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Medicine: Continuity and Change

What follows is an online version of an exhibition which was on display in the Upper Library exhibition cases from Michaelmas 2011 until Spring 2012.  

The exhibition was curated by Paul Ivanovic.

All images are copyright The Queen’s College and may not be reproduced without permission.

Introduction to the exhibition

The antiquarian medical collection at The Queen’s College was principally created in the eighteenth century through the generous benefactions of two physicians: Sir John Floyer (1649-1734) and Theophilus Metcalfe (1690-1757). Floyer’s library, of one-hundred and fifty books, could best be described as that of a working doctor. Metcalfe’s medical library, of over one thousand books, reflects his strong intellectual interests in science and medicine and his bibliophilic tendencies. Combined, these medical libraries give a wonderful insight into medical knowledge and practice over a period of two hundred years.

Sir John Floyer (1649-1734) matriculated at Queen’s College in 1664, obtained his BA in 1668, MA in 1671, BM in 1674 and DM in 1680. After leaving Oxford, Floyer returned to his home city of Lichfield where he practised medicine until his death at the age of eighty-five. He published a number of important medical texts during his life time including A treatise of the asthma (1698), which appears in this exhibition, An inquiry into the right use and abuses of the hot, cold and temperate baths in England, (1697), The physician’s pulse watch (1707), his pioneering work on the development of a pulse watch, and Medicina gerocomica (1724), the first book on geriatrics, all of which are in the Queen’s College collection.

Theophilus Metcalfe was not a member of Queen’s College, but of Hart Hall (later Hertford College) where he matriculated in 1706, obtained his BA in 1710, MA in 1713, BM in 1716 and DM in 1724. Little more biographical detail is known about his life. However, his memorial in the church of Ambrosden, Oxfordshire states he was a “learned, skilful and tender hearted physician”.  The reason for his donation to Queen’s College is uncertain. However, it made the Queen’s College antiquarian medical collection one of the largest in the Oxford colleges. The collection includes two of Floyer’s publications, one of which is a second edition of A treatise of the asthma (1717).

The exhibition features two books from Metcalfe’s collection, A compleat body of chirurgical operations, by M de La Vauguion (1699), and the first book dedicated to the subject of plastic surgery, De curtorum chirurgia per insitionem libri duo, by Gaspare Tagliacozzi (1597).

How the other five works included in the exhibition came to be in the Queen’s College collection is unclear. The 1673 edition of William Harvey’s work on the circulation of the blood does bear the provenance name Arthur Fleetwood, although nothing more is known about him.

Paracentesis: a technique still in use today

La Vauguion, de.  A compleat body of chirurgical operations. London : Printed for Henry Boswick …, 1699. Shelfmark NN.s.4240.

Definition – Tapping; the process of drawing off fluid from a part of the body through a hollow needle or canula.

The handwritten inscription indicates that the poor woman in question was suffering from ascites, an accumulation of fluid in the peritoneal cavity or, in simpler language, a swelling of the abdomen caused by the retention of fluid. At the time this book was published she would have been described as suffering from dropsy or hydropsy.

Causes of ascites include kidney disease, liver failure and metastatic cancer. Today, there are a number of reasons why paracentesis would be performed, for example, to relieve abdominal pressure.  One imagines it was simply performed in the 17th century for this reason, and therefore principally to make the patient more comfortable.

Instructions on how to perform a Caesarean section

La Vauguion, de.  A compleat body of chirurgical operations. London : Printed for Henry Boswick …, 1699. Shelfmark NN.s.4240.

Reading the instructions on page 280, it is chillingly clear why this surgery was almost always fatal at this time: “… Wipe the blood off the wound with a sponge dipt in wine warmed and make a suture of the belly, as in its proper place was directed, without stitching the womb at all.” Needless to say, most women simply bled to death from the unstitched wound in the uterus. The vertical incision described was in use until the 1950s when a new side to side incision just above the pubic hair, outlined by German surgeon and gynaecologist  Hermann Pfannenstiel in 1900, began to routinely replace the classical method.

The first Caesarean in Great Britain was performed on 29 June 1737 by an Edinburgh surgeon, Mr. Smith, on a woman with a distorted pelvis. Sadly, the baby was stillborn and the mother died 18 hours later. It was 1793 before the first “successful” Caesarean section was performed in Great Britain, with the mother surviving although the child died (History of obstetrics & gynaecology, O’Dowd and Philipp, 1994).

Caesarean section has a long history dating from the pre-Christian era, but until recent times would only be performed in an attempt to save the child when the mother had died or was dying. Sadly, even here success was limited. “Hyman and Lange reported 331 post-mortem cases during the nineteenth century up to 1878 when only nineteen children were saved” (Caesarean birth in Britain, Churchill, Savage and Francome, 2006). Caesarean sections were initially performed on living women only in extremis, as the results were so poor. For example, in Paris, between 1787 and 1876, no woman is known to have survived a Caesarean (Birth: a history, Tina Cassidy 2007).

The first major English monograph on asthma

Floyer, John, Sir, 1649-1734. A treatise of the asthma. London, Printed for Richard Wilkin, … , 1698. Shelf mark Sel.f.120.

Sir John Floyer matriculated at Queen’s College Oxford aged 15.  He graduated BA in 1668, MA (1670), BM (1674) and DM (1680). In his long medical career he was to make significant contributions to the study of asthma, the pulse and geriatric medicine. Indeed, he could be considered the father of geriatric medicine with the publication of Medicina Gerocomica, the first book on geriatrics, in 1724. He is also well-known for his study and promotion of the value of cold bathing with his: An enquiry into the right use and abuses of the hot, cold and temperate baths in England (1697).

The motivation for this special study on asthma can be traced to Floyer having suffered from asthma since his youth.  His idea of a bronchospasm as the cause of an asthma attack was a major breakthrough.  Amongst other insights he also clearly identified exercise induced asthma.

The circulation of the blood

Harvey, William, 1578-1657. The anatomical exercises of Dr. William Harvey. London : Printed for Richard Lowndes … 1673. Shelfmark Sel.f.121.

It has been remarked by historians that the three greatest works published by members of the English intelligentsia were written in a brief period in the 17th century*, namely:

  1. The King James authorized version of the Bible (1611)
  2. The First Folio edition of Shakespeare’s plays (1623)
  3. Exercitatio anatomica de motu cordis et sanguinis in animalibus (1628)

Harvey’s seminal 72 page essay, often simply referred to as “De motu cordis” has been described by the historian K. F. Russell, as the “greatest single contribution to anatomy and medicine in any century”. Written in Latin, and published in Frankfurt (the location of an annual book fair which would aid dissemination of the work) in 1628, it was first translated into English in 1653. This display copy is the second English printing, published in 1673, and includes Harvey’s responses to criticisms of the theory of blood circulation. Harvey was profoundly influential in shrugging off the legacy of Galen (ca. 130-210 A.D.). Galen was perhaps the most significant medical researcher of antiquity making contributions to many disciplines including anatomy, physiology and pathology. Harvey convincingly refuted, by argument and experimentation, Galen’s enduring idea that blood crossed the septum from the right to the left side of the heart. Knowledge of blood circulation was profoundly significant for the future development of modern physiology and rational medicine. However, in the shorter term many medical practitioners appeared to ignore the implications of blood circulation and still advocated bloodletting from different parts of the body to treat different conditions (please see caption of book on scurvy).

*Meyer Friedman and Gerard W. Friedland. “William Harvey and the circulation of the blood”. Chapter 2 in Medicine’s ten greatest discoveries. New Haven: Yale University Press. 1998.

Injuries to the brain

Yonge, James, 1647-1721.  Wounds to the brain proved curable. London : Printed by J. M. for Henry Faithorn … , 1682. Shelfmark Sel.f.126.

This fascinating and hopeful case study begins: “On Saturday the 28 of February 1679 I was called to Swilly, a house above a mile distant from Plimouth, where Mr. John Stone was retired with his family, to secure them from the smallpox, at that time raging in town … ”. However, although safe from the smallpox, an accident had befallen the son of the family. The daughter, of almost six, and a son of four had wanted to go into a field, and had pulled at a gate which had defective hinges, and which then fell towards them. The daughter escaped injury but the boy’s head was crushed between a pin of wood projecting from the gate and a small stone on the ground. These caused penetrating wounds to either side of the skull and inner membranes, and the issuing forth of brain tissue. Cleaning the wounds and removing bone fragments, applying poultices and giving medications (of dubious value) was sufficient to save, and apparently resulted in a complete recovery for, the boy. Sweetly, the text is lacking in all visual gore and the main illustration is the gate shown below.

The impulse for the publication of this case study is contained in the preface: “About two years since I had the good fortune to be a successful chirurgeon to the child, whose case is contained in the following narrative: but I had scarce wiped my instruments, and put up my plaister-box, before a physician of this town, sneakingly and maliciously endeavoured to stifle the reputation Dr. Spenser and myself got by that cure, insinuating that it was impossible to be performed, because wounds of the brain were absolutely mortal …”.

The first printed book devoted to the subject of plastic surgery

Tagliacozzi, Gaspare, 1545-1599. De curtorum chirurgia per insitionem libri duo. Venetiis: Apud Gasparem Bindonum iuniorem, 1597. Shelf mark NN.n.345.

De curtorum chirurgia per insitionem (1597) was written by Gaspare Tagliacozzi, a professor of anatomy and surgery in Bologna, and published two years before his death. This work, the title of which can be translated as On the surgical restoration of defects by grafting, considers the surgical treatment of mutilated lips, ears and noses. It is divided into two books: The first book is theoretical and philosophical musings on the face and on surgery, whilst the second book includes the practical details of the surgeries. A very useful English summary of both books can be found on pages 197-216 of The life and times of Gaspare Tagliacozzi (1976) by Martha Teach Gnudi and Jerome Pierce Webster, which can be found near this exhibition case. Gnudi and Pierce’s magisterial study also includes facsimiles of the twenty-two illustrations within De curtorum chirurgia per insitionem.

The illustration shows the repair of a mutilated lower lip, which in modern medical terms is known as cheiloplasty. The defect shown is too large to be repaired by simply stitching the remaining healthy parts of the lower lip together, and therefore quires a graft of additional tissue. Tagliacozzi’s “Italian method” uses a graft of skin from a distant body site, in this case the inside of the upper arm. The graft once stitched to the lip must remain attached to the donor site for around 14 days until it is established, and has a blood supply from the lip. This requirement explains the elaborate tunic the individual must wear in order to maintain this attachment.  When the donor flap is severed from the donor site, the free end is stitched to the other part of the lip to cover the defect. The graft would later be shaped to give the best possible result.

Cosmetic surgery has a long history. Physicians in India were using skin flaps in reconstructive surgery close, or adjacent, to a facial defect (the “Indian method”) possibly as far back as 3000 BC. However, with nose reconstruction at this time, for example, using tissue from the cheek or the forehead one was left with an obvious facial scar, which the “Italian method” avoided.

Today, a variety of techniques using local skin flaps, as far as possible, are utilised in facial reconstructions of the nose and lips as these provide the best tissues matches and ultimately give the best possible functional and aesthetic results.

 

Unborn child

Blégny, Monsieur de, Nicholas, 1652-1722. A true history of a child anatomized. London : Printed by Tho: James … 1680. Shelfmark Sel.f.127.

The wife of a cloth worker in Toulouse, “after happily bringing forth into the world ten children in the latter part of the year 1652, found herself with child of the eleventh; and at the expiration of the accustomary time, she felt the pangs of travel …”. However, no child was born, despite the attention of, and the medications given by, physicians. Over many years the “burden” caused her great back pain, though the pain lessened towards the end of her life as it had by then “grown fast and without any motion”. Finally, on 17th June 1675 she died of a fever at the age of 62. When her body was opened a hard substance was encountered covering the body of a male child, 14 inches long when stretched out. The plate shows the “mummified” remains of the child in her womb. Although this is an unusual case, similar cases have been reported in the medical literature.

Scurvy: the most lethal occupational disease in history?

Harvey, Gideon, 1640-1700.  A new discourse of the smallpox, and malignant fevers, with an exact discovery of the scorvey. London : Printed by H. Hodgskin for James Partridge, … , 1685. Sel.f.132.

Scurvy has been described (McCord, 1959*) as the foremost occupational disease in history, as it killed around two million sailors between 1500 and 1800. Death from scurvy entailed terrible suffering. It was not clearly established until the 20th century that a nutrient deficiency, that is, lack of vitamin C, was the cause of scurvy, although the idea of nutrient deficiency was raised numerous times throughout the period when scurvy was most prevalent.

Despite the organisation of the title-page the first 174 pages of Gideon Harvey’s 200 page monograph is devoted to scurvy.  Harvey recognised different forms of the disease and wrote that mouth scurvy was caused by acid lymph, and leg scurvy by an excess of alkalinity in the blood. He treated the former with bloodletting from the left arm and the latter with bloodletting from above the knee.  As William Harvey’s discovery of blood circulation was accepted at this time, Gideon Harvey’s different treatments would be difficult to justify rationally.

*McCord, C. P. (1959) Scurvy as an occupational disease. The Sappington Memorial Lecture.  Journal of occupational medicine v.1: page no.315-no.318.