The First Bone Atlas—A Success or Failure?

William Cheselden completed a surgical apprenticeship in 1709. Remaining in London, he was unable to immediately develop a practice and instead taught anatomy. He eventually turned his class notes into a book, The Anatomy of the Humane Body. It was wildly successful, partially because it was in English rather than Latin. The book proceeded through 13 editions and was the go-to source for surgical anatomy for a hundred years.

Based on his deep understanding of anatomy, Cheselden became an adept surgeon—setting fractures, removing cataracts, and extracting bladder stones. His surgical reputation rapidly spread far and wide.

Cheselden is best remembered, however, for what might be considered a failure. Understanding that skill in surgery requires a thorough understanding of anatomy, in 1733 he published Osteographia, or the Anatomy of the Bones. The book took several years and £17,000 to complete. It was the first book devoted solely to bone anatomy. It sold only 97 copies, yet Osteographia is a treasure of anatomy and artistry.

Cheselden recognized that techniques of perspective and shading were critical to rendering three-dimensional objects accurately onto paper. Just a slight shift of the artist’s head or an urge to highlight a shadowed surface distorted the results. These were outcomes that Cheselden wanted to avoid. Surgeons needed absolutely accurate representations of the skeleton. The subtleties of each contour had to be perfect.

Under Cheselden’s guidance, two artists accomplished his aim. Unique at the time for medical illustration, they suspended the bones from a tripod placed in front of a large box. A tiny hole in one end allowed light and an image of the bones to enter. One of the artists sat at the open end and traced every detail onto a glass plate, which Cheselden then converted to an engraving. At the time, the technique of using a camera obscura was unique for medical illustration. Today we recognize the device as a pinhole camera.


Osteographia ranks as one of the all-time great anatomy atlases in scope and elegance. The camera obscura, depicted on the book’s title page, signals the work’s accuracy. Osteographia’s sensitivity and elegance become quickly evident when noting the exquisite detail of the drawings, their arrangement on each page, and the lack of overlying labels or lines. The text is sparse. Cheselden knew that the images could tell their own story. They continue to do so.

Roy A. Meals, MD blogs regularly at www.aboutbone.com

Jenner, Fewster and Jesty

Jenner vaccinating (Gillray) – Courtesy Wellcome Images

On the 14th May 1796 Edward Jenner carried out the first stage of his now famous vaccination experiment and inoculated a young boy named James Phipps with cowpox. To this day Jenner’s name is associated with the discovery of vaccination as a concept, and the worldwide eradication of smallpox. However, there were others who helped light the path to Jenner’s discovery, and even carried out that same experiment decades before Jenner.

Vaccination could not have happened without the development of variolation; the process of inoculating healthy individuals with smallpox matter in order to confer immunity against the disease. It was based on the observations that a primary attack of smallpox often provided a degree of immunity against contracting the disease again in the future. It was introduced to Britain in the early eighteenth century by Lady Mary Wortley-Montagu, who had come across the concept of ‘smallpox parties’ whilst living in Turkey. Following the successful variolation of her own son, she also had her daughter inoculated with smallpox matter in 1721 by the surgeon Charles Maitland. Others soon followed suit, including a royal variolation when George II had his two daughters inoculated with smallpox, at the request of his wife Caroline, Princess of Wales.

The concept gradually spread across the country, but it was not until it reached the county of Suffolk and the ears of a young surgeon named Robert Sutton, that it truly took off. Sutton advertised variolation as a service, including bed and board with the added incentive of ‘tea, wine, fish and fowl’ all for a monthly fee. Gradually inoculation houses started to appear across the country, inspired by the likes of Sutton and his business enterprise.

It was at one of these inoculation houses that in 1768 John Fewster, a Gloucestershire surgeon and apothecary, recognised that a great number of patients could not be infected with smallpox. On enquiry he discovered that they had all previously been infected with cowpox. He made note of this and communicated it to a small medical society of which he as a member at the time. It just so happened that Edward Jenner was also present at this society meeting, as a young apprentice to another local surgeon named Daniel Ludlow. Fewster was a strong supporter of the Suttonian method of variolation and he did not recognise the importance or see the need at the time for the development of inoculation with cowpox.

It would be wrong to talk about the history of vaccination without mentioning Benjamin Jesty (1736-1816), a dairy farmer from Yetminster, in Dorset. Not only did he recognise the protective effect that cowpox had over smallpox, but he also went so far as to vaccinate his wife and children with cowpox in 1774, at least twenty years prior to Jenner’s famous experiment. Furthermore he tested his vaccination trial in 1789 when his two sons were variolated by their local doctor and they did not go on to exhibit any signs of a reaction. Jesty unfortunately did not go on to publish his results, and perhaps due to the public outrage that ensued when the locals discovered that he had inoculated his family with animal matter, did not go out of his way to publicise them either. However, his experiment did not go unrecognised, and he was invited to attend George Pearson’s Original Vaccine Pock Institute in 1805. The physicians at that institute decided that Jesty’s experiment had pre-empted Jenner’s, and they awarded him with a testimonial scroll stating just this.

It is evident that the history of vaccination is more complex than the well-known story of Jenner, the milkmaid and the cow. The concept of cowpox being protective against smallpox was reportedly widely known throughout the dairy country in England and across the continent in Germany. However, it cannot be disputed that Jenner was the only one to make this fact publicly known and to recognise the importance that this discovery could have in the fight against smallpox. It was his determination and dedication to the subject which subsequently led to the World Health Organisation declaring the eradication of smallpox on 8th May 1980.

More can be discovered about this fascinating subject by paying a visit to Dr Jenner’s House, Museum and Garden in Berkeley, Gloucestershire. https://jennermuseum.com/

Roy Porter, ‘The Prevention of Smallpox’, in The Greatest Benefit to Mankind. A Medical History from Antiquity to the Present.(London: HarperCollins, 1999) 275-6

S.L. Kotar and J.E. Gessler, Smallpox: A History (North Carolina: McFarland & Company, 2013),18

Robert Jesty and Gareth Williams, ‘Who invented vaccination’, Malta Medical Journal, 23, 2 (2011) 29-32

Lydia Thurston and Gareth Williams, ‘An examination of John Fewster’s role in the discovery of smallpox vaccination’, J R Coll Physicians Edinb,45 (2015) 173-179

Lydia Thurston

Arnica Pharmaceutical Jar

 

Can you help the Archivists at Boots Nottingham to identify the figure on the lid of this beautiful pharmaceutical jar?

Some officers of the British Society for the History of Medicine recently visited the Boots Archives in association with the Annual meeting of the British Society for the History of Pharmacy. We were shown this beautiful Arnica pharmaceutical jar. Discussion ensued regarding the figure on the lid of the jar. Several suggestions were made. We agreed to ask members for the British Society for the History of Medicine for their opinions.

Mike Collins

Papworth 100

Patients on the balcony of the Bernhard Baron Hospital, Papworth Village Settlement

Royal Papworth Hospital is a leading cardiothoracic hospital and is best known for its trailblazing work in transplantation since performing the UK’s first successful heart transplant in 1979. However, Papworth has a long standing tradition of pioneering work since its inception as a tuberculosis colony, 100 years ago.

At a time when 41,800 in the UK died from tuberculosis, a young Welshman Dr (later Sir) Pendrill Varrier-Jones was appointed Cambridgeshire TB Officer during WWI. Following sanatorium treatment patients would risk a relapse when they returned to the overcrowded, unsanitary and damp conditions which had led to infection in the first instance. Frustrated by this cycle, Varrier-Jones took a holistic approach to care and wanted to develop a combined treatment and rehabilitation facility that would leave patients, “a useful and productive member of society, a man who, though a consumptive, has learned to be a consumptive, to lead the life of a consumptive and even enjoy that life.”

Having successfully established treatment for a small number of patients in 1916 in the nearby village of Bourn, Varrier-Jones’ vision went through a process of rapid expansion. Papworth Hall was purchased following a large charitable donation in 1917 with the first patients arriving on 12 February 1918.  Patients were prescribed bed rest, a hearty diet and ample fresh air. Once the patient’s condition had improved they were moved onto graduated work within one of the light industries and provisions were available for family members to also settle in the village. Sir Varrier-Jones’ revolutionary aim was to treat the “whole-person,” by providing treatment, suitable employment and allowing patients a home life.

With the discovery of streptomycin in the 1940s, the number of TB patients declined and what was then known as the Papworth Village Settlement opened its remit to include people with other disabilities. This led to the creation of the Papworth Trust, a charity which continues to support disabled people. In 1948, the hospital officially became part of the NHS and became known as Papworth Hospital which moved from the treatment of TB to specialise in chest medicine.

2018 is an important next chapter for us. It’s the year when we become Royal Papworth Hospital, commemorate our centenary, celebrate the 70th anniversary of the NHS, and move from the village of Papworth Everard to our new state-of-the-art hospital located in the Cambridge Biomedical Campus. We’ve made a film to commemorate with the support of the Heritage Lottery Fund (for trailer click here) with the first screening coinciding with the NHS’ 70th birthday on 5th July at the Cambridge Arts Picturehouse, this will be followed by screenings in the village of Papworth Everard on 21st July (to book click here) with additional screenings planned for the autumn. This film and screenings were made possible with a generous grant from the Heritage Lottery Fund and the Papworth Hospital Charity

Nico Ferguson, Heritage Assistant
Royal Papworth Hospital NHS Foundation Trust