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.

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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!

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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]

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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].

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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.

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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.

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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.

Maister Peter Lowe and Glasgow

Our first event of 2017 will be an informal gathering in College Hall on Thursday 19th January to hear our Honorary Librarian, Mr Roy Miller, discuss our founder Maister Peter Lowe and the town of Glasgow, c1599.

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We will hear about the background of this intriguing man, his arrival in Glasgow from France in the 1590s, and what compelled him to petition King James VI to set up what became the Royal College of Physicians and Surgeons of Glasgow in 1599. Lowe’s education and surgical training in France, and his writings on the practice of surgery, played a key role in how medicine and surgery developed in Glasgow at this early stage.

The event will take place in our College Hall, which features portraits of our founding members and of James VI. In addition, there will be a pop-up display of historical collections relating to our early history, for example our first Minute Book (1602 – 1688), rare copies of Peter Lowe’s 16th century surgical texts, and a pair of gloves belonging to the founder.

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Detail of first College Minute Book, summarising 1599 Charter (1602)

Our event is part of St Mungo Festival, now in its ninth year, which celebrates the life of St Kentigern, better known as St Mungo, patron saint of Glasgow. Find out more about the Festival and its programme of events at the St Mungo Festival Facebook page.

Here are the details of the event:

Date – Thursday 19th January 2017

Time – 12.30 – 1.30 with refreshments served afterwards

Venue – Royal College of Physicians and Surgeons of Glasgow, 232-242 St Vincent Street, Glasgow G2 5RJ

To book – Email library@rcpsg.ac.uk or phone 0141 221 6072. This is a free event but places are limited.

16th Century Surgery & Comic Creation

Origin / foundation stories are so important to an organisation’s identity.  The foundation story should always address the questions – Why do we exist? Why do we do what we do? This theory has been well-used in marketing and branding, from products such as drinks and shoes, to film and literary franchises. We’re lucky at the College to have a very clear link from our foundations in 1599 to our current aims – to set the highest possible standards of healthcare.

Flyer for the event Glasgow's Marvellous Medicine - A comics workshop with Adam Murphy

Yet, there are challenges in how we communicate this. How do you engage audiences with the origins of a 16th century medical and surgical college? In November we worked with leading comic book artist and writer Adam Murphy for a creative workshop with families. Inspired by the 16th century foundations of the College and its enigmatic founder Maister Peter Lowe, Adam led us on a journey of comic creation. Under the gaze of the Maister himself in our College Hall, Adam used Lowe’s 1597 book The Whole Course of Chirurgerie and our 1599 Royal Charter to create graphic stories of surgical and medical improvement.

We invited families along and the event sold out very quickly, mainly through social media promotion and Glasgow event listings. It was important for us to hold the event in our main historical space, College Hall, where portraits of our 16th century founders are on display.

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The workshop kicks off in College Hall

 

Adam kicked things off by setting the scene of a character seeking medical care in the 16th century, and the various options available: the heavy-handed barber-surgeon, the expensive physician, or the unpredictable remedies of folk medicine. Then, via our 1599 Charter, he introduced the idea of surgical training and licencing of practitioners. Never before have the words “Out of the way, losers!” been attributed to the College founder!

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Adam’s initial rough sketches

 

The young people and adults taking part got hands-on instruction on the basics of comic creation, how to build characters, sequence stories, and most importantly, to take risks and make mistakes.

Participants spent some time viewing a pop-up display of our surgical instruments and old medicine cabinets, sketching these and incorporating them into their own stories. The audience chose a large amputation saw as the item for Adam to demonstrate some drawing tips (capturing the impact of the saw’s teeth, for example!).

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Viewing and sketching museum collections in the Lower Library

Wild ideas and the creative imagination took over, and participants let loose with a whole range of comic strip stories, all of which retained a link to the medical and surgical foundations of the workshop. Adam captured some of these ideas – particularly the introduction of a unicorn character which gets its horn cut off by a careless barber-surgeon.

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Adam capturing some audience ideas

The event was a great way to engage a completely new audience with our early history. Participants left knowing much more about the College’s place in Glasgow’s history and in Scotland’s medical history. And our feedback shows that many went home to draw more comics! We look forward to developing further creative events to open up our heritage and collections to a wider audience.

Find out more about Adam’s work at www.adammurphy.com.

The event was kindly supported by Scottish Book Trust’s Live Literature Scotland scheme.

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Festival of Museums 2016 – Glasgow’s Marvellous Medicine

We’re really looking forward to taking part in Festival of Museums again and this year we’ll be trying something a little bit different! We’ll be transforming our beautiful College Hall into a pop-up museum showcasing Glasgow’s amazing contributions to the world of medicine (antiseptic surgery, brain tumour operations, x-ray units and so much more all have connections to our city).

Ink drawing of College founder Peter Lowe

Scottish surgeon, Peter Lowe – Founder of our College in 1599 and author of the first general surgical text to be written in English.

There’ll be lots of interesting items on display including an apothecary’s cabinet filled with potions, some amazing rare books and some very gruesome looking surgical instruments. There’ll also be the chance to meet some famous faces from Glasgow’s medical past including Joseph Lister, pioneer of antiseptic surgery, Scottish surgeon and founder of our College in 1599, Maister Peter Lowe, nurse Rebecca Strong and even King James VI!

Lots of fun for all the family!

Saturday, 14th May 2016. Open 10am-4pm

For more information on all the other amazing events taking places as part of Festival of Museums 2016 please visit www.festivalofmuseums.com.

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.

 

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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.

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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.

A Tradition of Fine Dining

Dinners and social events have been a long tradition of College life.  In the College archives there is a dinner book which describes many of the magnificent dinners attended by Fellows and Members and their guests. Before the move to St Vincent Street in 1862, the annual Faculty Dinner was held in a local hotel.  In 1855, for instance, the dinner was held in Mr James Carrick’s Royal Hotel 66 George Square, Glasgow, the cost for 26 being £27.6s.0d.

With the move to 242 St Vincent Street, the Faculty could dine at home and a Dinner Book covering the period 1865-1932 records the menus and “Names of the Gentlemen Invited to the Annual Dinner”.  The dinner held on the 9th October 1865 merited an article in the local newspaper which has been duly cut out and pasted into the Dinner Book.  The dinner, described as a “banquet” was attended by 38 Fellows of the Faculty and guests and included a range of city dignitaries including the Lord Provost, the City Chamberlain, the Dean of Guild,  the Deacon Convenor of the Trades House and the Dean of the Faculty of Procurators.  Following a “sumptious dinner”, numerous speeches and toasts were given.  The President, Dr Fleming, in his toast of Flores res Medica, declared that: “Probably at no date since the days of Hippocrates has there been a more practical improvement to medicine and surgery than since the beginning of the present century”.

The earliest menu in the Dinner Book is that of the annual dinner of 29th November 1871.  The Fellows and their guests dined on a wide variety of fish and meats including Oysters au Gratin, Lobster a l’Indienne, Cutlets aux Petits Pois, Round of Beef, Saddles of Mutton, Braised Turkey, Pig’s Cheek and York Ham.  The dinners continued in similar style as can be seen from the menu below from 1876.  On this particular occasion, 34 Fellows and 30 guests attended at a total cost of £80.00.

Menu for the Faculty's annual dinner in 1876 (RCPSG 1/22/4/2)

Menu for the Faculty’s annual dinner in 1876 (RCPSG 1/22/4/2)

A menu for the Tercentenary Dinner of the Faculty has recently come to light during the  cataloguing our bound pamphlet collection.  Held on the “Penult [penultimate] day of November, 1899”, the front of the menu contains an image of Maister Peter Lowe, the College’s founder, who petitioned King James VI of Scotland in 1599 in order that a corporation be founded for the maintenance of medical standards.  A rich and varied menu was provided followed by the usual variety of toasts and the celebrations ended with the singing of Auld Lang Syne.

Menu for the Tercentenary Dinner, 1899 (pamphlet collection)

Front page of the menu for the Tercentenary Dinner, 1899 (pamphlet collection)

The dinners would have been held in what is now known as the Alexandra Room in 242 St Vincent Street.  During the early 1890s a large hall was erected behind 242, designed by the Glasgow architect J.J. Burnet.  The Faculty really could now dine in considerable splendour as can be seen in the photograph below, dating from around 1914.

Dinner in Faculty Hall c. 1914 (RCPSG 1/12/4/9)

Dinner in Faculty Hall c. 1914 (RCPSG 1/12/4/9)

Nowadays, dining within the College is not just restricted to Fellows and Members.  College Hall is used for corporate dinners, banquets, balls, and weddings as well as conferencing and exhibitions. The room accommodates up to 100 guests for dining and entertaining.

College Hall set up for a present day banquet.

College Hall set up for a present day banquet.

The elegant Alexandra Room, which was first used as a meeting hall, can accommodate up to 50 guests for dining.

The Alexandra Room, formerly used as a meeting hall when the Faculty moved to St Vincent Street in 1862

The Alexandra Room, formerly used as a meeting hall when the Faculty moved to St Vincent Street in 1862

The food is as sumptious as in previous years (although thoroughly designed for modern tastes) with a wide variety of menus. If you are interested in using the College as a venue then please contact Fifteen Ninety Nine or view the Fifteen Ninety Nine website.

Glasgow Cathedral

Today, Monday 4th August, a special service is being held at Glasgow Cathedral to commemorate the 100th anniversary of the outbreak of the First World War. The service is being held in Glasgow just after the close of the Commonwealth Games, thereby allowing the Commonwealth heads of state to attend.

Glasgow Cathedral, also sometimes known as St Mungo’s Cathedral, is a medieval church in the centre of Glasgow, with strong links to the foundation of the city. It was built between the late 12th and 15th centuries and houses the tomb of St Mungo, the founder and patron saint of Glasgow. The cathedral is built on the site where Mungo is believed to have been buried in AD 612, on the bank of the Molendinar Burn (which is now covered over by Wishart Street). Along with many other cathedrals in Scotland, Glasgow Cathedral was badly damaged during the Protestant Reformation of 1560. It was not destroyed, however, and today it is the only medieval cathedral in Scotland to have survived the Protestant Reformation of 1560 largely intact (i.e. without becoming unroofed).

Plate from The Cathedral Church of Glasgow: A Description of its fabric and a Brief History of the Archi-Episcopal See by O. MacGregor Chalmers

Plate from The Cathedral Church of Glasgow: A Description of its fabric and a Brief History of the Archi-Episcopal See by O. MacGregor Chalmers

In the College Library, our Glasgow Collection is an excellent source of information about the history of Glasgow Cathedral, and our archive also includes a selection of photographs and engravings. The College’s strongest link to the cathedral is probably the tombstone of our founder, Peter Lowe, which can still be seen in the cathedral grounds. A service is held at the cathedral every year on our Founder’s Day, to commemorate the life of Lowe.

Tomb of Peter Lowe in the grounds of Glasgow Cathedral (RCPSG 1/12/9/4)

Tomb of Peter Lowe in the grounds of Glasgow Cathedral (RCPSG 1/12/9/4)

President W.R. Snodgrass, laying a wreath at Peter Lowe's tomb after the Commemoration Service on the 350th Anniversary of the Royal Faculty in November 1949 (RCPSG 1/12/7/189)

President W.R. Snodgrass, laying a wreath at Peter Lowe’s tomb after the Commemoration Service on the 350th Anniversary of the Royal Faculty in November 1949 (RCPSG 1/12/7/189)

The cathedral is often regarded as one of the finest in Europe, and there are many features to be admired both inside and out. The cathedral is large enough that, following the Reformation, it was put to work as three distinct parish churches, with the Inner High Kirk making using of the choir, the Outer High Kirk residing in the nave, and the Barony Kirk using the crypt. However, the latter two eventually vacated the premises and since 1835 the cathedral has functioned as a single great church, as was perhaps originally intended.

Floor plans of the cathedral from "The Book of Glasgow Cathedral" by George Eyre-Todd (1898)

Floor plans of the cathedral from “The Book of Glasgow Cathedral” by George Eyre-Todd (1898)

The cathedral warrants a detailed exploration for many reasons, not least the quality of the masonry work on display. The crypt, or lower church, is mostly of 13th century construction, and is home to some of Scotland’s finest examples of medieval masonry. In the upper level, the screen standing between the choir and the nave is truly striking, and some excellent carvings can be seen in the Blackadder Aisle (built around 1500 under the command of Archbishop Blackadder). The cathedral has been constructed and rebuilt in parts over many years, and visitors with a keen eye may be able to spot where the 12th and 13th century construction work merges with work from later periods.

Copy of a 19th century picture, showing the interior of the cathedral (RCPSG 1/12/9/6)

Copy of a 19th century picture, showing the interior of the cathedral (RCPSG 1/12/9/6)

Somewhat unusually the building has actually been Crown property since 1857, and its upkeep and maintenance is managed today by Historic Scotland. Despite this, there is still an active Church of Scotland congregation, and Glasgow Cathedral continues to be used as a place of worship, as it has been for over 800 years. Admission to the cathedral is free, and all Glasgow residents and visitors are welcome. Please note that the cathedral is closed today (Monday 4th August) for the aforementioned service. Visit the Glasgow Cathedral website for more information on visiting times.

From Pagan's History of the Cathedral and See of Glasgow

From Pagan’s History of the Cathedral and See of Glasgow

The College’s library and archive collections offer a much more detailed history of the history, construction, and use of the cathedral. If you’d like to consult any of our collections, or to find out more, please email library@rcpsg.ac.uk or leave a comment below.