60. Syphilis at West Hill & Joyce Green Hospitals

Key words/phrases: West Hill Park, the West Hill Hospital VD Clinic, serological tests for syphilis, Dr Pauline O'Neill (neé Ripley) Consultant Microbiologist at Joyce Green Hospital.

No.60

If you maintain an interest in any of Dartford's former hospitals I wonder if you have had a look at the new "West Hill Park" development on the http://www.barratthomes.co.uk/. website ?

Barratts plc seem to have bought the former West Hill Hospital site and are now offering 230 new homes for sale on it within a “landscaped setting”. However not only are they offering houses and apartments for sale but the company is also restoring and converting some of the original buildings into premises for small business enterprises.

Whilst looking at their website yesterday I found myself remembering the old VD clinic at West Hill Hospital where I once did a clinical placement as a student nurse. At that time the clinic was situated near to the small staff dining room beyond the hospital chapel and behind the Casualty Department. The male clinic was staffed by a visiting Consultant and a male Enrolled Nurse who formed a mini, peripatetic team that provided a sexually transmitted disease service for male patients in Dartford, Gravesend and one or two other towns.

This was at the time when several of the traditional screening tests for syphilis such as the Treponema Pallidum Immobilisation test (the TPI), the Wasserman Reaction (the WR) and the Kahn tests were coming to the end of their working lives as diagnostic tests.

Nowadays in addition to dark field microscopy where a sample of fluid or tissue from an open sore is visually checked for the pathogenic spirochete one or more of the following are likely to be used:

An ELISA (enzyme linked immunosorbent assay) test is one of the newer tests being used for screening purposes. If such a test is found to be positive then this result would need to be confirmed by one (or both) of the following tests: The VDRL (venereal disease research laboratory) test and/or the RPR (rapid plasma reagin) test.

These latter two are broad spectrum tests used to examine large numbers of samples taken from the at-risk population that can pick up the potential presence of any one of the possible treponemal infections, including yaws, pinta and syphilis. Thus if a serological reaction IS noted certain specific and confirmatory tests will be required such as the FTA-ABS (fluorescent treponemal antibody absorption) test or a TPPA (Treponema pallidum particle agglutination assay) test to complement the patient's history and medical examination findings.

Dr Pauline O'Neill (neé Ripley), who took up an appointment as a Consultant Microbiologist at Joyce Green Hospital in 1974, realised the importance of using a range of serological tests to confirm exactly what was happening in a clinical situation where someone was suspected of having syphilis.

Because of the importance of running a range of tests for syphilis on 'at risk patients' at appropriate points during the incubation period of the disease I must say that felt a degree of pride in reminding myself that Dr O'Neill was working at Joyce Green Hospital when she produced her paper "A New Look at the Serology of Treponemal Disease" for the British Journal of Venereal Diseases (Br J Vener Dis. 1976; 52 (5): 296-9.

Why ? Because syphilis remains an extremely serious problem today and because of the fact that one of the medical scientists who affirmed the need for comprehensive and accurate diagnostic serology all those years ago was a Joyce Greenite.

After Pauline O'Neill, neé Ripley (b. 9/5/26 - d. 6/3/06) qualified at St Thomas' Hospital Medical School London she went to Bermuda where she was responsible for setting up their Path Lab Services. She subsequently returned to St Thomas' Hospital to undertake further studies and then began work at Joyce Green Hospital in 1974. Later on she moved to Lewisham Hospital. She had a special interest in the serology of early syphilitic infection and re-infection. Sadly she died of primary peritoneal cancer.

59. I'm forever blowing bubbles at Joyce Green Hospital.

Key words/phrases : handwashing in the management of cross-infection, Dr. John Emsley of Cambridge University, glycerine in the manufacture of weapons, British Government supply strategies during World War I.

No.59

Not only is hot water and soap the bane of every little boy’s life -if you believe the popular myth - but according to public health experts many nurses and doctors also seem very reluctant to use these simple ingredients as often as they should.

If it is really is true that insufficient or poor hand-washing is contributing to current levels of cross-infection within hospitals perhaps mandatory basic hygiene updates are going to have to be introduced and compliance monitored.

However to avoid going down the road of criticising colleagues here you might instead be interested in going back to “basics” and reviewing what soap actually is and how it works, as a prelude to considering a situation during which soap was in short supply ?

It seems that our forebears used to take dollops of greasy animal fat from the bottom of their cooking pans, add some wood ash from the fire, mix them together and then use the resulting “goo” to clean themselves.

This is the essence of soap. Obviously although today’s soaps are slightly more sophisticated this seems to be how our ancestors made it. In due course someone also cottoned on to the fact that if you boil and cool the mixture several times it will eventually go hard, thus becoming even more practical to use.

Dr. John Emsley, previously of Cambridge University, says that it is worth remembering that "soap molecules have a head and a tail." "The head likes to attach itself to water; the tail likes to attach itself to grease and so when soap is put into water, it will find the grease, attach itself to it and will pull it into the water whereupon the grease can be washed away."

Emsley reminded interested parties that "all kinds of oils and fats can be used to make soap including mutton fat, tallow from cattle, palm kernel oil, coconut oil, olive oil, palm oil and fish oil.” “However”, he says, “if you want the soap to last a long time it is better to use a saturated fat because using unsaturated fats in the manufacturing process will - in time - cause the soap to go rancid whereas soaps that are made from saturated fats will last for years."

Another of the natural ingredients found in soap was (and still is) glycerine which is also used in the manufacture of explosives. So I wonder if you realise that during WWI the government regulated and subsidised the supply of oil and fat in order to ensure that commercial soap makers had enough material with which to carry on making their soap, from which the glycerine was extracted to be sent to munitions factories ?

Does this mean then that hospitals, including Joyce Green, never experienced shortages of hand soap, floor soap and laundry soap during the First World War because of positive government strategies aimed at maintaining the supply of these products as well as the supply of glycerine for weapons manufacture and does this also mean that adequate supplies of soap in hospitals and an old-fashioned commitment to hand washing meant that less cross-infection occurred ?

I don’t have any data to hand to support the notion that there was less cross-infection in UK hospitals during the First World War but with fewer anti-microbials (and/or supplies of them) in existence it would certainly be interesting to read anything relevant that has been written by staff who worked at Joyce Green Hospital during that era, don’t you think ?