Joseph Lister, Glasgow and the Birth of Antiseptic Surgery

2017 marks 150 years since Joseph Lister published his ground-breaking article “Antiseptic Principle of the Practice of Surgery” in the medical journal, The Lancet. To mark this occasion our annual Goodall Symposium will be celebrating Joseph Lister and his outstanding contribution to antiseptic surgery.

There is, arguably, no more appropriate place to celebrate the beginnings of antiseptic surgery than in Glasgow as it was in Glasgow Royal Infirmary that Lister first started using carbolic as an antiseptic, heralding the beginnings of a surgical revolution.

Lister ward at Glasgow Royal Infirmary c.1900

Lister ward at Glasgow Royal Infirmary c.1900

Based on Louis Pasteur’s research into fermentation, Lister began covering wounds in dressings containing carbolic acid which was known to prevent putrefaction in substances of animal origin. His first attempt was a failure but with his second patient, an eleven year old boy, Lister succeeded. As part of the patients treatment, pure carbolic acid on calico was applied to all areas of the wound – the wound healed; there was no infection, no gangrene and so amputation was avoided.

Lister continued to expand his use of carbolic acid using a steam spray (pictured below) to spray the air in his operating theatre. He was particularly driven by his intense revulsion towards the conditions of the surgical rooms and wards at Glasgow Royal Infirmary and devoted his full attention to reducing cross infection. Poor sanitation in 19th century hospitals meant patients were at serious risk of contracting diseases such as pyaemia, gangrene and tetanus. Lister was constantly battling with the managers of the Glasgow Royal Infirmary over the poor conditions of the wards and in 1870 wrote a letter to the Lancet entitled On the effects of the antiseptic treatment upon the salubrity of a surgical hospital, where he described the wards at the Royal as “some of the most unhealthy in the Kingdom”. The wards had been built over cholera burial pits and were close to the pauper burial pits at Glasgow cathedral. Lister also stated that the wards had not been properly cleaned for three years and were dreadfully overcrowded.

A Lister carbolic spray c.1870

A Lister carbolic spray c.1870

Lister’s success with antiseptic procedures revolutionised the treatment of disease and injuries.

Join us to celebrate 150 years of safer surgery!

Lister continues to be an inspiration to many of today’s doctors and surgeons and we are delighted to welcome Mr Pankaj Chandak, Specialist Registrar in Transplant Surgery at Guy’s, St Thomas’ and Great Ormond Street Hospitals and Research Fellow at Kings College London, to deliver the Goodall Lecture. Mr Chandak is passionate about Lister’s achievements and his legacy in surgical safety, linking the innovations of the 1860s with today’s developments in 3-D printing, robotics and perfusion machines. You can see more of Mr Chandak here – https://www.youtube.com/watch?v=JKUIvt9DI_Q

Setting the context of Lister’s 1867 article is Mr David Hamilton, transplant surgeon, medical historian, and author of the classic text The Healers: a History of Medicine in Scotland.

Our Goodall Symposium takes place on the 15th June 2017.
Time: 7pm (refreshments from 6:30pm)
Price: Free
To book contact library@rcpsg.ac.uk or call 0141 221 6072.

Our Goodall Symposium is part of the Glasgow Science Festival 2017.

Flyer advertising the Goodal Symposium

Glasgow Surgical Instrument Makers

One of the themes for this year’s Doors Open Day Festival in Glasgow is industrial heritage.  The College museum collection contains many items relating to surgical instrument makers during the 19th century and several of these items are on display in the College’s Crush Hall until the end of September.

Designated surgical instrument makers appear in Glasgow from around the beginning of the 19th century. W.A. Norie, for example is known to have been established at Hutcheson Street, Glasgow, by 1801. The rise in instrument makers coincides with the growth of Glasgow as a large industrial city and the establishment of hospitals, clinics and surgeries to care for the growing population. Glasgow Royal Infirmary opened its doors to patients in 1794 and remained the main city hospital until the second half of the 19th century; the Western Infirmary opening in 1874 and the Southern General in 1890. The variety of instruments manufactured by the Glasgow makers demonstrate the great advance in surgical techniques that occurred from the second half of the 19th century onwards, often developed in conjunction with local surgeons.

Scalpel by Norie, Glasgow, early 19th century. Liston amputation knife and dental forceps by James Dick, Glasgow 19th century.

Scalpel by Norie, Glasgow, early 19th century. Liston amputation knife and dental forceps by James Dick, Glasgow 19th century.

W.B. Hilliard and Sons were the largest surgical instrument maker in Glasgow during the 19th century. The firm was known for its fine workmanship and was awarded several medals and prizes in exhibitions in both Glasgow and London. Originally established in Buchanan Street in 1834, the firm subsequently moved to Renfield Street. The firm worked closely with local surgeons to perfect and introduce new instruments and also imported items from specialist manufacturers in Europe. By 1888 Hilliard and Sons was said to supply ‘with but few exceptions, all the principal infirmaries, asylums and institutions in Scotland with surgical instruments and fine steel goods’. In addition to surgical instruments the firm also patented and sold two different types of ice skate.

Haemorrhoid forceps manufactured by W.B. Hilliard, 19th century

Haemorrhoid forceps manufactured by W.B. Hilliard, 19th century

W.B. Hilliard took a keen interest in the development of surgical instruments and was keen to perfect the items he manufactured. He published a paper in the Glasgow Medical Journal in 1859 “On lithotomy instruments”.   The rectangular lithotomy staff had been developed for Dr Andrew Buchanan in 1846 (President of the Faculty of Physicians and Surgeons of Glasgow 1877-80). Hilliard considered the rectangular staff to be ‘the greatest improvement which has been made in lithotomy instruments since the use of a staff in the operation was first discovered’. In comparison to the previous curved version: ‘It affords the shortest route to the bladder; it gives ready and certain access to the knife; and offers no obstruction to the passage of the knife’.

Part of lithotomy set by W.B. Hilliard and Sons

Part of a lithotomy set including rectangular staff by W.B. Hilliard and Sons

Hilliard also manufactured a form of lithotrite for crushing bladder stones in situ.  The lithotrite had been devised by French surgeon Jean Civiale (1792–1867) who, in 1832 performed transurethral lithotripsy, the first known minimally invasive surgery, to crush stones inside the bladder without having to open the abdomen (lithotomy). This particular lithotrite is an example of one developed by Scottish surgeon Sir William Fergusson (1808-77), Professor of Surgery at King’s College, London. The key is inserted into the main screw shaft to lock it. The set belonged to Sir George H.B. McLeod (1828-1892), Regius Professor of Surgery at the University of Glasgow, 1869-1892 who entered the Faculty of Physicians and Surgeons of Glasgow in 1858.

Lithotrite and key manufactured by W.B. Hilliard, c. 1860.

Lithotrite and key manufactured by W.B. Hilliard, c. 1860.

Tinsmith Andrew Brown based in George Street, Glasgow was a familiar figure at the Glasgow Royal Infirmary during the last half of the 19th century/early years of the 20th century.  As a boy he had worked for Joseph Lister when Lister was at the Glasgow Royal Infirmary. Brown’s sterilizers were used in the Glasgow Royal Infirmary and many nursing homes. The College has an example of a foot warmer made by Brown in the early years of the 20th century.

Foot warmer made by tinsmith Andrew Brown.

Foot warmer made by Andrew Brown, early 20th century.

Optometrists Black and Lizars are celebrating their 185th anniversary this year.  John Lizars (1810-1879) set up shop as an optician in Glassford Street in 1830. By 1859 he was selling spectacles, eyeglasses, telescopes, microscopes, barometers, thermometers and a ‘great assortment’ of other items.

Sight testing set by Lizars. On loan from Black & Lizars optometrists.

Sight testing set by J. Lizars. On loan from Black & Lizars optometrists.

The firm was subsequently directed and expanded by Lizars’ son-in-law, Matthew Ballantine and his successors. In 1999 Lizars merged with C. Jeffrey Black to form Black & Lizars with a combined total of more than twenty branches mainly in the West of Scotland. Black & Lizars have kindly loaned glass eyes and sight testing equipment especially for our display.

Glass eyes manufactured by Lizars, Glasgow. On loan from Black & Lizars optometrists.

Glass eyes manufactured by Lizars, Glasgow. On loan from Black & Lizars optometrists.

John Trotter set up business in Gordon Street, Glasgow in the 1880s with a branch opening in Edinburgh in the 1920s. Trotter was a pioneer in many branches of optical science and he also advised hospitals on the instillation of X-ray apparatus.

Newman’s cytoscope for examination of the bladder by John Trotter Ltd.

Newman’s cystoscope for examination of the bladder by John Trotter Ltd.

Ophthalmic surgeon Hugh Wright Thomson worked with Trotter to develop the skiascope which he used initially for eye examinations in school children although he subsequently also found it helpful for adults in hospital refraction work. A long stem was attached to its centre and the circular frame was fitted with twenty of the lenses most commonly used in retinoscopy (technique to objectively determine the refractive error of the eye – farsighted, nearsighted, astigmatism – and the need for glasses).

Skiascope developed by Hugh Wright Thompson in conjunction with John Trotter

Skiascope developed by Hugh Wright Thompson in conjunction with John Trotter, 1905

Trotter died in 1940, the firm continuing in operation until it was acquired by Black & Lizars in 2014.

For further information about any of the items described in this blog please email library@rcpsg.ac.uk

 

 

Glasgow’s contribution to radiology

The college’s triennial conference, Advancing Excellence in Healthcare, takes place at the SECC in Glasgow on the 19th and 20th June 2014. To celebrate, we’ve been running a series of blogs relating to the History of Medicine symposium which is focusing on Glasgow’s contribution to medicine. This week we turn our attention to Professor Ian Bone’s talk on “Macintyre and the world’s first radiology department”.

John Macintyre was born in High Street, Glasgow in 1857. He initially trained as an electrician under the tutelage of Lord Kelvin before going on to complete his degree in medicine at the University of Glasgow in 1882. It was this interesting combination of expertise that placed Macintyre at the forefront of the development of radiology.

Sketch of Dr John Macintyre

Sketch of Dr John Macintyre

Professor Wilhelm Roentgen, a German physicist, first discovered x-rays in the November of 1895 whilst studying electrical effects on vacuum tubes. Roentgen sent details of his discovery to Lord Kelvin who passed the information on to Macintyre. At this time, Macintyre was employed by Glasgow Royal infirmary as their Medical Electrician and he very quickly grasped the significance of the discovery – In March 1896, only a few months after the discovery of x-rays, Macintyre obtained permission from the hospital managers to establish an x-ray laboratory, creating the first x-ray unit in the world to provide a service to patients.

electrical department at Glasgow Royal Infirmary c.1914

Electrical department at Glasgow Royal Infirmary c.1914

Macintyre was a pioneer of x-rays and is credited with taking the first x-ray of a kidney stone in-situ, a foreign body (halfpenny stuck in the gullet of a child), and the first cineradiogram showing the movement of a frog’s legs.

We hold many items relating to Dr John Macintyre and his work in our collections but perhaps the most interesting (and fragile!) is a set of high voltage vacuum discharge tubes used by Macintyre at the Glasgow Royal infirmary to create x-rays.

high voltage vacuum discharge tubes used by Macintyre

3 high voltage vacuum discharge tubes used by Macintyre

In recognition of his achievements he was made President of the Roentgen Society, Doctor of Laws of Glasgow University, President of the British Laryngological and Rhinological Society (Macintyre also specialised in otolaryngology and opened a very lucrative private practice at 179 Bath Street, Glasgow), and a Fellow of the French and American Associations. He became a Fellow of our College (then Faculty) in 1918.

Dr John Macintyre’s signature in our Register of Fellows

Dr John Macintyre’s signature in our Register of Fellows

To find out more about the History of Medicine Symposium, or for more information and booking details for the triennial conference, please visit the Advancing Excellence in Healthcare website: http://aeh2014.rcp.sg.

Rebecca Strong – remarkable nursing pioneer

Rebecca Thorogood was born on the 23 August 1843 in London.  She married and had a daughter before the age of 20.  Very little is known about her husband apart from his surname, Strong, and the fact that he died within a couple of years of marriage and was buried in Liverpool.

Widowed at a very young age, Rebecca Strong decided to go into nursing and was accepted as a probationer at the Nightingale Training School which had started in 1860 at St Thomas’ Hospital in London.  In 1868, following her training, she gained nursing experience at Winchester and at the British Army hospital at Netley, being appointed matron of the Dundee Royal Infirmary, in 1874.  At Dundee, Rebecca Strong was able to introduce new nursing practices (see the Dundee Women’s trail for further information about her time in Dundee).

In 1879 Mrs Strong was appointed matron at Glasgow Royal Infirmary, the largest voluntary hospital in Scotland.  Attracted by the challenge, when she arrived in Glasgow she was shocked to find how backward the Infirmary appeared in relation to its nurses.  She devoted her energies to improving nurse education and training and working conditions.

An example of the letters from Mrs Strong to Sir William Macewen in the College archive (RCPSG 10/1A/128/49)

An example of the letters from Mrs Strong to Sir William Macewen in the College archive (RCPSG 10/1A/128/49)

Letters from Rebecca Strong can be found in the papers of Sir William Macewen in the College archives.  The relationship between the two could at times be stormy but they greatly respected one another.

In January 1891, Macewen gave an address at Glasgow Royal Infirmary on the subject of “Nurses and Nursing”.  A copy of the address is in the College archive (RCPSG 10/1A/129/11).  In the lecture he said “Cannot nursing be raised to a distinct profession, with its entrance examination, its minimum requirements, theoretical and practical, its teachers, its examiners and its diploma?”  He also felt that  nursing was specially suited for women: “Nursing is, beyond all cavil, a sphere for women’s work; indeed man can scarcely enter there . . . one can scarcely expect a man to be a nurse, as his instincts and training do not suit him for it . . .  A woman possesses such a magnificent compass of susceptibilities, is so full of human sympathies and soft compassions, if her life is not to be a barren wilderness she requires opportunities to enable these to expand”.

With the support of Macewen, Rebecca Strong initiated the ‘block apprenticeship’ training programme, later adopted world-wide.  Short periods of instruction in the hospital school was followed by periods of practice on the wards.  This was a great improvement on previous nurse instruction whereby nurses were expected to attend lectures and study while still working long hours on the wards.  The pioneer Preliminary Training School was opened in January 1893 under an arrangement between Glasgow Royal Infirmary and St Mungo’s Medical College.

Mrs Strong Medal in Medical Nursing

Mrs Strong Medal in Medical Nursing

In 1942 the Macewen medal in surgical nursing and the Mrs Strong medal in medical nursing were established at Glasgow Royal Infirmary to commemorate the pioneer work of Macewen and Strong in elevating nursing to the status of a profession.

Rebecca Strong was a strong supporter of State Registration for nurses which eventually happened in 1919.  She also worked for the improvement of the social life of nurses and was the moving spirit, along with Sir William Macewen, in the opening of a club for them in Glasgow in 1918.  In 1939, at the age of 95, she was awarded the O.B.E.  and celebrated her 100th Birthday on 23 August 1943.  She died almost exactly a year later, on 24 April 1944.

Further biographical details about Rebecca Strong can be found on the Royal College of Nursing website

For those wishing to find out more about the early years of nursing, digitised copies of the The Nursing Record/British Journal of Nursing can also be found on the Royal College of Nursing website.

The College Library holds books on the history of Glasgow Royal Infirmary and also has some archive material relating to the hospital.  The administrative records of Glasgow Royal Infirmary (including registers of nurses) are in the NHS Greater Glasgow and Clyde Archives.