Edinburgh Mystery Object

(from Surgeons’ Hall Museum, Edinburgh)

One of the earliest published descriptions of this instrument (possibly the earliest),  was by a famous Scottish surgeon-anatomist who collected examples from other surgeons and made modifications.

What is the instrument called, what was it used for and who was the surgeon ?

Clue – his portrait hangs in  Surgeons’ Hall, Edinburgh, venue of the BSHM September Congress

submitted by Iain Macintyre

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The Mesmerist: John Elliotson (1791-1868)

In 1837, when 19-year-old Queen Victoria ascended the British throne, medicine was a bleak and brutal business. Operations were performed without pain relief while the standard medical therapies were bloodletting, purging and dosing with toxic potions. But that summer a promising medical innovation crossed the Channel from Paris: mesmerism. Most of the British medical establishment scorned this new-fangled French idea but one doctor, the highly esteemed physician John Elliotson, embraced mesmerism with zeal. For 18 months in 1837 and 1838 Elliotson staged dramatic demonstrations on his patients at University College Hospital which drew fascinated audiences, provoked sensational headlines and – ultimately – split the medical profession.

The Mesmerist: John Elliotson (1791-1868) is an exhibition at the Library of the Royal Society of Medicine.
1 Wimpole Street, LONDON  W1G 0AE

This exhibition tells the story of John Elliotson and his battle to promote mesmerism – hypnotism as it was later renamed – in the face of furious opposition from the medical establishment and medical press.  Elliotson was President of the Medical and Chirurgical Society of London in 1833, and it was during his term of office that the Society was granted a Royal Charter to become, in 1834, the Royal Medical and Chirurgical Society.

Robert Greenwood, Heritage Officer, The Royal Society of Medicine Library

Robert Fludd MD. FRCP. (1574-1673)

Robert Fludd. Line engraving by T. de Bry, 1645, after Matthäus Merianafter
Credit: Wellcome Library, London. Wellcome Images

A respected physician, Censor four times of the Royal College of Physicians, Robert Fludd was also an anatomist, a friend of William Harvey whose experiments he witnessed, and well-respected by both James I, and by Charles I who awarded him the income from Crown land in Suffolk. All this was perhaps nothing unusual among those who stood well in the senior world of that hierarchical society, a society to which he belonged by birth and by his own medical reputation, and his father’s reputation as an honest and well-rewarded public servant of the redoubtable Queen Elizabeth I.

It was less usual that he was also a distinguished and well known neo-platonist, hermetic philosopher and alchemist, who summed up in himself and in his numerous and large-scale publications the pre-scientific synthesis of cosmic harmony; that is, the intimate and harmonic relationship of the sentient platonic universe with the sentient human being. This was the world before the Cartesian ‘cogito, ergo sum’, which divides the observing ego from its observed subject, a definitive change in perception which has revolutionised human culture since the mid-17th century.

Fludd’s philosophy is epitomised in his magnificent if uncompleted Utriusque Cosmi … Historia 1617-1626 (‘The History of the Macrocosm and Microcosm’), and in his Medicina Catholica 1629-1631 (‘Universal Medicine’) whose lavish, graphic and cogent illustrations illuminate for us the rich world-picture of the Renaissance multi-layered mind, of the prescientific magus, which perceived by metaphor and symbol rather than by our logic. It is not surprising that his illustrations are increasingly used in works on Renaissance literature, philosophy, art and culture. His images speak louder than words. And they are some of the finest and most detailed illustrations, published during that period.

Caught between the old world of symbol and metaphor and the new world of rigorous investigation and scientific experiment (which he also exercised in practical demonstrations of anatomy), Fludd provides for us a passage back to an integrated and sentient universe. Though few of us could support the analogical base on which his system is founded, his symbolism may still speak validly to us today. It is no bad thing to understand the past from within. Our forebears deserve respect, understanding, and even empathy. In history, as in anthropology (of which history is a part) it is possible to maintain participant / observer status. History then ceases to be entirely an account of the past.

Further reading: Godwin J. Robert Fludd: hermetic philosopher and surveyor of two worlds. London: Thomas & Hudson, 1979.

Robin Price – British Society for the History of Medicine

Neurology and Psychiatry in Babylon

How rapidly does medical knowledge advance?  Very quickly if you read modern newspapers, but rather slowly if you study history.  Nowhere is this more true than in the fields of neurology and psychiatry.

It was believed that studies of common disorders of the nervous system began with Greco-Roman Medicine, for example, epilepsy, “The sacred disease” (Hippocrates) or “melancholia”, now called depression.  Our studies have now revealed remarkable Babylonian descriptions of common neuropsychiatric disorders a millennium earlier.

Figure 1. A well preserved Babylonian cuneiform Tablet on Epilepsy.
Number 26 in a series of 40 medical “diagnostic” Tablets.
Reproduced by kind permission of the British Museum.

There were several Babylonian Dynasties with their capital at Babylon on the River Euphrates.  Best known is the Neo-Babylonian Dynasty (626-539 BC) associated with King Nebuchadnezzar II (604-562 BC) and the capture of Jerusalem (586 BC).  But the neuropsychiatric sources we have studied nearly all derive from the Old Babylonian Dynasty of the first half of the second millennium BC, united under King Hammurabi (1792-1750 BC).

The Babylonians made important contributions to mathematics, astronomy, law and medicine conveyed in the cuneiform script, impressed into clay tablets with reeds, the earliest form of writing which began in Mesopotamia in the late 4th millennium BC.  When Babylon was absorbed into the Persian Empire cuneiform writing was replaced by Aramaic and simpler alphabetic scripts and was only revived (translated) by European scholars in the 19th century AD.

Figure 2. A bas-relief of a wounded lioness from the Palace of Ashurbanipal at Nineveh.
An arrow in the centre of the spine was observed to lead to paralysis of the hind legs,
but knowledge of the spinal cord and its functions did not exist.
Reproduced by kind permission of the British Museum.

The Babylonians were remarkably acute and objective observers of medical disorders and human behaviour.  In texts located in museums in London, Paris, Berlin and Istanbul we have studied surprisingly detailed accounts of what we recognise today as epilepsy, stroke, psychoses, obsessive compulsive disorder (OCD), psychopathic behaviour, depression and anxiety.  For example, they described most of the common seizure types we know today e.g. tonic clonic, absence, focal motor, etc, as well as auras, post-ictal phenomena, provocative factors (such as sleep or emotion) and even a comprehensive account of schizophrenia-like psychoses of epilepsy.  Early attempts at prognosis included a recognition that numerous seizures in one day (i.e. status epilepticus) could lead to death.  They recognised the unilateral nature of stroke involving limbs, face, speech and consciousness, and distinguished the facial weakness of stroke from the isolated facial paralysis we call Bell’s palsy.  The modern psychiatrist will recognise an accurate description of an agitated depression, with biological features including insomnia, anorexia, weakness, impaired concentration and memory.  The obsessive behaviour described by the Babylonians included such modern categories as contamination, orderliness of objects, aggression, sex and religion.  Accounts of psychopathic behaviour include the liar, the thief, the troublemaker, the sexual offender, the immature delinquent and social misfit, the violent and the murderer.

The Babylonians had only a superficial knowledge of anatomy and no knowledge of brain, spinal cord or psychological function.  They had no systematic classifications of their own and would not have understood our modern diagnostic categories.  Some neuropsychiatric disorders e.g. stroke or facial palsy had a physical basis requiring the attention of the physician or asû, using a plant and mineral based pharmacology.  Most disorders, such as epilepsy, psychoses and depression were regarded as supernatural due to evil demons and spirits, or the anger of personal gods, and thus required the intervention of the priest or ašipu.  Other disorders, such as OCD, phobias and psychopathic behaviour were viewed as a mystery, yet to be resolved, revealing a surprisingly open-minded approach.

From the perspective of a modern neurologist or psychiatrist these ancient descriptions of neuropsychiatric phenomenology suggest that the Babylonians were observing many of the common neurological and psychiatric disorders that we recognise today.  There is nothing comparable in the ancient Egyptian medical writings and the Babylonians therefore were the first to describe the clinical foundations of modern neurology and psychiatry.

A major and intriguing omission from these entirely objective Babylonian descriptions of neuropsychiatric disorders is the absence of any account of subjective thoughts or feelings, such as obsessional thoughts or ruminations in OCD, or suicidal thoughts or sadness in depression.  The latter subjective phenomena only became a relatively modern field of description and enquiry in the 17th and 18th centuries AD.  This raises interesting questions about the possibly slow evolution of human self awareness, which is central to the concept of “mental illness”, which only became the province of a professional medical discipline, i.e. psychiatry, in the last 200 years.

Reference
Reynolds EH, Kinnier Wilson J. Neurology and Psychiatry in Babylon. Brain 2014; 137: 2611-2619.

Dr. Edward H Reynolds MD FRCP FRCpsych
Department of Clinical Neurosciences, King’s College, London

Open House London

Open-House

During the weekend of 17/18th September 2016 many private and public buildings in Greater London are open for viewing with free admission.

These include several premises related to the history of medicine:

The Royal College of Physicians (+herb garden)
Apothecaries Hall
The Royal College of GPs
The Royal College of Nursing
The College of Optometrists
The Old Operating Theatre Museum

For details go to http://www.openhouselondon.org.uk/

Medicine, Art and Stamp Covers: Semmelweis and hand washing

Semmelweis0001

Stamp covers with their artwork can reflect events in the history of medicine. This Hungarian stamp cover was issued in 1965 to mark the 100th anniversary of the death of Ignaz Semmelweis (1818-1865) who discovered the association between childbed (puerperal) fever and mortality from the inadequate washing of the hands of the birth attendants. Semmelweis was a physician at the Vienna Lying-in hospital in Vienna. He concluded that infection was carried by medical students and doctors from the dissecting room where they had recently carried out dissections and post-mortem examinations. Following the introduction of hand washing with chlorinated water before examining obstetric patients, the mortality from childbed fever on the wards in the hospital fell significantly. Sadly, his colleagues did not immediately recognise or appreciate the importance of his discovery leading to his frustration and dismay.

The artwork on this stamp includes the bust of Semmelweis and shows him washing his hands before examining a female patient. There appears to be a sign on the wall above the pitcher which presumably relates to hand washing. It is also worth pointing out the incorrect spelling of his name although this is correct on the stamp.

It is perhaps interesting to note that the lesson with regard to hand washing needed to be relearnt a few years ago when there was concern about methicillin resistant Staphylococcus aureus in hospitals.

Dr Martyn Thomas May 2016