The semi-flexible gastroscope

In her latest blog post, Digitisation Project Intern Kirsty Earley looks at the technology behind a mid 20th century gastroscope.

The development of gastroscopy and endoscopy evolved during the 19th century. Philipp Bozzini in the early 1800s is regarded as the first to attempt to see inside the body using a light source – at this stage candlelight and mirrors. The use of electric light in the later 19th century advanced the procedure. In 1868 Adolph Kussmaul tested a rigid gastroscope on a sword-swallower to establish the line from mouth to stomach.

mayer-and-meltzer-gastroscope-c-1914a

Rigid gastroscope in Mayer & Meltzer catalogue, c1914

Prior to any form of recording technology, visualization of the gastrointestinal tract could only be achieved via rigid gastroscopes. These were essentially long telescopes through which the physician could view inside of the patient’s stomach (see illustration above and below).

gastroscope-illustration

Due to the limitations on flexibility, the patient had to be positioned in order that the gastroscope could simply slide down the oesophagus towards the stomach. It would then be rotated to visualize all areas of the stomach. Not the easiest of procedures. For gastroscopy to advance, something had to be done to the gastroscope itself.

Rudolf Schindler (1888-1968) was a German doctor who specialised in gastroenterology. Considered the “father of gastroscopy”, Schindler made incredible efforts to promote the use of gastroscopy as a diagnostic technique for gastrointestinal conditions [1].

Schindler was the brains behind the first ever semi-flexible gastroscope, created in 1931 [2]. He constructed the gastroscope in such a manner that the distal end could be rotated, while the proximal end remained stationary (see image below). This allowed easier access to all areas of the stomach. But how did he test his design? Often, his instruments were tested on his own children, especially his daughter Ursula as she had a strong gag reflex [3].

2000-10-2_gastroscope-2

One of our mid 20th century gastroscopes

To ensure that procedures were being carried out safely, Schindler trained practitioners in how to use his gastroscope as a diagnostic tool. He argued for many years that gastroscopy should not become a specialised field of medicine, but an examination technique performed by any level of practitioner.

2000-10-2_gastroscope-7

Detail of mid 20th century gastroscope

Ultimately, the gastroscope was replaced by fiberoptic endoscopes [4]. Instead of a flexible distal end, the entire length of the fibreoptic endoscope was flexible. This allowed the patient to be in a more natural position, e.g. sitting up, during the examination, [5].

Gastroscopy today involves examining components of the gastrointestinal system by inserting a wire-like endoscope down the patient’s throat. The endoscope contains a camera and light, and is controlled by the physician performing the examination. The images from the camera are then fed to a monitor screen for visualization.

References

  1. Gerstner, P., 1991. The American Society for Gastrointestinal Endoscopy: a history. Gastrointestinal Endoscopy, 37(2).
  2. Olympus, date unknown. Olympus History: VOL 1 The Origin of Endoscopes. [online] Available at: http://www.olympus-global.com/en/corc/history/story/endo/origin/.
  3. Schindler Gibson, U., 1988. Rudolf Schindler, MD: living with a Renaissance man. Gastrointestinal Endoscopy, 34(5).
  4. DiMarino, A.J., and Benjamin, S.B., 2002. Gastrointestinal Disease: An Endoscopic Approach. Slack Incorporated: New Jersey.
  5. Hirschowitz, B., 1961. Endoscopic Examination of the Stomach and Duodenal Cap with the Fiberscope. The Lancet, 277(7186).

Old and new surgical tools

Our Digitisation Project Intern expands on the previous post about Dr Harry Lillie’s medical bag.

The recent donation of a medical bag belonging to Dr Harry R.Lillie, a medical officer aboard whaling ships during World War Two, revealed some interesting stories. It also highlighted fascinating insights in the development of basic surgical instruments.

hr-kit-3

Dr Lillie’s surgical kit

Within the bag, one item drew much attention- a set of surgical tools (above). These tools drew attention not because of their scarcity, or obscurity, but because of their profound similarities to modern tools used today.

hr-kit-7

1939 or 2016?

A set of modern dissection tools was located and compared with the surgical tools found in Lillie’s surgical case. The designs of the tools are very similar, as are their materials. Modern dissection tools are made of stainless steel, as are Lillie’s. Most surgical instrument makers adopted stainless steel since its popularity grew in the 1930s. Even the canvas bags are remarkably similar.

kirstys-tools

2016 or 1939?

Apart from some signs of wear and tear, it is hard to believe these two surgical kits have over 75 years between them.

 

Dr Harry R. Lillie

We recently received an unusual donation, and one that holds an incredible story. A medical bag belonging to Dr Harry R. Lillie was generously given to the College, along with a copy of his book The Path through Penguin City (1955). In this blog post our Digitisation Project Intern Kirsty Earley explains its significance.

dr-hr-lillie

Dr Lillie’s medical bag

 

Dr Harry Russell Lillie was a surgeon and medical officer aboard British whaling ships in the Antarctic during the 1940s. Originally from Dundee, Lillie received his MB ChB from the University of St Andrews in 1939, previously graduating with a BSc Engineering in 1926.

hr-blood-pressure

Dr Lillie’s Baumanometer

He began his career at sea during the whaling season of 1946-1947. Serving up to 600 sailors at a time, Lillie was putting his surgical skills to good use at sea [1]. Life at sea was always busy, and certainly not a 9-5 job. Surgeons and medical officers had to be ready to deal not only with common illnesses contracted at sea, but also severe injuries of the whaling profession. It wasn’t unheard of for sailors to find themselves inside the mouth of the whale they were trying to hunt:

“Trapped with only his boots sticking out as the jaws came together, he got off with a moderately crushed chest and emphysema from the neck to the waist, but was back on his job in six weeks.” [1]

hr-kit-3

Dr Lillie’s surgical kit

As well as exercising his medical skills, Lillie was able to observe the conditions and methods of whaling in the Antarctic. The hunting of whales has been performed since prehistoric times, however the reasons for hunting whales has changed over time. Whales have been targeted as a food source for some communities, as well as being killed for oil and blubber.

The tools used to kill whales have evolved over the years. Lillie describes in detail the specific methods sailors used to take down their prey, and, as the true scientist he was, didn’t leave out any details. “Explosive Harpoons” were used to take down the whale instead of standard iron harpoons used previously. These harpoons had a delayed mechanism, where the spear would pierce the whale’s tissue, and then explode via implanted grenades after a few seconds. As would be expected with such a large mammal, death wasn’t immediate; often it required several hours for the whale to die after more than one harpoon fired.

Such scenes were the cause of Lillie’s campaigning for new whaling laws. He reported the horrific methods used to kill whales to make a clear point- things had to change. And things did change. His book The Path through Penguin City was published in 1955 and remains to be one of the most influential books in whaling conservation. Here he uses helpful imagery to explain the how horrible whaling was:

“If we can imagine a horse having two or three explosive spears stuck in its stomach and being made to pull a butcher’s truck through the streets of London while it pours blood into the gutter, we shall have an idea of the method of killing. The gunners themselves admit that if whales could scream the industry would stop, for nobody would be able to stand it.” [2]

It was this work that led to the formation of several conservation groups, including the International Whaling Commission, [3]. In fact, Sir David Attenborough has quoted Lillie’s work when discussing the still present inhumane methods of whaling [4].

With such an interesting background, it is safe to say that there is still much to discover about H.R.Lillie, his workings as a surgeon and as a conservationist.

References

  1. Lillie, H.R., 1949. With whales and seals. The British Medical Journal, 2(4642), p.1467-1468.
  2. Lillie, H.R., 1955. The Path through Penguin City. Benn Publishers.
  3. Society for the Advancement of Animal Wellbeing. Whaling. Available at: http://www.saawinternational.org/whaling.htm.
  4. Kirby, A., 2004. Whaling too cruel to continue. BBC News. [online] Available at: http://news.bbc.co.uk/1/hi/sci/tech/3542987.stm.

Foundations of the College Library

On 29th October 1732, a fire broke out in a house in Glasgow, next door to the home of one John Colquhoun, Clerk of the Faculty of Physicians and Surgeons of Glasgow. The fire spread quickly to Colquhoun’s house and many of Colquhoun’s possessions were burnt to a crisp. Also in Colquhoun’s possession at this time, and thus sadly lost to the fire, was the Faculty’s second minute book, covering the period 1688 to 1732. This leaves us today with a frustrating gap in the early records of the Faculty.

The lack of reliable records for the years between 1688 and 1733 makes it especially difficult to piece together the early history of the Faculty Library. The Library was founded in 1698, shortly after the first Faculty Hall was erected near the Trongate. We know, largely thanks to the efforts of the 19th century librarian Alexander Duncan, that the nucleus of the library was formed by donations from Faculty members and their well-to-do patients and friends. In Duncan’s book, Memorials of the Faculty (1896), he transcribes a manuscript listing “the names of such worthie persons as have gifted books to the Chierurgions Librarie in Glasgow”. Although Duncan notes that “many of [the books] are still on the shelves,” he does not provide a list of their titles, so it is difficult to know what the size and scope of the Library was like in its early years.

This is where our ongoing ESTC matching project comes in. As part of our work to match our current holdings to the records on the English Short Title Catalogue, library staff and volunteers have been closely scrutinising many of the pre-1800 titles in our collections. In the last month we have started looking at books from the Lister Room, and have rediscovered some important inscriptions indicating early donations to and purchases by the Faculty Library.

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The title page of Robert Bayfield’s “Exercitationes anatomicæ in varias regiones humani corporis”, with the autograph of Dr Peter Patoun.

In one diminutive volume, containing the first and second editions of Robert Bayfield’s Exercitationes anatomicae in varias regiones humani corporis (ESTC R31574 and R23670, respectively), we find an “Ex Libris” inscription dated 1687, belonging to Dr Peter Patoun. Dr Patoun (sometimes spelled “Patoune” or “Paton”) was a Glaswegian physician who graduated with an M.D. from Leiden in 1691 and became, according to Duncan, “one of the leading physicians in Glasgow”. He was Praeses (i.e. President) of the Faculty between 1709 and 1710, and is known to have donated a number of books to both the Faculty Library and the Library of the University of Glasgow. Although this is the first of his books we have identified here, a list of his donations to the university appears in volume 3 of Munimenta Alme Universitatis Glasguensis (1854, p.440).

Not all the donations to the library were from Faculty members. Our copy of the 7th edition of Philip Barrough’s The method of physick (ESTC S101230) features this fairly detailed inscription: “This book is gifted by the Lady Barrowfield Elder to the Chyrs of Glasgow – the Library, by the influence of Mr Henry Marshall … Bibliothecarius, Nov. 26 1705”. Both Lady Barrowfield and Mr Henry Marshall appear in the list of “worthie persons” to have donated books to the library, the latter listed as “Mr. Henrie Marshall, Chyrurgeon Apothecar”. According to the list, Marshall also persuaded the Earl of Wigton to donate some books, although we have yet to identify these.

These donations formed the nucleus of the library, and eventually the Faculty began buying books to further expand the collection. On the front flyleaf of Plantarum historiae universalis Oxoniensis pars tertia (ESTC R8391), we find this inscription, “Ex Libris Facultatis Chirurgorum Glasguensium, Londin: Empt. 1707”, marking out the 3rd volume of Robert Morison’s herbal as one of the earliest purchases for the Faculty Library. We’ve only just started matching Lister Room items to ESTC, so we are keeping our fingers crossed that more evidence about the Library’s early life is waiting to be uncovered.

Cause of Death?

Latest update on our Uncovering our Medical Instruments project by our Digitisation intern, Kirsty Earley.

Death is an unfortunate certainty for us all, but how people die often differs. Sometimes it is even a mystery. Mysterious deaths are not only found in crime novels, but also in real life, and it is the job of pathologists to solve these mysteries.

The process by which pathologists determine the cause of death is known as a Post-mortem Examination, or an Autopsy. They will examine every inch of the body for any clues as to how the individual died. As would be expected, the examination involves several stages, with several different techniques used to investigate the tissue. Tissue is sampled and checked for any abnormalities. The pathologist may also test to identify any poisons that may be present in the victim’s system.

 

Wooden case containing a 20th century post-mortem kit.

Wooden case containing a 20th century post-mortem kit.

 

The findings can then be used to assist in a court case, e.g. to convict a suspected murderer. Biological evidence like this, along with DNA profiling, gives the court a strong indication of what happened to the victim, and whether or not to convict or release the suspect.

This is clearly a combination of medicine and law working together to discover the truth. However, this relationship hasn’t always existed. There was a time when post-mortem examinations were rarely carried out by medical professionals, but instead those who had some form of legal background. This all changed due to the efforts of one man- Thomas Wakley.

Thomas Wakley (1795-1862), was a surgeon based in London and also a coroner for the region of Middlesex, (1). During the 1800s, the care for employees was much more relaxed, workers in industrial environments were at high risk of injury, even death. For example, when the railways lines were first built, many of the men constructing the lines died while on shift. And this death rate increased over time. Hence, Wakley took it upon himself to campaign for medical coronerships. This would mean that coroners would need to have some form of medical training, ensuring that the cause of death would be investigated on a legal and medical level. This would then hopefully reduce the number of deaths.

Scalpel blades (c.1900) used in post-mortem examinations

Scalpel blades (c.1900) used in post-mortem examinations

Unfortunately, Wakley did not see the day when his fight was won. It was not until 1926 that The Coroner Amendment Act was passed, and the requirement for coroners to be legally or medically trained was compulsory (2). And this is still the case today; coroners must either be qualified lawyers or doctors with years of previous experience, (3).

An example of a post-mortem examination kit was found within the collection of medical instruments here at the College. It contains an array of instruments that were used during a post-mortem examination, including a bone chisel, cartilage knife, and solid steel saw. This particular kit dates from 1900, and it is uncertain as to who it belonged to and whether they were trained in medicine or not.

hooks and papers contained in the post-mortem kit

hooks and papers contained in the post-mortem kit

Despite the fact that there was much debate over exactly who should investigate the cause of death, the role of the coroner was still of vital importance in order to bring out justice in the courtroom.

References
1. Cawthon, E.A., 2004. Medicine on Trial: A Handbook with Cases, Laws, and Documents. ABC-CLIO: California.
2. Sprigge, S., and Morland, E., 1926. House of Lords: Coroners Bill. The Lancet, 1, p. 630.
3. http://www.inputyouth.co.uk/jobguides/job-coroner.html

The Vapo-Cresoline Scam

Latest update on our Uncovering our Medical Instruments project by our Digitisation intern, Kirsty Earley.

Ever see advertisements that offer to solve all of your problems? “Live longer by taking this pill!”, “Grow back your hair with this miracle wax!” There are a variety of products out there that promise outstanding results, but do they actually work? Or is it all a con?

We have good reasons to be sceptical of certain healthcare products; the exploitation of people through the manufacturing of useless healthcare remedies is not a new story. In fact, it has happened several times throughout history.

One of the most popular examples is that of the Vapo-Cresolene lamp.

Vapo-Cresolene lamp with box

Vapo-Cresolene lamp with box

The lamp advertised as a cure for a variety of respiratory conditions, such as asthma and whooping cough. The idea was that it was a “Night Lamp”, providing light during the dark nights, but also providing a cleansing vaporised gas that opens up the airways and cures ailments.

The glass container at the base of the lamp was to be filled with kerosene, dousing the candle wick. The lamp would then be lit for 10-15 minutes to heat up. Then, the cresolene, which is derived from coal tar, would be placed in the vaporiser tray above the flame of the lamp. Over time the cresolene would vaporise into the atmosphere.

But did it actually work? Was there any evidence to show that this lamp helped to cure respiratory diseases while people slept? This product was manufactured by The Vaso-Cresolene Company, which was founded in 1879. It was advertised in such a manner that the vaporised form of cresolene had antiseptic “superpowers”, able to kill all germs incredibly efficiently. After an in-depth analysis of the chemical constituents of cresolene by the American Medical Association, it was discovered that the vapo-cresolene lamp used the simple disinfectant, cresol. Any such miraculous powers of this chemical were deemed false.

Box containing the Vapo-Cresolene lamp

Box containing the Vapo-Cresolene lamp

The popularity of the vapo-cresolene died out with time. However, these lamps can still be found in charity shops, antique shops, and even everyday households. So, have a look around and see if you can spot this false cure from history!

Risky Business for Treating Tuberculosis

Latest update on our Uncovering our Medical Instruments project by our Digitisation intern, Kirsty Early.

The lungs are vitally important for the proper running of the human body. They help us get essential oxygen to the cells of the body and rid of carbon dioxide waste. Lung tissue itself is very flexible, and must be in order to expand and deflate during breathing. The lungs can essentially be seen as two balloons sitting in your chest cavity.

Due to their importance, any form of damage to the lungs can ultimately be fatal. Tuberculosis (TB) is an infectious disease that targets the lungs, and, if left untreated, can result in death. It is caused by an airborne bacterium known as Myobacterium Tuberculosis. As this condition mainly affects the lungs, common symptoms include a persistent cough with blood in the sputum, fevers, and weight loss.

Today, TB is mainly an issue in developing countries, with fewer cases found in Europe and the West. However, there was a time during the 19th and 20th century when TB was a worldwide concern. Although TB can be dated back to ancient times, it wasn’t until 1882 that the specific bacteria involved in TB was identified by Robert Koch, [1]. The current treatment of TB involves the administration of antibiotics, but this only came into practice in the late 1940s, [2]. Modes of treatment prior to antibiotics were a tad more invasive.

Artificial Pneumothorax

Artificial Pneumothorax

One such method was the Artificial Pneumothorax, pioneered by Carlo Forlanini. Forlanini was an Italian physician who specialised in research into TB and the respiratory system. He, along with his brother Enrico, designed a new model of an artificial pneumothorax, which allowed him to attempt to treat TB with “Collapse Therapy”. This technique involved introducing nitrogen gas into a patient’s pleural space, a small space between the layers of fibrous tissue lining the lungs. This gradual build up in pressure external to the lungs resulted in a pneumothorax, more commonly known as a Collapsed Lung, [3].

Artificial Pneumothorax

Artificial Pneumothorax used to treat TB with “Collapse Therapy”

This was quite a risky procedure. Applying too much nitrogen gas could collapse the lung to such the extent that the patient could die of respiratory arrest. If so dangerous, why was it used as a method of treating TB for nearly 30 years? The idea was that if the lung size was decreased, the lung would be able to relax and recover, [3]. It is difficult to see this as a treatment for TB as it had no effect on the bacterial infection itself.

Although collapse therapy and the use of an artificial pneumothroax was revolutionary at one time, the method was ultimately replaced by antibiotics. This reflects the development of medical practice as a whole; replacing invasive methods with minimally invasive procedures.

 

[1] Koch, R., 1882. The etiology of tuberculosis. Berlin Clinical Weekly, 19, 221-230.
[2] Rakovich, G., 2010. Artificial pmeumothorax: tapping into a small bit of history. CMAJ, 182(2).
[3] Sakula, A., 1983. Carlo Forlanini, inventor of artificial pneumothorax for treatment of pulmonary tuberculosis. Thorax, 38, 326-332.