Acting on Evidence: How Medical Research has informed Historical Drama - free talk at Gresham College

Acting on Evidence: How Medical Research has informed Historical Drama
Gresham College: talk from Prof John Powell, medical advisor
18 October 2012, 1pm.


Some dramatic music to listen to while reading - it's Alexandre Desplat's opening theme to the film Painted Veil which is suitable medical-themed (it features cholera). Press play.

Yesterday's free lunch time talk at Gresham College coincided both with my interests and my day off, which was handy.

Prof John Powell is a medical advisor who's worked on several television programmes and the ones he highlighted in his talk were Downton Abbey, Spanish Flu - the Forgotten Fallen and Casualty 1909. It was interesting stuff with some stills and clips, some of them pretty gruesome - prosthetics teams are a bit too good at gore these days.

As my spatial awareness and sense of direction is catastrophically dreadful I managed to miss the first five minutes of scene setting so I don't know how John got into the medical advising business (there's no career structure involved). I turned up as he was talking about a series he was involved in at the earliest stages (it might have been about anaesthetist / epidemiologist John Snow of cholera / water pump handle fame) which never came to fruition but which gave him contacts and an 'in' for the next time a medical advisor was needed.

He had a slide showing the various stages which a commissioned programme or series would go through, starting with an idea, a treatment (which is about ten pages long and gives an overview of story arcs and which characters are involved), draft script, shooting script, production (ie filming / shooting) and then post-production.

Depending on the programme the medical advisor may be brought in at the earliest stages of script writing and story development. For example to help in the thinking about what diseases people would get in the 1900s and what words did doctors use to describe them then (hence 'toxaemia' for pre-eclampsia in Downton Abbey in 1920).

Downton Abbey      **Spoiler alert**   **Spoiler alert**   **Spoiler alert**   **Spoiler alert**
I have written this bit in white text on a white background for those who want to skip it, but if you want to read it you'll need to select the white space below to see the text. This probably won't work on mobiles so just scroll down past the next steel blue Spoiler Alert marker.

In the recent Downton storyline Lady Sybil gives birth to a healthy baby girl but dies from the effects of pre-eclampsia. At one point she suffers a fit and John was on set to make sure that the fitting (nicely acted, and I suppose icted ⁽¹⁾, by the actress playing her, Jessica Findlay Brown) looked convincing on the cameras. As she's a bonny lass it was apparently rather hard work to make her look ill.

The storyline dramatised the tension between the fancy London doctor and the local family doctor (who was convinced that sonething was VERY WRONG but was overridden). Oops.

**Spoiler alert**   **Spoiler alert**   **Spoiler alert**   **Spoiler alert**    

John acknowledged that you really can't be 100% accurate in every aspect. For example the time course of a disease or its relief from medication tends to be compressed. A questioner at the end also pointed out that in modern real life there would be delays in even seeing a dictor, what with things as they are in the NHS. Also, a typical 1900s doctor wouldn't necessarily see such a wide range of ailments and any one patient might not experience multiple diseases in a short time frame. He also pointed out that the real life practice of medicine is plenty dramatic itself, with different characters and unpredictable outcomes.

Could anything look more 'medicine of yore'? This is 'medicine bottles' from Flickr user Leo Reynolds

In an example from earlier in the Downton series he talked about his research of the early medical literature so that they could create a scene in which a young healthy man (early 40s) has a plausible heart problem - something likely to be fatal but which some new technique could solve. They gave him pericarditis which had arisen from rheumatic fever. This introduced tension between the local family doctor, Dr Clarkson, and Mrs Crawley who is a nurse and widow of a paediatric specialist - she has more knowledge of this newer procedure but is of lower professional status. She encourages the wife of the afflicted man (Mr Drake) to give permission for fluid to be withdrawn from his pericardium and for adrenaline to be given if the heart needs restarting. Fortunately there's a happy ending.

The source material was Steell G (1900) A clinical lecture on pericarditis Br Med J. January 27; 1(2039): 181–183.

He showed us a page from the shooting script which contained a reference to cardiac tamponade which isn't actually in the final version. Even when you get to the stage of shooting with 'signed-off' dialogue an actor might not say a particular line or phrase if the director decides that it isn't needed.

There's a company that hires out old medical equipment and you might have to adapt to working with what's available. In the scene where the doctor removes fluid he's using a double-valve syringe which lets you pull fluid out of one place and then, by switching the valve, push it somewhere else.

.o0o.  .o0o.  .o0o.  .o0o.  .o0o.  .o0o.  .o0o.

John pointed out that Downton isn't a show about medicine of course, that's just incidental to the main story.

Spanish Flu - the Forgotten Fallen is about medicine though, and was broadcast in 2009, coincidentally around the time that there was an H1N1 flu epidemic. The BBC apparently has a drama compliance unit (!) who made sure that the series was non-alarmist at a time when temperatures were running high, so to speak.

John said he found himself along with someone else from the production (I think it may have been the writer) on breakfast television being asked about his role in the programme, but also about flu more generally. At this point he said he that luckily, as he was a public health doctor, flu was one thing he was pretty qualified to talk about.

The series dramatised tales of the Spanish flu in Manchester from Dr James Niven's private papers. He warned about the seriousness of the flu tried to shut down all sorts of events in Manchester, and that wasn't warmly received, until a vaccine became available.

We saw some scenes from it and I wondered how on earth I could have missed it when it broadcast - I recognised lots of people in it and it seems like quite an interesting story.

Picture credit: Me actually, aka Jodiepedia

Casualty 1909 belonged to a small series (I think there was a Casualty 1904 and a couple of others too) of hospital dramas which arose because the series' producer's great grandparent had been an anaesthetist at The London Hospital, where this was set.

Again, this looked fantastic and also a bit gruesome. In the clip we saw someone had set off a bomb in the east end of London and this gave the prosthetics team lots of opportunities to give people horrific injuries. Plenty of surgery was needed and the story unfolded about the development and use of anaesthesia and the way in which some doctors behaved (somewhat imperiously) towards their patients and juniors.

In one storyline there was a fictionalised medical error in which a patient has received too much spinal anaesthesia and remained 'under' for too long. The result seems to be some blotchy red problems with the patients' legs which didn't bode well for him. The anaesthetic used was the tropane alkaloid Stovaine and one of the fictional doctors turns out to be using it as a drug of abuse and as the series progresses he's shown being less able to do his surgical work.

There was also 'A case of a fractured pelvis complicated by laceration of the femoral vein treated by lateral vein suture' which was shown in a bit more detail than I'd ever want. It seems to have been rather good fun for John to do the background research and find some fairly odd examples of accidents and injuries. There was a paper he flashed up briefly which looked great, about a lion bite (I didn't get a good look at all the words but I think a circus lionkeeper had his trochanter 'craunched', which is a great word for bite - I'd only ever heard the word used once before in 'to craunch the marmoset' and had always wondered what it means, so now I know). Turns out you can read the article here, look out for 'lion bite' on the second or third page.

True story - one of the doctors experimented with having his own radial nerve severed to see what happened when it all healed up. I'm afraid I don't know because I was squeamishing at the accurately portrayed images of the surgery taking place, thanks to the work of the prosthetic people and the actors. Fortunately I hadn't had lunch yets, there was a nice Pret a Manger though on the way to the ferry home to Greenwich.

Thanks to Prof John Powell and the Gresham for putting this talk on, and to Prof Harold Thimbleby who told me about it.

(1) Not my wittiest of puns but 'ictal' refers to fits and strokes etc, so I had to do it ;)
If you can't see what this refers to it's the bit in the spoiler alerts above.