Total Health https://www.totalhealth.co.uk/rss.xml en Eating disorders at Christmas - could someone you know have orthorexia? https://www.totalhealth.co.uk/blog/eating-disorders-christmas-could-someone-you-know-have-orthorexia <span class="field field--name-title field--type-string field--label-hidden">Eating disorders at Christmas - could someone you know have orthorexia?</span> <div class="field field--name-field-related-conditions field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/your-condition/eating-disorders" hreflang="und">Eating Disorders</a></div> <div class="field__item"><a href="/your-condition/depression" hreflang="und">Depression</a></div> <div class="field__item"><a href="/your-condition/depression-nutrition" hreflang="und">Depression nutrition</a></div> </div> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/user/91" typeof="schema:Person" property="schema:name" datatype="">Lucy Hunter</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 12/21/2016 - 17:00</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><img alt="Christmas eating disorders" data-entity-type="file" data-entity-uuid="6f58fee3-fc29-41b0-ab47-d1a87153ddfa" src="/sites/default/files/inline-images/christmas-eating-disorder-800x420.jpg" class="align-right" /></p> <p> </p> <p> </p> <p><strong>Experts say that the obsession with clean eating is creating a new kind of eating disorder. Could orthorexia affect someone in your family? </strong></p> <p>Most of us adore Christmas. It’s a time of festivity and food – the kitchen table heaves with mouth-watering fare. You can feast on smoked salmon starters, before enjoying a helping of succulent turkey, with all the trimmings. Then there's Christmas pudding, or perhaps a slice of chocolate yule log for afters. The fizz flows, along with the laughter and chat. Christmas is all about blissful indulgence. However, if you have an eating disorder or emotional issues around food, the chances are, this season evokes rather different feelings.</p> <h2><strong>Orthorexia - the new eating disorder</strong></h2><p></p> <p>There will be a lot of families affected by eating disorders this Christmas - a study by the charity <a href="https://www.b-eat.co.uk/">BEAT</a>, revealed that 725,000 people in the UK suffer from such an illness. It’s estimated that 10% of those with an eating disorder are anorexic, around 40% bulimic. The rest fall into a non-specified group of eating disorders, which include bulimia and binge eating. Experts reckon this figure could mask an even bigger number. Specialists in eating disorders have identified a new category – <a href="http://www.totalhealth.co.uk/clinical-experts/stephanie-moore/orthorexia-new-eating-disorder-0">orthorexia</a>. According to <a href="http://www.totalhealth.co.uk/clinical-experts/stephanie-moore">Stephanie Moore, a Clinical Nutritional Therapist</a> and an expert in eating disorders, orthorexia is becoming a commonly used term to describe someone who has an unhealthy obsession with eating healthy food.  She says: ‘Although not yet officially recognised in the medical world, doctors are beginning to acknowledge this as a potentially serious issue that is affecting predominately teenagers and young adults.’</p><p></p> <h2><strong>Clean eating at Christmas</strong></h2><p></p> <p>You probably know someone who could be at risk of <a href="http://www.totalhealth.co.uk/clinical-experts/stephanie-moore/orthorexia-new-eating-disorder-0">orthorexia</a>. The person who really cares about the quality of their food. They’re worried about the salted caramel panettone. Is it organic? Gluten-free? Does it have any additives in it? The fact orthorexia has emerged at the same time as the move to ‘clean eating’ is probably not a coincidence. ‘Orthorexia often starts as a genuine desire to become healthier,’ says Stephanie Moore. ‘Sometimes there is a weight loss incentive, but the overriding focus is that everything consumed must be ‘clean’; that is, free of additives and preservatives, that the food is ‘natural’, often needing to be organic and unprocessed.  Further requirements might be that all food is dairy-free, sugar-free, gluten-free and/or free of all animal products.’</p><p></p> <h2><strong>The Instagram eating disorder</strong></h2><p></p> <p>This new type of eating disorder is closely linked to the surge in use in social media. Many fitness bloggers have spoken out about how their simple desire to get healthier then transformed into a far more worrying mode of behaviour. It went very wrong for Emilie Layla Lovaine, a health blogger who had more than 40,000 followers and regularly got over 200 likes after she posted a picture of her healthy food on Instagram. She has described how she would spend hours making raw-chocolate bites and cold pressed juices, and then artfully style them for Instagram shots. But instead of enjoying the treats, the blogger would just end up throwing the food away. When Lovaine found herself unable to force a spoonful of Weetabix down, she knew she needed some help. Lovaine’s problems were so severe, she was referred to an eating disorders clinic. She has written on her <a href="http://lovaine.blogspot.co.uk/2016/01/an-honest-twenty-sixteen-lifting-filter.html">blog</a>: ‘For any of you that maybe struggling or feeling overwhelmed with food and exercise, just know help is out there. Reaching out to your GP, friend or loved one is the first step.’</p><p></p> <h2><strong>The dangers of orthorexia</strong></h2><p></p> <p>Is orthorexia dangerous? According to Stephanie More, the answer is yes. ‘An orthorexic person will feel panicked and desperate if they cannot eat and exercise within their rules. If this extremely controlled behaviour endures for longer than a few weeks, it can result in numerous health complications.’ There are, however differences to anorexia nervosa, which has the highest death rate of all mental disorders. ‘Unlike a<span id="hovertip-626">norexia</span>, where patients are often at a critically low body weight and want to avoid eating altogether, orthorexics may not be underweight,’ explains Moore. ‘They are willing to eat regular meals but are often greatly restricting quantities of certain food types, such as starchy <span id="hovertip-837">carbohydrates</span> and/or fats. The danger comes more in the malnourishment and mental anguish that inhibits healthy function.’</p><p></p> <p></p><p> </p> <h2><strong>Getting help for eating disorders</strong></h2><p></p> <p>With family and friends coming together for meals, if it becomes apparent that any of your loved ones (or even yourself) have issues with food, it’s vital to get medical and psychological help. Anorexia nervosa and bulimia can be extremely dangerous. As well as the sadly very real possibility that an eating disorder can lead to death, sufferers are also more vulnerable to developing infertility problems and <a href="http://www.totalhealth.co.uk/clinical-experts/professor-david-reid/osteoporosis-definition-identification-and-prevention">osteoporosis </a>in later years.  Orthorexia poses a more tricky issue, because of the subtle way it manifests its self. ‘An experienced nutritional therapist, ideally with counselling and/or health coaching experience would be able to offer this guidance,’ advises Moore. ‘Someone suffering with this condition needs to seek on-going professional support to break these patterns of obsessive behaviour and to find a more comfortable balance with food, exercise and body image.’</p> <p></p><p>Stephanie Moore practises at <a href="harleystreet.co.uk/">25 Harley Street</a>.</p> </div> Wed, 21 Dec 2016 17:00:45 +0000 Lucy Hunter 9401 at https://www.totalhealth.co.uk Four steps to a natural menopause https://www.totalhealth.co.uk/clinical-experts/miss-tania-adib-consultant-gynaecologist/four-steps-natural-menopause <span property="schema:name" class="field field--name-title field--type-string field--label-hidden">Four steps to a natural menopause</span> <div class="field field--name-field-related-conditions field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/your-condition/menopause" hreflang="en">Menopause</a></div> <div class="field__item"><a href="/your-condition/irregular-and-heavy-periods" hreflang="und">Irregular and Heavy Periods</a></div> <div class="field__item"><a href="/your-condition/osteoporosis" hreflang="und">Osteoporosis</a></div> <div class="field__item"><a href="/your-condition/hysterectomy" hreflang="und">Hysterectomy</a></div> <div class="field__item"><a href="/your-condition/hormone-replacement-therapy" hreflang="und">Hormone Replacement Therapy</a></div> </div> <span rel="schema:author" class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/user/91" typeof="schema:Person" property="schema:name" datatype="">Lucy Hunter</span></span> <span property="schema:dateCreated" content="2016-12-20T09:02:24+00:00" class="field field--name-created field--type-created field--label-hidden">Tue, 12/20/2016 - 09:02</span> <div class="field field--name-field-article-paragraphs field--type-entity-reference-revisions"> <div class="field field--name-field-paragraph-image field--type-image field--layout-full"> <img src="/sites/default/files/pexels-photo-103127.jpeg" width="1280" height="666" alt="woman enjoying herself" typeof="foaf:Image" /> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><meta charset="utf-8" /></h2> <h2><strong>Symptoms of the menopause</strong></h2> <p>Does the thought of the menopause fills you with dread? Perhaps you’ve heard all about the hot flushes many women experience, the weight gain, the mood changes – and night sweats so severe that the bed sheets need changing. Then there’s the decrease in libido, painful sex, depression and anxiety to contend with. It’s no wonder this part of the normal ageing process concerns us so much.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2 dir="ltr"><strong>The average age of the menopause?</strong></h2> <p>The average age of the menopause in the UK is 50 years, just when women are at their prime of life, leading busy lives, holding down stressful jobs or juggling family life. A hundred years ago, women didn't live much past the age of 50, so the menopause was not such an issue. However, the age of the menopause has remained the same whilst we are surviving much longer. As women's life expectancy increases, so women are living for longer in the menopause.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><meta charset="utf-8" /><b id="docs-internal-guid-50e5b397-1ba5-963b-6773-ef7645e20520">Natural alternatives to HRT?</b></h2> <p dir="ltr">Hormone Replacement Therapy can certainly improve symptoms, but many women don’t wish to take it, and wish to find a more natural way to manage the menopause. Looking at other countries gives us an indication that this is certainly possible. The experience of menopause is different for each woman, but interestingly, western women have worse symptoms than women in some other countries, such as Japan, China and India. For example, <a href="http://www.tandfonline.com/doi/abs/10.3109/13697130903197479?journalCode=icmt20">one study</a> showed that 64 per cent of British women reported suffering from tiredness, compared to just six per cent of those from Japan. When it comes to those aches and pains that seem to become more prevalent in the menopausal years, 54 percent of British women reported these were a problem – but just 14 percent of Japanese women complained of these.<strong><b id="docs-internal-guid-50e5b397-1ba5-963b-6773-ef7645e20520"> </b></strong></p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>How Asian women manage the menopause</strong><meta charset="utf-8" /></h2> <p dir="ltr">Asian women do, in general, consume a far healthier diet than British women. It’s full of oily fish, soy, green tea, fruit and vegetables. So, taking our cue from the lifestyles of these women in other countries who seem to manage the menopause better than us, what lifestyle changes can we make? We could start by following these four steps, which should ensure a smoother path during the menopause.</p> </div> <div class="field field--name-field-paragraph-image field--type-image field--layout-full"> <img src="/sites/default/files/salmon-dish-food-meal-46239.jpeg" width="800" height="420" alt="salmon dinner" typeof="foaf:Image" /> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><b id="docs-internal-guid-50e5b397-1bae-abec-6306-2fefe5fe2ab6">Eat a healthy diet</b></h2> <h2><meta charset="utf-8" /></h2> <p>A healthy diet is the cornerstone of optimum health. A healthy diet allows the body to adapt to the changes in the hormones over time. It's so important to eat healthy and consistently to keep blood sugar levels stable in the menopause – eating sugary foods causes huge swings in blood glucose may cause symptoms very similar to menopausal symptoms such as excessive sweating, anxiety, irritability, mood swings, tiredness, poor memory and difficulty in concentration. Making sure your diet is balanced with protein, good fats (such as those found in salmon) and complex carbohydrates, lots of fresh vegetables and fruit, and plenty of hydration will help ease menopausal symptoms.  Avoiding or reducing refined sugar, coffee and alcohol, all of which can make hot flushes and sweating much worse. This also helps to beat the fat around the middle, on the stomach and abdomen which so commonly occurs. Also, including foods such as tofu, soya, red clover, alfalfa, flaxseed and dandelion may help. These all include Phytoestrogens - weak plant oestrogens. It has been suggested that these may help lessen menopausal symptoms. Eating these foods – which all have an high consumption in the East - are also associated with a lower rate of breast cancer and lower cholesterol.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2 dir="ltr"><b id="docs-internal-guid-50e5b397-1bae-abec-6306-2fefe5fe2ab6">Added benefits</b></h2> <p>Of course, eating a healthy diet is not just for the menopause. It has other benefits too, such as:</p> <ul> <li>Maintaining a healthy weigh</li> <li>Preventing heart disease</li> <li>Preventing osteoporosis</li> <li>Preventing cancer</li> <li>Prevents degenerative diseases such as arthritis</li> <li>Helps with joint stiffness</li> </ul> </div> <div class="field field--name-field-paragraph-image field--type-image field--layout-full"> <img src="/sites/default/files/pexels-photo-173428.jpeg" width="800" height="420" alt="Woman exercising during menopause" typeof="foaf:Image" /> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><b id="docs-internal-guid-50e5b397-1bb5-42cc-c97b-38cc8bb4b78c">Take regular exercise</b></h2> <p><meta charset="utf-8" /></p> <p>As women get older, without the benefit of oestrogen, bone density levels fall over time. It's especially important to do the right exercise to keep the bones strong, and keep the body supple to prevent falls. Weight bearing exercise, such as dancing and running are good choices, but if you don’t feel able to do this, even walking can help prevent osteoporosis. Use weights to strengthen the muscles, and cardio – that’s any activity that increases heart rate and respiration while using your muscles – is good for the heart. However, take note that cycling and swimming, don’t count as weight bearing exercise – although they’re still good for you. Put aside at least 30 minutes three times a week to exercise. It’s a great stress-buster - as well as helping keep your body strong, physical activity releases ‘feel good’ hormones, giving you a much-needed mood boost!</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>Reduce your stress</strong></h2> <p>Most women will tell you that menopausal symptoms feel far worse when they’re feeling stressed. Depression can also become worse at the perimenopause because of reducing levels of oestrogen. Of course, exercising and a good diet will make stress less acutely felt, but relaxation techniques can also reduce symptoms of the menopause, such as anxiety. Simply focusing on your breathing for five minutes can have a positive effect on how you feel. Just slow down and be present in yourself. Mindfulness, yoga, breathing all help give a sense of objectivity so physical symptoms, like hot flushes, aren’t so keenly felt.</p> <p><meta charset="utf-8" /></p> </div> <div class="field field--name-field-paragraph-image field--type-image field--layout-full"> <img src="/sites/default/files/capsule-pill-health-medicine.jpg" width="1280" height="853" alt="Supplements for the menopause" typeof="foaf:Image" /> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><meta charset="utf-8" /><strong>What supplements help the menopause?</strong></h2> <p>There are a number of vitamin and mineral supplements which can be very beneficial around the time of the menopause and beyond. Vitamin D is one of the most important vitamins. Low levels of vitamin D have been linked with a higher risk of breast cancer, heart disease and osteoporosis. It has also been linked with inflammatory conditions such as rheumatoid arthritis and inflammatory bowel disease. Lower levels are more common in the winter when there is a lack of sunlight, so taking a good quality supplement is essential. Talk to your doctor or pharmacist about which all-round multivitamin is right for you.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>Herbs to stop menopause symptoms</strong></h2> <p><meta charset="utf-8" /></p> <p>You’ve probably heard that herbs can help women during the menopause. Although herbal supplements often don’t have the kind of research to show their efficacy that prescription drugs have, many women find them very helpful. If you’re considering taking a herbal supplement, you should always talk to your doctor beforehand, in case there is a medical reason why you should avoid certain herbs - for example, they may interact with prescribed medication. If you do wish to take a herbal supplement, these are the ones commonly used, and how they help:</p> <p>• Black cohosh. Effective for hot flushes, night sweats, mood changes, although it does not alter oestrogen levels. This has received bad press due to few cases of liver failure, but is widely used in Europe with good safety data, and <a href="http://umm.edu/health/medical/altmed/herb/black-cohosh">considered</a> effective.</p> <p>• Sage. There’s some <a href="http://news.bbc.co.uk/1/hi/health/3189635.stm">evidence</a> to suggest this can help with memory.</p> <p>• Agnus castus. Has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764641/">hormone-balancing</a> properties.</p> <p>• Ginkgo biloba. Preliminary <a href="http://www.mayoclinic.org/drugs-supplements/ginkgo/evidence/hrb-20059541">studies</a> show it many help memory</p> <p>• Dong Quai. Said to help with menstrual problems.</p> <p>• Omega 3. Helps with dry skin, eyes and nails, fatigue, depression, aching joints, forgetfulness.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><p><meta charset="utf-8" /></p> <h2 dir="ltr"><b id="docs-internal-guid-50e5b397-1bbe-9416-a180-2545cc76e5da">Your menopause, your choice</b></h2> <p>As a doctor, I always point out to women who come and see me that HRT is really effective and actually very safe. However, there are so many alternatives that can really help with symptoms and most importantly, long term health. What is vital, is to talk to a menopause specialist who will look at your individual case and help you make an informed decision about what treatment option is best for you.</p> </div> </div> Tue, 20 Dec 2016 09:02:24 +0000 Lucy Hunter 9391 at https://www.totalhealth.co.uk Irritable Bowel Syndrome: How Nutritional Therapy Can Help https://www.totalhealth.co.uk/clinical-experts/stephanie-moore/irritable-bowel-syndrome-how-nutritional-therapy-can-help <span property="schema:name" class="field field--name-title field--type-string field--label-hidden">Irritable Bowel Syndrome: How Nutritional Therapy Can Help</span> <div class="field field--name-field-related-conditions field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/your-condition/irritable-bowel-syndrome" hreflang="und">Irritable Bowel Syndrome</a></div> <div class="field__item"><a href="/your-condition/inflammatory-bowel-disease" hreflang="und">Inflammatory Bowel Disease</a></div> </div> <span rel="schema:author" class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/user/91" typeof="schema:Person" property="schema:name" datatype="">Lucy Hunter</span></span> <span property="schema:dateCreated" content="2016-12-06T10:52:38+00:00" class="field field--name-created field--type-created field--label-hidden">Tue, 12/06/2016 - 10:52</span> <div class="field field--name-field-article-paragraphs field--type-entity-reference-revisions"> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><p>If you suffer from irritable bowel syndrome, you’ll already know that this debilitating illness can be difficult to treat. Top London nutritionist Stephanie Moore explain how a holistic approach can help heal your gut, and free you from the everyday misery of IBS.</p> </div> <div class="field field--name-field-paragraph-image field--type-image field--layout-full"> <img src="/sites/default/files/IBS-tummy-cramp-800.jpg" width="800" height="420" alt="IBS cramping" typeof="foaf:Image" /> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>What is irritable bowel syndrome?</strong></h2> <p>IBS is a combination of numerous symptoms that frequently appear together and for which there are any number of triggers. With IBS, these symptoms tend to range from persistent abdominal bloating, cramping pain and spasming in the intestine, foul smelling wind, irregular bowel habits (bouts of diarrhoea, constipation or a combination of both) and a general feeling of discomfort in the abdominal region.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>Healthy bowel function</strong></h2> <p>A daily bowel movement that feels complete and easy to pass without any urgency or major effort involved indicates healthy bowel function. People with IBS rarely, if ever, experience this. Commonly they experience chronic constipation, where there is no bowel movement for many days and/or small, hard stools on an infrequent basis. This can be very uncomfortable and often results in chronic bloating and pain. As the stools are retained in the bowel toxins that the body is trying to eliminate can be reabsorbed and re-circulated throughout the body. This puts an added burden on the liver and often leads to headaches, ‘brain fog’ and general malaise.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>When you HAVE to go to the toilet</strong></h2> <p>Equally, an individual may have chronic diarrhoea, where a sudden urgency to relieve the bowels can occur up to 30 times a day. This is obviously distressing and often results in feelings of insecurity about leaving the house. Having loose bowels can quickly lead to dehydration, which then affects many other bodily functions. In addition, nutritional deficiencies can occur as food is not being broken down and absorbed properly. This results in feeling weak and fatigued very quickly.</p> </div> <div class="field field--name-field-paragraph-image field--type-image field--layout-full"> <img src="/sites/default/files/vegetables-frying-pan-greens.jpg" width="800" height="420" alt="Healthy food for ibs" typeof="foaf:Image" /> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>Treat IBS without drugs</strong></h2> <p>As there is such a diversity of symptoms and triggers are individual to the sufferer, there is no specific medical intervention to cure or even abate symptoms exists. A low fibre diet is sometimes recommended but, as I will go on to explain, this is not necessarily helpful. If the IBS triggers are not well managed, inflammation can develop within the intestine. Once this occurs any number of further factors can cause a flare-up from fatigue, an increasing range of foods and even anxiety.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>Overhaul your habits to help cure IBS</strong></h2> <p>Having positive, practical advice to help address IBS is essential for the sufferer's physical and emotional well-being. Such a complex condition, which has been shown to be associated with many lifestyle factors, not just diet, tends to respond really well to a more holistic approach where stress, sleep and nutrition can all be addressed together.  By taking a thorough dietary and medical history, a nutritional therapist can begin to see patterns regarding specific triggers. Once these factors are addressed and better managed the internal irritation is able to calm and eventually heal, ultimately relieving the symptoms long-term and often enabling the people to resume eating foods that they once considered ‘problem’ foods.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>Why the gut microbiome is important</strong></h2> <p>One aspect of nutritional therapy that is an increasing focus for many clinicians is the effect of diet on the 100 trillion bacteria (known as the gut microbiome) that live in the digestive system. Long known to be involved with digestion and immune health, these bacteria have recently been shown to have a significant influence over our weight, our predisposition to chronic disease, including type 2 diabetes, our mental well-being and our ability to detoxify and eliminate carcinogens (cancer-causing substances) and even cancerous cells. They are also a big factor in the treatment of IBS.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>The gut brain connection</strong></h2> <p>There are many easy, daily practices that can quickly and effectively enhance the state of these highly influential gut bacteria and in turn improve inflammatory bowel problems and digestive discomfort. Anxiety, depression and other mental health problems may also be positively affected.  These highly beneficial microbes, which outnumber our human cells ten to one, rely upon certain foods to thrive. Therefore, what we eat is not only feeding our human cells but also our gut microbes.</p> </div> <div class="field field--name-field-paragraph-image field--type-image field--layout-full"> <img src="/sites/default/files/good_bacteria-and-bad-bacteria-800x700.jpg" width="800" height="700" alt="" typeof="foaf:Image" /> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>Good bacteria versus bad bacteria</strong></h2> <p>As well as the trillions of really helpful bacteria other bacteria, viruses and pathogens also reside in the body and these can undermine health, especially within the digestive system. If the good bacteria outnumber the bad ones, ideally at a ratio of about four to one, then the pathogens are unable to take a hold and have any significant, negative effect on the body. However, many modern factors such as chlorine in our water, medications, diets high in refined &amp; processed foods, artificial sweeteners to name but a few, result in the good bacteria dying off and the bad bacteria flourishing. When this gets to a critical point, inflammation and damage in the intestine occur and symptoms of IBS develop.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>Fermented foods support healthy gut microbiome</strong></h2> <p>Fermented (probiotic) foods, which contain live beneficial bacteria can help support a healthy gut microbiome by actually taking good microbes in to the gut to keep the ratio at a healthy balance. These foods include raw sauerkraut and Kimchi (fermented vegetables), live natural yogurt and kefir (fermented dairy foods), Kombucha (fermented tea) and Miso (fermented soy).  Fibre, mostly found in fruit, vegetables, nuts, seeds and pulses like lentils and beans also greatly support the health of the good bacteria as they thrive on digesting fibre (prebiotic foods). Humans do not have the capacity to digest fibre, but the bacteria do it really well, allowing the good bacteria to remain healthy and grow, ensuring any bad stuff is kept at bay. This then improves our capacity to manufacture nutrients within the gut, increases the ‘intelligence’ of our immune system and improves the body’s ability to control inflammation.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>Healing a damaged gut</strong></h2> <p>Ironically, an initial treatment plan for IBS may involve greatly reducing fermented foods and high fibre foods as a damaged, inflamed gut that is under-functioning, with an inadequate number and variety of beneficial bacteria will struggle to cope with the addition of these live and fibrous foods, which can trigger painful bloating and acute <em>diarrhoea</em>. Therefore, identifying an individual’s specific triggers be it to fermented foods, all or just some raw vegetables and salad foods (raw foods take a lot of breaking down) or whether it’s onions and garlic (very common bloaters), these foods need to be avoided until the digestive system has had the chance to heal.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>Getting the balance right</strong></h2> <p>However, total avoidance of fermented and fibrous foods is not the answer to solving IBS, far from it. The gut bacteria need to be enhanced in number and variety to ensure good health and vitality and this can only be achieved long-term if these functional foods are included. This is where a nutritional programme to support bacterial balance and digestive robustness is essential. Using strategic dietary protocols that allow the gut to rest and heal, healthy fibrous foods and live, fermented foods can be introduced gradually to support function without triggering a flare-up.</p> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><strong>Get help for IBS</strong></h2> <p>If you are not sure if you are suffering from IBS, consider this … if you have a general awareness of your digestive system not working well or feeling uncomfortable, it is likely there is something wrong. A healthy body should digest and pass food throughout the many metres of intestine without you ever really being aware of what’s going on in there. Don’t be embarrassed and don’t suffer in silence. A dysfunctional digestive system is not something to be ignored.</p> </div> </div> Tue, 06 Dec 2016 10:52:38 +0000 Lucy Hunter 9344 at https://www.totalhealth.co.uk Giles Davies https://www.totalhealth.co.uk/clinical-experts/giles-davies <span class="field field--name-title field--type-string field--label-hidden">Giles Davies</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Mr Giles Davies is a Consultant Oncoplastic Breast Surgeon at the Kingston Hospital NHS Trust and an honorary Consultant Oncoplastic Breast Surgeon at the Royal Marsden Hospital. He is also a Consultant Oncoplastic Breast Surgeon at the<strong> London Breast Clinic at 108 Harley Street.</strong></p> <p>Having trained at St Georges Hospital Medical School he qualified in 1997. He completed his basic surgical training at the Royal London Hospital and then his specialist surgical training in the South West Thames Specialist Registrar Rotation. During this time he undertook research for his MD at the Royal Marsden Hospital.</p> <p>Following this he spent a year as an international Oncoplastic Fellow at the Royal Adelaide Hospital in Australia where he was trained in Oncoplastic surgical techniques of the breast.</p> <p>Mr Davies specialises in the treatment of breast cancer including resection and reconstruction surgery. He is clinical lead of the Breast Unit at Kingston Hospital where he has developed a comprehensive breast reconstruction service for women diagnosed with breast cancer.</p> <h3><strong>Personal Philosophy</strong></h3> <blockquote> <p>I am a breast surgeon using the most up to date techniques at state of the art medical facilities but it is very important that I should always strive to offer my patients the most holistic care possible.</p> </blockquote> </div> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" typeof="schema:Person" property="schema:name" datatype="">Anonymous (not verified)</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 02/12/2014 - 15:43</span> Wed, 12 Feb 2014 15:43:18 +0000 Anonymous 6409 at https://www.totalhealth.co.uk Why choosing to have a private obstetrician could be best for you and your baby https://www.totalhealth.co.uk/healthy-interests/why-choosing-have-private-obstetrician-could-be-best-you-and-your-baby <span class="field field--name-title field--type-string field--label-hidden">Why choosing to have a private obstetrician could be best for you and your baby</span> <div class="field field--name-field-related-conditions field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/your-condition/pregnancy" hreflang="und">Pregnancy</a></div> </div> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" typeof="schema:Person" property="schema:name" datatype="">Anonymous (not verified)</span></span> <span class="field field--name-created field--type-created field--label-hidden">Tue, 01/14/2014 - 15:05</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><strong>Why a Private Obstetrician can be the best Investment for Baby</strong></p> <p>If you are pregnant you may be enjoying the idea of shopping for all of the things that you want for your unborn baby. Your wish list may include designer clothes and furnishings or a go-anywhere buggy but there is every chance  that you will not have given too much thought to the idea of paying privately for an obstetrician to care for you and your baby. However, if your priority is your wellbeing and the safe delivery of a healthy baby then you may want to think again.</p> <p><strong>Maternity Services Feeling the Strain</strong></p> <p>With the birth rates in the UK at their highest for over 40 years and NHS labour wards struggling just to cope with demand, choosing to have a private obstetrician could be the best decision that you will ever make. Indeed, in some parts of England the birth rate has increased by more than 50% in recent years, which is putting a huge strain on maternity services. The majority of babies in the UK are of course delivered by midwives but at just the time when many more babies are being born the NHS is faced with the problem of a chronic midwife shortage.</p> <p>A recent <a href="http://www.nao.org.uk/report/maternity-services-England">report</a> by the National Audit Office into the provision of maternity services in England revealed that the NHS in England is approximately 5000 midwives short of where it needs to be and raised serious concerns about the considerable variation between the performance of hospitals in respect of the quality, safety, cost and efficiency of maternity departments.</p> <p>These are also the findings of the third annual <a href="http://www.rcm.org.uk/college/policy-practice/government-policy/state-of-maternity-services">State of Maternity Services Report</a> compiled by the Royal College of Midwives, which states that in 2012, the last year for which there are up to date midwife and birth figures, 694,241 babies were born in England but the number of midwives working in the NHS that year was suitable for only 565,245 births, meaning there were 128,996 more births than the service was designed to cope with.</p> <p>The CEO of the Royal College of Midwives, Cathy Warwick, states that “the NHS is at the limit of what maternity services can safely deliver.”</p> <p>To put this another way, the NHS is at the limit of being able to deliver babies safely.</p> <p><strong>NHS cannot justify more than 'one size fits all'</strong></p> <p>Furthermore, even a fully resourced NHS cannot realistically provide more than a one-size fits all maternity service that offers little choice or flexibility and scant provision for the emotional and psychological side of pregnancy and birth that is so important to many women. On the other hand, those women who opt for a private Consultant Obstetrician are offered a much more personalised service and are able to choose the type of obstetric care and support that is right for them. The obstetrician will be responsible for providing care throughout the pregnancy, personally deliver their babies no matter how routine the delivery and be on hand until six weeks after the birth.</p> <p><strong>Obstetric Reassurance</strong></p> <p>Taryn M. chose to have a private obstetrician when she was pregnant with her baby daughter. She explained the benefit in the following way, “I believe that women want a private obstetrician so that they are in the care of one specialist who solely oversees their individual case from beginning to end. This gives a feeling of reassurance, security and wellbeing.”</p> <p>Speaking of her own experience she added, “I will be eternally grateful to my obstetrician, <a href="http://www.totalhealth.co.uk/clinical-experts/mr-ashok-kumar">Dr Ashok Kumar</a>, for his professional demeanour, understanding and kind, thoughtful, calm and gentle manner at all times. I was thoroughly supported throughout every stage of my pregnancy and felt that both myself and my baby were in the safest hands that one could possibly envisage.”</p> <p>Of course, the majority of pregnancies proceed smoothly and most babies are born safe and well but for many women the peace of mind that comes from having a private obstetrician is well worth the investment.</p> <p>Dr Ashok Kumar provides information for parents-to-be in his authoritative article - <a href="http://www.totalhealth.co.uk/clinical-experts/mr-ashok-kumar-consultant-obstetrician-and-gynaecologist/caring-you-and-your-baby-during-your-pregnancy">here.</a></p> <p><img alt="Image preview" height="76" src="http://www.totalhealth.co.uk/sites/default/files/imagefield_thumbs/articles/Ashok Kumar and baby.jpg?1392284867" style="float: right;" title="Ashok Kumar and baby.jpg" width="112" /></p> </div> Tue, 14 Jan 2014 15:05:07 +0000 Anonymous 6318 at https://www.totalhealth.co.uk Famous British Medical Pioneers - The History of Medical Innovation https://www.totalhealth.co.uk/healthy-interests/famous-british-medical-pioneers-history-medical-innovation <span class="field field--name-title field--type-string field--label-hidden">Famous British Medical Pioneers - The History of Medical Innovation</span> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" typeof="schema:Person" property="schema:name" datatype="">Anonymous (not verified)</span></span> <span class="field field--name-created field--type-created field--label-hidden">Fri, 10/11/2013 - 13:48</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><strong>by <a href="http://www.totalhealth.co.uk/clinical-experts/dr-edin-lakasing">Dr Edin Lakasing</a>, The Royal Society of Medicine and Chorleywood Health Centre</strong></p> <p> </p> <p>Britain has been at the forefront of medical research and practice throughout the modern era and British scientists have been responsible for numerous ground-breaking discoveries. In this section authored by Dr Edin Lakasing we look at some of the individuals who pioneered medical advancement and who saved the lives of countless people in the process.</p> <p><strong>Featured Famous Doctors in the following order:</strong></p> <p><a href="#Percivall Pott">Percival Pott</a> 1714 - 1788         "Injuries of the head from external violence"</p> <p><a href="#James Parkinson">James Parkinson</a> 1755 - 1824   "English born, English bred ... forgotten by the English"</p> <p><a href="#Astley Cooper">Astley Cooper</a> 1768 - 1841        First repair of an AAA and publicly dissected an Elephant</p> <p><a href="#Thomas Wakley">Thomas Wakely </a>1795 - 1862    Founded <em>The Lancet </em>and suspected of decapitating corpses</p> <p><a href="#Jmes Paget">James Paget</a> 1814 - 1899        Pathologically interested in medicine</p> <p><a href="#Marie Stopes">Marie Stopes</a> 1880 - 1957        Eugenics, compulsory sterilisation and sexual pleasure with younger men</p> <p><a href="#John Snow">John Snow </a>1813 - 1858             Sourcing the Soho Pump</p> <p><a href="#Elizabeth Anderson">Elizabeth Garrett Anderson</a> 1836 - 1917   Fighting a tide of prejudice</p> <p><a href="#Victor Horsley">Victor Horsley</a> 1857 - 1916   Unprejudiced rude humility</p> <p><a href="#Thomas Lewis">Thomas Lewis</a> 1881- 1945       Brave underground rescuer and heart disease pioneer</p> <p><a href="#Alexander Fleming">Alexander Fleming</a> 1881 - 1955  ... and the story of Penicillin</p> <p><a href="#Zachary Cope">Zachary Cope </a>1881 - 1974   Passionately opinionated</p> <p><a href="#McNeil Love">McNeill Love</a> 1891 - 1974   <em>Modern Trends in Biliary Surgery</em></p> <p><a href="#Hamilton Bailey">Hamilton Bailey</a> 1894 - 1961  Brilliance combined with turbulence</p> <p><a href="#archibold mcindoe">Archibold McIndoe </a>1900 - 1960   The Guinea Pig Club</p> <p><a href="#Dame Cicely Saunders">Dame </a><a href="#Cicely Saunders">Cicely Saunders </a>1928 - 2005   Founding palliative care in 120 countries</p> <p><a href="#Sheila Sherlock">Sheila Sherlock  </a>1918 2001 First Woman Professor of Medicine and Arsenal Fan</p> <p><a href="#Jean Shanks">Jean Shanks </a>1925 - 2002 Revolutionised diagnostic services in the UK</p> <p><a href="#Tunnadine">Prudence Tunnadine </a>1928 - 2006 Psychosexual Medicine</p> <p> </p> <p> </p> <h2> <a name="Percivall Pott" id="Percivall Pott"></a>Percivall Pott 1714-1788</h2> <p>Author of "Injuries of the Head from External Violence", and first to link scrotal cancer with chimney soot.</p> <h2> Leading figure in Surgery and Epidemiology</h2> <p><img alt="" src="/sites/default/files/Percivall Pott.jpg" style="width: 319px; height: 476px; float: right;" /><strong>The Bank of England now stands on the site of his old Home</strong></p> <p>Percivall Pott was an outstanding surgeon, teacher and writer. A native Londoner, he was born in 1714 on Threadneedle Street in the City, where his family home was sited exactly where the Bank of England now stands. His father, a draftsman, died when he was only 3 years old but the family was saved from financial hardship by the Bishop of Rochester, who was related to his mother by her previous marriage. He paid for Pott’s private education at Darenth in Kent, and then financed his apprenticeship to Edward Nourse, assistant surgeon at St Bartholomew’s Hospital and a pivotal figure in his life. The apprenticeship started when he was just 15, and began an association with the hospital that lasted a remarkable 58 years.</p> <p>As Nourse’s apprentice he procured bodies and assembled specimens for anatomy demonstrations, honing his own surgical skills in the process. In 1736 he was admitted to the Company of Barber Surgeons and he moved into practice in Fenchurch Street, where he lived with his mother and half-sister. When Nourse was appointed a full surgeon in 1745, Pott became his assistant. Two other significant events that occurred in that year were the death of his mother, and his marriage to Sarah Cruttenden. The union was a very happy one and produced nine children.</p> <p>It took Pott just four years to become a full surgeon in 1749, and he retained the post until 1787. He was to become the most eminent figure in the medical school at St Bartholomew’s Hospital, and although he had a heavy workload at the hospital he continued a successful private practice based at Princess Street, Hanover Square. Here he attended Samuel Johnson and Thomas Gainsborough among others. For his large family he acquired a home in Neasden, North London, though he resided at Watling Street during the week. </p> <p><strong>Avoiding Amputation following Compound Fracture</strong></p> <p>In January 1756 Pott survived a pivotal event that fortunately had a happy ending. Riding in Southwark to visit a patient, he was thrown off his horse and sustained a compound fracture of the tibia. Well aware of the dangers of rough handling, he sent for two chair men. He hastily purchased a door from which a makeshift stretcher was fashioned and he was carried over London Bridge to his home in Watling Street, a fair distance especially for a man in his state. One can only speculate why he chose not to attend Guy’s Hospital, located just 400 yards from the accident. His surgical colleagues advised amputation and he agreed. However, by coincidence Edward Nourse called at his house and had another idea for his stricken friend. Nourse pioneered a potentially limb-preserving manoeuvre for compound fractures whereby, after reduction, the position of exit of the bone through the skin was at a distance from the break in the bone to allow the intervening soft tissues to form a valve, excluding air and, with it, infection. The move was a success, and his limb was saved.</p> <p><strong>The Cause and Treatment of Ruptures</strong></p> <p>Although noted as a fine teacher, Pott had not thus far published anything of note, but that changed as he began writing in earnest during his convalescence. In 1756 he published <em>A treatise on Ruptures,</em> in which he discussed novel theories about the cause and treatment of hernia. In 1760 he described his eponymous ‘puffy tumour’ (not a malignancy but a scalp swelling caused by oedema overlying osteomyelitis, typically caused by frontal sinusitis or otitis media) in <em>Injuries of the Head from External Violence. </em>Interestingly the fracture that bears his name was not the one he sustained, but refers to a closed tibial fracture with dislocation of the ankle, which he described in <em>Some few general remarks on Fractures and Dislocations</em> in 1769. In 1775 he made a momentous discovery when he noted the high incidence of scrotal cancers in London chimney sweeps. Resisting the temptation to attribute this to venereal disease (though this was rife in London at the time), he concluded this was caused by carcinogens in the soot, thus making the first association between cancer and a putative cause, and starting the discipline of epidemiology. By contrast his description in 1779 of Pott’s disease of the spine due to destruction of vertebral bodies by tuberculosis was not new; indeed this had been a scourge of mankind for millennia, but his excellent description, which included reference to the ‘useless state of the legs’ due to neurological deficit, remains a classic of descriptive medical literature. Pott was also active in the Company of Surgeons, being appointed to the Court of Examiners in 1756, while his contribution to science was recognised by election to Fellowship of the Royal Society in 1764.</p> <p><strong>"My lamp has almost extinguished; I hope it has burned for the benefit of others"</strong></p> <p>A kind man, generous with his time and money and with a ferocious sense of public duty, Pott was revered by his colleagues. He never retired, operating at St Bartholomew’s until 1787 and continuing in private practice for the rest of his life. On 11<sup>th</sup> December 1788, riding back from a visit to a patient 30 miles outside London in appalling weather, he caught a chill. He was due to review the patient three days later but was persuaded by his son-in-law James Earle to stay home and allow Earle, a physician, to attend the patient. During Earle’s absence he made one last sick round in London. On 21<sup>st</sup> December he made his final diagnosis: “My lamp is almost extinguished: I hope it has burned for the benefit of others”. It was typically modest understatement. Percivall Pott died from pneumonia the following day, and was buried at the church of St Mary Aldermary in the City of London, where there is a commemorative plaque.</p> <p> </p> <h2> <a name="James Parkinson" id="James Parkinson"></a> James Parkinson (1755-1824)</h2> <p>Parkinson's Disease, Public Health Information and mental health crusade - "<em>Madhouses - observations on the act for regulating madhouses</em>"</p> <h2> Hoxton’s brilliant polymath</h2> <p><img alt="" src="/sites/default/files/James_Parkinson.jpg" style="width: 200px; height: 250px; float: right;" /></p> <p><strong>Parkinson's Disease</strong></p> <p>Today, Parkinson’s disease is among the best-known eponymous diseases, yet the man who described it was almost confined to historical obscurity. The American historian Leonard Rowntree lamented in the John Hopkins Hospital Bulletin in 1912 ‘English born, English bred, forgotten by the English and by the world at large, such was the fate of James Parkinson’. Whether by accident or design, Rowntree’s comments led to a resurgence of interest in the work of a remarkable man who was a pivotal figure not only in medicine, but also in national politics and in geology. </p> <p>James Parkinson was born at 1 Hoxton Square, Shoreditch, London, on 11<sup>th</sup> April 1755. The address served as the family home and surgery of his father John, a surgeon and apothecary (effectively a general practitioner). He spent his entire life in the area, being baptised, married and buried at St Leonard’s Church, Shoreditch.</p> <p>Parkinson studied at the London Hospital for 6 months under Richard Grindall, and was then apprenticed to his father for 6 years. In 1784 the Corporation of London approved him as a surgeon. His father died later that year and he took over his practice. The area, then as now, encompassed extremes of the social spectrum and his practice was lucrative thanks to private patients; however, he also attended the poor of the parish free of charge. Parkinson married Mary Dale in 1783 and they had six children; his son John became a doctor and in turn took over the Hoxton practice.</p> <p><strong>Popgun Plot</strong></p> <p>In addition to his medical practice, Parkinson was very active politically, being an advocate for the under-privileged, a Republican who admired the French Revolution, and a fierce critic of the Pitt government. He published over 20 critical pamphlets clamouring for social reform and campaigning against the suspension of the Habeas Corpus Act, often using his pseudonym ‘Old Hubert’. He was a member of two outspoken societies, the London Corresponding Society and the Society of Constitutional Information. In 1794 he was examined under oath before the Privy Council to give evidence about an alleged conspiracy to assassinate King George III by firing a poisoned dart from the pit of a theatre, which became known as the ‘Popgun Plot’. The plot never existed outside the fanciful mind of one Thomas Upton, who forged letters to incriminate three of the four men accused with Parkinson, who mounted a robust defence that earned the Privy Council’s respect. He took significant risks with regard to his own career and life, but escaped largely unscathed.</p> <p><strong><em>Medical Admonitions to Families</em> - medical education aimed at the public</strong></p> <p>This episode doused his political fire somewhat, and in middle age his contribution to medicine was more prolific. In 1799 he published <em>Medical Admonitions to Families,</em> a series of medical educational documents aimed at the public. Like William Harvey and Thomas Sydenham before him, he suffered from gout and in 1805 published <em>Observations on the Nature and Cure of Gout.</em> His humanitarianism appeared again in 1811 when he crusaded for better safeguards and regulation of asylums, and for the legal protection of mentally ill patients as well as their families, carers and doctors in <em>Madhouses - Observations on the act for regulating madhouses.</em> In 1812 he assisted his son in a case of appendicitis; sadly the 5-year old boy died from septic peritonitis, but the co-authored paper <em>Case of diseased appendix vermiformis </em>was the first such description. Parkinson was also a strong advocate of doctors’ rights, bemoaning the poor working conditions of many physicians: ‘A physician seldom obtains bread by his profession until he has no teeth left to eat it’</p> <p><strong>Shaking Palsy - Parkinson's Disease</strong></p> <p>However, Parkinson’s main legacy was <em>An essay on the Shaking Palsy,</em> a classic of descriptive medical literature. Published in 1817 when he was aged 62, the essential part of the description runs as follows: “Shaking palsy (paralysis agitans). Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported: with a propensity to bend the trunk forward and to pass from a walking to a running pace: the senses and intellect being uninjured”. His only omission was rigidity, which was added 40 years later by the Paris physician Jean Martin Charcot, also one of the greatest figures in medical history. Parkinson retired from medical practice is 1822, and was honoured by becoming the first recipient of the gold medal of the Royal College of Surgeons.</p> <p>Parkinson also had a keen interest in nature, and in particular geology and palaeontology. He amassed an impressive collection of specimens and drawings, often helped by his children. In 1804 he published the first volume of his <em>Organic Remains of the Former World, </em>with further volumes in 1808 and 1811. He personally illustrated each volume, and these superb prints were re-used by his friend Gideon Mantell in subsequent works. On November 13<sup>th</sup> 1807 a gathering of some of the most eminent minds of the era took place at the Freemasons’ Tavern, including Parkinson, Humphrey Davy, Arthur Aikin and George Bellas Greenough; it was the first meeting of the Geological Society of London, a thriving scientific institution to this day. Parkinson contributed several other notable publications in this field.</p> <p><strong>Leading Figure of the Enlightenment</strong></p> <p>When his busy and honourable life ended at his home on Kingsland Road on 21<sup>st</sup> December 1824, the medical profession did nothing to commemorate him, perhaps because his political views meant that he was never an Establishment figure. He was buried at St Leonard’s Church, and though no stone bearing his name exists, a memorial plaque was erected there in 1955, 200 years after his birth. In 1961 the governors of the London Hospital provided another memorial plaque, placed at the furniture factory of Lewis Wolf and Sons at 1 Hoxton Place, on the site of his birthplace, home and practice (though the original building was long ago demolished). Fortunately, there was belated recognition for the life of James Parkinson, Jacobin doctor, polymath, humanist and one of the leading figures of the Enlightenment.</p> <p> </p> <h2> <a name="Astley Cooper" id="Astley Cooper"></a> Sir Astley Paston Cooper (1768- 1841)</h2> <p>The first repair of an Abdominal Aortic Aneurism</p> <div> Distinguished surgeon</div> <p align="center"><img alt="" height="356" src="/sites/default/files/Astley_Paston_Cooper_4.jpg" style="float: right;" width="289" /></p> <p><strong>Incorrigible Practical Joker</strong></p> <p>One of the most influential and distinguished figures in clinical surgery, Sir Astley Paston Cooper was born in Brooke Hall near Norwich, Norfolk, on 23<sup>rd</sup> August 1768. The son of the Reverend Samuel Cooper, he was one of a large brood. Sadly, the family was beset by tragedy, with five sisters and a brother dying from tuberculosis. Nevertheless, he remained healthy, enjoying his childhood and youth and developing a reputation as an incorrigible practical joker. Once, suspecting a local publican of keeping a disorderly house, he dressed up as a young woman, lured the publican into a compromising position before abruptly revealing himself as a man.</p> <p>Surgery became a rather more serious pursuit, inspired by his uncle William Cooper, the Senior Surgeon at Guy’s Hospital to whom he was apprenticed in 1784. He subsequently switched his allegiance to Henry Cline at St Thomas’ Hospital, who was himself a former student of renowned Scottish surgeon John Hunter. In 1789 he was appointed anatomy demonstrator at St Thomas’, and in 1791 lecturer in anatomy and surgery (jointly with Cline).</p> <p>In 1791 he also married Anne Cock, the daughter of a wealthy merchant who had died weeks before the wedding. A year later their only child Anna Maria was born, though she died aged 15 months. They adopted a daughter, Sarah, and a son, Astley, who was Cooper’s nephew. In 1800 he succeeded his uncle’s post at Guy’s, and one of the most brilliant careers in medicine took off in earnest.</p> <p><strong>Destruction of the Tympanic Membrane</strong></p> <p>In 1802 he received the Copley medal for two papers read at the Royal Society of London on the destruction of the tympanic membrane, and in 1805 he was elected a Fellow of the society. In that same year he helped form the Medical and Chirurgical Society of London (the fore-runner to the Royal Society of Medicine). In 1813 he became professor of comparative anatomy at the Royal College of Surgeons, being noted as an erudite speaker.</p> <p><strong>First Repair of Aortic Abdominal Aneurism and Dissected an Elephant</strong></p> <p>Cooper was also noted as a most dexterous operator. This was by no means a universal trait among high-profile surgeons of the day, and his knowledge of anatomy was unrivalled. In 1817 he performed the first repair of an abdominal aortic aneurysm, having earlier performed carotid and femoral aneurysm repair. More mundanely, he removed a sebaceous cyst from King George IV’s scalp in 1820, and the baronetcy bestowed on him a year later was probably in part a reward for his efforts. Indeed, as surgeon to the royal household he also attended King William IV and Queen Victoria. He served the Royal College of Surgeons as president in 1827 and 1836, and was also vice-president in 1830. Always a showman, he once dissected an elephant in the front garden of his house at St Mary Axe in the City of London in front of a large crowd, ostensibly for public education.   </p> <p><strong>Dislocations and Fractures</strong></p> <p>A charming man, he numbered many influential amongst his patients including Lord Liverpool, the Duke of York and the Duke of Wellington. He was slow to develop his private practice, probably as his wife’s wealth ensured a comfortable living, but eventually his practice developed into the most lucrative in London. Nonetheless, he continued to make significant scientific contributions, based upon a diverse clinical practice. His key publications included <em>‘Anatomy and Surgical Treatment of Hernia’</em> (two monographs, 1804 and 1807), <em>‘Dislocations and Fractures’</em> (1822), <em>‘Lectures on Surgery’</em> (1824-7), <em>‘Illustrations of Diseases of the Breast’</em> (1829), <em>‘Anatomy of the Thymus Gland’</em> (1832) and <em>‘Anatomy of the Breast’</em> (1840).</p> <p> His books were well illustrated, in contrast to other medical texts of the day. He is eponymously linked with several anatomical structures and pathological conditions, including the covering of the spermatic cord, the suspensory ligaments of the breast, neuralgias of the testis and breast, and fibrocystic disease of the breast.</p> <p><strong>Astley Cooper School</strong></p> <p>Cooper’s health declined slightly in the 1820s as he suffered dizzy spells, and after the death of his wife in 1827 he retired from his London activities and moved to Gadebridge House, his estate in Hemel Hempstead, Hertfordshire. However, a year later he remarried, to Catherine Jones, and enjoyed new vigour, resumed work, and even travelled abroad. He remained active until 1840 when he developed symptomatic cardiac failure, from which he died at his home on Conduit Street, London, on 12<sup>th</sup> February 1841, aged 72. He was buried in the crypt beneath the Chapel at Guy’s Hospital. A statue of him by Edward Hodges Baily was erected at St Paul’s Cathedral. He is also venerated in Hemel Hempstead, where the grounds of his former home are a public park, and the former Grovehill School became the Astley Cooper School in 1984.</p> <p> </p> <p> </p> <h2> <strong><a name="Thomas Wakley" id="Thomas Wakley"></a>Thomas Wakley  (1795 – 1862)</strong></h2> <p>The neatness of the decapitations led the angry mob to suspect Wakley</p> <h1 align="left"> Doctor, Coroner and MP who founded the Lancet</h1> <p class="rtecenter"><img alt="" src="/sites/default/files/Thomas Wakely.jpg" style="width: 250px; height: 317px; float: right;" /></p> <p>Although not as famous as many contemporaries, Thomas Wakley was a brilliant and colourful character who blazed important trails in London during a controversial career.</p> <p><strong>Tumultuous Career</strong></p> <p>Thomas Wakley, the son of a county squire, was born in Membury, Devon, on 11<sup>th</sup> July 1795. Aged 15 he was apprenticed to an apothecary in Taunton where he impressed. At 20 he moved to London to study medicine at Borough’s Hospitals (presently Guy’s and  St Thomas’). Upon qualification he started a practice in Argyle Street, off Oxford Circus, with financial assistance from his father-in-law, a wealthy merchant. This was the start of a career for which the description tumultuous is surely an understatement.</p> <p><strong>Cato Street Conspiracy</strong></p> <p>A month after he started his practice, Wakley became vicariously embroiled in the sordid aftermath of what became known as the Cato Street Conspiracy – a plot to assassinate members of Lord Liverpool’s cabinet. The five convicted men were sentenced to death and hanged, and when their corpses were subsequently decapitated the angry watching mob was intent on revenge. The neatness of the decapitations led them to suspect it was the work of a doctor, and suspicion erroneously fell on Wakley following a newspaper article. Wakley was attacked at his home and assaulted by knives and clubs almost certainly with murderous intent, though he survived; his house was also set on fire. His insurers refused to pay up, suggesting that he had started the fire himself, though he eventually sued them successfully.</p> <p><strong>Birth of <em>The Lancet</em></strong></p> <p>Wakley restarted in practice in Norfolk Street, off the Strand. A critic of the London medical establishment, which he viewed as institutionally corrupt, he found a voice for his opinions through his friendship with William Cobbett, editor of the <em>Weekly Political Register</em> and the <em>Evening Post</em> and similarly imbued with anti-establishment views. Their joint collaboration was the <em>Lancet</em>, which remains one of the most prestigious of all medical journals. The first edition was published by A Mead of 201 Strand, London, and released on 5<sup>th</sup> October 1823. In the preface Wakley spoke up for the scientific approach in medicine, and articulated his desire for Sir Astley Cooper’s lecture notes to be published in the journal.</p> <p><img alt="" src="/sites/default/files/The Lanct.jpg" style="width: 600px; height: 402px; float: right;" /></p> <p><a href="#Astley Cooper">Astley Cooper</a> was the senior surgeon at Guy’s, and today universally recognised as one of the greatest medical minds of all time, as well as a very fine operator. Wakley came unstuck, however, as Cooper did not wish his lecture notes to be published; lecturing live was a lucrative business, attracting fee-paying students. They were close personal friends, however, and the compromise reached was that Cooper’s notes were published but without his name attached. Wakley edited the <em>Lancet</em> until his death.</p> <p><strong>Doctors Registered</strong></p> <p>Wakley’s other forays led him to becoming MP for Finsbury in 1835, and coroner for West Middlesex in 1839. Breaking an age-old tradition of coroner’s juries being something of a gentleman’s club where alcohol was on tap, he insisted that all members be sober during an inquest. He introduced the Medical Registration Bill in 1846, laying the foundations for the formal registration of doctors via the Medical Act of 1858.</p> <p>In 1861 Wakley developed tuberculosis and his own health deteriorated rapidly. He spent his final months in Madeira, where he died on 16<sup>th</sup> May 1862, aged 66.</p> <p> </p> <p> </p> <h2> <a name="Jmes Paget" id="Jmes Paget"></a>Sir James Paget 1814 - 1899</h2> <p>Unrivalled collection of pathological specimens</p> <p><strong>An outstanding medical life</strong></p> <p><strong><img alt="" src="/sites/default/files/James Paget_0.jpg" style="width: 185px; height: 251px; float: right;" /></strong></p> <p>James Paget was undoubtedly one of the most notable figures in medical history, and his lifetime work and legacy proved an inspiration to future generations of doctors.</p> <p>Paget was born in Great Yarmouth, Norfolk, on 11<sup>th</sup> January 1814. His father was Samuel Paget, a prosperous brewer, ship-owner and sometime Mayor of Great Yarmouth. He was one of seventeen children (though only nine survived into adulthood), and brother of Sir George Paget (1809–1892), who was to become Regius Professor of Medicine at Cambridge University.</p> <p><strong>Apprenticed to a Yarmouth Surgeon</strong></p> <p>His early education was at a local private school. However, Samuel Paget’s businesses slumped somewhat after their post-Napoleonic Wars peak, and James Paget was unable to follow his elder brothers onto Charterhouse and then university. Instead, he was apprenticed to Charles Costerton, a Yarmouth surgeon, in 1830.</p> <p>An early indication of his zeal for writing came with the publication in 1834 of a book on the natural history of Great Yarmouth, co-authored with his brother Charles.</p> <p><strong>Undercooked Meat and Parasites</strong></p> <p>In that same year Paget moved to London and became a student at St Bartholomew’s Hospital and he would remain associated with this hospital for the rest of his working life. During his first year he noted some white specks on the muscles of a body he was dissecting. Closer examination with a microscope showed them to be small worms, a species of roundworm later named <em>Trichina Spiralis</em> by the anatomist and palaeontologist Richard Owen (1804–1892). This was the first identification of the parasitic disease trichinosis, which is caused by eating undercooked meat.</p> <p>Paget’s path to becoming a surgeon was quite unusual. At that time surgeons usually demanded fees from students to be dressers, and Paget, too poor to afford this, became in 1835 a clinical clerk under the physician Peter Latham. He therefore did not become a house surgeon, but in 1836 graduated as a Member of the Royal College of Surgeons.</p> <p><strong>Pathological Specimens at Barts Museum</strong></p> <p>In 1837 he was appointed curator of the museum at St Bartholomew’s, and he began assembling his unrivalled collection of pathological specimens. His meagre annual salary of £100 was supplemented by writing; he was sub-editor of the <em>Medical Gazette</em> from 1837-42 and he also contributed to the <em>Medical Quarterly Review</em>.</p> <p>In 1843 he became warden of the new college at St Bartholomew’s and was also appointed lecturer in anatomy and physiology. That same year he became one of the inaugural Fellows of the Royal College of Surgeons. The warden’s post carried with it the bonus of accommodation on the campus, allowing him in 1844 to marry Lydia North. They enjoyed a long and happy marriage and had four sons and two daughters.</p> <p>In 1846 Paget began compiling catalogues of both the St Bartholomew’s museum and the Hunterian Museum at the Royal College of Surgeons. His reputation grew rapidly and the following year he was appointed an assistant surgeon. The post was keenly contested, and some conservative colleagues within the London surgical establishment opposed his appointment, as he had been neither a dresser nor a house surgeon.</p> <p><strong>200 Patients a Day</strong></p> <p>Paget was a phenomenal and tireless worker, and at this stage of his career he saw up to 200 patients a day whilst still pursuing his academic interests. From 1847 to 1852 he was Arris and Gale Professor of Anatomy and Surgery at the Royal College of Surgeons. These lectures gave considerable impetus to the field of clinical pathology when published. In 1851 his contribution to science was recognised when he was elected a Fellow of the Royal Society.</p> <p>He resigned his warden’s post that year and bought a house on Henrietta Street in Covent Garden from where he conducted his private practice. This became so successful that it was soon the largest surgical practice in London.</p> <p>Though this earned him around £10,000 a year he remained frugal in his personal tastes, and continued to make notable academic contributions, especially in the field of surgical, and in particular tumour pathology.</p> <p>Paget was a gifted lecturer, the finest of his era. He believed that science was paramount in medicine and fought against orthodox influence. He held German science in high regard, and was a lifelong friend of doctor and pathologist Rudolf Virchow (1821-1902). It was thanks to Paget that Virchow visited London and delivered his acclaimed lectures on the importance of pathological experiments.</p> <p>His friends included William Gladstone, Alfred Lord Tennyson, John Ruskin, Charles Darwin, Louis Pasteur and Florence Nightingale – the major scientific intelligentsia of their day.</p> <p><strong>Royal Surgeon</strong></p> <p>Paget became surgeon-extraordinary to Queen Victoria and surgeon to the Prince and Princess of Wales in 1858, the same year in which he moved to a larger house in Harewood Place, off Oxford Street. The following year he resigned his lecturer’s post and in 1860 was appointed a member of the Senate of the University of London. He became a full surgeon at St Bartholomew’s in 1861 and lecturer in surgery between 1865 and 1869. He was appointed to the Council of the Royal College of Surgeons in 1865 and served for a remarkable 24 years.</p> <p>In 1871 he became seriously ill with infection when he accidentally cut himself during a post-mortem. He resigned from operative surgery after this but continued consulting. He was bestowed a baronet by Queen Victoria in 1871. The zenith of his scientific acclaim came in 1875, when he was simultaneously President of the Royal College of Surgeons, the Royal Society of Medicine and the Royal Society.</p> <p>Fortunate with his own health, Paget remained active well into old age. He represented the Royal College of Surgeons on the General Medical Council from 1876–81, and in 1881 was President of the International Congress of Medicine when it met in London. In 1883 he became Vice-Chancellor of the University of London and served in this capacity until he was 81. In 1887 he was President of the Pathological Society of London.</p> <p>Lydia Paget died in 1895 and following the loss of his beloved wife his own health deteriorated. He died peacefully at home in London on 30<sup>th</sup> December 1899, just failing to see in the 20<sup>th</sup> century. His funeral service was held at Westminster Abbey and he was buried at Finchley Cemetery.</p> <p> </p> <h2> <strong><a name="Marie Stopes" id="Marie Stopes"></a>Marie Stopes 1880-1957</strong></h2> <p><strong><em>Controversial pioneer of women’s sexual health</em></strong></p> <p align="center"><img alt="" src="http://www.google.co.uk/url?sa=i&amp;rct=j&amp;q=&amp;esrc=s&amp;source=images&amp;cd=&amp;cad=rja&amp;docid=yKRBmRZysuYsqM&amp;tbnid=CbvJ254FmB3HeM:&amp;ved=0CAUQjRw&amp;url=http%3A%2F%2Fwww.mariestopes.org.uk%2FAbout_us%2FHistory%2FDr_Marie_Stopes.aspx&amp;ei=jW1ZUofMDYSf0QWIvoHoDQ&amp;bvm=bv.53899372,d.d2k&amp;psig=AFQjCNFQZZw0HKFxsZ6jwbDhswM71P9z2g&amp;ust=1381678856793862" /><img alt="" src="/sites/default/files/Marie Stopes.jpg" style="width: 300px; height: 300px; float: right;" /></p> <p align="center"> </p> <p><strong>One of The Most Famous Women in the World</strong></p> <p>Marie Stopes was a scientist, author and social activist whose efforts to promote safe birth control made her one of the most famous women in the world during the first half of the 20<sup>th</sup> century. The life story of this remarkable woman is, above all, a study in single-minded determination.</p> <p>Marie Charlotte Carmichael Stopes was born in Edinburgh on 15<sup>th</sup> October 1880. Her father Henry Stopes was an eminent paleobotanist; her mother, Charlotte Carmichael, an ardent feminist. Inheriting interests from both parents, Marie Stopes was to fuse science and feminism into a revolutionary combination.</p> <p>Aged 18, she won a science scholarship to University College, London. She was by far the best student in her year, passing her final examinations a year before schedule and achieving a double first (botany and geology) in 1901. She continued her studies in Munich, Germany, gaining a DSc in 1904, making her the youngest science doctorate in Britain. Later that year she was appointed assistant lecturer in botany at the University of Manchester.</p> <p><strong>Grounds of Non-Consummation</strong></p> <p>Stopes established a considerable reputation in the field of fossilised plants, and travelled as far as Canada and Japan to pursue this interest. She married a fellow scientist, Reginald Gates, in 1911 but the marriage was not a happy one. Gates was impotent and the problem remained unresolved. In 1914 Stopes went to court and successfully obtained a divorce on the grounds of non-consummation, mercilessly exposing Gates’ inadequacy in humiliating detail.</p> <p><strong>Sexual Rights for Women and Passionate about Sex Education</strong></p> <p>Motivated partly by disappointment, Stopes began writing <em>Married Life</em>, a book advocating both social and sexual rights for women. However, she had difficulty finding a publisher, with rejections on both moral and political grounds. In 1918 her fortunes changed when she met and married Humphrey Roe, a wealthy industrialist. He shared her passion for sex education, noting the toll taken on his female staff, for many of whom pregnancy was an almost permanent state. He paid the publishing costs and the book, now renamed <em>Married Love</em>, was an instant success; it was sold out in two weeks, and required six reprints within the year. Upon publication in the United States, it was banned as obscene.</p> <p>Self-induced Abortion</p> <p>Stopes then turned her attention to the related topic of birth control. Her interest in this was fuelled by her friendship with Margaret Sanger, an American birth-control campaigner. Whilst working as a nurse in the slums of New York, Sanger became appalled by the fate of women who raised large families in poverty and, all too often, died attempting self-induced abortion. She published her own newsletter, but when advice about birth control appeared in 1915, she was charged with publishing a ‘lewd and obscene article’. She fled to Britain and met with the like-minded Stopes, to whom she passed advice, several pamphlets and some diaphragms. Stopes incorporated this into her second book <em>Wise Parenthood</em>, also published in 1918.</p> <p><strong>Wise Parenthood and Married Love</strong></p> <p><em>Wise Parenthood </em>enjoyed the same commercial success as <em>Married Love</em>, but predictably drew fierce criticism from the Church of England and, even more so, the Roman Catholic Church, opposed as it was to any contraception. Stopes knew she was taking a risk, for other contemporary birth control campaigners such as Richard Carlile and Annie Besant had been imprisoned for their views. However, she escaped unscathed, and on 17<sup>th</sup> March 1921 she opened Britain’s first family planning clinic at 61 Marlborough Road, off Holloway Road in Islington, London. The clientele were mainly poor women, all married, and were attended by an all-female staff of doctors and nurses who fitted vaginal caps and dispensed advice on birth control. In 1925 the clinic moved to 108 Whitfield Street, off Tottenham Court Road in Central London, from where it continues to run successfully. A fading green plaque marks the site of the first Marie Stopes Clinic. She opened several regional clinics, and then branches in South Africa, Australia and New Zealand. She combined this with motherhood, for in 1924, aged 43, she gave birth to her only child, a son Harry.</p> <p><strong>Sterilisation for the insane - Compulsory</strong></p> <p>Stopes held many controversial views. She was a staunch believer in eugenics, and opposed reproductive rights for those with physical or mental defects. In <em>Radiant Motherhood</em> (1920) she suggested “sterilisation of those totally unfit for parenthood to be made an immediate possibility, indeed made compulsory”. In <em>The Control of Parenthood</em> (1920) she wrote that if she were in charge she would “legislate compulsory sterilisation of the insane, the feeble…revolutionaries…half-castes”. She viewed homosexuality and inter-racial sex as perverse. She tried unsuccessfully to prevent her son’s marriage to a woman she felt had a gross disability. The matter in question: the lady wore glasses to correct myopia. In her will Stopes left a large part of her fortune to the Eugenics Society. </p> <p><strong>She could Seek Sexual Pleasure with younger Men</strong></p> <p>Stopes’ marriage to Roe was initially happy, but began to deteriorate around the time she gave birth. From then on they led separate lives; her voracious sexual appetite did not brook monogamy, and with Roe’s written agreement that she could seek sexual pleasure elsewhere, she did precisely that. She had a succession of lovers, invariably younger men whom she dominated. Never beautiful and no longer young, her supreme self-confidence overcame such barriers. She lived this way for several years before age led to an inevitable slow-down.</p> <p>Late in 1957 she developed an aggressive form of breast cancer, and she died at her home in Dorking, Surrey, on 2<sup>nd</sup> October 1958, aged 77.  Today, her business legacy lives on thanks to her clinics, which, after a stormy period in the 1970’s were amalgamated as the Marie Stopes International Global Partnership, currently trading in 38 countries.</p> <p> </p> <h2> <strong><a name="John Snow" id="John Snow"></a>John Snow (1813-1858)</strong></h2> <p>Noted that Local Soho Beer saved Lives</p> <h1> Innovator in epidemiology and anaesthesia</h1> <p><img alt="" src="/sites/default/files/John_Snow.jpg" style="width: 416px; height: 540px; float: right;" /></p> <p><strong>From Yorkshire Farmer to Soho Doctor</strong></p> <p>John Snow was a brilliant physician who was active in London in the middle years of the 19<sup>th</sup> century. He is best remembered for tracing the source of the Soho cholera outbreak in 1854, but he also made significant contributions to other medical fields, particularly anaesthesia.</p> <p>John Snow was born on 15<sup>th</sup> March 1813 in York, the first of nine children born to William Snow, a farmer, and his wife Frances. The neighbourhood was one of the poorest in the country, with flooding from the River Ouse a constant hazard. He was educated in York and at the age of 14 was apprenticed to the surgeon William Hardcastle based in Newcastle. He worked as a colliery surgeon and developed his interest in cholera during the epidemic of 1831-2. From 1833 to 1836 he was an assistant in general practice in Durham and later North Yorkshire, after which he moved to London to further his education, travelling to the capital on foot.</p> <p><strong>Arsenic, dead bodies and Asphyxia</strong></p> <p>In October 1836 he enrolled as a student at the Hunterian School of Medicine in Great Windmill Street, Soho, and a year later he started working at Westminster Hospital. He remained here until 1838, the year in which he graduated as a member of the Royal College of Surgeons as well as a licentiate of the Society of Apothecaries. Further academic recognition came later with graduation as MD from the University of London in 1844 and membership of the Royal College of Physicians in 1850. After graduation in 1838, he set up a practice at his home at 54 Frith Street and that year also published his first paper <em>‘Arsenic as a Preservative of Dead Bodies’</em>, which appeared in <em>The Lancet</em>. In 1842 he published his best-known paper <em>‘On Asphyxia, and on the Resuscitation of Stillborn Children’. </em></p> <p><strong>Beer saved Lives</strong></p> <p>Snow had a keen interest in cholera, a nasty disease from which all too often death from massive dehydration resulted. In 1849 he published <em>‘On the Mode of Communication of Cholera’</em> in which he argued that it was an intestinal infection. This was controversial, since the ‘miasma’ (bad air) theory had firm advocates. His argument against airborne transmission was that he attended dozens of patients with the malady without catching it himself. In 1854 dramatic circumstances provided the platform to prove his theory. There was an initial trickle of cases in Soho during the last week of August, which by September 1<sup>st</sup> became a flood, with over 100 new cases reported over the next few days. Sadly, deaths swiftly followed. He was sure that contaminated water was the common link, and suspicion fell on the popular water pump on Broad Street (now Broadwick Street). He examined it on 3<sup>rd</sup> September and found little amiss. He contacted the local death registry and plotted the addresses of the deceased on a map of the local area, creating one of the iconic pictures in medical history. The common link indeed appeared to be the Broad Street pump. He also noted that the Workhouse on Poland Street had 535 inmates, yet only five died though it was in the middle of the stricken zone. Mr Huggins of the brewery confirmed that the men only ever drank beer meaning what would never pass as health advice today probably saved their lives.</p> <p><img alt="" src="/sites/default/files/soho pump.jpg" style="width: 669px; height: 455px; float: right;" /><strong>"She Liked the Taste of Water from Broad Street"</strong></p> <p>The cases that finally clinched it involved two ladies who had died well outside the immediate area, in Hampstead and Islington. He visited the home of the lady who died in Hampstead and, with poignant irony, her family confirmed that she liked the taste of the water from the Broad Street pump and had it delivered to her home each day. The Islington resident was her niece who drank the same water on a family visit.</p> <p>By 7<sup>th</sup> September Soho was deserted as most of those who had not actually died had fled the area. The handle was removed from the pump the next day. The well was 28 feet deep but at 22 feet there was a sewer. A few people had noticed an offensive smell to the water, and it was almost certain that this became contaminated with sewage. The cases began to diminish rapidly, though Snow himself modestly acknowledged that factors other than deactivating the pump played a role. Snow did not know the exact organism responsible, as <em>vibrio cholerae</em> was only identified by Robert Koch (1843-1910) in Germany in 1883, but his meticulous data gathering established a certain causal link.</p> <p><strong>Obstetrics and Anaesthesia</strong></p> <p>Snow’s other main legacy was in obstetric anaesthesia. During his career he anaesthetised 77 obstetric patients with chloroform, typically initiating the drug only when the 2<sup>nd</sup> stage of labour had been reached. He held discussions with Prince Albert who expressed an interest in obtaining anaesthesia for his wife, Queen Victoria, and conferred with her other physicians including Charles Locock. In 1853, when she was pregnant with her eighth child Prince Leopold, the Queen submitted to chloroform, which Snow administered successfully. <em>The Lancet</em> promptly criticised him for tampering with nature, but London’s social elite were captivated and soon followed the Queen’s lead. In 1857 Snow repeated the feat when Queen Victoria gave birth to her ninth and final child, Princess Beatrice.</p> <p><strong>Greatest British Physician of all Time?</strong></p> <p>By this time Snow had moved to a larger home and practice at 18 Sackville Street. There has been much speculation about his own health, for despite the fact that he was vegetarian and virtually teetotal, he never looked a healthy man. He contracted tuberculosis around the time he received his MD, and although he recovered it is thought that he subsequently suffered kidney disease. He may well have done some damage by testing anaesthesia on himself, and rumours of a mental breakdown also circulated. On 9<sup>th</sup> June 1858 as he had gathered a small group of colleagues at his home to discuss a new bi-aural stethoscope he suffered a stroke. He recovered sufficiently to pen his paper <em>‘On chloroform and Other Anaesthetics’</em>, but following a further stroke he died on 16<sup>th</sup> June at the tragically young age of 45. He never married, and his brother Thomas, who was by his side, registered his death. He was buried at Brompton Cemetery, where his friends erected a memorial stone. John Snow rose from humble origins to become one of the most eminent physicians of his day and a poll in 2003 named him as the greatest British physician of all time.</p> <p> </p> <h2> <strong><a name="Elizabeth Anderson" id="Elizabeth Anderson"></a>Elizabeth Garrett Anderson 1836-1917</strong></h2> <p>Tide and Prejudice</p> <h1> Britain’s first female doctor</h1> <p><img alt="" src="/sites/default/files/Elizabeth.jpg" style="width: 220px; height: 328px; float: right;" /><strong>Fighting Prejudice</strong></p> <p>Today, well over half of all graduates from British medical schools are female, yet just a century and a half ago there existed not a single female doctor. It took a steely Londoner called Elizabeth Garrett to change centuries of accepted male prejudice.</p> <p>Elizabeth Garrett was born in Whitechapel, East London on 9<sup>th</sup> June 1836.Her father ran a local pawnbroker’s shop at the time of her birth, but five years later purchased a corn and coal warehouse in Aldeburgh, Suffolk. The business was a great success, and within a decade he became a wealthy man and was able to send all of his twelve children to boarding school.</p> <p>Elizabeth went to school in Blackheath and during her time in London became interested in feminist issues, her meeting with Emily Davies in 1854 providing the catalyst. In 1859 she met Elizabeth Blackwell, the Bristol-born American who became the world’s first female doctor, and resolved to become a doctor herself. After initial hostility, her father, a strong advocate of education, became very supportive of her aspiration.</p> <p><strong>Barred by Male Students</strong></p> <p>The barriers, however, seemed impenetrable. In 1860 she became a nurse at the Middlesex Hospital and attended lectures for medical students, but her motive was soon uncovered and following complaints by male students she was barred from the lecture hall. She persevered, studying anatomy privately at the London Hospital, and found sympathetic tutors at the University of St Andrews who gave her private tuition. When ready to sit the final examinations, however, all of the universities, plus the Royal College of Physicians and the Royal College of Surgeons, rejected her candidature. She exploited a legal loophole when she discovered that the Royal Society of Apothecaries did not specifically bar women. She duly passed their Licentiate examination in 1865, and they predictably altered their laws to ban future female participation.</p> <p><strong>New Hospital for Women</strong></p> <p>Having climbed extraordinary hurdles to qualify, she forged a distinguished career in medicine. In 1866 she established the St Mary’s Dispensary in Euston, with the aim of allowing poor women to obtain medical care from female practitioners and she worked there for 20 years. The dispensary developed into the New Hospital for Women in 1872, with her mentor Elizabeth Blackwell appointed Professor of Gynaecology. Now named the Elizabeth Garrett Anderson Hospital, it continues to provide healthcare under the NHS today. She learned French and in 1870 graduated in medicine from the University of Paris.</p> <p>Garrett continued to be a feminist activist, and in 1865 teamed up with Emily Davies, Dorothea Beale and Francis Mary Buss to form a discussion forum called the Kensington Society. A year later the group organised a petition lobbying Parliament to grant women the vote. The petition was rejected, but individual support remained from many Liberal members, particularly Henry Fawcett, the blind MP for Brighton. Garrett and Fawcett were very close, but she rejected his marriage proposal, fearing it may harm her medical career. He later married her like-minded younger sister Millicent, who was to become leader of the National Union of Women’s Suffrage Societies.</p> <p><strong>London School of Medicine for Women</strong></p> <p>Garrett did eventually marry, in 1871. Her husband was James Anderson, a London ship owner, and she had three children, Louisa, Margaret (who died from meningitis) and Alan. Despite her domestic responsibilities she continued to work tirelessly, and in 1874 created the London School of Medicine for Women, another institute still thriving today. Now based in Hunter Street, it has around 200 students mainly from University College Hospital, which opened its doors to women in 1877; a year after Parliament passed its Act opening all medical schools to females. In 1897 she was elected President of the East Anglia branch of the British Medical Association.</p> <p><strong>First Female Mayor</strong></p> <p>Garrett retired in 1902 aged 66 and moved to Aldeburgh, but continued to remain active in politics. In 1908, a year after her husband died, she was elected Mayor of Aldeburgh – fittingly, the first female mayor in England. In 1908 she also became a member of the militant Women’s Social and Political Union, and later that year narrowly escaped arrest when the group stormed the House of Commons. In 1911 she left the WSPU as she found their methods, particularly their arson campaigns, distasteful. Her daughter Louisa Garrett Anderson remained an uncompromisingly radical member, and was jailed for militant activity in 1912.</p> <p>Elizabeth Garrett Anderson died at her home in Aldeburgh on 17<sup>th</sup> December 1917 aged 81, leaving a legacy that completely revolutionised the role of women within healthcare. </p> <p> </p> <h2> <strong><a name="Victor Horsley" id="Victor Horsley"></a>Victor Horsley (1857 – 1916)</strong></h2> <h1> Pioneering neurosurgeon, idealist and social reformer</h1> <p><span style="display: none;"> </span><img alt="" height="487" src="/sites/default/files/Horsley.jpg" style="float: right;" width="357" /></p> <p>Sir Victor Horsley was one of the outstanding and most versatile medical figures of the late Victorian and Edwardian period, at once a pioneering neurosurgeon, researcher, author, politician and social reformer.</p> <p>Victor Alexander Hayden Horsley was born into an eminent London family in Kensington on 14<sup>th</sup> April 1857. His father John Callcott Horsley (Isambard Kingdom Brunel’s brother-in-law) was a successful painter and royal academician who found fame as the inventor of the commercial Christmas card in 1843. He attended Cranbrook School, Kent and then read medicine at University College Hospital (UCH), where he won numerous prizes and also published several papers whilst still a student. He also developed his reputation as a passionate and articulate debater. </p> <p><strong>Removed first Spinal Tumour by Laminectomy</strong></p> <p>Neurology was always an interest, and whilst an undergraduate he assisted the likes of Sir William Gowers and John Hughlings Jackson with their research, based at the nearby National Hospital in Queen’s Square. Upon qualification in 1881 he was appointed surgical registrar and assistant professor of pathology at UCH. At around this time pioneers such as Sir William McEwen in Glasgow were performing the first brain operations, and when the Queen’s Square board decided to appoint their own surgeon, Horsley was the obvious choice, taking up the post in February 1886. His operative achievements alone were astounding. By the year’s end he performed 10 operations with just one death – a remarkable achievement for the time. The following year he removed the first spinal tumour using the laminectomy approach. By 1900 he had removed 44 brain and spinal tumours.</p> <p><strong>Stereontactic Surgery - the Horsley-Clarke Apparatus</strong></p> <p>He developed and perfected many surgical techniques, including the haemostatic bone wax, the skin flap, ligation of the carotid artery to treat intracranial aneurysms and division of the trigeminal nerve root for trigeminal neuralgia. He performed the first operations on the pituitary gland, and also mastered thyroid surgery, publishing several research papers on endocrine surgery as well as assisting Sir Felix Semons in researching the innervation of the larynx. His best-known invention (jointly with Robert Clarke) was the Horsley-Clarke apparatus, which allowed precise localisation of intracranial structures for stereotactic surgery. He continued a general surgical practice at the same time, and was admired by his peers for being a voracious and skilled operator. In 1902 he was appointed to the chair of surgery at UCH, and was also knighted that year.</p> <p><strong>Alcohol and the Human Body</strong></p> <p>Horsley kept meticulous operative records and was fastidious about audit long before this entered the medical lexicon. A prolific writer and researcher, his key contributions were <em>Functions of Marginal Convulsions</em> (1884), and (as co-author) <em>Experiments upon the Functions of the Cerebral Cortex</em> (1888) and <em>Alcohol and the Human Body</em> (1902). </p> <p>Though from a privileged background, Horsley had a strong sense of social justice and championed many socialist causes, often at considerable personal cost. For example, he stood as a Liberal candidate several times, knowing that his support for the suffragettes made him unelectable. Something of a rebel in the conservative medical establishment of the time, he refused to wear the top hat and tail on the grounds that it prevented him using his beloved bicycle in London. If there is any truth in the old adage about the thin dividing line between genius and madness, then Horsley straddled that line, for there is no doubt that he was an extremely eccentric and paradoxical character. Strong-willed but also rigidly inflexible, he was unable to brook an opposing viewpoint and, as an archetypal man of action, prolonged contemplation of a problem bored him. Unsurprisingly, this led to conflict with his peers, to whom he is said to have been unfailingly rude, and he acquired his share of enemies. Yet he was also hugely admired</p> <p><strong>Unprejudiced Rude Humility</strong></p> <p>In typically contrarian fashion, his great humility was also commented upon. He was unfailingly courteous to his patients, junior staff and researchers, as well being as being a devoted husband and father. Truly a man without prejudices, he is remembered for being extremely supportive of an outstanding young West Indian physician called James Risien Russell. When the next consultant neurosurgeon post at Queen’s Square became vacant, Horsley’s powerful reference sent to Sir William Gowers persuaded the panel to appoint a candidate with an unconventional background, and Russell became the first Afro-Caribbean appointed to a medical consultancy in the UK He in turn fashioned an excellent career, becoming a noted authority on embryology and congenital malformations of the nervous system.</p> <p>At the outset of the First World War, Horsley requested active duty on the Western Front, but in 1915 he became Director of Surgery of the British Army Medical Service in Egypt. The following year he volunteered for field surgery duty in Mesopotamia. Suffering severe heatstroke and hyperpyrexia, he died suddenly in Amarah, near Basra in Iraq, on 16<sup>th</sup> July 1916. He was just 59 years old. The world’s attention was understandably elsewhere and it is certain that his achievements would have been more celebrated had he died during less turbulent times.</p> <p> </p> <h2> <a name="Thomas Lewis" id="Thomas Lewis"></a>Sir Thomas Lewis (1881 - 1945)</h2> <p>Cadiovascular Research</p> <p><img alt="Sir Thomas Lewis" src="/sites/default/files/Thomas Lewis.jpg" style="width: 323px; height: 500px; float: right;" /><strong>Cardiology, Histamine and Inflammation</strong></p> <p>Thomas Lewis was arguably Britain’s foremost clinical scientist during the first half of the 20<sup>th</sup> century. He is particularly remembered for his ground-breaking research into investigative cardiology, and in delineating the role of histamine in acute inflammation.</p> <p>Thomas Lewis was born in Cardiff on Boxing Day 1881, the third of five children. His father, Henry Lewis, was a respected local figure, a mining engineer by training who became President of the Coal Owners’ Association and was awarded the Albert Medal for bravery for underground rescue work.</p> <p>Thomas Lewis was educated at home, the exception being a single year at Clifton College. He was tutored initially by his mother, and then by a private tutor. He developed an early interest in natural history and was a lover of the outdoors, finding the mountains and forests far more enticing than his father’s large and diverse collection of books. By his early teens he had decided on a career in medicine, moving to London to study at University College Hospital, graduating in 1905 and remaining there (or in linked hospitals) for the rest of his working life.  </p> <p>Lewis’ aptitude for research was immediately apparent, and after qualifying he worked at the London Chest Hospital whilst assisting Ernest Starling with cardiovascular research at UCH. The discipline was a rapid growth area at the time, following pivotal discoveries by some of medicine’s outstanding figures in the previous 100 years.</p> <p><strong>Pathophysiology</strong></p> <p>Thomas Lewis and his peers moved medical science a step further and, in developing diagnostic tools, revisited physiology as a science. This in turn heralded the recognition of pathophysiology, the body’s compensatory mechanisms when faced with subtle deviations from normal functioning, but which may independently have deleterious effects.</p> <p><strong>First Description of Atrial Fibrillation</strong></p> <p>In 1909 Lewis acquired Einthoven’s string galvanometer and published, in the BMJ the first description of atrial fibrillation that included both clinical and echocardiographic features - <em>‘Auricular fibrillation: a common clinical condition’</em>. Lewis collaborated closely with Einthoven, who was Professor of Physiology at the University of Leiden, Holland and whose innovations led him to be awarded the Nobel Prize for Physiology and Medicine in 1924. Some of the most influential of his numerous publications on cardiology were <em>‘Mechanism and graphic registration of the heart beat’</em> (expanded 3<sup>rd</sup> edition, 1925), <em>‘Disease of the heart’</em> (1933), <em>‘Vascular</em> <em>disorders of the limbs’</em> (1936) and <em>‘Exercises in human physiology’</em> (published posthumously in 1946).</p> <p><strong>"Triple Response" and Pain</strong></p> <p>Lewis gave up experimental cardiology in 1925 and pursued other interests. He evaluated the role of histamine in acute inflammation. In <em>‘The blood vessels of the human skin and their responses’</em> (1927) he described his well- known ‘triple response’ – when sensitive skin is stroked, vasodilatation, followed by weal formation and then a flare, occurred. Another interest was the science of pain, and he published a paper entitled simply <em>‘Pain’</em> (1942) in which he postulated that this sensation also owed its presence to neurotransmitters.</p> <p><strong>A Frugal and Impatient Workaholic</strong></p> <p>Something of a loner all his life, Lewis did not form close personal relationships and had a reputation for being studious, focussed and impatient. He was a frugal workaholic with no interest in personal wealth. However, he enjoyed unbridled respect among his peers and students, and several honours, including a knighthood, followed. Dr Sir Seewoosagur Ramgoolam, who had been his student in the 1930s and who became the first Prime Minister of independent Mauritius, instigated a stamp depicting him on the centenary of his birth in 1981 – the only non-Mauritian honoured in this way.     </p> <p>Ironically for a man who gave so much to cardiovascular science, Lewis himself developed premature coronary heart disease, at a time when, despite improved understanding of the pathology of atherosclerosis, there were no therapeutic interventions that could halt its progress. He suffered his first myocardial infarction at 43 and survived two more before succumbing to a fourth on 17<sup>th</sup> March 1945, aged 63 and still in practice.         </p> <p> </p> <p> </p> <h2> <strong><a name="Alexander Fleming" id="Alexander Fleming"></a>Alexander Fleming, Howard Florey, Ernst Chain and the Penicillin story</strong></h2> <p>Medical history is littered with examples of delays and missed opportunities. One of the most glaring of these is the half-century gap between the discovery of bacteria by Robert Koch in 1877 (at the same time that Louis Pasteur was correctly proposing the germ theory of disease) and that of the first antibiotic, penicillin, in 1928. Be that as it may, the penicillin story is a fascinatingly human one, involving three brilliant individuals, several unsung heroes, international collaboration and a good deal of raw luck.</p> <p>Alexander Fleming was born in Lochfield, Ayrshire, Scotland on 6th August 1881. He was educated locally before moving to London, spending four years in a shipping office before entering St Mary’s Hospital Medical School, where he would remain for the rest of his working life. He qualified in 1906 with distinction, and immediately began a research career, starting as an assistant to Sir Almouth Wright, a vaccine pioneer. Already a private in the London Scottish Regiment, he joined the RAMC at the outset of WWI in 1914 and served right through the war, being mentioned in dispatches. He married Sarah McElroy in 1915, and upon return from the war resumed his research, being appointed Professor of Bacteriology in 1928. He had already made his first significant discovery, when in 1922 he isolated lysozyme, a naturally occurring bacteriolytic agent.</p> <h2> <strong>Alexander Fleming</strong></h2> <p><strong><img alt="" src="/sites/default/files/Alexander-Fleming-penicillin-631.jpg" style="width: 631px; height: 300px; float: right;" /></strong></p> <p>In 1928 he was working on the influenza virus and he had cultured <em>Staphylococcus aureus</em>, which is a type of bacteria, on a petri dish. A rather untidy man with a cluttered laboratory, Fleming then left for a fortnight’s holiday. Upon his return he observed that some mould had grown in the dish after accidental contamination, and that this led to a bacteria-free circle around the mould. He isolated the substance and called it penicillin, and with further experiments proved that it inhibited the growth of <em>staphylococcus </em>even when diluted 800 times. He reported his momentous, albeit accidental, discovery in the <em>British Journal of Experimental Pathology</em> in 1929. </p> <p><img alt="Penicillin in the war" src="/sites/default/files/penicillin.jpg" style="width: 602px; height: 510px; float: right;" /></p> <p><strong>Penicillin story</strong></p> <p>A modest, slightly dour man, Fleming did not believe that mass production of penicillin was viable, and made little further reference to it. It was not until a decade later, several miles up the Thames in Oxford that the next chapter in the penicillin story would be written. Though he received numerous honours including Fellowship of the Royal Society in 1943 and a knighthood in 1944, his career as an innovative scientist peaked with penicillin and he continued with more routine work. His first wife, with whom he had one son, died in 1949, and four years later he married Dr Amalia Koutsouri-Voureka, a Greek colleague. He died from a heart attack in London on 11<sup>th</sup> March 1955, and was buried at St Paul’s Cathedral.</p> <h2> <strong>Howard Walter Florey</strong></h2> <p>The second strand in the penicillin story involves Howard Walter Florey who was born in Adelaide, South Australia on 24<sup>th</sup> September 1898. He was the son of an English immigrant and his Australian-born second wife. He studied Medicine at the University of Adelaide. Upon qualification in 1921, he arrived at Magdalen College, Oxford, on a Rhodes scholarship, gaining a BSc and MA. In 1926 he was elected a fellow of Gonville and Caius College, Cambridge, and received a PhD from there a year later.</p> <p>Brief periods in the USA on a Rockefeller Travelling Fellowship and back at Cambridge were followed by his appointment in 1931 to the chair of Pathology at Sheffield University, and four years later to the chair of Pathology at Oxford. In 1938, working with Ernst Chain and Norman Heatley, he read Fleming’s paper on the antibacterial qualities of penicillin and he set his research team to work on the large-scale production of the mould and extraction of the active ingredient. They were financed by a grant from the Rockefeller Foundation.</p> <p><strong>Howard Florey</strong></p> <p><img alt="Howard Florey in 1945" src="/sites/default/files/Howard_Walter_Florey_1945.jpg" style="width: 280px; height: 396px; float: right;" />In May 1940 a classic experiment was performed when eight mice were deliberately infected with <em>Streptococcus</em>; the four that were subsequently treated with penicillin survived whilst the others died. The following year penicillin was tried for the first time on a human. The patient, Albert Alexander, a 48-year-old Metropolitan Police Officer, sustained horrific facial swelling after a thorn scratch became infected necessitating several abscess drainages and removal of an eye. He appeared to improve after he was given the penicillin but due to insufficient quantities of the drug, he relapsed and died.</p> <p><strong>Foiled wish to Patent the new Drug in the UK</strong></p> <p>In 1943 Florey travelled to North Africa to test the effects of penicillin on wounded Allied soldiers, and he discovered that it was remarkably effective, literally saving life and limb. The clinical benefits having been clearly demonstrated, the focus now turned to mass production of the drug. Again using his American connections, Florey travelled with Heatley to Peoria, Illinois. This was against Chain’s wishes, as he wanted to patent the drug in the UK. In America an enthusiastic researcher called Mary Hunt found that the cantaloupe melon provided a medium for prolific growth of the mould. By late 1943 several major drug companies, including Merck, Squibb and Pfizer had begun mass production. By the tail end of WWII allied soldiers were to benefit from this, their wound infections as well as their gonorrhoea cured.</p> <p> </p> <p><strong>Florey - "The Greatest Australian"</strong></p> <p>Florey was a remarkably paradoxical character. Driven and ambitious, he was also extremely cautious, and he shunned publicity. He and Fleming rarely met and were certainly never friends, yet their lives had remarkable parallels, and though both spent most of their working lives in genteel academic circles, each retained the blunt manners typical of their native countries. Florey married his first wife, Ethel Reed, whom he met at medical school, in 1926. They had a daughter Paquita and a son Charles (who became Professor of Community Medicine at the University of Dundee), but although they worked closely together the marriage was not happy, and he became romantically involved with another member of the research team, the gastroenterologist Margaret Jennings. Ethel suffered ill health for many years and died in 1966. A year later Florey married Margaret but by then, always a heavy smoker, he was ailing and he died from a heart attack on 21<sup>st</sup> February 1968. Like Fleming Florey was a highly decorated scientist. He was knighted in 1944 and he made a life peer in 1965 becoming Baron Florey of Adelaide (Australia) and Marston (Oxfordshire). In 1959 he was elected President of the Royal Society. Florey remains an extremely revered figure in scientific circles, and former Australian Prime Minister Robert Menzies described him as the greatest Australian of all time.. </p> <p><img alt="Vial of Penicillin" height="356" src="/sites/default/files/vial of pen.jpg" style="float: right;" width="388" /></p> <h2> <strong>Ernst Chain</strong></h2> <p>Ernst Boris Chain was the third pivotal figure. Like Fleming and Florey, he was an outstanding scientist who led a very interesting life. He was born in Berlin on 19<sup>th</sup> June 1906, his Russian father having moved there to study Chemistry at Friedrich Wilhelm University; his mother was a native Berliner. Chain enrolled for the same course and at the same university as his father, graduating in 1930. Realising that he was no longer safe in Nazi Germany, he moved to Britain in 1933. He began work at Cambridge University, studying phospholipids under Sir Frederick Gowland Hopkins. In 1935 he moved to Oxford and researched a wide variety of biochemical areas before joining Howard Florey’s team in 1939. He theorised the structure of penicillin (which was confirmed by x-ray crystallography by Dorothy Hodgkin) and worked out how to isolate and concentrate the active ingredient.</p> <p><img alt="" src="http://upload.wikimedia.org/wikipedia/commons/thumb/a/ae/Ernst_Boris_Chain_1945.jpg/220px-Ernst_Boris_Chain_1945.jpg" style="width: 220px; height: 311px;" /></p> <p><strong>Ernst Chain</strong></p> <p>A brilliant polymath, Chain was also a fine pianist and spoke German, Russian, English, French, Italian and Hebrew. However, he suffered a personal tragedy as both his mother and sister perished in the Holocaust. In 1948 he moved to Rome as Scientific Director of the International Research Centre for Chemical Microbiology. Academic institutions in Italy at the time were bedevilled by corruption and nepotism, and Chain was one of several scientists recruited from abroad to restore damaged reputations as well as conduct research. In 1964 he became Professor of Biochemistry at Imperial College, London, and was knighted in 1969. He retired in 1973 and moved to the West of Ireland, He died in Castlebar, County Mayo on 12<sup>th</sup> August 1979.</p> <p>In 1945 Fleming, Florey and Chain were jointly awarded the Nobel Prize in Medicine or Physiology for their momentous work.</p> <p> </p> <p> </p> <h2> <strong><a name="Zachary Cope" id="Zachary Cope"></a>Zachary Cope (1881 – 1974)</strong></h2> <p>Surgeon who redefined the acute abdomen</p> <p><img alt="Zachary Cope" src="/sites/default/files/Zachary Cope.jpg" style="width: 313px; height: 428px; float: right;" /></p> <p>Zachary Cope was a leading light in academic surgery and is best known for his volumes on acute abdominal emergencies. However, his interests were diverse and he made significant contributions to other fields, particularly medical politics and history.</p> <p><strong>Influenced by electro-physiologist Augustus Waller</strong></p> <p>Vincent Zachary Cope was born in Hull on 14<sup>th</sup> February 1881, where his father Thomas Cope was a Methodist minister. He moved to London at a young age, attending Westminster City School and then St Mary’s Hospital Medical School. He graduated in 1905, gaining his MD two years later, and becoming a Fellow of the Royal College of Surgeons in 1909. He was immediately elected to the hospital’s academic staff, becoming an anatomy demonstrator and at the age of 30 he was appointed as surgeon, where his excellent teaching skills accounted for the large entourage during ward rounds. This was the start of a hugely successful clinical career, but Cope was also a keen academic whose influences included the electro-physiologist Augustus Waller and the serologist Almouth Wright.</p> <p><strong>Surgical Aspect of Dysentry</strong></p> <p>During the First World War he served as a Captain in the Royal Army Medical Corps. He saw active service in the Middle East between 1916 and 1918, being mentioned in dispatches during the last year. His paper ‘Surgical aspect of dysentery’(1921) was based on his experience in Mesopotamia (now part of modern Iraq).</p> <p>In 1921 he published ‘Early diagnosis of the acute abdomen’, the most authoritative text on the subject. In 1972, aged 91, he revised its 14<sup>th</sup> edition, and the proof of its phenomenal success is that it is still in print in the form of a 21<sup>st</sup> edition ‘co-written’ by William Silen.</p> <p><strong>History of St Mary's Hospital</strong></p> <p>Cope merged his interest in surgical emergencies with his other passion of medical history, publishing ‘Pioneers in acute abdominal surgery’(1939) and ‘A history of the acute abdomen’(1965). Most of his historical output was, however biographical. Notable contributions in this area include ‘William Cheselden 1688-1752’ (1953), ‘Florence Nightingale and the doctors’(1958) and his tribute to his mentor ‘Almouth Wright, founder of modern vaccine therapy’(1966). He wrote two books about his hospital, ‘The history of St Mary’s Hospital Medical School’(1954) and ‘A hundred years of nursing at St Mary’s Hospital, Paddington’ (1954). His largest single work was ‘The Royal College of Surgeons of England’(1959), in which he chronicled both the public and some less well known domestic history of the RCS, using minutes of meetings over the previous 150 years.  </p> <p>Cope was, indeed, an active member of the Royal College of Surgeons, becoming a Hunterian Professor and a member of the examining panel for the college Fellowship, in addition to being an external examiner of undergraduates at London, Birmingham and Manchester universities. In 1940 he was elected onto the Council of the college. He was also a member of the Council of the BMA and later became vice-president. During the Second World War he was Sector Officer of the Emergency Medical Service. In his political dealings he was also influenced by Almouth Wright, being passionately opinionated and often losing his normally genteel exterior.</p> <p>Cope suffered considerable misfortune in his personal life. His first wife Agnes Newth, whom he married in 1909, died in 1922. The following year he married Alice Watts, though she too died relatively young in 1944. He personally maintained excellent health into advanced old age, and in retirement he busied himself mainly with his historical writing. In 1951 he was made an honorary Fellow of the Royal Society of Medicine, and he was also involved in the Medical Society of London. He was knighted in 1953 in recognition of his public service, his name appearing in the first New Year’s Honours List of Elizabeth II’s reign.</p> <p>Zachary Cope died in Oxford on 28<sup>th</sup> December 1974, aged 93.</p> <p> </p> <h2> <a name="McNeil Love" id="McNeil Love"></a>Robert John McNeill Love (1891 – 1974)</h2> <p>Eminent surgeon and medical writer</p> <p>McNeill Love was an eminent surgeon and medical writer who is best remembered for several collaborations with Hamilton Bailey. Whilst his literary output was not as prolific as his more famous colleague’s, his overall contribution to surgery in the middle part of the 20<sup>th</sup> century was just as notable. There were remarkable similarities as well as contrasts between the two men, leading to inevitable comparisons.</p> <p><strong>Brillian Cohort of Young Surgeons</strong></p> <p>Like Bailey, Robert John McNeill Love, who was always known by the third of his forenames, had Celtic roots, being of Ulster Protestant stock. Born in 1891, he grew up on the Antrim coast, the family home being the former house of Robert Falcon Scott (Scott of the Antarctic). He studied medicine at the Royal London Hospital, qualifying in 1914. This coincided with the outbreak of the war, and he joined the army, seeing service in Turkey and the Middle East. Upon his return he joined the staff at the Royal London, and indeed his war experience was his only work outside of the capital. He passed the FRCS whilst working as Surgical Registrar. Indeed, he was part of a brilliant cohort of young surgeons working together at the London, including Donald Hunter (the founder of occupational medicine), Hugh Cairns (a pioneering neurosurgeon who attained the Chair in Surgery at Oxford), Russell Brain (future President of the RCS) and of course Bailey himself. In 1925 a Consultant vacancy occurred, which was famously keenly contested by both Love and Bailey. Inexplicably, neither was appointed, and Love continued his career at The London, with brief postings to the Metropolitan and Mildmay Mission Hospitals.</p> <p> </p> <p>In November 1930 McNeill Love and Hamilton Bailey were both appointed as Consultants at the Royal Northern Hospital, Holloway. Less obviously perturbed than Bailey by his failure to secure a teaching hospital appointment, Love enjoyed an excellent career, his skills as a tutor transforming the academic reputation of the surgical unit. He was also noted as a skilled and innovative operator.</p> <p><strong>Surgery for Nurses</strong></p> <p>Love’s best-known publications are two books he co-wrote with Bailey: ‘<em>A Short Practice of Surgery’</em> (1932) and <em>‘Surgery for Nurses’</em> (1933) – remarkably, the first book is still in print and is a standard text for surgical trainees. His papers indicate the breadth of his practice, amongst them <em>‘Prognosis after removal of semilunar cartilages’</em> (1923), <em>‘Gastrointestinal crisis of angioneurotic oedema’</em> (1932), <em>‘A guide to the surgical paper’</em> (1935), and <em>‘Modern trends in biliary surgery</em>’ (1952). He served the Royal College of Surgeons as an examiner for the FRCS for many years and as a Member of the Council from 1945 until his retirement in 1953. In retirement he endowed the College the McNeill Love medal, presented to a member of staff who served the organisation for 25 years or more in a capacity other than an academic or senior administrator. </p> <p>A devout Christian, Love, like Bailey, endured his share of personal distress. His first wife died quite young and he lost a son to tuberculosis; his daughter, Baroness Caroline Cox, is active in the current political scene. After living alone for many years, he married his housekeeper Rhoda, herself a widow, and they lived together happily until he died aged 83 from stomach cancer on 1<sup>st</sup> October.</p> <p> </p> <p> </p> <h2> <strong><a name="Hamilton Bailey" id="Hamilton Bailey"></a>Hamilton Bailey 1894 - 1961</strong></h2> <p><strong><em>The extraordinary life of a pivotal figure in emergency care</em></strong></p> <p align="center"><img alt="Hamilton Bailey" src="/sites/default/files/Hamilton Bailey.jpg" style="width: 180px; height: 270px; float: right;" /></p> <p>The 26<sup>th</sup> of March 2011 marked half a century since the death of Hamilton Bailey. However, his name remains known to medical students and doctors thanks to his extraordinary contribution to surgical literature. He also contributed significantly to important developments in emergency care.</p> <p><strong>Hard Drinking Scottish Roots</strong></p> <p>Henry Hamilton Bailey was born in Bishopstoke, Hampshire to Scottish parents on the 1<sup>st</sup> October 1894. His father James was a respected general practitioner. His mother was a nurse who drank heavily and probably suffered from depression, whilst his younger sister had schizophrenia, a source of shame the family tried to hide. Nevertheless, Bailey excelled academically and he entered the London Hospital Medical School in 1912.</p> <p><strong>Captured by the Germans</strong></p> <p>At the outbreak of the First World War and whilst he was still a medical student Bailey volunteered for the Red Cross. Arriving in Belgium, he was soon captured by the Germans as a prisoner-of-war, and he was sent to work on their railways. When a troop train was wrecked he was arrested on suspicion of sabotage; execution seemed certain until the intervention of the American Ambassador in Berlin helped reprieve him. He returned home to continue his studies but after he qualified in 1916 he joined the Royal Navy, serving on HMS Iron Duke at the Battle of Jutland.</p> <p>He returned to the Royal London Hospital to train in surgery, qualifying in 1920. In 1924 he accidentally pricked his left index finger during surgery and infection set in, resulting in a stiff and useless finger which was subsequently amputated.</p> <p><strong>Demonstrations of Physical Signs in Clinical Surgery</strong></p> <p>The London Hospital had a remarkable tradition in surgery and Bailey was developing a reputation as a fine teacher and writer. He moved from London in 1925, briefly held the post of Assistant Surgeon at Liverpool Royal Infirmary and was then appointed Surgeon to Dudley Road Hospital. It was here that he started writing in earnest. In 1927 he published his first major book <em>Demonstrations of Physical Signs in Clinical Surgery. </em>He met and married Veta Gillender, a young photographer whose superb pictures were an integral feature of his books. In 1929 there was a further unsuccessful application for a consultancy, this time at Bristol Royal Infirmary.</p> <p><strong>Organised Drill for Cardiac Arrest</strong></p> <p>In November 1930, however, he returned to London after he was appointed Consultant Surgeon to the Royal Northern Hospital, Holloway. Putting behind his disappointment at not securing a teaching hospital appointment, he expanded his reputation as a charismatic teacher and eloquent lecturer. These were the days before sub-specialisation, and Bailey’s large and diverse practice included abdominal surgery, urology, orthopaedics, trauma and head and neck surgery. He was particularly innovative in the emergency care domain. He was also one of the first surgeons to devise an organised drill for cardiac arrest, and wrote a paper on this in the BMJ which provoked enough correspondence to make the editor ‘close’ the matter.He made blood transfusions more widely used, and reiterated the importance of the delayed primary suture. He also organised the out-patient urology clinic into the one-stop format recognisable today.  </p> <p>It is, however, as the most prolific surgical writer of all time that he is best remembered. His three most famous works are <em>Demonstrations of Physical Signs in Clinical Surgery</em>(1927), <em>Emergency Surgery</em> (1930), and <em>A Short Practice of Surgery</em>(1932. Remarkably, all these books are still in print and widely read. He also edited <em>The Surgery of Modern Warfare </em>(1940) during the Second World War, and revitalised <em>Pye’s Surgical Handicraft </em>(1938), a classic text from an earlier age. He wrote seven smaller books, and published 120 papers. For all his ability there were, however, negative aspects to his character: he was demanding and domineering, had few social graces or respect for authority, and little rapport with patients or colleagues.</p> <p><strong>Horrific Railway Accident</strong></p> <p>The Baileys suffered an appalling tragedy in on 29<sup>th</sup> July 1943 when their son Hamilton, their only child, was killed in a horrific railway accident whilst returning to London from a school trip to Cumbria. As he leaned from a train window, a door from a passing northbound train flung open, dealing a massive, instantly fatal blow to his head. Bailey’s mental health had probably always been fragile beneath his driven exterior, and his family history portended vulnerability. The tragedy precipitated a rapid worsening, with a noticeable decline in the quality and quantity of both clinical and academic work. His behaviour became erratic, with frequent outbursts of anger.</p> <p><strong>Prefrontal Leucotomy or Lithium?</strong></p> <p>It was soon obvious that he could not continue in clinical practice, and he resigned his hospital post in 1948. Initially reluctant to seek help, he eventually came under psychiatric care, initially at Napsbury Hospital in St. Albans, Hertfordshire and then at St. Andrews, a private clinic in Northampton, but to no avail. Inevitably he was sectioned under the Mental Health Act and in dire straits he was admitted to Graylingwell Hospital in Chichester, Sussex, in 1949. He was paranoid, manic, uncooperative and, for three years, utterly unresponsive to treatment. The controversial prefrontal leucotomy operation seemed inevitable; however, David Rice, his Consultant Psychiatrist took the advice of his Registrar, a young Australian called David Moore, who alerted him to the new drug lithium and suggested it should be tried on Bailey as a last resort. Within weeks an improvement was evident, and three months after becoming possibly the first patient in Britain to receive the drug, he was discharged having made a remarkable recovery.</p> <p>The Baileys retired to Deal, Kent and later Malaga, Spain. He continued writing, and, though not in active practice was able by wide reading and contact with contributors to maintain an intimate knowledge of advances in surgical practice. Hamilton Bailey died from septic peritonitis in Malaga on 26<sup>th</sup> March 1961, aged 66. Veta continued to live in Spain until her death in 1989. </p> <p>The English Church in Malaga was and remains a focal point for the expatriate community. Perhaps fittingly for a man whose life was so turbulent, he was buried in its tranquil cemetery, where successors and aficionados of medical history continue to visit and pay respect to brilliant, tormented figure that was Hamilton Bailey.</p> <p> </p> <p> </p> <p> </p> <h2> <strong><a name="archibold mcindoe" id="archibold mcindoe"></a>Sir Archibald McIndoe 1900 - 1960</strong></h2> <p><img alt="Archibald McIndoe" src="/sites/default/files/archi mcindoe.jpg" style="width: 300px; height: 339px; float: right;" /><strong>War and Medicine</strong></p> <p>Wars are never pleasant experiences, but they have provided unique challenges as well as learning experiences for the medical profession. The discipline of plastic surgery, which today is inextricably linked to cosmetic treatment, evolved from the trauma domain, and Archibald McIndoe was a key figure in its development.</p> <p><strong>Spitfire Pilots and Plastic Surgery</strong></p> <p>Archibald McIndoe was born in Dunedin, New Zealand on 4<sup>th</sup> May 1900, where his father John was a printer. He attended school and university in Otago where he studied medicine, qualifying as a doctor in 1924. After house officer posts at his teaching hospital, he won a scholarship to the United States and he worked at the Mayo Clinic for five years, initially as First Assistant in Pathological Anatomy. His early interest was hepato-biliary disease, on which he published several papers. It was whilst in America that he met Lord Moynihan who, impressed by McIndoe’s precocious talent, suggested a surgical career in London. It was a natural progression as his cousin, Sir Harold Gillies, was an important figure in the relatively new discipline of plastic surgery.</p> <p>McIndoe arrived in London in 1930 and became clinical assistant to Gillies’ department at St Bartholomew’s Hospital. He qualified as a surgeon in 1932 and became General Surgeon and Lecturer at the Hospital for Tropical Diseases, before becoming a Consultant at the Royal North Stafford Infirmary and Croydon General Hospitals. He was also appointed Consultant to the Royal Air Force in 1938 and at the outbreak of World War II moved to the Queen Victoria Hospital in East Grinstead. With a foresight conspicuous by its rarity in healthcare planning, the hospital was built on ample land with room for expansion to allow the establishment of a plastic surgery unit, to cope with the inevitable war-related workload. The burns suffered by pilots were often horrific, due to the large fuel tanks carried by the powerful Hurricane and Spitfire jets. McIndoe and his team worked tirelessly, operating day and night, and he resolutely refused to be put in a uniform himself.</p> <p><img alt="Achtung Supermarine Spitfire" height="532" src="/sites/default/files/Supermarine_Spitfire_F.jpg" style="float: right;" width="592" /><strong>The Guinea Pig Club</strong></p> <p>McIndoe treated several hundred airmen, performing pioneering plastic surgery to rebuild their faces and hands. Many of them went back to fly again.</p> <p>From this experience came not only an improvement of the technical side of trauma management, but an understanding of the psychosocial consequences of disfiguring injury. McIndoe campaigned for the development of such facilities, and for the improvement of the pay and conditions of injured ex-servicemen. The Guinea Pig Club, founded by his former patients, perpetuates his memory.</p> <p>McIndoe became a CBE in 1944 and was knighted in 1947. He became a member of the Council at the RCS in 1946 and was vice-president in 1958, giving the Bradshaw Lecture that year on facial burns. He was a founder member of the British Association of Plastic Surgeons and became its third president. He was single-minded and not afraid to upset others in order to get his way. He died suddenly from a heart attack in his sleep on 12th April 1960. He was just 59, and still in service. His ashes were buried at the RAF church of St Clement Danes.</p> <p> </p> <p> </p> <h2> <strong><a name="Dame Cicely Saunders" id="Dame Cicely Saunders"></a>Dame Cicely Saunders 1928 - 2005</strong></h2> <p>Nurse, doctor and founder of the modern hospice movement</p> <p><img alt="" src="http://www.google.co.uk/imgres?imgurl=http://thepositivespirit.org/wp-content/uploads/2013/04/Dame-Cicely-Saunders.jpg&amp;imgrefurl=http://www.thepositivespirit.org/dame-cicely-saunders-work-for-the-hospice-movement-video/&amp;h=266&amp;w=189&amp;sz=1&amp;tbnid=_wQuoZNeK7poQM:&amp;tbnh=186&amp;tbnw=132&amp;zoom=1&amp;usg=__zUauVTC2hAzuShYQBwiCj3Wemuw=&amp;docid=jae_FSDpJjc1bM&amp;itg=1&amp;sa=X&amp;ei=3yyCUqgu6K7sBun3gbAF&amp;sqi=2&amp;ved=0CI0BEPwdMAo" /><img alt="" src="http://www.google.co.uk/imgres?imgurl=http://thepositivespirit.org/wp-content/uploads/2013/04/Dame-Cicely-Saunders.jpg&amp;imgrefurl=http://www.thepositivespirit.org/dame-cicely-saunders-work-for-the-hospice-movement-video/&amp;h=266&amp;w=189&amp;sz=1&amp;tbnid=_wQuoZNeK7poQM:&amp;tbnh=186&amp;tbnw=132&amp;zoom=1&amp;usg=__zUauVTC2hAzuShYQBwiCj3Wemuw=&amp;docid=jae_FSDpJjc1bM&amp;itg=1&amp;sa=X&amp;ei=3yyCUqgu6K7sBun3gbAF&amp;sqi=2&amp;ved=0CI0BEPwdMAo" /><img alt="Cicely Saunders" height="343" src="/sites/default/files/Cicely Saunders.jpg" style="float: right;" width="257" /></p> <p><strong>Paradoxical Relationship with Death</strong></p> <p>Strange as it seems, the medical profession’s relationship with death has been paradoxical. The scientific advancements of the 20<sup>th</sup> century served, if anything, to heighten the fear of death and the taboos that surround it. Two brilliant women must therefore take much of the credit for more enlightened attitudes to end-of-life care. The Swiss-born American Elisabeth Kübler-Ross carried out seminal work on the psychological impact of receiving a serious diagnosis and impending death. This coincided with the founding of the modern hospice movement in the UK by Dame Cicely Saunders.</p> <p><strong>Scoliosis of the Spine</strong></p> <p>Cicely Mary Saunders was born in Barnet, Hertfordshire in 1918 and was educated at Roedean School. Her interest in healthcare was stimulated by her own struggle with illness as scoliosis of the spine led to a taxing daily exercise routine. In 1938 she began studying at Oxford University but against her family’s wishes she abandoned her studies in 1940 to become a student nurse at St Thomas’ Hospital. Advised in turn to quit nursing due to her back condition, she returned to Oxford in 1944, qualifying as a medical social worker in 1947 and becoming a lady almoner at St Thomas's hospitalin 1947.</p> <p>"A Window in your Home"</p> <p>She began work as an almoner at the Archway Hospital in London where in 1948 she formed a pivotal relationship with David Tasma, a Polish-Jewish émigré who was dying of cancer. Before his death they discussed the possibility of founding a home where terminally ill patients could live out their final days peacefully and with this in mind, when Tasma died aged just 40, he left her the sum of £500, saying that he would be “a window in your home”</p> <p><img alt="David Tasma" src="/sites/default/files/David Tasma.jpg" style="width: 203px; height: 152px; float: right;" /><strong>David Tasma</strong></p> <p>"Nurses have no Political Clout"</p> <p>There were, however, further hurdles to overcome before this goal of could be realised. A surgeon who was an acquaintance advised her that, as a nurse, she would not have the necessary political clout to start a new movement. As a consequence, at the age of 33 she began her medical training at St Thomas’, qualifying as a doctor in 1957. </p> <p>After qualifying, she won a scholarship and she researched pain management in the terminally ill at St Mary’s Hospital, and also assisted nuns caring for the terminally ill at St Joseph’s in Bayswater. In 1959 she wrote a 10-page proposal for a hospice; building work started in 1965, and in 1967 St Christopher’s Hospice in Sydenham, South London, complete with 54 beds, admitted its first patient. It soon became a research centre with an academic unit. Having been founded entirely on charitable donations, just three years after opening the NHS was contributing two-thirds of the running costs. It continues to thrive at its original site, but has since been joined by many more hospices nationally.</p> <p><strong>Pallitive Care Programmes</strong></p> <p>Cicely Saunders married another Pole, the painter Marian Bohusz-Szyszko, in 1980 when she was 61 and he was 79.  She covered the walls of St Christopher's, where he came to live and paint, with his pictures. Saunders remained medical director of St Christopher’s until 1985. She died from breast cancer on 14<sup>th</sup> July 2005, receiving her own terminal care at St Christopher’s Hospice. St Christopher's Hospice has trained more than 50,000 students and spread palliative care programmes to more than 120 countries worldwide..</p> <p> </p> <p> </p> <h2> <strong><a name="Sheila Sherlock" id="Sheila Sherlock"></a>Dame Sheila Sherlock </strong>(1918-2001)</h2> <p><strong>Leading authority on liver disease</strong></p> <p><strong><img alt="" src="/sites/default/files/Sherlock Sheila_0.jpg" style="width: 155px; height: 219px; float: right;" /></strong></p> <p><strong>Development of Hepatology</strong></p> <p>Sheila Sherlock was the pivotal figure in the development of hepatology as a clinical and academic discipline, that is, the study of the liver ,gallbladder, biliary tract and pancreas), and for decades she was unchallenged as the world’s foremost authority in this field. In a glittering 60-year career, she became one of the most famous figures in clinical science.</p> <p><strong>Diseases of the Liver and Biliary System</strong></p> <p>Sheila Patricia Violet Sherlock was born in Dublin on 31<sup>st</sup> March 1918 and settled with her family in Folkestone, Kent in early childhood. She gained a place to read medicine at Edinburgh University in 1936, and graduated five years later, winning the Ettles scholarship for finishing top of the year. She was soon appointed assistant lecturer at the University’s department of surgery under her mentor Professor Sir James Learmonth, whom she credited with teaching her how to conduct research and write a paper. She stated that her interest in liver disease developed as ‘no one else was doing it’. The choice was timely, for the next few years would see increasing health challenges in this area, from the high incidence of jaundice in returning allied troops to alcohol-related disease and infective hepatitis. From Edinburgh she moved to London after being appointed first a research fellow and, aged just 30, a lecturer and honorary consultant physician at the Royal Postgraduate School at Hammersmith Hospital. She worked with Professor Sir John McMichael, building up a liver unit from scratch that became renowned within five years. In 1951 she was elected a Fellow of the Royal College of Physicians, by far the youngest woman to be honoured in this way. Her book <em>Diseases of the Liver and Biliary System</em>, published in 1954, was one of the earliest and certainly the most influential in this area; it has been translated into six languages and passed through 11 editions, latterly co-authored with James Dooley.  </p> <p><strong>The Royal Free Hospital</strong></p> <p>In 1959 she was appointed Professor of Medicine at the Royal Free Hospital Medical School, the first woman in Britain to hold such a post. Despite, or perhaps because of its tradition of helping students from relatively disadvantaged backgrounds to enter the medical profession, the Royal Free was often perceived as a poor relation among London teaching hospitals. Once appointed to the chair, however, Sherlock swiftly changed that image. A diminutive but tremendously energetic character who ‘moved like a tornado’ according to Sir Roy Calne, her distinctive presence had a galvanising effect on the medical faculty’s development and morale. She built up a liver unit which became world famous, the ripple effect benefiting allied specialties such as surgery, radiology and pathology. Research fellows were drawn from all over the world, and as the specialty was still in its relative infancy, she could at one time claim that every hepatologist in the world had worked under her.</p> <p><strong>Sheila's Green Pen</strong></p> <p>Her relationship with her research fellows was, however, famous in medical circles for its paradoxical nature. She worked ceaselessly for them, conducting a weekly ward round, teaching and supervising research. However, their draft manuscripts would receive a pounding from her green pen. On a bad day she was not averse to ripping up a paper whilst reciting a litany of its faults, sometimes reducing male colleagues to tears. Yet most persevered, holding her in great affection and they knew that a successful stint in the department was a true badge of distinction.</p> <p> </p> <p>Though her main commitments were academic, she maintained a sizeable clinical practice throughout her career and was paternalistic towards her patients – not entirely surprising, given that liver maladies can be the end product of self-indulgence, but still quite different from the consensual doctor-patient relationship that is in vogue today. In the 1950s and 1960s, patient consent for research was a far less bureaucratic process than now, and Sherlock had her critics amongst colleagues for what they perceived as over-zealous recruitment. Foremost among them was Maurice Pappworth, a prominent Liverpool physician and indefatigable critic of the medical establishment, who particularly railed against anti-Semitism and the lack of a meritocracy in consultant appointments. Whilst Sherlock was hardly guilty of either, Pappworth criticised her recruitment methods in an article in the magazine <em>Twentieth Century </em>and again in his 1969 book <em>Human Guinea Pigs</em>. Like James Paget before her, she remained a staunch defender of scientific method and its necessary tools. An unpleasant storm raged, and she never forgave Pappworth. </p> <p><strong><em>Gut</em></strong></p> <p>Sherlock was active nationally and internationally, serving as vice-president of the Royal College of Physicians, as president of the British Society of Gastroenterology, as editor of <em>Gut</em> and the <em>Journal of Hepatology,</em> and as founder and later president of the British Liver Trust, a charity supporting liver research and patients with liver disease. She was a famously entertaining lecturer, retaining the audience’s interest by homing in on what mattered in addition to a propensity for firing questions. Created a Dame in 1978, she retired from the chair of medicine in 1983 but continued to see patients and to write. Her final output was a staggering total of over 600 research papers, review articles and book chapters. In 1990 <em>Scientist </em>magazine named her in the top 10 of most cited women scientists of the previous decade.</p> <p><strong>The Arsenal FC</strong></p> <p>In contrast to many successful female doctors of her era, she enjoyed a conventional family life with her husband Gerry James, also an eminent physician, with whom she had two daughters. A keen tennis player, she also retained more than a passing interest in Kent County Cricket Club and Arsenal Football Club. Her health was good until pulmonary fibrosis began to take its toll in the last couple of years of her life. She died on December 30<sup>th</sup> 2001.</p> <p> </p> <p> </p> <h2> <strong><a name="Jean Shanks" id="Jean Shanks"></a>Jean Shanks  1925-199</strong></h2> <h1> Pathologist, entrepreneur and philanthropist</h1> <p align="center"><img alt="Jean Shanks" height="374" src="/sites/default/files/Jean.jpg" style="float: right;" width="305" /></p> <p>One of the leading doctors of her day, Jean Shanks enjoyed successful parallel careers as an innovative clinical pathologist, a businesswoman and a philanthropist. Prior to her private pathology company JS Pathology, the service levels provided by NHS path labs were notably poor with average turnaround times for routine tests, let alone esoteric ones measured in days. Jean improved this to an average of four hours and set a new benchmark for diagnostic service delivery. Due to the service levels provided by JS Pathology, the Harley Street consultants were able to provide their patients with unparalled levels of medical service. This then encouraged all other labs to raise their own performance levels.</p> <p><strong>Automated Laboratory Testing</strong></p> <p>She was born in 1925 and started her medical training at St Hugh’s College, Oxford, in 1943 before transferring to the Middlesex Hospital for her clinical studies. She qualified in 1950, one of only two female graduates in her year. She won a Fulbright scholarship to train as a pathologist. She became a reputable haematologist and retained an interest in chemical pathology, being instrumental in developing automated laboratory assays and computer-generated results.</p> <p><strong>JS Pathology Services on Harley Street</strong></p> <p>In the early 1960s she joined Martin Hyams in the private sector and in 1965 established her own pathology laboratory in Harley Street, later naming it JS Pathology Services. It would literally cover London’s most famous medical street, its interconnecting tunnels facilitating rapid transfer of specimens and results between practices. Though the overall economic situation in the UK was bleak during the 1970s, private practice flourished in London thanks in part to the patronage of wealthy foreigners, many of them from oil-rich Gulf Arab states. JS Pathology was floated as a public company in 1975, increasing Shanks’ personal wealth considerably. Shortly afterwards she started the Jean Shanks Foundation, a charity linked to the Royal College of Pathologists, providing scholarships for postgraduate training in the specialty. Always passionate about art and music, she expanded her philanthropy through the Jean Shanks Fund for the benefit of aspiring opera singers at Glyndebourne. </p> <p>Dr Shanks was a relentlessly hard worker, eschewing a conventional home life in her youth to build up her businesses. In 1976, aged 51, she married Prince Yuri Gaziltine, a suitably accomplished and versatile man. An aristocrat who was born in Japan of mixed Russian and British descent, he fashioned careers as a feature writer with the Sunday Express and then a press officer for Hunting Aviation. In 1952 he left for Northern Rhodesia, where he worked with the Prime Minister Sir Godfrey Huggins to fight for the federation of Rhodesia and Nyasaland, a plan that was ultimately doomed. Upon his return to London, Gaziltine entered the public relations industry, founding a consultancy firm. Though he had a colourful personal life and had been married three times before, his union with Shanks was successful and lasted until her death.</p> <p><strong><em>The Lancet </em>moves to the House that Jean Built</strong></p> <p>In 1992 Shanks moved her laboratories from Harley Street to a converted warehouse in Camden, which is now the home of Elsevier Publishing and <em>The Lancet</em>. She oversaw the development of the Chandos Clinical Research Centre to provide a biochemical resource to the drug industry. She retained personal control and was acknowledged as a caring employer although this was a large set-up with close to 2,000 staff. An excellent hostess, her annual parties formed important networking opportunities for doctors and related health professionals setting up in private practice. She was active in many medical clubs, especially the Chelsea Medical Society, of which she became president.</p> <p>Bob Davidson, the Editor of <a href="http://www.totalhealth.co.uk">Total Health</a> who used to work for Dr Shanks says, "Dr Shanks was an inspirational leader, she loved her staff and we loved her. She was also extremely 'canny' with the overheads and hated to see any lights left on or staff using the lifts when we could use the stairs. You were never surprised to be suddenly plunged into darkness when working late".</p> <p>In retirement Shanks divided her time between her farmhouses in Suffolk and France. Her own health was robust until she developed a rare malignancy, duodenal carcinoma, from which she died on 19<sup>th</sup> November 1999, aged 74. She was survived by her husband, who died on 28<sup>th</sup> November 2002, aged 83. Her name lives on through her charitable foundations and through the annual Jean Shanks lecture.  </p> <p> </p> <h2> <strong><a name="Tunnadine" id="Tunnadine"></a>Prudence Tunnadine (1928- 2006)</strong></h2> <h2> Founder of the Institute of Psychosexual Medicine</h2> <p><img alt="Prudence Tunnadine" src="/sites/default/files/Prudence Tunnadine.jpg" style="width: 301px; height: 480px; float: right;" /></p> <p>Prudence Tunnadine was one of a select group of single-minded women, including her famous predecessor Marie Stopes and contemporary Virginia Johnson, who combined scientific method, business acumen and not a little personal charm to publicise human sexuality, making it a recognised branch of medicine.</p> <p> </p> <p>Prudence Tunnadine was born Lesley Prudence Dundas Bellam in Chiswick, London, on 5<sup>th</sup> December 1928. Her father worked in the rag trade and was an army reservist who volunteered for service at the outbreak of World War II, being commissioned to the Royal Tank Regiment. This prompted the family’s move to Sussex, and having started her education at Bedford Park High School for girls, she completed her school days at Chichester High School. At the end of the war her father was posted to India, where she joined him for just over a year before moving back to London to study medicine at Guy’s Hospital, qualifying in 1953. </p> <p><strong>Doctors and Psychological Sexual Distress</strong></p> <p>Originally intent on a career in obstetrics and gynaecology, she reached registrar level but decided that this demanding specialty was incompatible with her home circumstances. She married David Tunnadine, who was to become a GP, when they were fourth year medical students, and went on to have four children. Using her knowledge and skills she turned to family planning work and subsequently realised that patients often brought psychological and sexual distress to their doctors in the guise of physical symptoms. Joined by a few like-minded colleagues, she recruited the eminent psychologist Tom Main who, using methods pioneered by Michael Balint, had been running training seminars for these doctors. From there, specialist psychosexual clinics developed, culminating in the foundation of the Institute of Psychosexual Medicine (IPM), based in Chandos Street off Cavendish Square in London, in 1974. It remains the UK’s foremost institution for education, training and research in this field, all under the umbrella of the NHS. In the early days the overwhelming majority of patients treated were women, but recent years have seen an increased awareness of, and interest in, male psychosexual problems.</p> <p><strong>"Sense and Nonsense about Sex"</strong></p> <p>Tunnadine was on the staff of the IPM from its inception, becoming scientific director in 1990 until her retirement in 2000 aged 71; she also ran a private practice on Harley Street. She published prolifically on the subject, including <em>‘Contraception and Sexual Life’</em> (1970), <em>‘Sense and Nonsense about Sex’</em> (1981), <em>‘The Making of Love’</em> (1984) and <em>‘Insights into Troubled Sexuality’</em> (1991). <em>‘The Making of Love’</em> drew on experience from her consulting practice, by which time she calculated that she had treated 30,000 patients. Her writing career was lucrative, for these texts were targeted at the wider public as well as health professionals. </p> <p>Her personal life was not without difficulties; her marriage broke up and she was divorced from David Tunnadine in 1978. In retirement she opted for a quieter life in her adopted Sussex. She died from carcinoma of the bowel in Ditchling, East Sussex on 15<sup>th</sup> December 2006, aged 78.</p> </div> Fri, 11 Oct 2013 12:48:39 +0000 Anonymous 6072 at https://www.totalhealth.co.uk Treating Benign Prostatic Hyperplasia (BPH) by PAE https://www.totalhealth.co.uk/clinical-experts/dr-nigel-hacking/treating-benign-prostatic-hyperplasia-bph-pae <span property="schema:name" class="field field--name-title field--type-string field--label-hidden">Treating Benign Prostatic Hyperplasia (BPH) by PAE</span> <div class="field field--name-field-related-conditions field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/your-condition/prostate-benign-prostatic-hyperplasia" hreflang="und">Prostate Benign Prostatic Hyperplasia</a></div> <div class="field__item"><a href="/your-condition/bph-and-cancer-prostate" hreflang="und">BPH and Cancer of the Prostate</a></div> <div class="field__item"><a href="/your-condition/benign-prostatic-hyperplasia" hreflang="und">Benign Prostatic Hyperplasia</a></div> </div> <span rel="schema:author" class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" typeof="schema:Person" property="schema:name" datatype="">Anonymous (not verified)</span></span> <span property="schema:dateCreated" content="2013-07-15T16:34:18+00:00" class="field field--name-created field--type-created field--label-hidden">Mon, 07/15/2013 - 17:34</span> <div property="schema:text" class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><em>Dr Nigel Hacking, is a senior Interventional Radiologist and leading expert in prostate artery embolisation (PAE). Dr Hacking has pioneered this minimally invasive and non-surgical option for treating the symptoms of enlarged prostate / lower urinary tract symptoms (LUTS). Dr Nigel Hacking is the acknowledged expert in the UK. The article provides an update on this highly promising and now fully recognised new treatment for benign prostatic hyperplasia (BPH) called Prostate Artery Embolisation (PAE). This new therapy will be of particular interest to men who are experiencing LUTS as well as those who have previously received medical or even surgical treatment for this condition that has not proved successful.</em></p> <h2><strong>Contents - Prostate Artery Embolisation (PAE) for BPH</strong></h2> <ul> <li><a href="#What is benign prostatic hyperplasia / benign prostate enlargement (BPH /BPE)?">What is benign prostatic hyperplasia / benign prostate enlargement (BPH /BPE)?</a></li> <li><a href="#What are the symptoms of BPH / BPE">What are the symptoms of BPH / BPE?</a></li> <li><a href="#What are the treatment options for BPH / BPE?">What are the treatment options for of BPH / BPE?</a></li> <li><a href="#What is Prostate Artery Embolisation PAE?">What is Prostate Artery Embolisation (PAE)?</a></li> <li><a href="#How successful is PAE for treating BPH / BPE?">How successful is PAE for treating BPH / BPE?</a></li> <li>PAE from research to treatment - The UK specialist centres</li> <li>Results from the UK-ROPE study</li> <li>For a private PAE referral</li> </ul> <h2><a id="What is benign prostatic hyperplasia / benign prostate enlargement (BPH /BPE)?" name="What is benign prostatic hyperplasia / benign prostate enlargement (BPH /BPE)?"></a>What is<strong> benign prostatic hyperplasia / benign prostate enlargement?</strong></h2> <p>Benign prostatic hyperpasia (BPH) or Benign prostate enlargement (BPE) refers to non-cancerous enlargement of the prostate gland. As the prostate enlarges it leads to compression and then obstruction of the urethra, which in turn affects urinary flow.</p> <p>The symptoms include the following:</p> <ul> <li>urinary frequency,</li> <li>urinary urgency,</li> <li>hesitancy in urination,</li> <li>poor stream and</li> <li>incomplete bladder emptying.</li> </ul> <p>Partial obstruction can ultimately become complete causing acute urinary retention and the urgent requirement for a bladder catheter. BPH is not however a pre-malignant condition. The symptoms of BPH / BPE can have a serious impact on quality of life.</p> <p>Traditionally, BPH has been managed with lifestyle changes and medication in the first instance but if the symptoms progress or become severe then surgery may be required. However, as this is an age-related condition fitness and suitability for surgery is often an issue. The process by which the prostate begins enlarging starts around the age of thirty and up to 50% of men will show histological signs (changes within the tissues) of BPH by fifty years of age. By eighty years of age this rises to 75% although not all of these men will have symptoms. Symptomatic BPH / BPE occurs in up to 50% of men of middle age or older.</p> <h2><a id="What are the symptoms of BPH / BPE" name="What are the symptoms of BPH / BPE"></a>What are the s<strong>ymptoms of BPH /BPE</strong></h2> <p>The symptoms of BPH fall into two broad categories</p> <ul> <li>Voiding (weak stream, hesitancy, stop and start micturition)</li> <li>Storage (frequency, urgency, nocturia, leaking)</li> </ul> <h2><a id="What are the treatment options for BPH / BPE?" name="What are the treatment options for BPH / BPE?"></a>What are the t<strong>reatment options for BPH / BPE?</strong></h2> <p>The management of BPH / BPE varies according to the nature and severity of the symptoms. Lifestyle changes and medication (such as the drugs known as alpha blockers and 5ɑ-reductase inhibitors) are used initially. But if symptoms progress despite conservative therapy then surgery may well be suggested.</p> <p>There are a number of different forms of surgery that will typically be offered depending on the size of the prostate gland, including Trans Urethral Prostatectomy (TURP) and various forms of Laser Prostatectomy (Green light and HoLEP). These procedures involve removing a section of the prostate gland in order to relieve pressure on the bladder and urethra. Urolift and Rezum have recently been approved for men with modest prostatic enlargement. However, minimally invasive thermal ablation using microwave energy (TUMT), radiofrequency (RF) and Water Vapour have not yet gained widespread use.</p> <h2><a id="What is Prostate Artery Embolisation PAE?" name="What is Prostate Artery Embolisation PAE?"></a>What is <strong>Prostate Artery Embolisation PAE?</strong></h2> <p>Prostate artery embolisation (PAE) is a new technique for relieving the symptoms of BPH / BPE although embolisation has been used for a long time in many clinical settings. In essence embolisation involves injecting tiny particles into the blood vessels supplying the affected areas in order to deliberately reduce or block blood flow. Initially introduced to stem life-threatening haemorrhage it then gained more widespread in blocking the blood vessels to tumours prior to surgery and also for definitive palliative treatment of tumours. It has been used in the setting of prostatic disease for many years either to stem acute or chronic bleeding due to advanced prostatic cancer, and also to control bleeding after prostatic surgery.</p> <p>PAE has been the subject of several studies since 2010, notably from Sao Paulo, Brazil, Lisbon, Portugal, China and the UK. These studies have been testing the hypothesis that trans-arterial embolisation of the prostate could lead to the death of the blood-rich and overgrown prostatic tissue, which in turn would result in a subsequent reduction in size of the prostate and thereby reduce obstructive urinary symptoms.</p> <h2><a id="How successful is PAE for treating BPH / BPE?" name="How successful is PAE for treating BPH / BPE?"></a>How successful is PAE for treating BPH / BPE?</h2> <p>The results of several Randomised Controlled Trials (RCTs) have now been published and in 2017 the results of a <a href="https://interventionalnews.com/1000-patient-study-indicates-prostate-artery-embolization-remains-effective-for-years/">1,000 patient study </a>was presented at the Society of Interventional Radiology (SIR) meeting in Miami. This study included the longest follow-up data, with over 800 patients monitored for 3 years and over 400 followed beyond this time. As in all published PAE studies to date symptomatic improvement was seen in just over 80% of men at 3-12 months, and these improvements were sustained at medium and long term follow-up with cumulative success rate of 78%.</p> <h4>Fig 1 (below) shows microcatheter placed deep into right and left prostate arteries under fluoroscopic control</h4> </div> <div class="field field--name-field-article-paragraphs field--type-entity-reference-revisions"> <div class="field field--name-field-paragraph-image field--type-image field--layout-right"> <img src="/sites/default/files/fig1a-and-1b-830x500.jpg" width="830" height="500" alt="micro catheter" typeof="foaf:Image" /> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h4><span style="font-size:10.0pt;font-family:&quot;Times&quot;,serif;&#10;mso-fareast-font-family:Cambria;mso-fareast-theme-font:minor-latin;mso-bidi-font-family:&#10;&quot;Times New Roman&quot;;mso-ansi-language:EN-GB;mso-fareast-language:EN-US;&#10;mso-bidi-language:AR-SA">Fig 1a Right Prostate Artery DSA<span style="mso-tab-count:2">                     </span>Fig 1b Left Prostate Artery DSA</span></h4> </div> <div class="field field--name-field-paragraph-image field--type-image field--layout-right"> <img src="/sites/default/files/Dyna-CT-Left-PA-axial-Fig-2-_2.jpeg" width="320" height="194" alt="" typeof="foaf:Image" /> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h4>Figure 2. Shows Dyna-CT image of left hemi-prostate acquired during a rotational angiographic study. The microcatheter was placed deep in the left prostate artery (Fig 1b) and contrast injected. No enhancement of the bladder or rectal mucosal gives extra confidence that non-target embolisation should not occur.</h4> <p>Post-procedural pain is usually mild to moderate, unlike the often severe post-procedural pain following fibroid and kidney embolisation. This discomfort can be managed by simple anti- inflammatory and pain killing oral medications.</p> </div> <div class="field field--name-field-paragraph-image field--type-image field--layout-right"> <img src="/sites/default/files/PAE-MR-post-contrast-ax-Fig-3-830x500.jpeg" width="640" height="386" alt="" typeof="foaf:Image" /> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h4>Fig 3. 3 month contrast enhanced MRI shows large almost symmetrical areas of infarction in the BPH adenoma and this correlates very well with symptomatic and long term improvement</h4> </div> <div class="clearfix text-formatted field field--name-field-paragraph-copy field--type-text-long field--label-hidden field__item"><h2><a id="PAE from research to treatment UK specialist centres" name="PAE from research to treatment UK specialist centres"></a>PAE from research to treatment - The UK specialist centres</h2> <h2><strong>The Southampton experience</strong></h2> <p>A carefully Monitored Clinical Introduction in 25 men with proven and symptomatic BPH, not responding to medical treatment was instigated at Southampton University Hospitals in 2012.  The procedure was technically successful in all patients and clinical improvement, although in some cases modest, was seen in 90% of patients. There were no serious complications and post procedural pain was mild to moderate only. In all but exceptional circumstances these were performed as day case procedures.</p> <p>NICE considered PAE as an option for treating men with significant Lower Urinary Tract Symptoms (LUTS) caused by benign prostate enlargement in 2013 and decided that at that time the evidence was still not strong enough to recommend approval for PAE. They suggested that more studies were needed and that included the setting up of a National Registry comparing PAE with traditional surgical techniques using TURP or HoLEP.</p> <p>Dr Nigel Hacking, as the Pioneer of PAE in the UK, was appointed as Chairman of the UK-ROPE Steering committee and it’s Clinical Lead (see below).</p> <h2><strong>Results from the UK-ROPE study</strong></h2> <p>A total of 305 patients (PAE, 216; transurethral resection of the prostate [TURP], 89) were recruited from 17 centres and followed out to 12 months post procedure. PAE produced a 10-point reduction in the International Prostate Symptom Score (IPSS) at 12 months with no significant complications compared to a 15-point IPSS reduction in the TURP cohort. On a 6-point quality-of-life scale, there was a 3-point reduction with PAE compared with 4 points after TURP.</p> <p>Urinary flow improved by 3 mls compared with 7.5 mls after TURP. P volume was reduced by 28% after PAE. There was also a significant reduction in hospital stay. Over 70% of PAE cases were performed as day cases, whereas 30% of TURP patients spent one night in hospital and 49% spent two nights. A few patients needed even longer stays after their TURP. </p> <p>Erectile function showed a slight improvement. Retrograde ejaculation was reported only half as often after PAE compared with TURP. </p> <h3><strong>Potential Complications</strong></h3> <p>Complications reported to date have been rare and mostly involve minor bruising of the groin. One case of non-target embolisation of the bladder and several minor self-limiting ulcerations to the rectum have been reported in over 2,500 cases; of these, one required surgical bladder repair. Minor again self- limiting penile ulceration has been reported in small numbers.</p> <p>It is encouraging that the common side effects of TURP, such as transient incontinence, erectile dysfunction and particularly new retrograde ejaculation have not been reported. <strong>Unlike TURP and laser prostatectomy, fertility is preserved after PAE and there have been several children fathered by PAE patients reported around the world</strong>. The results from this UK-ROPE (Registry of Prostate Embolisation), which was sponsored by NICE, as well as the National Professional Societies of both Interventional Radiology (BSIR) and Urology (BAUS) were published in 2018 and <a href="https://www.nice.org.uk/guidance/ipg611">NICE</a> approval for PAE was issued with new Guidelines in April 2018.</p> <p>To date Dr Nigel Hacking and his team at Southampton University and Spire Hospitals have performed over 400 PAE cases with excellent results. A few patients have shown early symptom recurrence at 3-12 months and have undergone a limited TURP to remove an enlarged ‘Median lobe’. This limited surgery can still avoid the side effects seen after full TURP and this 2-stage procedure may be helpful in some cases.</p> <h3><strong>For a private PAE referral </strong></h3> <p>Due to training issues PAE is not widely available on the NHS, but is available by Dr Hacking privately at Spire Southampton Hospital.</p> <p>Following a request for an appointment a medical questionnaires will need to be completed prior to consultation. A GP or Urology referral will be required before PAE can be offered. This Urology assessment can be arranged in Southampton or London.</p> <p><strong>Or, for further information on the author of this article, Consultant Radiologist, </strong><a href="http://www.totalhealth.co.uk/clinical-experts/dr-nigel-hacking"><strong>Dr Nigel Hacking</strong></a><strong>, please </strong><a href="http://www.totalhealth.co.uk/clinical-experts/dr-nigel-hacking"><strong>click here</strong></a><strong>.</strong></p> <p> </p> </div> </div> Mon, 15 Jul 2013 16:34:18 +0000 Anonymous 5791 at https://www.totalhealth.co.uk Breast Cancer FAQs https://www.totalhealth.co.uk/clinical-experts/mr-simon-marsh/breast-cancer-faqs <span property="schema:name" class="field field--name-title field--type-string field--label-hidden">Breast Cancer FAQs</span> <div class="field field--name-field-related-conditions field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/your-condition/breast-cancer" hreflang="und">Breast Cancer</a></div> </div> <span rel="schema:author" class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/user/1" typeof="schema:Person" property="schema:name" datatype="">cb2409</span></span> <span property="schema:dateCreated" content="2011-10-18T08:25:24+00:00" class="field field--name-created field--type-created field--label-hidden">Tue, 10/18/2011 - 09:25</span> <div property="schema:text" class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><em>This article by an acknowledged breast cancer expert answers the questions that are most frequently asked about breast cancer. These include questions about the causes, symptoms, diagnosis and treatment of breast cancer. </em></p> <!--break--> <h2> Breast Cancer; FAQs Contents</h2> <p><img alt="" src="/sites/default/files/breast cancer awareness_1.png" style="width: 250px; float: right; height: 250px;" /></p> <ul> <li> <a href="#whatis">What is breast cancer?</a></li> <li> <a href="#whatcauses">What causes breast cancer and how can I reduce the chances of getting it?</a></li> <li> <a href="#symptoms">What are the symptoms of breast cancer?</a></li> <li> <a href="#howoften">How often should I have a mammogram?</a></li> <li> <a href="#breastlumps">How are breast lumps investigated?</a></li> <li> <a href="#whattypes">What types of breast lump are there?</a></li> <li> <a href="#treatments">What are the treatments for breast cancer?</a></li> <li> <a href="#What gene testing should be performed for breast cancer?">What gene testing should be performed for breast cancer?</a></li> </ul> <p> </p> <p> </p> <h2> <a name="whatis" id="whatis"></a>What is breast cancer?<img alt="" src="/sites/default/files/Breast_cancer_cell_(1).jpg" style="width: 135px; height: 150px; float: right;" /></h2> <p>A cancer can be considered as the uncontrolled growth of certain cells of the body. It can occur in any organ and there are over 100 different types. In addition to uncontrolled growth, cancer cells have the ability to spread around the body (metastasis). Breast cancer starts in the cells of the breast, usually either the ducts (ductal cancer) or the lobules (lobular cancer). However there are also several other types and breast cancer is not a single disease but several diseases that happen to occur in the breast.</p> <h2> <a name="whatcauses" id="whatcauses"></a>What causes breast cancer, and how can I reduce the chances of getting it?</h2> <p>The problem is that we simply do not know the cause of breast cancer. In fact, there is unlikely to be a single cause. What probably happens is that lots of different things have to occur over a long period of time before a breast cancer starts. We can, however, look at things that seem to be associated with an increased risk and see if we can change any of these in order to reduce that risk.</p> <p>There are two categories of risk factors. The first group is termed “intrinsic” factors and there is not much you can do about these.<img alt="" src="/sites/default/files/Breast Genetics.jpg" style="height: 260px; float: left; width: 166px;" /></p> <p>One of the main intrinsic factors is your genes. There are two genes that we know are related to breast cancer if they are abnormal (these are called the BRCA1 and BRCA2 genes). If someone has an abnormality in one of these genes the lifetime risk of breast cancer might be as high as 80% or as low as 40%. Other factors seem to relate to the number of normal ovulatory cycles a women has in her lifetime; so if your periods start early and finish late and you did not have any children your risk will be slightly higher than if your periods started late, finished early and had several children, particularly if the first child was born when you were quite young. The reason breast feeding may be protective is that you tend not to have periods when you are breast feeding.</p> <p>The second group is the “extrinsic” factors, also known as the environmental or lifestyle factors. These you can do something about. Put very simply, if you are overweight, smoke and drink too much then you increase your risk of breast cancer. The number of breast cancers has been rising for quite a few years now and it seems that being overweight may be the single most important cause for this rise.</p> <h2> <a name="symptoms" id="symptoms"></a>What are the symptoms of breast cancer?</h2> <ul> <li> Definite lump</li> <li> Nipple discharge</li> <li> Inverted nipples</li> <li> Dimpling of breast skin</li> <li> Rashes around the nipple (similar to eczema)</li> </ul> <p>The most common symptom is a definite lump. Although most lumps are not cancer at all, but other sorts of benign lumps such as cysts, all lumps must be checked by a specialist. Occasionally a lump in the armpit can also be related to breast cancer.<img alt="" src="/sites/default/files/breast lumps.jpg" style="width: 500px; height: 500px; float: right;" /></p> <p>There are other changes that women should look out for. Most of these will not be related to breast cancer but all changes to the breasts should be checked:</p> <p>Nipple discharge is very common, particularly towards the menopause. Nipple discharge will nearly always be harmless, unless there is a lump present as well.</p> <p>Similarly it is very common for the nipples to turn in as women get older. If a nipple is turned in (inverted) and there is a lump then this might be due to a cancer.</p> <p>The breasts can also, commonly, change size with age. As the menopause approaches the gland tissue in the breast is replaced by fatty tissue and this can cause a change in size, often greater on one side compared with the other.</p> <p>Some women noticed a dimpling or puckering of the skin and this must always be reported to a doctor. Sometimes it will be due to age related changes in the elastic tissue in the breast. Sometimes there will be a lump or an area of abnormal breast tissue associated with the dimpling and this may be due to a cancer.</p> <p>Rashes around the nipple can also be quite common. Most of these will turn out to be simple dermatitis or eczema. However, there is a very rare form of early breast cancer called Paget’s disease that can sometimes look like eczema. An important difference is that normal eczema tends to be only on the areola around the nipple whereas Paget’s disease can go onto the nipple itself.</p> <p>Breast pain is almost always completely harmless (although undoubtedly a nuisance).</p> <h2> <a name="howoften" id="howoften"></a>How often should I have a mammogram?</h2> <p>There is no definite correct answer to this question. The NHS Breast Screening Programme (NHSBSP) performs a mammogram every three years on women aged between 50 and 70.</p> <p><img alt="" src="/sites/default/files/mammogram memo.jpg" style="width: 160px; height: 107px; float: right; margin: 2px;" /></p> <p>This is supposed to be extended to women aged 47 to 73 over the next few years. Other countries, such as Australia and New Zealand start at a younger age and offer mammograms every 2 years. Some European countries suggest every 18 months and in the USA yearly from 40 is common.</p> <h2> <a name="breastlumps" id="breastlumps"></a>How are breast lumps investigated?</h2> <p>All definite breast lumps should be seen by a breast specialist. The full assessment of a lump focuses on what is called the triple assessment. The lump is examined, mammograms and ultrasound scans may be performed and a tissue sample will be taken. This will give a definite diagnosis in the vast majority of cases.</p> <h2> <a name="whattypes" id="whattypes"></a>What types of breast lump are there?<img alt="" src="/sites/default/files/Women generations.jpg" style="width: 300px; height: 200px; float: right;" /></h2> <p>The most likely cause for a breast lump depends on a woman’s age.</p> <p>In the teens and early twenties the most likely cause is a fibroadenoma. These are harmless but can sometimes grow quite big.</p> <p>"Frozen Peas Syndrome"</p> <p>In their thirties many women find the breast tissue becomes quite nodular (this is sometimes referred to as the “packet of frozen peas” syndrome! Just as when frozen peas are removed from a freezer and a clump have stuck together, so it might be considered that breast tissue can “clump” in a similar way and cause a lump). This is a normal, age related, change.</p> <p>In the forties cysts become the most common cause of a definite lump. These are harmless, fluid filled, sacs that can be drained off with a small needle if they are troublesome. Women who get cysts will often get them for several years.</p> <p>Over the age of fifty breast cancer begins to get more common, although it can, of course, occur at any age.</p> <p>There are other, less common lumps that can occur such as abscesses, phyllodes tumours, cysts in the skin, lipomas (fatty lumps) as well as lumps that have spread from other diseases such as lymphoma or lung cancer.</p> <h2> <a name="treatments" id="treatments"></a>What are the treatments for breast cancer?</h2> <p>Treatments that may be used for breast cancer include surgery, radiotherapy, endocrine therapy and chemotherapy. Different women may need different combinations of the treatments in different orders (some will not need all of them) and the treatment will always be discussed between the patient, the surgeon and the oncologist.</p> <h2> <a name="What gene testing should be performed for breast cancer?" id="What gene testing should be performed for breast cancer?"></a>What Gene testing should be performed for breast cancer?</h2> <p>Following a core biopsy, EndoPredict examines twelve genes in the tumour cells and identifies those patients who will respond to anti-hormonal treatment, and in more than 95 % of cases will not develop a recurrence within the next ten years. The genes identified are those associated with abnormal cell division (these include UBE2C, BIRC5 and DHCR7), whether or not hormone receptors are expressed (including STC2, AZGP1, IL6ST, RBBP8 and MGP) as well as reference and normalisation genes.</p> <p>See also - <a href="http://www.totalhealth.co.uk/clinical-experts/mr-simon-marsh/why-do-patients-breast-cancer-need-gene-testing#Differences%20between%20hereditary%20testing%20and%20prognostic%20tests">Why do patients with breast cancer need gene testing?</a></p> <h6> For further information on the author of this article, Consultant Breast Surgeon, <a href="http://www.totalhealth.co.uk/clinical-experts/mr-simon-marsh">Mr Simon Marsh</a>, please <a href="http://www.totalhealth.co.uk/clinical-experts/mr-simon-marsh">click here</a>.</h6> </div> Tue, 18 Oct 2011 08:25:24 +0000 cb2409 1684 at https://www.totalhealth.co.uk Hip conditions https://www.totalhealth.co.uk/your-condition/hip-conditions <span class="field field--name-title field--type-string field--label-hidden">Hip conditions</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p><img alt="" src="/sites/default/files/Hip implant.jpg" style="width: 200px; height: 200px; float: right;" /></p> <p>The information set out in this section has been written exclusively by senior Orthopaedic Consultants who specialise in hip replacement surgery. They explain the range of implants and procedures that are available for hip replacement and their own very personal surgical approach.</p> <p><strong>Orthopaedic Surgeons specialising in Hip Replacement, discuss "My Choice of Hip Replacement".</strong></p> <h2>Total Health asks ten top hip Consultant Surgeons the following questions:</h2> <ul> <li> <p>Q1: Which type of hip prosthesis do you routinely use and why?</p> </li> <li> <p>Q2: How long have you used this choice of hip prosthesis?</p> </li> <li> <p>Q3: Do you use this prosthesis exclusively?</p> </li> <li> <p>Q4: If you sometimes use alternative prostheses please specify which type(s) and why?</p> </li> <li> <p>Q5: What procedure do you use?</p> </li> <li> <p>Q6: If you needed a hip replacement now which prosthesis and procedure would you opt for?</p> </li> <li> <p>Q7: What over-riding piece of advice would you give to someone considering having hip replacement?</p> </li> </ul> <p>See what they say:</p> <ul> <li><a href="http://www.totalhealth.co.uk/clinical-experts/mr-edward-davis">Mr Edward Davis</a>, Consultant Orthopaedic Surgeon - <a href="http://www.totalhealth.co.uk/clinical-experts/edward-davies/my-choice-hip-replacement-mr-edward-davies">read more</a></li> <li><a href="http://www.totalhealth.co.uk/clinical-experts/mr-paul-jairaj">Mr Paul Jairaj</a>, Consultant Orthopaedic Surgeon, - <a href="http://www.totalhealth.co.uk/clinical-experts/mr-paul-jairaj/my-choice-hip-replacement-mr-paul-jairaj">read more</a></li> <li><a href="http://www.totalhealth.co.uk/clinical-experts/mr-stephen-jones">Mr Stephen Jones</a>, Consultant Orthopaedic Surgeon - <a href="http://www.totalhealth.co.uk/clinical-experts/mr-stephen-jones/my-choice-hip-replacement-mr-stephen-jones">read more</a></li> <li><a href="http://www.totalhealth.co.uk/clinical-experts/mr-winston-kim">Mr Winston Kim</a>, Consultant Orthopaedic Surgeon - <a href="http://www.totalhealth.co.uk/clinical-experts/mr-winston-kim/my-choice-hip-replacement-mr-winston-kim">read more</a></li> <li><a href="http://www.totalhealth.co.uk/clinical-experts/mr-jeremy-latham">Mr Jeremy Latham</a>, Consultant Orthopaedic Surgeon - <a href="http://www.totalhealth.co.uk/clinical-experts/mr-jeremy-latham/my-choice-hip-replacement-mr-jeremy-latham">read more</a></li> <li><a href="http://www.totalhealth.co.uk/clinical-experts/mr-warwick-radford">Mr Warwick Radford</a>, Consultant Orthopaedic Surgeon - <a href="http://www.totalhealth.co.uk/clinical-experts/mr-warwick-radford/my-choice-hip-replacement-warwick-radford">read more</a></li> <li><a href="http://www.totalhealth.co.uk/clinical-experts/mr-mark-rickman">Mr Mark Rickman</a>, Consultant Orthopaedic Surgeon - <a href="http://www.totalhealth.co.uk/clinical-experts/mr-mark-rickman/my-choice-hip-replacement-mr-mark-rickman">read more</a></li> <li><a href="http://www.totalhealth.co.uk/clinical-experts/miss-samantha-tross">Miss Samantha Tross,</a> Consultant Orthopaedic Surgeon - <a href="http://www.totalhealth.co.uk/clinical-experts/miss-samantha-tross/my-choice-hip-replacement-miss-samantha-tross">read more</a></li> <li><a href="http://www.totalhealth.co.uk/clinical-experts/mr-howard-ware/my-choice-hip-replacement-mr-howard-ware">Mr Howard Ware</a>, Consultant Orthopaedic Surgeon - <a href="http://www.totalhealth.co.uk/clinical-experts/mr-howard-ware/my-choice-hip-replacement-mr-howard-ware">read more</a></li> <li><a href="http://www.totalhealth.co.uk/clinical-experts/mr-charles-willis-owen">Mr Charles Willis-Owen</a>, Consultant Orthopaedic Surgeon - <a href="http://www.totalhealth.co.uk/clinical-experts/charles-willis-owen/my-choice-hip-replacement-mr-charles-willis-owen">read more</a></li> <li><a href="http://www.totalhealth.co.uk/clinical-experts/mr-philip-stott">Mr Philip Stott,</a> Consultant Orthopaedic Surgeon - <a href="http://www.totalhealth.co.uk/clinical-experts/mr-philip-stott/my-choice-hip-replacement-mr-philip-stott">read more</a></li> </ul> </div> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" typeof="schema:Person" property="schema:name" datatype="">Anonymous (not verified)</span></span> <span class="field field--name-created field--type-created field--label-hidden">Thu, 05/26/2011 - 22:32</span> Thu, 26 May 2011 21:32:30 +0000 Anonymous 1366 at https://www.totalhealth.co.uk Lanserhof at the Arts Club https://www.totalhealth.co.uk/hospitals-and-clinics/lanserhof-arts-club <span class="field field--name-title field--type-string field--label-hidden">Lanserhof at the Arts Club</span> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><h2>The Medical Gym in Mayfair</h2> <h3>Lanserhof Functional Diagnostics and Precision Treatment </h3> <p><img alt="Flying functional dynamics" data-entity-type="file" data-entity-uuid="8ca600e8-e289-4811-9c52-35f894e0a8f5" src="/sites/default/files/inline-images/Lanserhof%20virtual.jpg" class="align-left" /></p> <p>Combining advanced medical diagnostics including spine lab, movement assessment and 3T open-MRI with innovative treatments. Operating and integrated with an international standard, precision-movement gym and functional treatment programmes.</p> <p>Small group training classes – including yoga, fascia training, Pilates and functional training. Medical consultations, induction training for the highly specialised gym equipment included and Body Composition Analysis.</p> <p>Cardiovascular screening (spiro-ergometry, stress ECG)</p> <p>Functional diagnostic assessment in the Movement Lab or Spine Lab</p> <p>Bespoke training plan, complete with micro-chip technology which loads your programme onto the gym equipment, ensuring your individual settings on selected machines</p> <p>Exclusive Members’ Lounge</p> <p> </p> <h3>3T Open MRI - Diagnostic Power</h3> <p><img alt="Diagnostic power" data-entity-type="file" data-entity-uuid="04eee697-aec8-4110-8971-8b66b70f09d4" src="/sites/default/files/inline-images/3T%20Open%20MRI.jpg" class="align-left" /></p> <p>In depth diagnostic insight provided by one of the world's most powerful MRIs.</p> <p>The beauty of MRI is that unlike CT scans and X Ray, it does not use ionising radiation and is therefore safe.</p> <p>The strength of a magnetic field in an MRI machine is called a Tesla (T). Most MRI scanners operate at a strength of 1.5 Tesla. So, 3T MRI is twice the normal strength and can generate the highest quality image. </p> <p>The additional power of 3T is useful for the following reasons:</p> <ol> <li>Aids with claustrophobia; the shorter size relieves the sense of confinement usually associated with more traditional MRI scanners.</li> <li>Shorter examination times.</li> <li>Higher resolution detailed images.</li> <li>Radiologists can identify smaller lesions and anatomical structures that cannot be seen with traditional MRI.</li> <li>Highly sophisticated imaging procedures.</li> <li>More accurate diagnosis.</li> <li>Reduces risk of distortion, so eliminating need for repeated scans.</li> </ol> <h3>Individual Differences</h3> <p>The primary factor affecting image quality relative to magnet strength is human body variation. Most bodies are composed of approximately 60% water, some fat, muscle, and organs. This relative body composition can change over time.</p> <p>Due to variations in tissue composition the strength of scanner required will vary depending on what area is being examined. The 3T MRI is specifically geared for spine and musculo-skeletal images.</p> <p> </p> <p> </p> <h3>Your Specialist Team</h3> <p><img alt="Functional diagnostics" data-entity-type="file" data-entity-uuid="d051aaca-ea3d-43af-8cd7-68c5885cdc32" src="/sites/default/files/inline-images/mm1006_TAC_Lanserhof_2019_1002_FINAL.jpg" class="align-left" /></p> <h3>Diagnostic and Treatment Precision</h3> <p>Two different doctors to perform an initial detailed health assessment. Given this information, the medical, biomechanics and orthopaedic specialists work together with further diagnostic testing to establish the precise picture of your current physical condition. This thorough analysis informs absolute precision for the proposed treatment approach.</p> <p>See also - <a href="https://www.totalhealth.co.uk/blog/alpine-clinic-comes-london">Alpine clinic comes to London</a> and <a href="https://www.totalhealth.co.uk/blog/ideal-prescription-burnout">Ideal prescription for burnout</a></p> <p> </p> </div> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span lang="" about="/user/76" typeof="schema:Person" property="schema:name" datatype="">Bob Davidson</span></span> <span class="field field--name-created field--type-created field--label-hidden">Wed, 09/18/2019 - 16:45</span> <div class="field field--name-field-hospital-url field--type-link field--label-hidden field__item"> <a href="https://www.theartsclub.co.uk/lanserhof" target="_blank">Website <i class="fa fa-external-link"></i></a> </div> Wed, 18 Sep 2019 15:45:59 +0000 Bob Davidson 9926 at https://www.totalhealth.co.uk