the London Docklands and is in the east of the city, it was a destination for immigrants, such as Jews, and members of the working class.

Finally, the main factor that drew me this research topic was Syphilis. It was a very prevalent disease in the early twentieth century in comparison to present day, where it is estimated that a fifth of the population might have been infected at any one time. This shift makes it interesting to look into how the disease was viewed, diagnosed, and treated. Additionally, given it is a sexually transmitted disease, it was highly stigmatized, reflected in works of art from the time.

Hogarth-Harlot-3
A Harlot’s Progress by William Hogarth (1733), Plate 3 – it is suggested, based on the medicine bottles and visible symptoms, that the female protagonist is suffering from syphilis

My first step in researching this topic was reading books from the early twentieth century, housed in the archives, to establish the theoretical side of medicine at the time, and how they envisioned the disease. With reading, I found that the area that I wanted to be my main focus was treatments, as it had been the most dynamic in terms of change over time. From this I found the main treatments used at the time were; Mercury, Bismuth, Salvarsan (606) and Neosalvarsan (914) as well as antiseptics.

L0066881 Sealed glass tube of Arsphenamine, ‘Salvarsan 606’, Europe
Sealed glass tube of Arsphenamine, ‘Salvarsan 606’, Europe (Wellcome image ref.: L0066881)

The diagnostic methods were roughly the same as today, using serology, microbiology and examinations of the physical symptoms.

img162
Example of a statistical register Nadya had access to for her research (ref.: RLHAK/2/2/7)

 

The second step was looking at the practical aspect of medicine and how they applied the theory I had read. To do so, I looked at patient records to find patients that presented at different stages of syphilis, then look at their specific patient case files in the archives to see how and why they were treated as such.

Finally, the use of journal articles helped complete the picture of the development of treatments and their use around that time.

Nadya Alfardan is 21 and from Bahrain, she has a BSc in Biomedical Science from the University of Brighton.

 

Advertisements

Digitisation Assistant’s Perspective

Digitisation Assistant’s Perspective

Digitisation (converting material of various formats to a digital copy) has been a central part of this project, helping us to achieve our aim of providing access to the collection. Digitising material is beneficial for a variety of reasons; it minimises the need for fragile items to be handled, allows information to be found more quickly, can be used by multiple audiences and does not require access to older technology such as microfilm readers. It also allows for the redaction of confidential data without defacing the original copy, something that is essential when dealing with medical history – particularly, material such as this, which is of a sensitive nature.

There are a number of stages in the digitisation process. Clinical photographs and teaching slides are scanned in-house and then, if appropriate, attached to the catalogue. Microfilmed case notes and physical patient registers were sent to an external contractor to be digitised, and are now being redacted on site by myself. This process involves looking through each document and redacting any information that would identify an individual, such as their name, address and date of birth, so they can remain anonymous for researcher use.

Over the course of redacting the collection I have come to appreciate that they contain much more than just information about how sexual health treatment has progressed. They are for instance a valuable source for researchers of social history – providing an insight into life in the East End of London and surrounding areas in the mid-20th century. The occupation of every patient is recorded, and there are references to nationality and migration, adoption, divorce proceedings and homosexuality (including before the 1967 decriminalisation).

Given the proximity of the clinic to the London Docklands area it is unsurprising that many migrant sailors came for treatment and checkups. One of my favourite finds has been this quote, a postscript on a 1951 letter between two doctors:

Reel 3555 pg 1546
RLHAK/3/3/10

 

“P.S. Please excuse this rushed and inadequate letter but a boat of greek sailors have descended on me like the Athenian navy on the Persian tyrant”

Sometimes however the completely unexpected can crop up. Whilst redacting a digitised microfilm of male patient notes from 1947 I came across a magazine clipping of a rather glamorous lady in a bikini and heels, stepping out of a wetsuit in a boat. Perhaps a clinic worker of the time hid the picture quickly to avoid being caught distracted, and then forgot to retrieve her?

Reel 3277 pg 219
RLHAK/3/2/19

 

Whatever the reason, finds like these add a little colour and life to the collection.

By Jacqueline Etchells, Digitisation Assistant

Biography: Ambrose King

Biography: Ambrose King

The Ambrose King Centre was established in 1929 by the London County Council (LCC), and came to be known as the Whitechapel Clinic. It is a department which specifically deals with venereal diseases. The London County Council ran the department until the establishment of the National Health Service in 1948 and afterwards it was run by The London Hospital.

Prior to the establishment of the Ambrose King Centre there had been little treatment for venereal diseases at the hospital and it was only in the 1920s that specific units were set up to deal with such conditions. ‘Venereal Diseases I’ (VD I) was held in the Skin Department and dealt mostly with syphilis and other skin related conditions. ‘Venereal Diseases II’ (VD II) was run by the genito-urinary surgeons and dealt mainly with gonorrhoea and other conditions involving genitalia. Both wards were only open for two afternoons a week, leading to problems relating to overcrowding and long waiting times, and this prompted the LCC to establish a full-time department dedicated to venereal diseases. A new department was built and the premises were rented by the LCC from the hospital.

The man who gave his name to the centre was Ambrose King; a physician and surgeon responsible for modernising the study and treatment of venereology in the UK. From 1959-1969 he was consultant adviser in venereal diseases, initially to the Ministry of Health and then to the Department of Health and Social Security.

RLHMC-P-3-101

Ambrose J. King had qualified at The London Hospital in 1924 and spent two years working in the VD II unit [Venereal Disease II unit] and was later appointed one of the Chief Assistants of the Whitechapel Clinic when it was opened in 1929. King found himself in charge of the department, which dealt with gonorrhoea and its complications. Venereology was not a popular field and King sought advice from his mentor William Bulloch who replied, “King, if you take up this work you will have an interesting life and your future will depend on human nature. Human nature will never let you down.” It took courage to enter into the unpopular speciality of venereology; standards of care were often poor, resources were sparse, and the staff were held in low esteem – referred to as pox doctors.

After the Second World War, Ambrose returned as director of the venereal disease clinic at the London (now the Royal London) and was later appointed to the London Lock Hospital. He began the task of rebuilding his former private practice. At that time Ambrose staffed his department with the brightest young physicians and surgeons, from whom he demanded the highest standards for his patients, but gave plenty of spare time to study for higher degrees; in this way he attracted staff of the highest calibre. King was later appointed Director and the Whitechapel Clinic was renamed the Ambrose King Centre in 1989 in honour of his distinguished career.

The continuing success of the treatment of sexually transmitted diseases in the UK can be traced to the efforts and dedication of Ambrose King and his staff.

Our collections don’t contain the personal papers of King but the papers of King’s centre instead. Among these records are reprints of King’s articles for the British Medical Journal and the Lancet, reports submitted by King to the World Health Organisation about the international treatment of STDs, and also course guides for the teaching of venereal diseases and infections at Bart’s and the London Queen Mary’s School of Medicine & Dentistry. To search our online catalogue for these records search under the reference RLHAK.

(Image ref: RLHMC/P/3/101)

Ginny Dawe-Woodings BA MA, Project Archivist

For further information:
Ambrose King’s entry on Plarr’s Lives of the Fellows
Ambrose King’s obituary in the Guardian Newspaper

Introduction

This exciting project aims to make the papers related to the treatment of Sexually Transmitted Infections at the Royal London Hospital available to the public for the first time.

Dating from approximately 1903-2000, this fascinating collection comprises a range of materials including confidential registers, case notes, photographs and slides, as well as items relating to the study of STIs by medical professionals such as teaching slides, reference indexes and draft papers.

The collection is particularly illuminating on the treatment of patients, some of whom were treated at the hospital for years or even decades. A patient’s occupation, age, symptoms, marital status, and nationality were included in the confidential registers and much more detailed information has been entered in to the case notes including background details of the patient, their family history, exposure to diseases, precautions taken, tests carried out, and treatment given. The case notes also occasionally include correspondence with patients, family members and other medical professionals which offer a further insight in to the experience of the patient.

The collection contains a vast number of slides and photographs showing the ailments of various patients and we are also lucky enough to have a number of films relating to the subject which have not been viewed for years. These films are currently being converted in to a readable format for researchers to view when the project is complete.

Thanks to the generous support of the Wellcome Trust, a small team of staff have been employed to tackle the different aspects of the project: a Project Conservator to repair and stabilise the material and rehouse it in archival quality packaging; a Project Archivist to catalogue the collection and manage the digitisation project; and a Digitisation Project Assistant to edit the digitised material and scan the photographs and slides in-house.

The funding has also been used to employ a digitisation company to scan a large portion of paper records and microfilms. All patient names will be then be redacted from the scans, allowing us to make the material available to the public, whilst crucially maintaining patient confidentiality. All patients were also given unique reference numbers to ensure anonymity in the records and these patient numbers allow for cross-searching of the collection.

We are still very much in the early stages of the project but it is already clear what an incredible resource this collection will be for anyone interested in the study of STIs. Particular topics that come up include the spread of the diseases over the last 100 years, as well as attitudes towards infections, the different types of treatment available and the range of individuals affected. You can also see the beginnings of active tracing of sexual partners to try and limit the spread of infection, as well as the use of early prosthetic noses…..

Over the coming months, we will be reporting to you on the progress of the project and sharing exciting discoveries that we come across in our work!