Royal Infirmary of Edinburgh in the 1920s
Photographs from the 1920s and 1930s
The first biochemistry laboratory in the Royal Infirmary (and, indeed, the first in Scotland) was established in 1921 in two rooms in a disused isolation block. These had been the old cholera wards and the toilets still had fixed iron frames over them, to assist with disinfection. Practically all the work was accounted for by seven different analyses; urea, protein and non-protein nitrogen, creatinine, ammonia, glucose and chloride. Some of the methods, recalled by William Forshall (1926 to 1934) and Robert Gaddie (1929 to 1936) as being in use in the 1920s and 1930s were:-
protein and non-protein nitrogen by Kjeldahl - this would involve hot digestion with selenium dioxide/sulphuric acid followed either by addition of Nessler's reagent (alkaline iodine in potassium iodide solution) for colorimetric determination or by liberation of ammonia by the addition of excess sodium hydroxide and aeration of the released gas into dilute sulphuric acid for titrimetric determination.Colour measurements were made using a Duboscq colorimeter (which has a superficial resemblance to a dissecting microscope and in which the path length of the test solution was varied) and by a Zeiss Step Photometer. The laboratory analysed about 1000 specimens of "biological fluids" - blood, urine, C.S.F., gastric contents, etc - per annum in the 1920s. (ref: 9, 91)urea by Van Slyke and Cullen - the urea is converted by urease to ammonium carbonate, ammonia liberated by addition of potassium carbonate and the blood urea is calculated from the volume of acid neutralised by this ammonia when it is aerated into a measured amount of sulphuric acid.
sugar by Benedict's picric acid method - this method, introduced by Lewis and Benedict in 1931, was based on the reduction of picric acid in hot alkaline solution to the red salt of picramic acid: it fell into disuse because it was non-specific and succeeded by the Hagedorn and Jensen method in which unreduced alkaline ferricyanide is determined iodometrically.
phosphate - by colorimetric determination of a phospho-molybdate complex
calcium by oxalate precipitation and titration with potassium permanganate,
chloride by Volhard - silver nitrate solution is mixed thoroughly with a Folin Wu filtrate of plasma (i.e. after a sodium tungstate precipitation of proteins). Concentrated nitric acid is added and the silver chloride is allowed to flocculate. Ferric alum is added and titrated with ammonium or potassium thiocyanate to a reddish-brown end point.
carbon dioxide by Van Slyke's gasometric method. (ref: 9,51,91,93)
In addition, split and unsplit fats (i.e. soaps and fats) were estimated on specimens of faeces and the occasional blood pH was measured by a very elaborate glass electrode set-up which required a specially copper screened room all to itself.
The surge in requests for Basal Metabolic Rate (BMR) measurement reflected the growing understanding of thyroid function. The structure of thyroxine was determined in 1926 and it was synthesised in 1927 and tested on patients in the RIE that same year.
| Specimens | Tests | Blood Sugars | Urine Sugars | BMRs | |
| 1921 | 396 | 782 | 21 | 101 | |
| 1922 | 508 | 764 | 50 | 1 | 157 |
| 1923 | 1344 | 1585 | 682 | 137 | 227 |
| 1924 | 1275 | 1635 | 597 | 47 | 318 |
The "miscellaneous tests" included CSFs (8 in each in 1922 and 23 and 10 in 1924), plums (3 in 1922). Bread (6 in 1922 and 3 in 1924), gin (1 in 1922), air from pneumothorax (3 in 1923) and human milk (2 in 1924). (ref 166)
In the early 20th century urinalysis had become a feature of clinical practice but before 1920 measuring compounds in blood was rarely done. The department rapidly developed clinical research with a distinctly academic slant and became a place where academic scientists could get access to clinical material. It was this aspect which interested Richard Pearce, Director of Medical Education of the Rockefeller Foundation and subsequent negotiations led to the new clinical laboratory and a full time chair of therapeutics (and a full time chair of surgery). (ref: 167)
The new department, which was opened in 1928, was on the ground floor of a purpose built combined research and investigation suite for patients with metabolic disease. This was a two storey building situated at the end of the main medical corridor of the hospital and it was built with money provided by the Rockefeller Foundation. Apart from a spacious library, the building consisted entirely of laboratories and offices and was next door to two small experimental wards equipped with a diet kitchen and other research facilities. The ground floor was devoted to clinical chemistry except for a general office, two rooms devoted to the laboratory side of tropical medicine and an electrocardiographic department. The basement provided a chemical store and workshop. During the next thirty years the Department of Clinical Chemistry expanded from three rooms and a basement store until it occupied almost half of the building and eventually even this became hopelessly overcrowded. (ref: 9, 51)