Experiences of a Deaf Man

From The Albion Magazine (1907):

When a man suddenly becomes deaf there is little or nothing he would shrink from if it afforded, or seemed to afford, the smallest chance that he would recover the enjoyment of a sense which he never properly valued until he lost it. About sixteen years ago, when well advanced in life, I suddenly lost my hearing, first in one ear and after a few days in the other; and so great was my desire for a cure, that in the course of the next twelve-month I had placed myself, consecutively, under no fewer than six medical men, most of them well-known specialists.

 

The writer then summarizes his treatments and remarks in a table:

Treatment 1: Politzer’s inflation and Eustachian Catheterism on both sides. Pilocarpine internally. Result: Deafness became absolute on both sides.

Treatment 2: Potassium Iodidum in heroic doses. Potassium Bromidum. Blisters behind Ears. Result: Depression to the verge of suicide.

Treatment 3: Phosphorus. Result: Exaltation to the verge of lunacy.

Treatment 4: Ferrum Perchloridum. Galvanic Chain. Stimulating Food, Wine. Result: none.

Treatment 5: Gaiffe’s Battery. Result: none.

Treatment 6: Nitro-Glycerine. Arsenic. Result: none.

Shock machine developed by Adolphe Gaiffe (1830-1903) for treating nervous diseases. (Gilai Collectibles)

Shock machine developed by Adolphe Gaiffe (1830-1903) for treating nervous diseases. (Gilai Collectibles)

Refitting a Hospital during the Great War

During the Great War, several institutions in London were refitted as auxiliary hospitals to treat the wounded servicemen returning from the battlefields. With large numbers of hospital staff heading to the front lines or volunteering for the war effort, some smaller hospitals even refitted their premises to contribute to the war effort.

photo

One such volunteer hospital was the Royal Ear Hospital, formerly the Royal Dispensary for Diseases of the Ear. Located on 42-43 Dean Street, Soho, the hospital provided specialized treatments for aural diseases since its founding in 1816. As practically the entire staff of the institution was depleted by military duties or volunteer service during the Great War, the hospital closed down. In August 1914, the Governing Committee unanimously resolved that the building should be offered to the Red Cross Society and beds temporarily placed at the disposal of the War Office, for the benefit of soldiers suffering from deafness or ear injuries inflicted during the war. The offer was promptly accepted and 20 beds were reserved for the use of the Navy, though a smaller outpatient clinic overseen by the aural surgeon MacLeod Yearsley still operated in London.

An October 1914 report revealed that the committee debated whether the hospital should provide only specialist care:

It occurred to us that we must decide whether we should still require that only ear cases be sent or should admit other than ear cases. We are agreed I think that the administration should be entirely in the hands of the Committee and that if we reopen, all the medical arrangements [should] be left to the Medical Board.

It was decided that the hospital would deal with ear cases that were too complex for the physicians or surgeons to deal with at the Naval Hospitals, but also welcome general injuries if needed so by the Admiralty.

Yet, apparently there was still plenty of space being unused at the Royal Ear Hospital during the Great War. As I was examining the archives of the hospital, I came across interesting correspondence between the Committee and a Mr. Peter Gallina, proprietor of the Rendezvous Restaurant that occupied space next to the hospital.  The Franco-Italian restaurant was praised for its clean kitchen, economic cookery, and tasteful interior, and became one of the “landmarks” of Dean Street, catering up to 200 people.[1]

A letter dated 15 March 1915 from Gallina reveals that there some vacant rooms under the children’s ward of the hospital, and that Gallina inquired whether the Committee was willing to accept an offer or £50/annum plus rates and taxes for the use of these rooms for the purposes of storage and cellarage, possibly for a lease up to 21 years. A letter by Allan Collard, one of the Committee members and presumably their lawyer, indicates that the Committee was uncomfortable with the offer but found it difficult to ignore the financial benefits that could serve the institution. Collard’s letter reveals that he did

not regard the offer of £50 per annum for the two vacant floors of the rear of the hospital as particularly good. It would be much more tempting of he paid a premium of say £100. Even in that case it would be prudent for the hospital to insist upon payment of the rent in advance annually.

If Mr. Galilna were to use the premises solely for the purposes of storage and cellarage and not as lavatories for his staff, a former objection to his proposed tenancy would be eliminated…I think it would be quite easy for Mr. Gallina to have an opening cut in the party wall which separates the back of his restaurant from the room under your Children’s ward.

The Committee decided to decline the offer on the recommendation of Collard and Mr. G.H. Paine, another of the Committee members.

However, meeting records of the Royal Ear Hospital Committee of Management dated to March 1921 reveals that the Committee reconsidered the offer. They unanimously agreed to recommend that the proprietors of the Rendezvous Restaurant be offered two rooms at the rear of the hospital for a tenancy of one year, and such tenancy thereafter subject to termination by either party at 6 months’ notice, for a yearly rental of £150. The proprietors renegotiated the offer for storage purposes on a 7 year lease terminable at the end of three or five years at the option of the hospital.

Minutes from the January 1922 meeting outline that

The Clerk reported that no reply had been received from the Rendezvous Restaurant regarding the letting of the rooms at the rear of the Hospital. It was suggested by Mr. Lake that if the one room were turned into a ward, which had been the original scheme, it would be of the greatest service. Mr. Pain produced the original plans that had been draw up relating to that proposal…

Discussions continued on with the Committee, largely due with heavy costs associated with renovating the rear rooms into wards. They kept tabling the discussions to analyzing the cost-benefit ration of renovations, the amount of financial support, as well as for an analysis of waiting lists of patients. Changes recommended including another ward for isolation cases, a lavatory and bathroom strictly for the House Surgeon, and the addition of extra baths. Minor renovations were made, including the addition of four extra beds, and a makeshift waiting room with a curtain for the Sister-in-Charge. No major renovations were made: in 1920, it was announced that Mr. Geoffrey Duveen, supporter of the hospital and once on the Governing committee, donated £50,000 to build a new building for hospital on a piece of land purchased on Huntley Street.

NOTES

[1] Judith Walkowitz, Nights Out: Life in Cosmopolitan London (University Press, 2012), 101-2.

Photo Essay: Vesalius at 500

Earlier this week I finally found the time to check out the exhibit, Vesalius at 500 at Thomas Fisher Rare Books Library in Toronto, curated by Philip Oldfield. The exhibit chronicles the history of anatomy and anatomical illustrations prior to, and following, the anatomist Andreas Vesalius’ (1514-1564) publication of De humani corporis fabrica (The Fabric of the Human Body), which was first published in 1543. De Fabrica exemplifies the perfect marriage between art and anatomy, between text and illustration. It is enormously detailed, brilliantly and profusely illustrated and helped to spearhead the new method for anatomical studies in which the anatomist combined the roles of dissector and instructor. Moreover, the book set the standard for all future publications of anatomical illustrations.

With de Fabrica, Vesalius introduced a number of important changes in the study of anatomy, including the notion that students must not depend their learning from authoritative textbooks, or even their teachers. Rather, Vesalius advocated the humanist doctrine to see for oneself: students should see and understand anatomy by looking and investigating the bodies themselves. Truth could be found under the skin, not in the books. While de Fabrica did not outline any shattering discoveries, Vesalius did correct 200 previously unquestioned theories, many of them from the Greek surgeon Galen’s works, which significantly relied on animal cadavers for anatomical studies. Other anatomists had previously criticized isolated pieces of Galenic anatomical doctrine, but de Fabrica was the first publication to systematically demonstrate how Galenic anatomy was mistaken.

As you can see below, de Fabrica is noteworthy for its illustrations, which were drawn by the Dutch artist Jan Stephan van Calcar (1499-1546). Vesalius used these technically accurate drawings of the dissected body to incorporate realism and reveal the process of dissection. De Fabrica thus laid the groundwork for observation-based anatomy, emphasizing anatomical statements could only be revealed by examining human cadavers first hand.

Please excuse the poor quality of some of the photos; I was not allowed to use my flash camera.

Ves1

Ves2

In the second edition of De humani corporis fabrica libri septem (Basel: J. Oporinus, 1555), the entire text was reset, with more space between lines and illustration; passages were deleted or amended. Most of the changes were stylistic. This is a copy of an extensively annotated second edition with Vesalius’ notes, revealing that Vesalius intended to publish a third edition that never came to pass.

In the second edition of De humani corporis fabrica libri septem (Basel: J. Oporinus, 1555), the entire text was reset, with more space between lines and illustration; passages were deleted or amended. Most of the changes were stylistic. This is a copy of an extensively annotated second edition with Vesalius’ notes, revealing that Vesalius intended to publish a third edition that never came to pass.

Ves4

The standing book, featuring "Adam & Eve" is the Epitome, which was published as a condensed version of de Fabrica and intended for students. It cost one-sixth of the price and consisted of 12 folio leaves. Most of the illustrations here are reproduced from Fabrica, but some new ones are added for the purposes of instruction, including “Adam and Eve."

The standing book, featuring “Adam & Eve” is the Epitome, which was published as a condensed version of de Fabrica and intended for students. It cost one-sixth of the price and consisted of 12 folio leaves. Most of the illustrations here are reproduced from Fabrica, but some new ones are added for the purposes of instruction, including “Adam and Eve.”

When Vesalius sent his manuscript and woodblocks of illustration to his printer Johannes Oporinus, he attached a letter with specific instructions for printing. The letter included descriptions on how to align the text and illustrations. As well, Vesalius asked Oporinus to forbid anyone from printing any of the illustrations without his consent.  This book is the first unauthorized reproductions of the plates of Fabrica: Thomas Geminus, an engraver and printer from Flanders, who produced Compendiosa totius anatomie delineation (London: John Herford, 1545) under the command of King Henry VIII of England who wanted to improve the state of surgery. The Compendiosa was the first English book to have an engraved title page. In 1553, Geminus produced an English version for surgeons who did not know Latin; the English version was re-issued in 1559 with an engraving of the newly-crowned Queen Elizabeth.

When Vesalius sent his manuscript and woodblocks of illustration to his printer Johannes Oporinus, he attached a letter with specific instructions for printing. The letter included descriptions on how to align the text and illustrations. As well, Vesalius asked Oporinus to forbid anyone from printing any of the illustrations without his consent.
This book is the first unauthorized reproductions of the plates of Fabrica: Thomas Geminus, an engraver and printer from Flanders, who produced Compendiosa totius anatomie delineation (London: John Herford, 1545) under the command of King Henry VIII of England who wanted to improve the state of surgery. The Compendiosa was the first English book to have an engraved title page. In 1553, Geminus produced an English version for surgeons who did not know Latin; the English version was re-issued in 1559 with an engraving of the newly-crowned Queen Elizabeth.

Another plagiarism: Juan de Valverde de Amusco, Anatomia del corpo humano (Rome: Ant. Salmanca & Antonio Lafreri, 1560).

Another plagiarism: Juan de Valverde de Amusco, Anatomia del corpo humano (Rome: Ant. Salmanca & Antonio Lafreri, 1560).

The exhibit continued downstairs, but there was a class present. Alas, I didn’t get a chance to take a look at the second part of the exhibit. Go check out the exhibit when you can–it closes August 29.

You can see more illustrations from de Fabrica here.

Inside an Operating Theatre of the 1900s: A Review of Cinemax’s “The Knick”

This post includes a review of Cinemax’s The Knick and contains minor spoilers.

On arriving to Bellevue Hospital in New York in the 1880s, American surgeon Robert Morris (1857-1945) commented on the new surgical operating rooms at the institution:

[T]he operating room was similar to that of other large general hospitals. The set-up consisted of a plain wooden table to carry instruments, lint or oakum dressing, unbleached muslin bandages (we had no absorbent gauze or cotton), and a large tin basin of tap water. Sometimes plaster of paris and other splint outfit was added.[1]

image

Dr. William Williams Keen conducts a surgical clinic in the Jefferson Medical College Hospital amphitheater, c.1890s.
Archives & Special Collections, Thomas Jefferson University, Philadelphia.

I’m utterly fascinated with the surgical operating theater and how it evolved from a simple room with minor equipment to a packed theatre stage, and eventually to the sterile and spacious environment of modern operating rooms. The transformation of the operating theatre mirrors many tremendous advancements in the surgery during the twentieth century, as surgeons became more skilled and innovative as they mastered complicated and dangerous procedures. It’s no surprise then that I was completely riveted by Cinemax’s new television series, The Knick, directed by Steven Soderbergh, written  by Jack Amiel and Michael Begler, and starting Clive Owen.

image

The show takes place in turn-of-the-century New York City, with Owen playing the anti-hero Dr. John Thackray, surgeon at the Knickerbocker Hospital. The pilot episode, “Method and Madness” brilliantly captures the dual nature of medicine: we see Thackray begging his nurse (Eve Hewson) to inject him with 22cc of cocaine, and a short time later, watch him order her to prepare a 2% solution as an innovative spinal anaesthetic to inject a patient on the operating table.

The show’s opening scene in the operating room is, in a word, gory, illustrating the difficulty of procedures that are considered as routine today. Bareknuckle surgery. 100 seconds to perform a caesarean section on a patient with haemorrhage in the womb. Brass hand cranks for suction. White aprons and rolled-up sleeves of street clothes. The rubber apron of Dr. Jules Christiansen (Matt Frewer), which could barely camouflage the surgeon’s hopelessness and despair over 12 unsuccessful caesarean operations. When the patient and baby die on the operating table, Christiansen turns to his audience and reminds them that surgery is about advancement: “It seems…it seems we are still lacking. I hope, if nothing else…this has been instructive for you all.”

image

During the early 19th century, operative surgery was limited to breakages, fractures, and amputations. Experimental operations to save the life of a patient were incredibly painful, gruesome, and, in many instances, unsuccessful. Two major advances during the mid-19th century would establish a foundation for surgeons to innovate new life-saving operations with greater confidence: the discovery of anaesthetics and the introduction of antiseptics. Analgesics were always made use of in medicine, as medical practitioners were aware of certain natural substances contained properties for relieving pain, such as opium or alcohol. During the 1790s, experiments of the effects of inhaling various gases and vapours first initiated the possibility pain relief could be achieved by inhalation of some suitable vapour or gas. Humphrey Davy (1778-1829) experimented with nitrous oxide (laughing gas), but other medical practitioners did not pay attention to his developments. The 1840s introduced ether as a more satisfactory anaesthetic, though chloroform anaesthesia became widespread as well after 1847 when James Young Simpson (1811-1870) first used it to relieve a patient’s difficult childbirth pains.

image

Dr. William Halstead is the inspiration for Clive Owen's character.

However, post-operative sepsis infection accounted for the majority patient deaths after major surgery. Antiseptics and antiseptic surgical methods became widespread with Joseph Lister’s (1828-1912) introduction of carbolic acid (phenol) as a method for eliminating bacteria on skin and on surface objects. The development of anaesthetics and antiseptics spearheaded the notion of a painless surgical operation. In the 1870s, towns with 10,000 residents had only 100 hospitals within their limits or nearby; by 1910, the number of hospitals increased to over 4,000, as new, innovative surgical procedures were became more successful.[2]

Even with anaesthetics and antiseptics, surgery was an incredible gruesome practice. Operations were performed either in patient wards, a small operating room, or in front of hundreds of students in the ordinary lecture theatre. We see this in The Knick, which surely benefited from the medical, historical and technical advice of Dr. Stanley Burns and the Burns Archive.

image

The scenes in the operating theatre appear to jump out of the incredible photographic collections housed at the Burns Archives. I found it difficult to get emotionally connected to characters, though the pilot episode did set up a solid foundation to explore their developments as well as the broader cultural strokes of America in the 1900s. Midwifery and “Stretcher Men;” divisions of the rich and poor; hospital administration; and of course, new technological developments like electricity being fitted in the Knick as it undergoes renovation. Dr. Algernon Edwards (Andre Holland) the “Negro” surgeon, gives us an interesting insight into America racial tensions, but I was more captivated with the scenes of the squalor and poverty of immigrants. The New York Public Health Board’s inspections of tuberculosis cases and their forced removal of sick persons, for instance, shows us how medicine was enforced in the legislative level, as laws outlined demands to enforce structural changes in housing to eradicate breeding grounds for disease. These scenes are a reminder of the terrifying cloud of disease and death.

You can watch the first episode here: http://youtu.be/ItBAXOEE8Vk

 

NOTES

[1] Quoted in Roy Porter, Greatest Benefit to Mankind: A Medical History of Humanity (New York: W.W. Norton & Company, 1997), 374.

[2] Morris J. Vogel, “Managing Medicine: Creating a Profession of Hospital Administration in the United States, 1895-1915,” in Lindsay Granshaw and Roy Porter (Eds.), The Hospital in History (New York: Routledge, 1989).

Surgeons & Surgical Kits

There’s always a scene in any movie or television show depicting a surgical operation: a nurse or assistant clad in scrubs, enters the room pushing a cart. On the cart lies several delicate instruments, their hard steel glistening under the harsh lights of the theatre. None of the instruments touch each other, and they are placed in a carefully organized order.

Then we see the scene after the operation: the once pristine instruments stained with the bright red of blood, and discarded into a bowl. They have fulfilled their purposes, the dangers embodied in their construction has diminished and they are to retire until they are called for again.

I love those scenes. The instruments play as much of a role in surgical operations as the nurse, the lights, the antiseptics anesthetics and of course, the surgeon. But without the instruments there really is no operation. Without the instruments is a surgeon even a surgeon?

The 10th century Arabic scholar and physician, Abu al-Quasim ibn al-Abbas al-Zahrawi (936-1013) introduced many notable surgical instruments in his eponymous Kitab al-Tasrif ( Method of Medicine), a thirty volume encyclopedia on the anatomy and practise of medicine. Al-Zahrawi, also known by his Latinized name Albucasis, details over 200 instruments, many of which he devised himself, combining ideas from ancient Greek and Roman physicians with his own observations and experiences as a surgeon.

A replica of Roman surgical instruments in a cloth roll, AD50. 13 instruments made of brass and steel. (The Old Operating Theatre Museum)

A replica of Roman surgical instruments in a cloth roll, AD50. 13 instruments made of brass and steel. (The Old Operating Theatre Museum)

Al-Zahrawi stressed a skilled surgeon would not only know the uses and benefits of numerous types of instruments, but will apply the knowledge to make sure an instrument was used properly and carefully to prevent excessive pain to the patient. Other medieval surgeons also stressed the importance of instruments–the surgeon’s kit–as an essential part of the surgeon’s practice.

Before the operating theatre had instruments nicely laid out on a cart, surgeons often carried their own instruments in a box or bag, taking with them as they attended to patients. Some were of simple designs, while others were more elaborate, with ivory, gold, or silver detailing.

An ivory surgical presentation set, c.1868. It contains  a full complement of scalpels, bistouries, needle threaders and tenaculum hooks.  The lid compartment contains two scissors, one pair of scissor handled and two hand forceps. The lower tray contains a crosshatched ivory metacarpal saw, a director, two silver tracheotomy tubes, a crosshatched ivory and silver trocar and a pair of bone forceps. This was the Governor's Prize at Middlesex Hospital and awarded to Mr. Robert Harry Lords. (Phisick Medical Antiques)

An ivory surgical presentation set, c.1868. It contains a full complement of scalpels, bistouries, needle threaders and tenaculum hooks. The lid compartment contains two scissors, one pair of scissor handled and two hand forceps. The lower tray contains a crosshatched ivory metacarpal saw, a director, two silver tracheotomy tubes, a crosshatched ivory and silver trocar and a pair of bone forceps.
This was the Governor’s Prize at Middlesex Hospital and awarded to Mr. Robert Harry Lords. (Phisick Medical Antiques)

These kits consisted of knives, razors, and lancet for making incisions; cattery irons grasping tools, probes, suture scissors, saws, needles, cannulae, pads, bandages, and in some instances, even tools for trepanation. Some kits also contained analgesics such as opium or hashish as pain relievers, or plasters for treating wounds.

A 19th century 14-piece surgical instrument kit (Barcelona)

A 19th century 14-piece surgical instrument kit (Barcelona)

A 19th century French surgical leather kit with knife and needle, artery forceps, curved scissors, curette, trocar, director, blunt needle, thermometer, caustic stick holder,  toothed forceps and two plain forceps. (Phisick Medical Antiques)

A 19th century French surgical leather kit with knife and needle, artery forceps, curved scissors, curette, trocar, director, blunt needle, thermometer, caustic stick holder, toothed forceps and two plain forceps. (Phisick Medical Antiques)

Pre-anesthetic surgery was crude, gruesome, and horrifying. Operations were limited to amputations, suturing, and bone-setting. And because it was preferable patients remained awake during the operation (as it was easier to deduct whether there was serious danger), speed was a crucial factor for ensuring a higher degree of success. Instruments were used over and over, frequently without being cleaned, and without being disinfected–antiseptics wouldn’t arrive until the second half of the nineteenth century.

Five surgeons participating in the amputation of a man's leg while another oversees them.  Coloured Aquatint by Thomas Rowlandson, 1793.

Five surgeons participating in the amputation of a man’s leg while another oversees them.
Coloured Aquatint by Thomas Rowlandson, 1793.