The Portable Ophthalmometer

Within our museum collection there are a variety of medical instruments, from the simple to the complex to the mysterious. One such mysterious item is the Thomas Reid Portable Ophthalmometer:

2003.77.30_thomas reid portable ophthalmometer

On first glance, this small instrument appears to be some type of pocket telescope! However, this device was designed for ophthalmic purposes rather than astronomical. An ophthalmometer is used to measure the curvature of the cornea, the transparent layer of the front of the eye, which would have aided with the diagnosis of astigmatism.

eye anatomy 900

Astigmatism is a very common condition of the eye where the shape of the cornea or lens is not circular, but more oval. This results in a distortion of vision. In fact, your favourite Digital Heritage Officer at the College has astigmatism in her right eye!
So, who was Thomas Reid? Dr. Thomas Reid graduated from the University of Glasgow in 1857, and became a fellow of the Faculty of Physicians and Surgeons of Glasgow in 1867. He began to work in general practice before working at the Glasgow Eye Infirmary as a house surgeon in 1868 [1]. It was here that he worked alongside the great Scottish ophthalmologist, William Mackenzie. His post involved putting together medicines, administrative work, bloodletting patients, and helping with surgeries when needed. He even followed in the footsteps of Mackenzie when he became the Waltonian Lecturer in Ophthalmology at the University of Glasgow, a post previously occupied by Mackenzie [2].
He was an incredibly well-read man and had a keen interest in mathematics, especially with regards to optics. This can be seen in the designs of the instruments he invented. His pocket ophthalmometer was demonstrated to the Ophthalmological Society of the United Kingdom, now the Royal College of Ophthalmologists, in 1886 and his paper on the instrument was read at the Royal Society of London by the then president, Lord Kelvin, in 1893 [3].
For such a small instrument, it is incredibly complex. An aspherical lens is situated in front of two rectangular prisms, through which the image of the cornea passes to the telescope at the opposite end of the device. Light shines through a disc at the side of the instrument, and the level of exposure can be altered at will. The curvature of the cornea is then measured manually by the ophthalmologist, who determines whether the patient has astigmatism or not.
Being a man who didn’t want a lot of public attention, it is understandable that Dr Thomas Reid is less well-known than his colleague, William Mackenzie. However, it is clear to see that Reid continued the excellency in ophthalmic practice and teaching that Mackenzie had established in Glasgow all those years ago.

 

References
1. Wright Thomson, A.M., 1963. The history of The Glasgow Eye Infirmary, 1824-1962. Glasgow: John Smith.
2. Buchanan, L., 1919. Thomas Reid, M.D. (1830-1911). The British Journal of Ophthalmology. Available at: <http://bjo.bmj.com/content/bjophthalmol/3/7/nil2.full.pdf&gt;.
3. Reid, T., 1893. On a Portable Ophthalmometer. Proceedings of the Royal Society of London, 53, 1-5. Available at: <http://rspl.royalsocietypublishing.org/content/53/321-325/1.full.pdf+html&gt;.

Artist in Residence: Month Two with Joseph Lister

Our Artist in Residence, Marianne MacRae, tells us more about her work at the College and how she is getting on with Joseph Lister. 

My second month here at the College has gone a little quicker than I might have liked which is why this blog is a touch later than I’d intended! According to my notes I’m on “Lister, Day 26” as I write this, which makes it sound as though Lister has become my metaphorical Everest. Gargantuan as his achievement was, I don’t think I need to don my snow shoes just yet. In fact, Joe and I are (tentatively) getting along quite well. I’ve slowly but surely been reading through his Collected Papers, which show a lovely turn of phrase about his writing – I’ve managed to work some of his words into a poem about urine, which I’m quite pleased with. I’ve also been battling through some handwritten lecture notes by his students, but must admit this has been very stop-start on account of the fact that some of the handwriting is atrocious! Imagine a continuous line that occasionally peaks and troughs. Reading it is not unlike watching a heart monitor actually, so maybe these guys were just really in tune with their own rhythms? Either way, I was able, after much squinting, to decipher an interesting entry about his technique for removal of the tongue (we all have a preferred method, right??) and the ways in which the antiseptic technique had to be adapted to deal with wounds in the mouth.

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Pic. 1: Terrible Victorian student handwriting hurts my modern eyes.

Blog Post Pic 2

Pic. 2:Comparatively great presentation skills from this student.

I’ve also been reading a biography of Lister written by Hector Charles Cameron, son of Hector Clare Cameron, a student and advocate of Lister during his time at Glasgow. It’s been great to read more about him from the perspective of someone who actually met him. Some of my favourite discoveries so far have been the brief glimmers of Lister’s character. For example, he survived a bout of smallpox, he had vertigo and he was a terrible timekeeper. These small, human details are really helpful in making a connection to a historical figure, allowing me to form a well-rounded impression of his personality, which I hope translates well into the creative work I’m producing. It also turns out Lister’s ancestors were from Bingley, West Yorkshire, about 15 miles from where I grew up. To be fair, this is of little relevance since my own ancestors are conversely all from Glasgow so there could be absolutely no crossover, but it was nice to read a familiar place name all the same!
Speaking of which, I’ve spent some time this month wandering around the city, trying to get a feel for the history of the place from its atmosphere. We came here a lot to visit family when I was growing up, but this is the first time as an adult that I’ve had the chance to really experience the city. And (don’t tell Edinburgh) I’ve already written more “place” poems than I ever have about anywhere else! When it’s not threatening rain, lunchtime down at the Clyde is just the right mix of bustling and serene. I really want to make sure Glasgow itself, now and in Lister’s time, becomes a central feature of the project.

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Pic. 3: Sunny Lunch at the Clyde.

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Pic. 4:  Sun disappears, I get soaked.

Outside of the writing itself, plans are currently being laid to put together a wee video that will draw together the different aspects of the residency; namely Lister, the heritage collection here at the College, the city and my own poetic output. It should be a very accessible overview of the project as a whole and I’m quite excited to get started with it! Similarly we’ve been discussing some workshops that I’ll be facilitating with a group of local school children, with the aim of encouraging a creative response to Lister’s work from them. However I shall save the details of that until we meet with the school and get their input on the project.
To end, I thought I’d share this quote I found in the Lister biography last week. Supposedly Lister said this when he was teaching students on his wards – a kind of self-fulfilling prophecy, perhaps? Either that or Cameron exercised huge poetic license and just pretended this was verbatim…I’ll let you decide!
“Trouble of the gravest kind is always apt to follow…when a wound of the skin is present. How is this? The man who is able to explain this problem will gain undying fame.”

Joseph Lister’s Impact on America

Sir Joseph Lister’s impact on the field of surgery was monumentous, applying the germ theory to humans and solving the mystery of why wounds so often got infected. By dabbing wounds with carbolic acid, as well as dressing the wounds in acid-dipped lint, Lister was able to stop the putrification of wounds and sepsis altogether. Today, it is easy to see how revolutionary his work was. However, Lister’s findings were not as well received at the time as one might think.

As soon as he published his initial papers on antisepsis in The Lancet in 1867, Lister received vast amounts of criticism from distinguished surgeons around the world. Despite having support from his colleagues and students, the number of people opposed outweighed them all. With all this opposition, it seemed almost impossible that Listerism would catch on [1]. But catch on it did, and this was in part due to the few individuals bold enough to stand up for Lister and employ his practices in antisepsis. One such man was that of William Halsted, one of the greatest American surgeons of all time.

William Halsted was born in New York City in 1852, and graduated from the College of Physicians and Surgeons in New York City in 1877. Before graduating from medical school, he obtained an internship at the Bellevue Hospital, an internship that was usually only offered to medical graduates. However, Halsted showed such potential that the hospital offered him the internship before he even graduated!

After graduating, Halsted became the house physician at the New York City Hospital, where after a year he travelled to Europe to study the practises of European surgery. Upon returning from his European travels, Halsted began to implement the practice of safe surgery in New York City. His regime was built upon the three pillars of surgery; anaesthesia to relieve pain, the prevention of haemorrhaging, and antisepsis to prevent wound infections. The latter, as we know, was introduced and pioneered by Sir Joseph Lister as a surgeon at the Glasgow Royal Infirmary.

Halsted copied Lister’s use of carbolic acid as a disinfectant not only to sterilise wounds, but also his surgical instruments. The downfall of using carbolic acid in antisepsis was its hazardous chemical properties. Although it was an effective antiseptic, carbolic acid was also corrosive and toxic. This meant that severe damage could be done to an individual from over-exposure. One example was that of Mr. Halsted’s wife, Caroline, who happened to be his chief nurse in the operating room [2]. In 1889, Caroline contracted severe contact dermatitis from using carbolic acid in the operating theatre. This condition is characterised by the formation of a rash alongside blisters. To overcome this issue, Halsted suggested that his wife wear rubber gloves in theatre to avoid skin contact with the carbolic acid. Not only did this move prevent Caroline’s dermatitis from worsening, but it also improved Lister’s antiseptic technique. This is the first known documented use of rubber gloves in surgery.

Why all this talk about William Halsted? Not only was he an advocate of antisepsis, but he was also a keen scientist, and introduced several new operations into the field. With these new operations were introduced adaptations of popular medical instruments, such as the artery forceps (haemostats). Artery forceps are essentially clips that are used to temporarily clamp blood vessels and arrest the flow of blood. Halsted designed his own form of artery forceps, known as the “Halsted Mosquito Forceps”, an example of which is held within the College’s museum collection:

 

2003.2.13_halstead artery forceps

 

This haemotstat is ratchetted and would have been used to block small blood vessels during an operation. The teeth of the handle allow the haemostat to be locked in place, meaning that the haemostat can clamp the vessel and stand alone, instead of having to be held for the entire operation. Halsted mentions in one of his publications that his instruments were immersed in carbolic acid to keep them sterile, and that the operator handling the instruments would have worn gloves to prevent the spread of infection [3]. Throughout his published works he reiterates the importance of Lister’s antiseptic technique and the part it plays in the practice of safe surgery.

It may have taken some convincing, but Lister’s findings on antisepsis proved to be true and not only impacted America, but the world.

 

References

  1. Rutkow, I., 2013. Joseph Lister and His 1876 Tour of America. Annals of Surgery, 257(6), pp. 1181-1187.
  2. Cameron, J.L., 1996. William Stewart Halsted: Our Surgical Heritage. Annals of Surgery, 225(5), pp. 445-458.
  3. Halsted, W.S., 1913. Ligature and Suture Material: The employment of fine silk in preference to catgut and the advantages of transfixion of tissues and vessels in control of haemorrhage, also an account of the introduction of gloves, gutta-percha tissue and silver foil. The Journal of the American Medical Association, 60(15), pp. 1119-1126.

The Curious Case of Mr. Tipple

Held within the College’s archive collection are a variety of patient case documents, ranging from the common to the peculiar. Practitioners often documented their cases for future reference or publication purposes.

One such publication within the archives that is particularly interesting is “An Account of a Case of Recovery: After the shaft of a chaise had been forced through the thorax”.

tipple case

Front cover of Dr.Maiden’s publication.

This book gives an account of a Mr. Tipple, who in 1812 was in a life-threatening accident where a metal shaft perforated his thorax and pinned him to the wall of a building. What makes this case more fascinating is the fact that he survived the accident! Flicking through the book the reader can find the account of the accident, Dr. Maiden’s examination notes, and the results of the post-mortem taken upon Mr. Tipple’s death in 1822.

The first statement within this book is that of Mr.Tipple, who gives an account of the events that led to his injury. He was arriving at the house of his friend at which point the horse pulling his cart became irritable. Trying to calm the horse, Mr. Tipple began to dissemble the cart:

“ I incautiously took off the bridle, as the first step towards disengaging the horse from the chaise and harness: the horse immediately became unruly…the horse made a violent plunge, and thrust me, by the end of the off shaft, against the part of the chaise-house which projects from the clump of out-buildings…at this instant, I felt the end of the shaft perforate my side, under my left arm…and I soon felt the end of the shaft pass from under my right arm, occasioning acute pain…” [1]

tipple illustration

Interpretation of how the shaft penetrated Mr. Tipple’s chest.

The shaft of the chaise had passed all the way through Mr. Tipple’s chest, exiting at about the level of his right arm pit. Witness accounts of the accident state that he was slightly suspended off the ground by the shaft, standing on his toes to relieve some of the pressure in his chest.

tipple case 6

Illustration showing the site of the accident. A) The position of the horse and chaise. B) The situation of Mr. Tipple. C) The end of the shaft penetrating into the chaise house.

Once the shaft was removed, Mr. Tipple entered the house and retired to the guest bedroom, where he removed his shirt and lay back slightly on the bed. It was at this point that he experienced periods of dyspnoea (difficulty breathing) and began to feel faint. The doctor arrived 10 minutes after the accident occurred, and on examining the wounds found there to be an escape of air-filled blood.

In attempt to relieve his difficulty in breathing, doctors frequently drained blood from his body and did so by opening a vein in his right arm. This procedure gave Mr. Tipple immediate rest and his breathing would return to normal. (At this time in history, bloodletting was the go to procedure for a variety of ailments, but in this case it was done to reduce internal haemorrhaging in the chest. The practice of draining the chest via a chest tube was not made popular until the 1950s, which could be why Dr. Maiden let blood from the arm instead).

chaise illustration

Illustration showing the portion of the chaise that pierced Mr. Tipple’s side.

For weeks the situation was the same; Mr. Tipple would experience bouts of dyspnoea and his blood would be drained to relieve the pressure. This continued for the rest of his life, along with periods of cardiac arrhythmia, which ended 10 years after the accident, in 1823.

On examination of the body during the post-mortem, it was visible that the shaft had entered the thoracic cavity between the second and third ribs through the second intercostal space, and exiting on the right hand side via the second intercostal space. The holes in the intercostal muscles created by the shaft had been closed over by a clear membranous tissue to which the lungs adhered. This was most likely scar tissue. The lungs themselves were intact and had not been punctured by the shaft because of its blunt end. The blunt end would not have been sharp enough to actually damage the lung tissue, which would have simply been pushed out of the way. Mr. Tipple’s heart was also untouched by the shaft; however there was some hypertrophy in the region of the right ventricle. This would suggest that Mr.Tipple’s death was a result of heart failure caused by a fibrosis of the lungs. This fibrosis (scarring and stiffening) of the lungs would have been a result of trauma from the accident ten years before. The breathlessness that he experienced after the accident was due to a pneumothorax induced by the sucking chest wound from the shaft penetration.

A curious case indeed, it is a mystery how Mr. Tipple not only survived the trauma, but also the volume of blood that was drained from his body during treatment. Although such an accident could easily recur, (maybe not in the exact same circumstances), healthcare today is much more advanced and more than capable to properly diagnose and treat such cases.

For more details about Mr. Tipple’s case and the above document, feel free to contact us at: library@rcpsg.ac.uk

Many thanks to doctors-in-training, Jenny Crabbe and Rosie Jacks, for their expertise and guidance on this patient case.

 

References

  1. Maiden, W., 1824. An Account of a Case of Recovery after the Shaft of a Chaise had been Forced through the Thorax: to which is now added a statement of the health of the sufferer from the period of his recovery until his decease: with the appearances of injured parts after death. Carpenter&Son: London.

 

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.