History of health, medicine and naval history
The discovery of penicillin by Alexander Fleming at St Mary’s Hospital in 1928 is arguably one of the most important events of the last century if you think of its effects on the health of everyone. Not surprisingly many people wanted to see the laboratory where history was made, but for many years there was nothing to see. It was not until 1993 that St Mary’s Hospital NHS Trust opened the Alexander Fleming Laboratory Museum, funded by pharmaceutical giant SmithKline Beecham. Its centrepiece was a reconstruction of the laboratory as it was in 1928 in the actual room in which Fleming had made his discovery.
At this point, I should perhaps indicate to you my role and background. I came to St Mary’s Hospital in 1989 to set up an Archives service and rapidly became responsible for all heritage matters, including the setting up of the Alexander Fleming Laboratory Museum which I now manage. My own background is that of a graduate in History with professional postgraduate qualifications as an Archivist. I am not a bacteriologist and I am not a scientist. I am not a doctor of medicine. Should this be a drawback for anyone running a museum whose subject matter is heavily scientifically and medically based? Yes and no! Traditionally there is a great divide between the Arts and Sciences, and it is a truism that it is easier to bridge for someone with a scientific grounding than someone educated in the humanities. Well, perhaps I am a nonconformist, or just an awkward customer, but I like to challenge the orthodoxies! I did have to gain very quickly a working knowledge of bacteriology to set up the museum, but working in a teaching hospital with a closely linked School of Medicine did have its advantages. I was able to call on a wealth of specialist expertise. And the fact that I am not a scientist and have had to understand the bacteriology in laymen’s terms perhaps makes it easier for me to convey the information to the general public and to schoolchildren in easily comprehensible terms. Simplicity is one of the keys to communication.
The Museum relies heavily on volunteer guides for its day to day staffing. Some of them are ex-nurses and one of the first of them was actually Fleming’s Ward Sister, in charge of the ward in which he had his beds from 1947 until 1955, and also nursed Sir Winston Churchill, such a wealth of experience can really bring the past to life. But we also have had volunteer guides with no prior medical knowledge, a retired barrister, a librarian, a sports physiotherapist, teachers, businesspeople and they can be just as good as the guides with medical or nursing expertise. What matters is enthusiasm and the ability to communicate.
The Museum was set up with a number of aims, one of the most important being as an educational facility to further the public perception and understanding of science and the history of medicine.
Visitors come from all over the World. Most have a medical bias as the Fleming Museum is of specialist interest. For visitors with little or no English we have information sheets in fourteen or so languages.
Group visits fall into two main types: leisure visitors seeking an interesting day out and those with an educational purpose.
Presentations individually tailored to the specific interests and requirements of educational groups in such a setting as the in situ reconstruction of Fleming’s laboratory uniquely bring alive the context in which this momentous discovery was made and its consequences for mankind. The general approach is a cross-curricular one, but individual sessions can be modified for a particular group’s needs. Such has been our success that some groups return regularly, including a number of British and North American universities.However take up from schools was less than anticipated. The problem lay not with the product we offered but within the difficulties schools had in organising visits: cost, the logistics of organisation and full timetables. A problem having been identified, the answer was that if not all schools could come to the Museum, the Museum should be taken to schools with presentations on Fleming and penicillin and hospitals and nursing tailored to the requirements of individual schools, many of which study the history of medicine.
I always attempt to make these sessions as interactive as possible and usually adopt an extempore approach, working without notes to keep the session as flexible and fresh as possible. When discussing the history of nursing, I often bring along a lantern used by Florence Nightingale and ask the students what they think it was and how it was used. I have shocked many teachers by beginning my talk on penicillin by holding up a medallion containing a piece of the penicillium mould and conducting a mock auction. One of these items went for £25,000 sterling at Sotheby’s Auction Rooms a few years ago, so the auction can proceed until we reach that price. I then ask them how much penicillin itself is worth when one considers the number of lives it has saved. Some continue to bid, a surprisingly large number see the point that a value can not be put on life.
If the students get involved from the beginning and feel some relevancy to themselves, half the battle is won and they may remember something. I often explain the nature of the bacterium Staphylococcus aureus Fleming was studying when he discovered penicillin by asking a volunteer to hold out a hand and then pretend to take a swab, inoculate it in agar jelly on a petri dish and incubate it an amateur dramatics performance. Holding a swab in my hand I promise that it won’t hurt, On one occasion a very concerned little girl uttered “ugh”, a sound of disgust, and wiped her hands on her friend’s sleeve!
Each presentation is copiously illustrated with a slide show and backed up with handouts which were later used to compile two education packs. These packs exploit the wealth of unique primary source material held within the archives of St Mary’s Hospital. The original sources can be used flexibly and adapted for use with different groups, but there are also work sheets to accompany them which are more focused at particular ages and ability levels. I now propose to take you through a few examples of the slides and handouts used when talking about Alexander Fleming. What you must not forget is that each session is tailored to the specific needs, attainment level and abilities of the group to which I am talking. With younger age groups of about nine or ten years of age, the approach is a narrative one of making it into a story for them. With sixth form of university groups, at the other extreme, the approach is much more analytical.
A photograph of a hospital ward in 1898 raises many questions which students can be prompted to both ask and answer. If they have themselves been in Hospital, how does it compare with the ward they stayed in? How has the uniform worn by the nurses changed and what is more practical, the uniform of today or of 1898? What were the advantages of having plants, carpets, pictures, frilly bedspreads and other homely touches? And what were the disadvantages? How easily could sources of infection be controlled? The accompanying handout contains a series of photographs of wards as they changed in appearance over the years and a series of questions is aimed at getting the student to compare these and understand why the changes took place, both chronologically and also in terms of a changing philosophy of patient care. The teacher using the pack for follow up work is free to dispense with the suggested questions and activities, and to use the primary sources in other ways.
Similarly, a photograph of an operating theatre of the same period raises many questions about standards of hygiene and the lack of understanding of the transmission of infection. The point is then reinforced with a graphic account of operations at St Mary’s Hospital in the 1850s. The Surgeons would all operate on the same afternoon and take turns to perform their own operations. They would keep dirty, torn, blood stained old coats to wear in the theatre to keep their street clothes clean. If one of them had had a particularly messy and bloody case, his colleagues let him take the next turn to save him from having to wash his hands only to get them dirty again later!
Everyone loves the story of how Fleming came to make his first major discovery of the body’s own antiseptic, lysosyme. He had a cold and a drop of nasal mucus fell from his nose on to a culture plate of bacteria, which began to dissolve. Yes, it does sound disgusting, but that is how it happened! Have you ever wondered why a cat or dog licks its wounds? It is bacause saliva, like other body fluids, contains a mild antiseptic lysosyme. Children also enjoy a cartoon which appeared in the satirical magazine Punch in 1922. This shows school children queuing up to be paid a penny to be caned to produce a tear antiseptic, which can then be bottled. Of course, lysosyme was never of any commercial importance, but Fleming always said that his best work as a scientist was done on lysosyme. I also do a trick with a lemon here – but perhaps we’d better not go into that so as not to spoil the surprise for those who haven’t seen it. A few years ago one school group put up a spoof appreciation society for me on Facebook with one post commenting that my next book was 1,000 things to do with a lemon!
The discovery of penicillin is the heart of the matter. In the summer of 1928, Fleming went on holiday and left some petri dishes containing the bacterium Staphylococcus aureus on his laboratory bench. He had no further use for them. On his return to work on 3 September 1928, he took one last look at them before asking his laboratory technician to sterilise them. In a modern laboratory, the petri dishes would be made of plastic, used once and then destroyed. In 1928, they were made of glass and reused after being soaked in a shallow bath of disinfectant followed by a quick wipe. I make non comment on lab hygiene but if things had been more hygienic penicillin may not have been discovered when it was. Then something caught his attention. “Hmm, that’s funny”, he said. The petri dish had been contaminated by a mould which had inhibited the growth of the bacteria. We use a replica of the original penicillin culture plate to illustrate this and also have a photograph of it taken by Fleming at the time of the discovery. Students are given the opportunity to take part in this discovery for themselves. I again ask for a volunteer to look at the replica of the plate, describe what they can see, how it compares to the petri dish of Staphyloccoci they have seen earlier and come up with a conclusion about what is happening. Sometimes lots of guidance and hints are required before they can collect their Nobel Prize on the way out!
Where did this chance contaminant originate? This is the perfect opportunity to hold a poll as to the likeliest explanation as to where the spores of mould came from. There are two main theories. The first and most popular is that the mould came through an open window from the street outside. However, there is evidence to suggest that Fleming never worked with an open window. The second theory is that the mould came from the laboratory below his lab where a mould specialist was studying the ways in which fungi can have an allergic effect on asthma sufferers. The only other sample of fungi which Fleming could find that also produced penicillin was obtained from there. Whilst I believe that the second explanation is the most likely, I let the students make their own decision. The main point is that there is often very little conclusive proof in history or in life; we need to examine the evidence to come to the most plausible conclusion.
There is an undeniable romance in this story of the discovery of a life saving drug almost by chance which can not fail to enthral even a small schoolchild. Indeed it has caught the imagination of children as young as five years of age, even though such children are far too young to really benefit from the educational function of this particular museum. However, the role of fortune does raise some other issues for discussion. Wasn’t Fleming just lucky? Admittedly, but it was Louis Pasteur who said “le hasard ne favorise que les esprits préparés”, chance events favour only the prepared mind. Fleming’s mind was certainly prepared. The discussion is opened as to the role of fate and luck in science and in life in general. When discussing antibiotics, I show the museum film on dvd which has a section demonstrating the action of an antibiotic on bacteria. The use of electro-microscopy and animation techniques gets across the point much more graphically and successfully than I could ever attempt to do in words. The video was funded by the pharmaceutical company SmithKline Beecham, a beneficary of the development of penicillin, which generously gave us funding for the initial setting up of the museum. By taking a copy of the video out to show in schools, we are widening access to it.
Success has been indicated by a number of institutions making these visits a regular annual event. Feedback and comments from staff and pupils is actively sought and acted upon. Some of the best feedback is often the amount of interaction and empathy built up between speaker and audience. The schools taking up these services do tend to be those with higher academic records and in relatively more prosperous areas rather than from disadvantaged areas. I suspect that much depends on the morale of the school and the enthusiasm of its staff.
Great financial resources are not a pre requisite for an educational programme such as we operate. It is all done with limited financial resources on the part of the Museum and in return for the payment of travelling expenses and a donation, where affordable, from the School. All that is needed is a collection of slides, photocopied handouts and portable artefacts that may be taken out to other institutions. The starting point comes from the extensive collection of Museum artefacts and associated archive collections, since the object of any Museum educational programme must be based on its collections, its unique selling point. The biggest outlay is actually in staff time. What matters above all is staff enthusiasm to bring history to life. After all it is an enthusiasm for learning and for museums that we wish to foster; and we can’t do that without the energy and enthusiasm starting with the Museum professional: an enthusiasm for the subject matter, for the collections, for education itself, and for communicating with those of all ages embarking on the great adventure of the pursuit of knowledge