Glasgow Pathological and Clinical Society

As the College embarks upon a refurbishment programme, we’ve been delving into the historical uses of the rooms of our St Vincent Street building. The old Faculty Hall (now named Alexandra Room) was the venue for most of the College’s business until the new College Hall extension was built in 1893. In addition to Faculty meetings, and meetings of the Medico-Chirurgical Society of Glasgow, this room hosted the meetings of the Glasgow Pathological and Clinical Society from 1876.

GP&CS Transactions book

Transactions, 1873 – 1883 (RCPSG 4/1/6)

We were keen to explore what these meetings involved, who attended them, and the history of the Society itself. We are extremely fortunate to hold the archives of the Society, from its foundation in 1873 until its merger with the Medico-Chirurgical Society of Glasgow in 1907.

There is mention of an earlier Glasgow Pathological Society (established 1850) in the 1852 Medical Directory. However, it appears to have only lasted for 2 or 3 years. The idea of forming a new Pathological Society came from four prominent Glasgow physicians and surgeons in the early 1870s – Thomas Reid, Joseph Coats, William Leishman, and William Tennant Gairdner. James Finlayson was the first secretary and describes the initial idea for “a society composed of working members“, creating an environment where “specimens could be quietly examined and discussed… in a friendly manner, without any temptation to ostentatious display or personal bitterness.”

GP&CS First meeting proposal 1873

From Transactions, 1873 – 1883 (RCPSG 4/1/6)

The first meeting was held on 25th November 1873 in the rooms of the University Lying-In Hospital and Dispensary for Women on Wellington Street. James Finlayson and Hector Cameron constituted themselves interim secretaries, while Dr Gairdner (then Professor of Medicine at the University of Glasgow) became chairman. In addition to those already mentioned, the original membership included the young surgeon William Macewen.

GP&CS first agenda 1873

From Transactions, 1873 – 1883 (RCPSG 4/1/6)

From the first meeting, the format was established. The Agenda pictured above shows the list of specimens presented by the members for discussion. In further meetings, patients would also be presented. For example, in May 1874, Dr McCall Anderson showed a patient who had been treated for syphilitic paralysis.

In 1874 the name was changed to the Glasgow Pathological and Clinical Society, and with the number of members increasing to 30, a new venue was found at the Glasgow Eye Infirmary on Berkeley Street. Then, in the fourth session, beginning in October 1876, the venue settled at the Faculty Hall, in the College’s current building on St Vincent Street. The origins and early history of the Society were usefully added to the book of Transactions (RCPSG 4/1/6) by James Finlayson in 1879 (below).

GP&CS Memorandum 1879

Memorandum by James Finlayson, 1879 (RCPSG 4/1/6)

An important part of the Society’s business was the publication of its reports, in both the Glasgow Medical Journal and the British Medical Journal. This placed the research and practice of the Society in the context of the wider medical and surgical literature, which was at this time exploring many new areas and innovations.

Notable in the records of the Society are cases concerning neurological conditions and physiology, the treatment of cranial injuries, and cranial surgery. For example, Glasgow physicians such as Alexander Robertson, who was pioneering in his approach to aphasia in the 1860s, and William James Fleming, who investigated the physiology of the ‘motions of the brain’, provide a stimulating context for the advances in brain surgery made by William Macewen in the 1870s.

GP&CS Agenda 1879

From Society Minute Book 1879 – 1891 (RCPSG 4/1/2)

An exciting discovery in the Society’s Minute Book shows that on the 11th November 1879, Macewen presented to the meeting in the Faculty Hall “two patients on whom trephining was performed, one for injury and one for disease.” One of these patients was the fourteen year old girl upon whom Macewen had performed the first removal of a tumour from the dura mater (minute book detail below).

GP&CS Minute 1879

From Society Minute Book, 1879 – 1891 (RCPSG 4/1/2)

This procedure has since been identified as a major breakthrough in the history of neurosurgery. An editorial in the British Medical Journal (11th August, 1888) acknowledges the innovation and success of Macewen’s early brain surgery: “With indisputable justice… may Dr Macewen claim the proud distinction of having been the leader in this country, and we believe in the world, of this great advance in our art.”

These records of the Glasgow Pathological and Clinical Society not only provide us with a wonderful source of evidence of the innovative research and practice in the city in the late 19th century, but also provide us with inspirational stories to tell in our College rooms.

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.

instruments-and-cauters-actuals-for-extirpation-copy

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!

amputation-set

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]

tourniquet

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].

liston-knife

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.

amputation-saw

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.

trephine1

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.

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.