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.

Uncovering our Medical Instruments

We recently appointed a Digitisation Project Intern for Uncovering our Medical Instruments, a project which aims to make our collections much more accessible and visible. Kirsty will be photographing and researching our instrument collection, and sharing them as much as possible, via this blog, @RCPSGlibrary and the Museum Collection pages on our website.

Opthalmic Mask Higher Exposure

Ophthalmic Phantom, c1900 – 1920 (for teaching eye surgery)

The project will delve into our Instrument Store to uncover medical and surgical instruments and equipment that is rarely seen. These collections date from the 18th – 20th century, many with a link to Glasgow. As well as making these collections more visible online, the project will also contribute to our exhibition programme and pop-up displays.

Photography set up 3

Pop-up studio

So far Kirsty has been trying out some new kit and testing backgrounds. Many of the instruments are metallic so achieving the right conditions for digitisation can be challenging. The collections also vary in size, from tiny surgical needles to heavy respiratory equipment. Some items can’t be displayed traditionally, so we will develop digital displays to complement our exhibition space.

WT microscope side view high contrast

Wilson Type Microscope

Uncovering our Medical Instruments is a nine month project, kindly supported by Museums Galleries Scotland. During that time, we hope to provide access to hundreds more instruments from our collections.

What led Laennec to invent the wooden stethoscope?

This year our annual Goodall Symposium (16th June 2016) will be celebrating the 200th anniversary of the invention of the first stethoscope. We’ll be taking a look at the origins of the stethoscope and how the methods and technologies for listening to the heart have developed over the last 200 years. In this blog our Honorary Librarian, Mr Roy Miller discusses why the stethoscope was invented.

Laennec stethoscope

Made of wood and brass, this is one of the original stethoscopes belonging to Laennec.
Image from: Science Museum London / Science and Society Picture Library

The stethoscope was invented in 1816 by French physician, René Théophile Hyacinthe Laennec. While a physician in Paris, Laennec was examining a woman with an apparent heart condition and found that he was unable to use hand or ear to examine the patient without embarrassment. He records the event thus:-

“In 1816 I was consulted by a young woman labouring under general symptoms of diseased heart, and in whose case percussion and the application of the hand were of little avail on account of the great degree of fatness. The other method just mentioned [the application of the ear directly to the chest] being rendered inadmissable by the age and sex of the patient, I happened to recollect a simple and well-known fact in acoustics, and fancied, at the same time, that it may be turned to some use on the present occasion. The fact I allude to is the augmented impression of sound when conveyed through certain solid bodies – as when we hear the scratch of a pin at one end of a piece of wood, on applying the ear to the other. Immediately, on this suggestion, I rolled a quire of paper (24 sheets) into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised that I could thereby perceive the action of the heart in a manner much more clear and distinct than I had ever been able to do by the immediate application of the ear.”1

Laennec soon replaced the rolled up paper cylinder with a hollow wooden tube. This had a small hole at one end and, at the other, a conical hollow. A plug fitted into the hollow to allow the physician to listen to the sounds of the heart. When removed, the physician could listen to the sounds of the lungs. Unlike its modern equivalents it was designed to be listened to through only a single ear so it did not have the familiar Y-shaped double earpiece. The original stethoscope could also be unscrewed in the middle for carrying in the pocket.

Illustration from De l' auscultation mediate (1819) by Laennec showing his design for a wooden stethoscope.

Illustration from De l’ auscultation mediate (1819) by Laennec showing his design for a wooden stethoscope.

In the 1820s the Glasgow Medical Journal reported on the introduction of the stethoscope to Glasgow medicine, pointing out that the tool was at first “suspected, ridiculed, and sometimes abused as a piece of pompous quackery.” By the late 1820s such suspicions were dismissed as use of the stethoscope grew. By the 1850s, the stethoscope had become one of the doctor’s most vital tools.

The Goodall Symposium takes place in the College on the 16th June 2016 @ 6:30pm. It’s free to attend but please book your place for catering purposes – please contact library@rcpsg.ac.uk or call 0141 221 6072. You’ll also have the chance to see our latest exhibition which focuses on the development of the stethoscope over the years.

This years Goodall Symposium is part of the Glasgow Science Festival 2016.

1. Laennec RTH. De l’’auscultation mediate. Paris : Chez J.-A. Brosson et J.-S. Chaudé, 1819

Veedee Massager, c1903

This week we are displaying a rarely seen item from our collections, the Veedee Massager from c1903. The Massager comes in a purple velvet-lined box, with attachments (including cup and ball), polishing cloth and oil.

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Veedee Massager and polishing cloth, c1903 (RCPSG)

 

There is a handy instruction booklet – The Veedee and How To Use It which gives detailed guidance on how the instrument can cure or relieve a wide range of conditions, from cold and headache, to digestion problems and hysteria. The booklet informs us that it can be used for “curative vibration, vibratory massage, nerve stimulation and blood circulation.”

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The Veedee and How to Use It (RCPSG)

 

There are also chapters that claim it can be used to enhance beauty, treating baldness, double chins and wrinkles.

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From The Veedee and How to Use It (RCPSG)

 

The Veedee was widely advertised between 1900 and 1915, during which time there was a craze for vibration therapies and circulation stimulators. We also have in our collections an example of Dr Macaura’s Blood Circulator (also known as Macaura’s Pulsocon), from the early 1900s. It was claimed to cure a range of conditions, for example heart disease, deafness, paralysis and polio.

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The Veedee Massager pop-up display in RCPSG Library

 

Our Veedee Massager was manufactured in Germany and distributed by The Veedee Co., 96 Southwark Street, London. It was originally purchased from J. C. Pottage, photographic chemist and optician, Edinburgh, as an early treatment for multiple sclerosis.

Emergency Surgery – The Trephine

Trepans and trephines have been used to treat head trauma and other conditions for thousands of years. Our current exhibition A History of Emergency and Trauma Surgery contains a display case dedicated to trephination (as well as illustrations of head injury procedures). Practical Cases and Observations in Surgery (1751) by Percival Potts reports successful use of trephination to treat serious head injury caused by a kick from a horse, a common and very serious injury. Potts’s Chirurgical Works (1779) contains an illustration of trepan procedure on a patient (who looks understandably anxious).

Another variant of the trepan can be seen in the 2nd edition of College founder Peter Lowe’s book The Whole Course of Chirurgerie (1612) . In its Sixth Treatise, Chapter 10, ‘Of Woundes in the Head’, Lowe expresses caution in the use of the instrument, which at the time was quite commonly used to relieve pressure on the brain resulting from depressed fracture. In line with the general focus of his book, Lowe is concerned about unskilled surgeons carrying out the procedure. Looking at the array of instruments illustrated below, it is easy to see why.

 

A trepan with other instruments for the head - Copy

From The Whole Course of Chirurgerie (2nd edition) (1612) by Peter Lowe

 

Our exhibition also features our 18th century trephine set (below). The set was made by Edward Stanton of Lombard Street, London, between 1738 and 1744. The difference between the trepans as shown above, and the trephine below, is described by John Woodall in his book The Surgeon’s Mate (1639). Woodall claimed to have invented the modern trephine, outlining the improved features of the new instrument. The trephine handle was t-shaped rather than a two-handed brace-and-bit, meaning the tool could be used with one hand. Next, the cutting head was cone shaped, making it easier to extract the disc of bone from the skull. Also, to improve cutting, spiral grooving and spiral cutting teeth were used.

20151214_121450-1 - Copy

As well as the four trephines of different sizes and handle, the set contains a perforator, a double ended elevator, raspatory, lenticular, extracting forceps, and a brush, used to clean the trephine teeth.

Similar instruments were used well into the 20th century. The illustration below from a 1950s edition of Surgical Instruments and Appliances used in Operations by Burrows and Raven shows a very similar instrument to that in our set.

 Our exhibition is in the College’s Crush Hall until the end of April 2015. To visit please get in touch by emailing library@rcpsg.ac.uk or calling 0141 221 6072. Alternatively, pop in on a Monday afternoon between 2pm and 5pm.