Breath-taking encounters with records of lung disease

To celebrate Explore Your Archive week, the Royal College of Physicians (RCP) welcomed visitors to a hands-on display of records relating to lung health, chronicling people and practice over 400 years.  

Just as people breathe in air, absorb the oxygen in their lungs and breathe it out again, they also take in information, apply it as necessary to create documents, and pass those documents on. Many of the RCP’s records of lung health were formed as their creators received information from others, and were created to pass that information on.

For example, when Sarah Wigges (active 1616) started writing her medical recipe book in 1616, she used recipes received from family members and medical practitioners, and she intended the book to be passed onto her children and future generations. Her treatment for consumption (a sensible name for tuberculosis, as the disease consumes the sufferer by causing severe weight loss) is to give the patient warm white wine flavoured with chicken, nutmeg and cinnamon. At that time, domestic remedies often involved a certain amount of magic, and Sarah’s recipe requires that the chicken be killed in a particularly brutal way:

[Take] a red cock[,] plucke him alive, hange him by the heeles[,] beate him with a [birch rod] till he be dead[,] then quarter him in foure peeces, but washe him not

‘A medicen for a Consumption’, Sarah Wigges, c.1616

Similar recipes continued to be used to treat consumption throughout the seventeenth and eighteenth centuries, usually involving beer instead of wine. The drink came to be known as cock ale, and this may be the origin of the word cocktail.

When Francis Sibson (1814–1876) created his spectacular watercolour drawings of post-mortem bodies in the 1850s, he also intended the information to be passed on; the illustrations formed the basis of his anatomy textbook. The RCP holds his original drawings, which depict patients he treated at St Mary’s Hospital, London, and include lung and breathing-related conditions. A tracheotomy has been performed on the patient below. This ancient procedure involves opening up the airways, which may have collapsed for a number of reasons, and inserting a tube for air to pass through.

Anatomical drawing of a tracheotomy patient, Francis Sibson, c.1840-1860

The patient below had emphysema; his lungs have turned black because of the particle-filled mucus clogging up his airways, and have become warped in shape due to trapped air and a hardening of the lung tissue.

Anatomical drawing of a patient with emphysema, Francis Sibson, c.1840-1860

This next patient had tuberculosis. You can see how thin he became, and how his lungs are dappled with cavities and nodular lesions called tubercles.  

Anatomical drawing of a patient with tuberculosis, Francis Sibson, c.1840-1860

In 1796, Edward Jenner (1749–1823) had noticed that these tubercles often coincided with tapeworm cysts called hydatids in the lungs of animals he dissected, including sheep, cows, toads and pigs. Jenner famously learned to use cowpox as a vaccination against smallpox. His neighbours in Gloucestershire who worked with animals had known for generations that people who had caught cowpox didn’t then contract smallpox, and they passed this information onto Jenner. Similarly, his investigations into tuberculosis also involved conversations with local workers.  He records in his notebook, held by the RCP, that a Mrs Self, who for years had worked in her father’s butcher’s shop ‘frequently cough’d up little worms, similar to what she had often seen in the lungs of hogs when she lived with her father.’ Jenner asked himself ‘Does tuberculous consumption arise from our familiarity with an animal that nature intended to keep separate from Man[?]’ He wrote to his brother Henry:

the cause [of tubercles in the lungs] has not (as far as I know) been known or even guess’d at till now […] from comparing the diseas’d lungs of different quadrupeds with human lungs their origin has been clearly develop’d & it appears to be owing to Hydatids.

However, Edward Jenner had only solved part of the puzzle. We now know that tapeworms can inhibit the immune system and increase the risk of tuberculosis in humans, but it was Robert Koch (1843–1910) who first demonstrated in 1882 that tuberculosis itself was caused by a bacterial infection, Mycobacterium tuberculosis. Koch’s discovery was timely, as tuberculosis was a major killer of people across Europe; at its height it was the cause of death of 25% of Londoners. Two RCP fellows involved in fighting the spread of the disease were William Broadbent (1835–1907), who co-founded the National Association for the Prevention of Consumption (which evolved into the Chest, Heart and Stroke Association and is now the Stroke Association), and George Buchanan (1831–1895), who as Medical Officer for the Local Government Board inspected public buildings and sanitation systems, and worked to improve living conditions for poor people.     

One record that clearly shows the passing of information from one generation to the next is the notebook of a student who we know only as T. Cawley. He attended a series of lectures by William Hunter (1718–1783) in 1778, and observed the famous anatomist demonstrating how lungs and other organs worked. At one point, Hunter contrasts his own theories with those of the physiologist Stephen Hales (1677–1761), so we get a view of lung anatomy through the lens of three generations of writers, Hales, Hunter and Cawley. The notebook briefly mentions smoking and a supposed difference between the smoking habits of Indians, who, according to Cawley’s notes, inhale smoke into the lungs, and Europeans, who, it is claimed, only take smoke into the mouth.

Two hundred years later, debates about the effects of smoking were still raging, stoked by the publication in 1962 of the RCP’s landmark report, Smoking and health. (The misapprehension that smoking isn’t harmful if you don’t inhale was still widely accepted; in fact, smoke inevitably enters the lungs regardless, and tobacco can also cause mouth cancer.) Smoking and health was the first major report advising the public of the link between smoking and diseases such as lung cancer and chronic obstructive pulmonary disease (COPD). The report incited a mixture of praise and ridicule from the media, and letters of support and criticism from the public. One correspondent wrote:

I’ll swallow smoke from my delicious Capstan, but I refuse to swallow your witchdoctors’ mumbo-jumbo’, while another asked ‘why doctors are not very angry because so much of their efforts are laid waste by cigarette smoking – just as Jesus Christ showed righteous anger in cleansing the temple.

In the wake of the report, the RCP received hundreds of requests from individuals for advice on giving up smoking, and from organisations such as schools and local authorities for information they could disseminate. The report and its follow-ups were published around the world in many different languages, and led to the establishment of clinics and programmes to help people give up smoking.

Smoking and health, Japanese edition of the third report, Royal College of Physicians, published 1977

All the records on display, as well as thousands more in the RCP archives, can be searched via our online catalogue, and are available to view in our reading room

Felix Lancashire, assistant archivist

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