The development of reference charts for infants’ length and weight – a historical review - Sara Wilkinson  

Infancy is a period of particular risk for growth failure and growth monitoring can help detect feeding difficulties, chronic ill health, social deprivation, and child abuse. The first documented monitoring of growth occurred in 1759 when De Montbeillard measured his son every 6 months from birth to 18 years old. Scammon plotted the results on a graph, joined up the data points and entered the chart in the 1927 American Journal of Physical Anthropology, to give the first published growth chart.  

In 1965 Tanner et al created the first widely used growth charts. The study set a basis for standard techniques of measuring children and infants, to be used by all health care professionals. It did however contain a number of flaws.  The data was collected on children in 1948 to 1954, and the sample was taken at random. However, subjects were all from   London  , and the techniques used and ethnicities sampled were not stated. Any discrepancies between the sample and the   UK  population due to geographical or socio-economic differences were dismissed.  The curves were smoothed by eye at three stages during the construction. This problem could be easily remedied today using computers. The chart includes both longitudinal and cross-sectional data, which could be a source of confusion especially as the instructions are unclear.  

Tanner and Whitehouse did achieve their aim, which was to provide a set of standards for surveillance of a growing population. Updated versions of the Tanner-Whitehouse charts, based on the data collected in 1940s and 50s, are still used today. Is it time for a completely new set of growth charts? 

History of tuberculosis -David Tarney 

Tuberculosis has plagued humanity since before civilization. It reached epidemic proportions in  Europe in the 17th Century and spread throughout the world killing millions. Yet halfway through the 20th century, TB had declined in the west for 100 years; a vaccine and effective chemotherapy were available and the WHO predicted that it would be eliminated by 2025. This was not the end of the story however, as there has been a dramatic increase in TB in the developing world where there were 8.3 million new cases worldwide.  The decline in TB that occurred during the second half of the nineteenth century occurred due a number of factors. The most important one was a natural waning in the epidemic due to the build up of resistance in the population. Other factors such as improving wages and increasing public health measures also had a role.

The resurgence of TB is also multi-factorial, and is partly due to the fact that population levels in the developing world are increasing and people are migrating to cities in a similar fashion to  Europe in the 19th century. It is also due to the HIV/AIDS pandemic as TB and HIV make quite fearsome bedfellows. Lastly what can be done?  Several measures are needed including increasing funds and the development of new drugs.

The Liverpool Hospital for Consumption and Chest Diseases - Gabriella Noblet

The Nineteenth Century was a time of great change for  Great Britain . The Industrial Revolution led to a huge migration of people from the countryside to the busy, over-crowded cities in the hope of better jobs and more money. There was a population explosion with the population of  England and   Wales  growing from 8,893,000 in 1801 to 10,164,000 in 1811. This was reflected by  Liverpool ’s population, which increased due to industry, expansion of trade and the large number of Irish immigrants. The squalid, inhumane conditions working people were forced to live in meant that disease was rife. Epidemics such as smallpox, cholera and typhoid were a regular occurrence, but these diseases, although claiming many lives, came and went relatively quickly. Pulmonary tuberculosis, known at the time as consumption or phthisis, was endemic and took lives every day. It is estimated that in 1839 consumption caused a quarter of all deaths in  Britain.

Tuberculosis is still a major disease today: over a third of the world’s population  carry the latent or active form of the bacillus. Although effective treatment regimens have been developed, the emergence of multi-drug resistant strains has created yet another problem to overcome in the battle against tuberculosis

The history of the   Liverpool  Hospital  for Consumption and Chest Disease represents a major landmark in the fight against tuberculosis. The hospital had a major impact on tuberculosis treatment, from its humble beginning in 1862, to its closure in 1964. The dedication of those who worked in the hospital is an inspiration to the world today, especially when one considers the global tuberculosis crisis being faced.   

Why was the Abortion Act introduced in 1967? -  Lydia  Dodd 

In 1967 the Abortion Act decriminalised abortion in the   UK  .  Elective abortion or termination of pregnancy has existed throughout history as a method of fertility control, and a form of contraception for use principally by women.  The law in the   UK  , however, had historically set itself against the use of abortion as a form of contraception.  A gradual loosening of the restrictions of the19th century laws concerning the practice throughout the first half of the 20th century was followed by a drastic change in the law in 1967.  Why was this law deemed necessary at all, and why was it introduce in 1967 as opposed to any other year in history?

The unfolding story of the Abortion Act 1967 reached its crescendo in a convergence of social climate, parliamentary practice, moral argument, public outcry and campaign lobbyists. This presentation examines the years leading up to the introduction of the Act in order to discern its origins and influences.  The contributions of the Abortion Law Reform Association, David Steel MP, the Church and medical bodies are examined.  The historical evidence is interpreted with reference to women’s rights and gender issues.

The Abortion Act was controversial in its time and it continues to have a wide-reaching impact on medicine and society today.  This impact is only likely to increase with ever advancing embryological and fertility technology.

Bovine Spongiform Encephalopathy and variant Creutzfeldt-Jakob Disease – a review of the UK  crisis - Ellenore Tidey

The harrowing images of smoking pyres of culled cattle and of desperate politicians attempting to allay public anxieties are ingrained in the memories of British people.  Bovine Spongiform Encephalopathy (BSE), and its claimed link to variant CJD in humans, was a health crisis that had wide ranging impacts and has shaped the way the government addresses food safety issues today.

An objective, concise account of events will be presented, based on a literature search, video and audio sources, and newspaper archives.  The natural history of the spectrum of spongiform encephalopathies and a detailed timeline of events is discussed as well as clinical details and potential treatments of vCJD.  The large impact on consumer confidence, trade and EU relations will be summarised.  There was also considerable press and political mishandling of the crisis.  There was miscommunication between government agencies, and the interests of the agriculture industry were perhaps valued above those of public health, whilst both parties were represented by the same government ministry.

There have been, up to now, 156 deaths from vCJD.  The beef industry is recovering, but with reports of BSE and vCJD all over the world and the possible transmission of these spongiform encephalopathies to other species, the problem unfortunately continues.  Also, in looking at the crisis in depth and learning from the outcomes, we can understand how to better deal with future similar public health crises.

Women’s entry into the medical profession in nineteenth century Britain - Rachel Graham

During the past 150 years, the number of female medical students has continued to rise, with female medical student admissions reaching 61% in 2003.  With such high levels of female medical students, it is hard to imagine that women were once excluded from university and the medical profession.  An early example of women’s exclusion from the medical field is apparent from ancient Egyptian records, with the art of embalming becoming a male art, resulting in women losing both anatomical knowledge and experience.  The professionalisation of medicine in the nineteenth century was an era when women started to aspire to becoming physicians.  In Victorian Britain, it was more acceptable for a woman to be a nurse, which was a subordinate and auxiliary role, under the control of male doctors.  Hence the concept of a “woman doctor” in the early nineteenth century was widely viewed as preposterous and repulsive.

Over a period of forty years, women struggled to gain entry into the medical field, with opposition from not merely medical institutions, but the government and society too.  There are several important women including Elizabeth Blackwell, Elizabeth Garrett Anderson and Sophia Jex-Blake who were most influential in gaining women’s position in the medical field.  So vast was the opposition to women becoming doctors that passing medical examinations did not guarantee women attaining degrees or to allow registration as doctors, unlike their male counterparts, as Jex- Blake encountered.  This presentation will provide an account of the women that challenged the barriers to women’s medical education, whilst taking into account Victorian life and how being female impacted upon Blackwell’s, Garrett Anderson’s and more so Jex-Blake’s careers.

The history of Sports Medicine -Harry Laing

Sports Medicine, although only recently recognised as a speciality in the  United Kingdom, has existed in different forms for a very long time.  The development of Sports Medicine in the form we know it is a collaboration of many peoples from the Romans and Greeks through to the Hindus, Muslims and Chinese.  Herodicus, who is seen as the father of Sports Medicine, was the teacher of Hippocrates and the first to encourage the use of therapeutic exercise.  Hippocrates himself encouraged therapeutic exercise in his writings.

Sports Medicine as defined now encompasses subjects such as massage, diet, physical therapy and hygiene.  About the time of the beginning of the ancient Olympics (776 BC) this was undertaken by an athletic trainer.  These trainers developed various methods rather like modern coaches, of increasing the strength of their athletes.  One of the most famous, Milo of Croton, used principles of progressive resistance training used in sports science nowadays.  He found that by lifting a young bull daily, one could lift the animal when it was fully grown.

There was initially a rivalry between these trainers and doctors.  Though doctors were involved in the treatment of injuries, they were not involved in other aspects.  Claudius Galen is widely recognised as the first team physician, working with the gladiators in the time of the emperor Marcus Aurelius.

Sports Medicine is a very old and varied speciality that throughout the years has made many contributions.  Sport has always formed an important part of entertainment, and those who take part are revered.  Sports Medicine is even more important today with the increasing public participation in sport.

Ronald Ross and the great malaria problem - Mark Lavery 

Malaria was long thought to be transmitted through the air – its name is derived from the Italian for “bad air” – mal aria.  It was not until the 19th century that the cause of malaria was discovered and its mode of transmission determined.  The symptoms of malaria, which were described as long ago as the 4th century BC by Hippocrates, were well recognised in the 19th century and were very prevalent in tropical regions.  During the 19th century many scientists and doctors provided evidence which would ultimately fit together to provide knowledge of malaria’s cause and transmission.

The mode of transmission was determined by Ronald Ross.  He was an Indian Medical Service doctor, born at the foot of the Himlayan mountain range.  In 1889 Ross began his research into malaria but it was not until 1984 that he began to make progress, when he met Patrick Manson, who in 1878 had determined that the parasite which causes human disease could infect a mosquito.  Ross had been unable to observe the parasite bodies, which were first described by Laveran, under the microscope.  Manson’s part was initially to demonstrate how this was done.  On returning to   India  , Ross used this new knowledge to prove that malaria was transmitted by mosquitoes.  By 1898, Ross was able to demonstrate the malaria parasite in a species of mosquito.  Ross was awarded the 1902 Nobel Prize in Medicine for his contributions to malarial research.

During Ross’s years of research, and for some time afterward, he and Manson corresponded frequently, and in subsequent years they had their letters copied and bound, each keeping copies in their respective Schools of Tropical Medicine (Liverpool and   London  ).  Through reading these letters, it is possible to see how their relationship evolved over the years and how they sadly grew apart.

The development of endoscopy - from Bozzini to Hopkins - Shaima Shareef 

Five men (Bozzini, Desormeaux, Bruck, Nitze and Hopkins) brought the cytoscope to its place today.  This was achieved in three main phases, namely the Bozzini era, the Nitze era and the era of the flexible endoscopes.  Philipp Bozzini created the “Lichtleiter” (or lightening conductor), the protype of the modern-day endoscope, for which he is known as the father of endoscopy.  His main idea behind the construction and development of his version of the endoscope was to introduce a light source directly into the area that needed to be observed.

Antonin Jean Desormeaux was the first to introduce the Lichtleiter to a patient.  He is hailed as the father of cystoscopy because of the many contributions he made to the field and to urology in general.  Julius Bruck used an incandescent platinum wire filament as a light source to examine the bladder diaphanoscopically.  His method utilised indirect illumination, which differed from Bozzini’s method of directly lighting up the body cavity to be observed.  Maximillian Nitze is credited with bringing the field of urology to life as a result of two fundamentally important inventions. Thomas Edison’s invention of the vacuum bulb revolutionised endoscopy.  Harold Hopkins, a physicist, created the rod-lens system and later collaborated with Karl Storz (inventor of the cold-light system) to form the Hopkins-Storz cytoscopes that revolutionised modern urology. Soon the basic ideas behind their cystoscopic designs spread to other specialities of medicine.  It can be concluded that it was cystoscopes that influenced the design of today’s modern endoscopes, irrespective of which form or medical speciality they are used in.

Society and the HIV epidemic  - Essy Omoregie 

HIV is a widespread virus which attacks the immune system and can cause death.  The AIDS epidemic began in the early 1980s following the emergence of HIV.  There are many controversial issues surrounding the transmission of HIV including the change in primary mode of infection from male homosexual sex to heterosexual intercourse.  The ongoing medicalisation of disease has also placed unnecessary pressures on health care professionals.  Real reasons behind the fear of HIV are startling, as well as the ironic freedom delivered by the decriminalisation of homosexuality.  The projection of homosexuality in the media and the ongoing issue of heterosexism are both important when examining the stigma that has occurred in the past and today, and to some extent still is applied to homosexuals.  Despite complex societal opinions of same-sex relationships as well as past responses to sexually transmitted disease epidemics, the energy and vigour devoted to stigmatisation of the gay community after the advent of HIV should have been redirected into fighting for equality for those with HIV-positive status.  The aim of the presentation is to follow the change in attitudes to those with HIV-positive status from the 1980s to the present day, and examine what has lead to this change.

The history of cosmetic surgery - Sarah Bruce  

The development of plastic and reconstructive surgery spans several centuries and often mirrors the health and medical pressures of the time.  Early developments reflected the need for therapy to tissues destroyed by infection.  Innovations in surgical treatment occurred in response to the devastating injuries of burns and major trauma seen in military conflicts.

Interestingly, the modern history of cosmetic surgery has been dictated by the public. The saying  “what the public wants, the public gets” is particularly apt.  Reputable surgeons who condemned this type of surgery were forced to embrace it due to the increasing prevalence of rogue physicians operating to meet public demand.  Technological advances, pioneering surgeons and cultural changes also had roles in the formation of modern cosmetic surgery.

Today we live in a society transfixed with celebrities, their image, figures and beauty.  The self-improvement and beauty industry has a commanding market.  The general public, it seems, will go to any length to achieve aesthetic perfection.  More recently issues of body image and obesity have stimulated further development.  Even facial transplantation is now possible.  The fact that many boundaries within cosmetic surgery are crossed every day gives rise to great debate.

  Cosmetic surgery raises serious ethical issues in an environment of potential or real health rationing.  The ethical dilemma is complicated and embraces some fundamental questions e.g. should a procedure be undertaken simply because the patient requests it; should a procedure be undertaken because the patient can afford it, thereby potentially excluding the poor; and is it appropriate that the NHS should underwrite such procedures?  In conclusion such dilemma can only be addressed by case scrutiny and perhaps greater regulation of a burgeoning medical industry.

The story of Rudolf Nureyev - Deepak Khara

Rudolf Nureyev was regarded as one of the greatest male dancers of the 20th century.  As famous for his temperamental nature as his dancing, at his first performance in England , the applause from the audience lasted longer than the ballet itself.  In January 1993, it was announced to the world that Nureyev had died “of a cardiac complication, following a grievous illness”.  Later, it was discovered that he died of an AIDS-related disease.

Nureyev is just one of the twenty-five million people that have died from AIDS-related diseases so far, but this figure pales in comparison to the estimated 38.6 million people worldwide who are currently living with human immunodeficiency virus (HIV), the causative organism of AIDS.  Acquired Immune Deficiency Syndrome (AIDS) is an international disease that has spread worldwide to devastate entire countries, and has left generations of children destitute with the loss of both parents to this condition.  With rapidly increasing incidence rates and as yet no cure for this illness, AIDS continues to have a negative impact on all facets of life.  From a historical perspective, AIDS has received notorious publicity, whilst our understanding of this unique condition has advanced greatly.

Nureyev never publicly disclosed that he had AIDS, amidst intense speculation. The fact remains that despite advances in research many people who are diagnosed with AIDS choose to hide it rather than face the consequences of disclosure.  AIDS is an extremely important health issue, yet misconceptions about the disease are widespread within communities and the medical profession.  Until the mystery surrounding this disease is dispelled, people who have AIDS will suffer needlessly.

A history of medicine from an Irish perspective - Aoibhinn Lawlor

The early part of the 19th century represented a very productive era for Irish medicine; several key figures were responsible for formalising medical teaching and advancing medical knowledge, particularly in the fields of anatomy and pathology. Their contribution led to the development of the   Irish  School  of Medicine.  Previously medical training had been conducted in less formal settings.  Some of the best-known Irish doctors remain familiar to all of us, as they have leant their names to various diseases, laws and principles.  Among the main characters are Robert Adams, Abraham Colles, Robert Graves, William Stokes and Sir Dominic Corrigan.

Robert Adams secured his place in medical history through his work on heart disease.  He is possibly more familiar to every medical student for the Adams-Stokes syndrome.  Abraham Colles was appointed professor of anatomy, physiology and surgery at the Royal College of Surgeons in   Dublin  .  He contributed to topographical anatomy; in every day practice we come across the Colles’ fracture first described by him.  Robert Graves was the first physician to fully describe exophthalmic goitre, now called Graves’ disease.  William Stokes was the leading representative of the Irish school of anatomical diagnosis.  Stokes, a pioneer in the new methods of clinical diagnosis, published more than a hundred scientific works.  Sir Dominic Corrigan’s most famous contributions were in eliciting symptoms of heart disease; he leant his name to several clinical signs including Corrigan’s pulse and Corrigan’s respiration.

This review is not intended to be an exhaustive discussion of the history of Irish medicine, but more of a meander through an exciting period of prolific advances in medical knowledge.  These figures, consigned to history, have made contributions which to this day form the basis of our scientific knowledge and clinical skills.

Kept under covers – the rise and fall and rise of syphilis 1800-2006; and the emergence of HIV -  Alexandra May

This review compares and contrasts two sexually transmitted  diseases – syphilis and HIV.  The reasons behind the patterns of incidence in both diseases will be explored, as will the patterns of spread and other similarities including public and medical response to both diseases.  Major issues are:

• Syphilis in the 19th century:  bizarre methods that were tried to halt the spread of the disease and reasons behind the maintenance of the syphilis epidemic.
• Syphilis from 1900-1950: the introduction of  “venereal disease” clinics in Britain and the use of propaganda posters during Word War II as a prophylaxis against venereal disease; the magic bullet which could cure syphilis - penicillis
• Syphilis 1950s-present:  recent trends such as peaks in new cases of syphilis in the 1960s, and the reasons behind this
• The emergence of a new scourge:  similarities between the syphilis and HIV epidemics – myths, pattern of spread, search for a cure

Lessons learnt from the syphilis epidemic could be applied to the HIV pandemic, for example, how public health campaigns could be arranged to reflect these lessons.

History of asthma - Alireza Salehzadeh

Asthma is a common inflammatory condition affecting the airways of the lungs. The walls of the airways can become inflamed, oedematous and congested with mucous. These changes are generally reversible.  There is substantial worldwide variation in the prevalence of asthma, with numerous causative and trigger factors implicated.

The word “asthma” is a derivative of the ancient Greek word aazein.  It was first mentioned in Homer’s Iliad around 2,700 years ago.  Hippocrates of Kos first mentioned it in a medical context, as well as leading medical figures along the way including Moses Maimonides, Thomas Willis, John Floyer, Henry Salter and Charles Blackley have added to the understanding of the disease.  The trial and error basis for treatment has also resulted in improvements in the management of asthma over the years   Modern day ideology of asthma, its causes, triggers, investigations and management have been heavily dependent on previous advancements, which have acted as stepping stones upon which the knowledge has been built.

There have been massive improvements in the understanding, diagnosis and management of asthma, which have subsequently resulted in an improvement in patient prognosis though there remain improvements to be made.

Medicine and health through time -  Laura Pearson

Examples of treatment in prehistoric times would include trepanning and herbal remedies.  Egyptian doctors were able to record treatments and remedies using hieroglyphics and papyrus and were able to identify many body organs through mummification, but did not know how they worked.  The Greek doctor Hippocrates is considered as the father of medicine.  He encouraged natural treatments and observing and recording the symptoms and development of diseases, and he developed the theory of the 4 humours.  The Romans realised that health and cleanliness were linked. Good sewage disposal and cheap public baths greatly advantaged their health.  Galen was a Greek doctor in   Rome  whose ideas lasted more than 1,500 years because he had the support of the Christian church.  After the collapse of the  Roman Empire , public health ceased to exist.

In the Middle Ages surgery was basic and on external body parts.  During the Renaissance the printing press and the microscope was invented.  Vesalius proved that animal anatomy was different to human anatomy.  Ambroise Pare replaced the use of boiling oil and cauterisation with bandages and silk thread.  William Harvey made important discoveries about the circulatory system.  In the 19th century, anaesthetics were developed enabling doctors to perform surgery inside the body, and Lister developed an antiseptic carbolic spray to reduce infection.    Edward Jenner discovered that people vaccinated with cowpox did not die if they caught smallpox afterwards.  Pasteur developed vaccines and proved that germs were responsible for causing disease.  Koch then discovered that different germs caused different diseases.

Florence Nightingale was a nurse in the Crimean war.  Her teaching and practice made nursing into a respectable profession.  Public Health improved in the 19th century due to the work of John Snow, Edwin Chadwick and the Public Health Acts of 1848 and 1875.

The first and second world war brought about great medical progress such as X-rays, blood transfusions, skin grafts and more.  Other major medical developments included the discovery of penicillin by Fleming, which was later developed and mass-produced by Florey and Chain. Aneurin Bevan later introduced the NHS.