Uncovering our Medical Instruments- Lucy Baldwin and Maternity Health

Childbirth has always been considered a miraculous event. Bringing a new life safely into this world is always a momentous occasion and victory. The health of both mother and child is of utmost importance to those involved in maternity health, and the practice as we know it today is the safest it has ever been in history.

However, there was a time when childbirth was considered a death sentence for the expectant mother [1], and maternity healthcare was based on class, on where the mother ranked in the public hierarchy. Not only was the likelihood of the mother dying during childbirth much higher than it is today, the life expectancy of the child was much shorter, although this varied depending on where the child was brought up. Yes, the process of childbirth has changed tremendously in the past 200 years and this change has been brought about by those fighting for better maternity healthcare.

One man that vastly improved the survival rate of mothers was Ignaz Semmelweis, an unsung hero of antisepsis. Working as an obstetrician at the Vienna General Hospital in 1846, Semmelweis noticed a difference in mortality rates between the two maternity clinics there. Where the clinic run by midwives had a mortality rate of around 4%, 10% of mothers died after giving birth in the clinic run by teaching staff of the University of Vienna [2]. These mothers were dying of a condition known as “childbed fever”.

Semmelweis took it upon himself to solve this mystery. The difference between clinics, he discovered, was in hygiene- the medical students would attend their patients straight after performing autopsies and would not have washed their hands or clothes efficiently in between sessions. This meant that the wounds and reproductive tracts of the recovering mothers were being contaminated, resulting in childbed fever and ultimately death.  The concept of contamination was not yet understood at this time in history, thus explaining Semmelweis’ difficulty in identifying the root of the problem.

When Semmelweis discovered this, he put in place the practice of handwashing with chlorinated lime in both clinics in 1847. Obstetricians were to wash their hands before and after examining patients in the first clinic, as well as the midwives in the second clinic. With this change in hygiene, the mortality rate of the first clinic dropped to around 1% within two months. However, Semmelweis was not recognised for his astounding work due to his unpopularity in the research field. The lack of belief from his contemporaries drove him insane, which resulted in his admittance to a mental institution in 1867. Semmelweis sadly died of blood poisoning, from the contamination of a wound caused by the institution staff [3]. It has only been after his death that his work has been recognised and praised.  His work paved the way for Lister’s contribution to antiseptic practices in medicine.

Another name often associated with maternity healthcare is Lucy Baldwin. Lucy Baldwin, Countess Baldwin of Bewdley, was the wife of Stanley Baldwin, the prime minister of the United Kingdom from 1923-1924, 1924-1929, and 1935-1937. Although some may remember Countess Baldwin as a Prime Minister’s wife, Baldwin was an active writer and campaigner for equal maternity health care for all women. Having six children of her own, Baldwin was all too aware of the importance of maternal care during and after childbirth.

In the early 1900s, the rate of maternal deaths was incredibly high and little was being done to reverse the statistics [4]. Baldwin supported the work of the National Birthday Trust Fund to improve the care of pregnant women, and had an important role in obtaining equal access to anaesthesia for all mothers regardless of their financial income. Her great efforts lead to the introduction of self-administered anaesthetic machines into many hospitals across the country [5]. She had close ties with maternity health in Glasgow, having opened a New Infant Health Visitors Association centre in Bridgeton, and paved the way for the employment of the first anaesthetists at the Glasgow Royal Maternity Hospital in 1930 [6]. Named after her in her honour, a Lucy Baldwin Gas-Oxygen Analgesia Apparatus can be found with the College’s museum collection, [Fig 1].

2003.74_Lucy Baldwin apparatus 4

The apparatus would include a face mask, which was connected to the machine through a tube. The midwife could then manipulate the dial to alter the percentage of oxygen within the gaseous mixture. The machine would be mounted onto 4 wheels for easy movement between patient beds.

Although Baldwin was not medically trained herself, she used her position and the resources available to her to fight for equal rights in healthcare.

For more information on the Lucy Baldwin Gas-Oxygen Analgesia Apparatus, feel free to contact us at: library@rcpsg.ac.uk

 

References

  1. Cellania, M., 2013. The Historical Horror of Childbirth. Mental Floss. [online] Available at: http://mentalfloss.com/article/50513/historical-horror-childbirth
  2. Semmelweis, I., 1861. Etiology, Concept, and Prophylaxis of Childbed Fever.
  3. Carter, K.C., 1994. Childbed Fever: A Scientific Biography Of Ignaz Semmelweis. Transaction Publishers: New Jersey.
  4. Schafer, E., 1998. Schafer on Williams, ‘Women and Childbirth in the Twentieth Century: A History of the National Birthday Trust Fund 1928-93’. Humanities and Social Sciences Online. [online] Available at: < https://networks.h-net.org/node/24029/reviews/29853/schafer-williams-women-and-childbirth-twentieth-century-history>
  5. Blakeway, D., 2011. The Last Dance : 1936 The Year Our Lives Changed. Hodder Paperbacks: London.
  6. Dow, D.A., 1984. The Rottenrow: The History of the Glasgow Royal Maternity Hospital 1834-1984. The Parthenon Press: Lancashire.

Re-Framed: Celebrating Diversity

PLEASE NOTE: Due to unforeseen circumstances we are having to postpone this event. We will be rescheduling for later in the year (date TBC). If you have booked tickets for this event or have any queries please do not hesitate to contact us at library@rcpsg.ac.uk.

For Festival of Museums 2017 we’re hosting an event in College Hall that celebrates diversity while disrupting our traditional display space. We’re working with an artist to create a projection and animation that will fill the room with light, sound and the faces of College members, trainees and medical students. The effect of this will be to subdue the impact of our portraits of College founders, Presidents and eminent Fellows. As the evening light dims the intensity of the projection will grow, and these new, diverse faces will dominate the room.

Re-Framed facebook graphic

So why are we doing this?

First all of, Festival of Museums gives museums the opportunity to try new things, take risks, and attract new audiences. As a newly accredited museum within a very old institution, we’re keen to grasp these opportunities.

Secondly, our portraits on display in College Hall follow a similar pattern to most late 19th century celebrations of an institution’s rich history. The subjects are all white, and they are all men. It was during this late 19th century period that the College’s community began to diversify, with licentiates appearing in the minute books from many other parts of the world, for example South Asia.

And then, during the same period, women began to be admitted to the College, to be licensed in surgery. Now, the College has a truly international membership. Glasgow itself is a proudly multi-ethnic city. In the 21st century, women are leaders in medicine. The College has had two female Vice Presidents this decade. Yet College Hall has remained virtually unchanged since it was built as an extension to the St Vincent Street building in the 1890s.

The College isn’t unique in this habit of using symbolic spaces in the same way for 100+ years. However, it does invite questions, challenges, and debate. And that’s one of the important roles for museums in the 21st century.

So we asked members, trainees and students to submit selfies that would form part of the projection. So far we’ve received almost 100 submissions from around the world!

fom poster

Founder of the College in 1599, Maister Peter Lowe

 

At the event, we’ll have contributions from acclaimed author Louise Welsh, Professor of Creative Writing at the University of Glasgow, and Takondwa Itaye-kamangira, a Medical Training Initiative (MTI) participant from Malawi, supported by the College.

Taking on a project like this needs support from outside the organisation, and we received strong support and advice from the Glasgow Women’s Library. We even borrowed their Designer in Residence to help us produce some visuals to promote the event (Maister Peter Lowe having a party, above). Staff at Museums Galleries Scotland also provided super support and encouragement.

Delegates at the College’s Medical Undergraduate Conference in March enthusiastically volunteered to have their portraits taken to contribute to the artwork and poster design (top of the page).

The event has been kindly supported by Festival of Museum. See all of the events around the country at http://www.festivalofmuseums.co.uk/.

To find out more about our event and to book tickets go to rcp.sg/events.

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Glasgow Pathological and Clinical Society

As the College embarks upon a refurbishment programme, we’ve been delving into the historical uses of the rooms of our St Vincent Street building. The old Faculty Hall (now named Alexandra Room) was the venue for most of the College’s business until the new College Hall extension was built in 1893. In addition to Faculty meetings, and meetings of the Medico-Chirurgical Society of Glasgow, this room hosted the meetings of the Glasgow Pathological and Clinical Society from 1876.

GP&amp;CS Transactions book

Transactions, 1873 – 1883 (RCPSG 4/1/6)

We were keen to explore what these meetings involved, who attended them, and the history of the Society itself. We are extremely fortunate to hold the archives of the Society, from its foundation in 1873 until its merger with the Medico-Chirurgical Society of Glasgow in 1907.

There is mention of an earlier Glasgow Pathological Society (established 1850) in the 1852 Medical Directory. However, it appears to have only lasted for 2 or 3 years. The idea of forming a new Pathological Society came from four prominent Glasgow physicians and surgeons in the early 1870s – Thomas Reid, Joseph Coats, William Leishman, and William Tennant Gairdner. James Finlayson was the first secretary and describes the initial idea for “a society composed of working members“, creating an environment where “specimens could be quietly examined and discussed… in a friendly manner, without any temptation to ostentatious display or personal bitterness.”

GP&amp;CS First meeting proposal 1873

From Transactions, 1873 – 1883 (RCPSG 4/1/6)

The first meeting was held on 25th November 1873 in the rooms of the University Lying-In Hospital and Dispensary for Women on Wellington Street. James Finlayson and Hector Cameron constituted themselves interim secretaries, while Dr Gairdner (then Professor of Medicine at the University of Glasgow) became chairman. In addition to those already mentioned, the original membership included the young surgeon William Macewen.

GP&amp;CS first agenda 1873

From Transactions, 1873 – 1883 (RCPSG 4/1/6)

From the first meeting, the format was established. The Agenda pictured above shows the list of specimens presented by the members for discussion. In further meetings, patients would also be presented. For example, in May 1874, Dr McCall Anderson showed a patient who had been treated for syphilitic paralysis.

In 1874 the name was changed to the Glasgow Pathological and Clinical Society, and with the number of members increasing to 30, a new venue was found at the Glasgow Eye Infirmary on Berkeley Street. Then, in the fourth session, beginning in October 1876, the venue settled at the Faculty Hall, in the College’s current building on St Vincent Street. The origins and early history of the Society were usefully added to the book of Transactions (RCPSG 4/1/6) by James Finlayson in 1879 (below).

GP&amp;CS Memorandum 1879

Memorandum by James Finlayson, 1879 (RCPSG 4/1/6)

An important part of the Society’s business was the publication of its reports, in both the Glasgow Medical Journal and the British Medical Journal. This placed the research and practice of the Society in the context of the wider medical and surgical literature, which was at this time exploring many new areas and innovations.

Notable in the records of the Society are cases concerning neurological conditions and physiology, the treatment of cranial injuries, and cranial surgery. For example, Glasgow physicians such as Alexander Robertson, who was pioneering in his approach to aphasia in the 1860s, and William James Fleming, who investigated the physiology of the ‘motions of the brain’, provide a stimulating context for the advances in brain surgery made by William Macewen in the 1870s.

GP&amp;CS Agenda 1879

From Society Minute Book 1879 – 1891 (RCPSG 4/1/2)

An exciting discovery in the Society’s Minute Book shows that on the 11th November 1879, Macewen presented to the meeting in the Faculty Hall “two patients on whom trephining was performed, one for injury and one for disease.” One of these patients was the fourteen year old girl upon whom Macewen had performed the first removal of a tumour from the dura mater (minute book detail below).

GP&amp;CS Minute 1879

From Society Minute Book, 1879 – 1891 (RCPSG 4/1/2)

This procedure has since been identified as a major breakthrough in the history of neurosurgery. An editorial in the British Medical Journal (11th August, 1888) acknowledges the innovation and success of Macewen’s early brain surgery: “With indisputable justice… may Dr Macewen claim the proud distinction of having been the leader in this country, and we believe in the world, of this great advance in our art.”

These records of the Glasgow Pathological and Clinical Society not only provide us with a wonderful source of evidence of the innovative research and practice in the city in the late 19th century, but also provide us with inspirational stories to tell in our College rooms.

Shine a Light on Those Backstage: Recognising the Engineers Behind Medical Technology

Our digitisation intern discusses some of the remarkable people behind medical technology.

When looking back at significant moments in medical history, it is easy to see the progression of medical technology along with the practice. From the replacement of dental keys with dental forceps, to the development of the heart-lung machine, medical technology has greatly advanced.

The manufacturing of this technology was often performed by instrument makers, specialised engineers in the fields of medicine and surgery. It was up to these men to deliver products that matched every detail of the original design to perfection. Anything less and the apparatus may not work at all. These were the men that were producing new technology. Their names are unforgettable.

Or are they? Having such important roles to play in the advancement of clinical practice, surely these men are remembered by all? Unfortunately, this is not the case. Aside from some brief mentions in published articles, it is rare to find much detail about the lives of instrument makers. All credit was given to the professional pioneering the technology, not the engineer.

As the research continues in the “Uncovering our Medical Instruments” project, the lack of information on instrument makers from history becomes more and more evident. This begs us to ask a question: Did they ever get the recognition they deserved?

The topic of instrument makers was brought up after digitising an artefact from our anaesthesia collection- the Portable Anaesthesia Apparatus:

Portable anaesthesia apparatus

This apparatus is a nitrous oxide/oxygen machine dating from 1955-1960. There is no hidden meaning in the name; this tool was an anaesthesia apparatus that could easily be transported from location to location. This particular machine was manufactured by the British Oxygen Company (BOC). With regards to manufacturers, most people would be satisfied knowing that the BOC made this product. However on closer inspection of this particular instrument, other names are mentioned:

Portable anaesthesia apparatus

BOC trademark (top left) with the names of Coxeter and King displayed around the edge.

Around the BOC trademark are the names “King” and “Coxeter”. After some digging into the archives, it was discovered that these names referred to two instrument makers; A. Charles King and James Coxeter.

Arthur Charles King was an engineer from London, active during the early 1900s. After the First World War, he set up his own company in London, manufacturing simple medical instruments to local physicians. As anaesthetic technology was advancing abroad, King was one of the first engineers to sell the machines in the UK. Thus, he made a name for himself in the anaesthesia world, [1]. Unfortunately, King’s business plummeted and was ultimately taken over by the British Oxygen Company in 1939.

James Coxeter was an active instrument maker during the 1800s, establishing his own business in 1836, [2]. Based in London, Coxeter was a supplier to many, including the University College Hospital, of which he was the chief instrument maker, [3]. Coxeters also specialised in anaesthetic equipment, including producing Boyle’s Anaesthetic Machine, designed by British anaesthetist Henry Boyle,[1]. The company grew over the years, but was also taken over by BOC. This will be why the names “King” and “Coxeter” are on the trademark.

For all the hard work behind the scenes, was a reference in a publication the best they could get? Thankfully, no. James Coxeter was such a respected instrument maker that he was able to publish articles in the Lancet, giving detailed descriptions of new instrument designs he had created. And it wasn’t just one publication. In fact, Coxeter was published in the Lancet several times, [4,5,6]. A side note to one article describes Coxeter’s contribution to medicine and surgery:

“We have examined the instruments described by Mr Coxeter, and think them ingenius modifications of those in use, and worthy the attention of the profession.” [4]

Although he was very much a member of the backstage crew, Coxeter, and many like himself, were able to get the proper recognition and thanks that they deserved. It is hoped that this article will be added to that list of thanks.

The Portable anaesthesia apparatus

The Portable anaesthesia apparatus

References
1. Wilkinson, D.J., 1987. A. Charles King: a unique contribution to anaesthesia. Journal of the Royal Society of Medicine, 80(8), p. 510-514. Available at: < http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1290960/>
2. Science Museum Group, Collectors Online- people. Coxeter. Available at: < http://collectionsonline.nmsi.ac.uk/detail.php?type=related&kv=46728&t=people>
3. Braithewaite, W., and Braithewaite, J., 1845. The Retrospect of Practical Medicine and Surgery: Being a Half-yearly Journal Containing a Retrospective View of Every Discovery and Practical Improvement in the Medical Sciences …, Volumes 10-12. W.A.Townsend Publishing Company.
4. Coxeter, J., 1845. New Surgical Instruments. The Lancet, Volume 2.
5. Coxeter, J., 1874. Aspirators. The Lancet, 103(2635), p. 319.
6. Coxeter, J., 1849. The Sonometer and instruments used in the application of glycerine in deafness. The Lancet, 54(1352), p. 109-110.

Uncovering our medical instruments – British Science Week 2017

In June 2016 we started an exciting project to digitise items from our museum collection. The project, which has been kindly funded by Museums Galleries Scotland, is sadly nearly at an end, so to celebrate all the amazing work that has been done we’re hosting a special drop-in session as part of British Science Week.

The drop-in session will give visitors the opportunity to view some items from our collection, learn about how they were used, take a look at the processes involved in their digitisation, and maybe take a few photos too!

The drop-in session takes place on Wednesday, 15th March 2017 from 1pm – 3pm. No need to book – just pop in to the College!

Horsley's Skull Trephine

Horsley’s Skull Trephine

So far, our digitisation intern has photograph over 300 items including our collection of 18th/19th century stethoscopes, apothecary cabinets, the surgical instruments of William Beatty (surgeon on board HMS Victory at the battle of Trafalgar), early 19th century x-ray tubes, Victorian quackery gadgets, and many other fascinating surgical instruments.

Surgical Instruments of William Beatty

Surgical Instruments of William Beatty

The collection dates back to the mid 1700s – the earliest item we have is a trephine set – and covers all areas of medicine, surgery and dentistry. You can read a little bit more about some of the items we’ve digitised and get updates on the project on our blog.

For more information on British Science Week 2017 please visit: https://www.britishscienceweek.org/

Flyer for our British Science Week event

Flyer for our British Science Week event

Amputation

In this post by our Digitisation Project Intern, we look at our amputation instruments, while referring to the work of Maister Peter Lowe, College founder and 16th century surgeon.

The surgical procedure of an amputation involves the removal of a section of a limb of the body. The volume of tissue removed from the body depends on a variety of factors, including the severity of the patient’s condition.

instruments-and-cauters-actuals-for-extirpation-copy

Woodcut illustration, 2nd ed. of Lowe’s Chirurgerie (1612)

 

It is uncertain as to how long amputations have been a regular form of surgical treatment, however the term can be traced back to the 16th century. For example, Peter Lowe uses the term “amputation” when describing how to treat a gangrenous limb in his 1597 work The Whole Course of Chirurgerie [1].  Here he explains how the operation should be carried out, referencing the works of previous scholars:

The judgements are, that it is for the most part incurable, and the patient will die in a cold sweat. The cure, in so much as may be, consists only in amputation of the member, which shall be done in this manner, for the patient must first be told of the danger, because often death ensues, as you have heard, either from apprehension, weakness, or loss of blood.”

It has only been within the last 170 years that amputations, and surgical procedures in general, have been performed in a safe manner, e.g. with the patient under anaesthesia. Prior to this, the limb was removed as quickly as possible. A successful and speedy amputation required precision, strength, skill, and a steady hand, as well as a set of sharp amputation instruments!

amputation-set

Mid 19th century amputation set

 

Within the museum collection are examples of amputation sets from the 1800-1900s.

Several components make up a set, from trephine heads to amputation saws to tourniquets. Each instrument would be used at a different stage of the surgical procedure. Let’s take a look at how a lower limb amputation would be performed.

First of all, the patient would be prepped for the surgery. In the days before pain relief, alcohol was the method used to calm the nerves. The patient would be given some rum or whisky, and then wheeled into the surgical theatre. Most likely the theatre would be structured with the operating table in the centre of the room surrounded by rows and rows of stands for spectators. Spectators would include the students of the chief surgeon involved in the procedure- not only was this a surgical operation, it was also a lesson. Once the patient was placed on the operating table, the chief surgeon would enter the theatre and the operation would commence.

One of the major dangers of amputating a limb is blood loss. Several blood vessels must be carefully salvaged during the procedure in order to limit haemorrhaging [1]. To enable the surgeon to operate on a bloodless area of the body, a Tourniquet was applied proximal to the site of amputation (a couple of inches above the site of incision).

“The use of the ribband is diverse. First it holds the member hard, that the instrument may curve more surely. Secondly, that the feeling of the whole part is stupefied and rendered insensible. Thirdly, the flow of blood is stopped by it. Fourthly, it holds up the skin and muscles, which cover the bone after it is loosed, and so makes it easier to heal.”[1]

tourniquet

Example of a tourniquet from an amputation set

 

The tourniquet would have been tightened in order to restrict blood flow and reduce haemorrhaging. It would also have reduced sensation to the limb, providing slight pain relief. However, this would also mean that oxygen was restricted. Hence another reason as to why amputations were performed as quickly as possible.

tourniquet-illustration

The initial incision would have been made with a sharp amputation knife. Amputation knives evolved in shape over the years, from a curved blade to a straight blade. Peter Lowe comments on the use of a curved blade for the procedure:

“…we cut the flesh with a razor or knife, that is somewhat crooked like a hook…”[1]

The blade was curved in order to easily cut in a circular manner around the bone (see image from Lowe’s book above) [2]. Amputation blades became straighter as the incision technique evolved. An example of a straight amputation knife is that of the Liston Knife. With a straight and sharp blade, this knife was named after the Scottish surgeon Robert Liston. Liston is best known for being the first surgeon in Europe to perform an amputation procedure with the patient under anaesthesia [3].

liston-knife

Liston knife, mid 19th century

 

The straight blades enabled the surgeon to dissect more precisely in order to form the flap of skin and muscle that would become the new limb stump.

As one can imagine, bone tissue would not be easily removed by an amputation knife. Instead, an amputation saw was required to separate bone. Amputation saws were similar to those found in carpentry, with sharp teeth to dig into and tear bone tissue for a quick procedure.

amputation-saw

Amputation saw, mid 19th century

 

Aside from the major dissecting tools, there are more specialised instruments within an amputation set that we must consider. One of the main risks of an amputation operation was death by haemorrhaging. For years, the letting of blood was used to treat certain ailments according to the ancient teaching of the “Four Humors”. However, in a surgical procedure the major loss of blood was something to be avoided. In order to prevent the haemorrhaging of dissected vessels, the surgeon would have used a Ligature to tie off the vessel and disrupt blood flow. This technique was pioneered by French surgeon Ambroise Paré during the 1500s [4].

Found within our amputation sets are trephine heads with accompanying handles. Rather than being used during an amputation procedure, trephine heads were used to drill into the skull to treat conditions by relieving intracranial pressure. Nowadays, access to the brain via the skull is achieved with the use of electric drills.

trephine1

Trephine, mid 19th century

 

Amputation procedures have changed dramatically since the days before anaesthesia and antiseptics, but the risks have remained. Blood loss, sepsis, and infection are factors that can still occur today. Thankfully, their likelihood is much lower than they were 170 years ago.

References

  1. Lowe, P., 1597. The Whole Course of Chirurgerie.
  2. Science Museum, 2016. Amputation Knife, Germany, 1701-1800. Brought to Life: Exploring the History of Medicine. [online] Available at: http://www.sciencemuseum.org.uk/broughttolife/objects/display?id=5510
  3. Liston, R., 1847. To the Editor. The Lancet, 1, p. 8.
  4. Hernigou, P., 2013. Ambroise Paré II: Paré’s contribution to amputation and ligature. International Orthopaedics, 37(4), pp. 769-772.

Art, Culture and Patronage in Renaissance Scotland

Last year we were very fortunate to host placements for four undergraduate history students from the University of Glasgow. The placements were undertaken as part of their class ‘Art, Culture and Patronage in Renaissance Scotland, 1406-1625’ and involved working with primary source materials from the collections of either the University’s Archives and Special Collections, the Hunterian Museum, or the Royal College of Physicians and Surgeons. Each student spent time studying a single item from one of these repositories, thinking about how to interpret the source, assessing its significance, and imagining the curatorial possibilities it offers.

img_3177

A manuscript rental on a blank page in ‘The workes of the most High and Mightie Prince, James’ (1616)

The students’ work is now available to read on the class blog:

You can read more about the students’ work in other repositories on the class blog: https://glasgowuniscotrenaissance.wordpress.com/.