A ‘new’ disease?

Posted on April 29, 2013 by | Leave a comment

At the November and December meetings of the London Clinical Society in 1884, an interesting debate unfolded: was a ‘new’ disease appearing in England? A number of patients had been seen in hospitals and asylums in the preceding years who exhibited unusual joint affections. It was a sudden phenomenon, characterised by severely swollen but usually painless joints. Though any joints of the body might be affected, knees and ankles tended to fare worst. The lack of pain and generally dulled sensations that were experienced impacted on the everyday actions of sufferers, who dropped objects, frequently fell, or had difficulty walking. Other bodily manifestations appeared in the form of ulcers, often on the feet. Many patients also reported that they suffered from ‘neuralgia’, ‘flying gout’, and gastric crises.

Deformity of the knee in Charcot's disease. © Wellcome Images/St Bartholomew's Hospital Archives & Museum.

Deformity of the knee in Charcot’s disease.
© Wellcome Images/St Bartholomew’s Hospital Archives & Museum.

The condition was first properly identified by neurologist Jean-Martin Charcot in 1868, earning it the moniker ‘Charcot’s joint’ (Charcot noted that the condition had also received attention from J.K. Mitchell in the 1830s). In 1880s England, though, according to W. Hale White of Guy’s Hospital, ‘discussion about Charcot’s joint [had] waxed very warm’. Alienist interest in the condition stemmed from its appearance in tabes dorsalis (nerve degeneration in the spinal cord due to untreated syphilis) patients, who were often seen in asylums before the incidence of syphilis was vastly reduced with the use of penicillin in the 20th century. Charcot said he had only ever seen the condition in tabes dorsalis patients, and other asylum doctors related similar cases. Conolly Norman at Dublin’s Richmond Asylum hosted a meeting of the Irish division of the Medico-Psychological Association in 1896 at which delegates viewed two cases of Charcot’s joints on Richmond’s wards, both occurring in general paralytic (neurosyphilitic) patients. In syphilitic conditions, nerve degeneration impaired patients’ reflexes and sensations whilst muscle wastage reduced the natural protection around the joints. The result was that patients became increasingly vulnerable to injury (discussions of the disease often noted spontaneous fractures), or their bones literally ‘wore away’ as they ground together.

L0061441 Dissected knee joint, the subject of marked locomotor ataxy

Dissected knee joint exhibiting Charcot’s disease.
© Wellcome Images/St Bartholomew’s Hospital Archive & Museum.

Alongside syphilis, physical injuries were also cited by some as an immediate, exciting cause. (Whilst syphilis was the condition most commonly associated with Charcot’s disease by nineteenth-century doctors, it was gradually recognised as a condition with much wider aetiological factors. It may be present in diabetic neuropathies, for example, where nerve damage affects the weight-bearing joints.) J. Wallace Anderson related the case of a patient at Glasgow Royal Infirmary. Admitted to the hospital due to his difficulty in walking, the 45 year old gardener ‘ascribe[d] his complaint to a stroke of lightning … twelve years ago’, following which he began to experience ‘tingling’ pains and weakness in the hips, until finally his right hip “went out”. Though he was discharged from the hospital able to walk with the aid of sticks, he remained prone to ‘unusual variations in his general condition’. Charcot’s disease was, ultimately, untreatable, and little could be done for patients other than try to assist their mobility in various ways.

N0008052 Charcot's knee

X-ray of a Charcot’s knee.
© Wellcome Images.

Ascertaining if Charcot’s disease was indeed novel to the late nineteenth century was difficult. One stumbling block was the apparent lack of such specimens in pathological museums: if it wasn’t a new disease, why were there no samples from previous years? At the London Clinical Society meeting, Sir James Paget suggested that museum curators – even if they were able to secure a specimen of a comparatively rare condition – tended to collect normal rather than abnormal specimens for teaching purposes. Interpretations of the disease ranged from osteo-arthritis to ‘modified’ chronic rheumatic arthritis, though such diagnoses were complicated by the sudden onset of the joint affection.

Although W. Hale White said that discussion about the disease had ‘waxed very warm’ and ‘everyone [had] had an opportunity of expressing his opinion’, he doubted if ‘exact knowledge of the subject [had] been much advanced’. At a point in time when doctors were increasingly keen to pinpoint the physical lesions of disease, Charcot’s joint seemed a perfect opportunity to trace a visible physical deformity to minute changes in the nerves. This was complicated by its resemblance to other conditions, however: was it just a form of rheumatism? Was it a ‘new’ disease? Or a ‘new compound of diseases’? These were – and are – fascinating questions that bring to mind current historical debates about retrospective diagnoses, the ‘framing’ of disease, and how we assess medical knowledge of the past: giving a condition a name didn’t necessarily mean that its identity was static, or signal a ‘pinnacle’ of understanding.

Further reading

D. Ferrier, On Tabes Dorsalis: the Lumelian Lectures, delivered before the Royal College of Physicians, London, March, 1906 (London: John Bale, son & Danielsson, 1906).

W.J.M.A. Maloney, Locomotor Ataxia (Tabes Dorsalis): An Introduction to the Study and Treatment of Nervous Diseases, for Students and Practitioners (London: D, Appleton, 1918).

L.C. Rogers et al, ‘The Charcot Foot in Diabetes‘, Diabetes Care 34 (2011).

L.J. Sanders, ‘Jean-Martin Charcot (1825 – 1893): The Man Behind the Joint Disease‘, Journal of the American Podiatric Medical Association 92 (Jul./Aug. 2002).

H. Waldo, ‘A Case of Charcot’s Joint Disease, with Perforating Ulcer of the Foot in a Tabetic Patient‘, BMJ (1 Dec. 1894).

R. Waterhouse, ‘Remarks on the Arthropathies of Acquired Syphilis‘, BMJ (10 Oct. 1908).

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The Giants’ Shoulders #58: Without theme

Posted on April 17, 2013 by | 4 Comments

Hello, and welcome to Giants’ Shoulders #58, the monthly online carnival of history of science blogging, this month hosted at Asylum Science. There have been a whole load of interesting posts and programmes on the history of science, technology and medicine recently, so here’s a round-up of what caught my eye: a bit like the Top 40, but without the (public) ding-dong battle over what to include.

Politics

Margaret Thatcher (1925-2013): pictured not inventing soft-scoop ice cream

With the death of Margaret Thatcher (pictured right), histories of politics (and economics) in the second half of the twentieth century seem to have dominated the news in the UK over the last week. But, that doesn’t mean historians of science had nothing to say about the Iron Lady. Over at the Guardian’s Political Science blog, Jon Agar and Alice Bell both commented on Thatcher’s ambiguous relationship with science policy (and even more ambiguous relationship with Mr Whippy). And, looking forward in the field of science policy, Rebekah Higgitt and James Wilsdon discussed the positive role that historians of science can play in political decision-making. Before this, history in general (but only in relation to Britain) had become something of a political football in the heated responses to Michael Gove’s proposed new national curriculum (discussed last month by Seb Falk). Add this to the ongoing debates over open access and the impact agenda, and the rise of pseudo-academic journals, and there are plenty of contemporary issues for historians of science to be mindful of. Robin Schleffer’s thoughts on ‘slow science’, Patrick McCray on the opium of technology, the ever thoughtful contributions of Will Thomas, and the recent focus section in Isis on the Future of the History of Science (free access), also give plenty of food for thought on the future directions of the discipline.

Troubled Minds

Emotional Time Machine

There was further 80s revisionism on the BBC as it commemorated the 25th anniversary of the introduction of Prozac. In fact, there have been a few interesting Radio 4 shows on the history of psychiatry recently, and on BBC 2 there is a series currently airing on Royal Illnesses, including an obligatory retrospective diagnosis of George III (whose recovery was celebrated with a blaze of light). Elsewhere in London, Chris Millard queried the possibility of equating emotional states across different centuries, as he took audiences back in time in a Carnival of Lost Emotions, as part of a Festival of Neuroscience. Thomas Dixon examined the complex meanings that can be attributed to weeping, Lisa Smith raised the historical problems of measuring physical or emotional pain and linking it with particular brain states, and Jesse Bering reported on the surprisingly sexual etymology of the neuro-anatomical terms used for the brain’s different parts.

In his Trying Biology blog, Adam Shapiro wrote a couple of interesting posts on the links between anti-evolutionary thinking and, firstly, the anti-eugenics movement, and secondly, antidisestablishmentarianism. Laura Jane Martin noted Darwin’s interest in monstrosities, David Bressan recounted Charles Lyell’s search for the sea snake, and Romeo Vitelli wrote about early 20th century attempts to train chimpanzees. Outside of the academy, Bess Lovejoy presents the story of Orrill Stapp, whose search for the Other World was recorded at the Seattle Public Library. Importantly, if you want to understand human character, look here.

Doctors, Patients, Poisons and Potions

Brains weren’t the only suggested source of mental illnesses, however, as Jennifer Wallis explored in her post on the surgical origins of post-operative insanity. Meanwhile, Maev Kennedy reports on the happier products of surgery, as the design for a statue of the WWII plastic surgeon Sir Archibald McIndoe and his ‘Guinea Pigs’ was unveiled in East Grinstead. The Dead Bell blog uncovered an individual (though perhaps typical) case of industrial poisoning from chemical dyes in early 20th century USA; Linda M. Richards detailed the widespread poisoning of Navajo people and land by uranium mining waste in the latter decades of the century; and Dominic Berry began investigating Sir William Gavin, who may well have poisoned the entire English countryside! Bloggers from the British Library looked at the roles of Indian doctors and the East India Company in combating outbreaks of cholera in the nineteenth century. Jennifer Evans considered the intriguing relationships between doctors and patients in the early modern period, and the way the location of treatment affected their position (anyone fancy staying with their surgeon for a few weeks?). On the subject of human reproduction, Lisa Plotkin writes about the presence of ‘foreign bodies’ in pregnant women, including slippery elm bark and uterine fibroids (UCL have an exhibition on this theme, open until July); at the Dittrick Museum, Brandy Schillace traces the emergence and disappearance of William Smellie’s 18th century birthing automaton (see also the story of another, chess-playing automaton); and, following the passing of Sir Robert Edwards (1925-2013), this 2010 article (free access) provides an interesting account of the hostile reception to his IVF research in the early 1970s.

Food stuffs and ingenious concoctions were also popular this month. At the Chirurgeon’s Apprentice, Lindsey Fitzharris discussed the Victorian hostility to masturbation, which led to the production of graham crackers and cornflakes, among other things! Thony Christie provided a lovely Roman recipe for stuffed dormouse delicately seasoned with fermented fish sauce, and also presented us with an account of Dr Thomas Moffet, a Paracelsian practitioner who recommended salt for a healthy sex life. Also at the Recipes Project, Tillmann Taape outlined the heavenly properties of super-distilled wine, and Ashley Buchanan looked at the secret medicines produced at the Medici court. From the concoctinghistory blog we got ancient recipes for soap, Rebecca Unsworth took us through the history and processes of producing a starched ruff, and Fiona Keates described the solid food and detestable coffee served at the Royal Society under Sir Joseph Banks.

A Ruff Made by Rebecca Unsworth Once Starched. Photo © Rebecca Unsworth, Courtesy of the School of Historical Dress.

Picturing, Measuring, and Exploring

Albert Einstein holding a puppet of Albert Einstein.

Images remain a popular subject in the history of science, and there were plenty of wonderful pictures to see in the blogosphere. At The H-Word, Rebekah Higgitt began a series on ‘Picturing Science’, exploring a range of paintings, caricatures and slides from the National Maritime Museum’s collections, whilst Vanessa Heggie recounted the physiological planning that went into flying over, and photographing, Mount Everest. Felicity Henderson considered Robert Hooke’s Micrographia - the first fully illustrated book of microscopy – and Nehemiah Grew’s Musaeum Regalis Societis; Mike Rendell illustrated the varied career of an image based on Erasmus Darwin’s Botanic Garden; Google honoured the illustrations of Maria Sibylla Merian; Keith Moore looked at blue lizards; Genotopia turned attention back to composite photography; John F. Ptak presented pictures of star clusters; St Andrews Special Collections and Paula Findlen discussed the work of Athanasius Kircher; and Albert Einstein held a puppet of himself (above right). At Scientific American, Clarissa Ai Ling Lee began a detailed study of the culture of scientific diagrams, beginning with examples from mathematics and physics.

The clocks went forward for British Summer Time, but the loss of sleep didn’t affect the Board of Longitude Project blog, where a constant stream of posts covered topics including: setting the date for Easter; timekeeping on the Bounty; and using earwax to fix quadrants. For those of us looking at the stars, there was Thony Christie on grumpy astronomers in the late 17th century, Alice Sage on star-gazing girls in the 18th century (see also these other great links about women in science), Imogen Clarke on early 20th century astronomical expeditions (and the split between ‘classical’ and ‘modern’ physics), and Amy Shira Teitel on cosmonauts stranded in the Siberian forest. There were also stories of travel that included Edmond Halley on HMS Paramore, Charles Wilkes on the last great worldwide sailing expedition, Vincent Lunardi in a balloon, Albert Einstein sailing around in search of wisdom, and forensic biologists in search of Tycho Brahe’s nose. Finally, we also learned that Tom Lehrer (of ‘The Elements Song’ fame) turned 85 recently, that Michael Faraday occasionally failed, and that Sherlock Holmes was a great chemist.

The End

Phew! Well hopefully that should be enough reading to keep everyone busy for an hour or two. Thanks to Lisa Smith, Thony Christie and Rebekah Higgitt for all their suggestions, and thanks to you for visiting our website. Giants’ Shoulders #59 will return again on 16 May 2013 in… Something by Virtue of Nothing, a blog run by Kata Phusin (http://somethingbyvirtueofnothing.blogspot.de). You can send your suggestions directly to Kata, or to Thony Christie at The Renaissance Mathematicus.

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Surgery in the asylum III: Post-operative insanity

Posted on April 1, 2013 by | 1 Comment

In our final instalment of the ‘Surgery in the Asylum’ series, I want to consider the possible effects of surgery on patients – not necessarily those in the asylum, but hospital patients more generally. Towards the end of the 19th century, concerns were growing about cases in which surgeries of various kinds appeared to have caused insanity.

To take one example, a 48 year old woman was admitted to hospital in February 1883 after suffering from an ovarian tumour for some years:

‘Ovariotomy was performed … The progress of the case for the first six days was satisfactory enough; she was cheerful, anxious to get well, and slept and ate normally. On the sixth day her physical condition was satisfactory, but her expression had entirely altered. She still recognized her husband and those of us who were immediately concerned with her care, but her mind was full of delusions varying in their nature, but all to her of an alarming character. She was very restless in bed. On the eighth day she was in a condition of acute mania. She recognized no one, attempted to injure those about her, and was very violent. … My friend Dr. Savage was kind enough to see the patient with me, and looked upon it as an ordinary case of acute mania. The wound was dressed on the eighth day [where it was found] she had torn the edges apart in her struggles …  During the next eight-and-forty hours the mania continued with undiminished intensity. Her physical condition became weaker, and the greatest difficulty was experienced in getting her to take any food. She died exhausted on the eleventh day.’

At post-mortem, it was reported that nothing could be found that explained the woman’s rapid mental decline. What had caused such a marked change in her character after the operation?

One possibility was simply the disturbing experience of undergoing an operation. The dread and fearful anticipation experienced by patients before surgery was recognised by C.T. Dent, who reminded the readers of ‘Insanity following Surgical Operations’ that almost everyone felt somewhat emotional before such procedures. If a person was especially nervous, he said, it was ‘no uncommon thing to see [them] in a deeply hysterical state, continuing for days, after [for example] the extraction of a tooth, where no anaesthetic was administered.’

V0017053 An unconscious naked man

Man attacked by demons armed with surgical instruments, symbolising the effects of chloroform on the human body. Watercolour by R. Cooper.
© Wellcome Library, London

Administering anaesthetic, however, was no sure-fire way around the problem. An oft-cited explanation for post-operative insanity was the use of anaesthetics and antiseptics during surgery. The use of chloroform or ether to sedate the patient, and of iodoform or carbolic acid to prevent infection, were increasingly implicated in post-operative issues – and sometimes death. ‘Chloroform deaths’ attracted significant press attention in the late 1800s, where doctors were often depicted recklessly administering chloroform to helpless patients. It wouldn’t be surprising if such a perilous chemical could also bring about insanity. Too much chloroform or iodoform absorbed into the body was suggested by some to have a toxic effect on the brain causing mental disturbance, much like excess alcohol. (Conversely, some writers posited that alcoholic patients might become temporarily insane as a result of the enforced drying-out period in hospital before and after an operation.)

Variations between cases, though, made it difficult to pin down any particular cause with confidence (what about cases of insanity where anaesthesia hadn’t been given?) and it was here that the patient’s predisposition was appealed to. In inherently ‘unstable’ individuals, an operation might – like an accident or traumatic event – act as a catalyst. S. Weir Mitchell put this forcefully in a speech to the College of Physicians of Philadelphia in 1910: ‘We must consider the patient as a loaded gun, and that the surgeon merely pulls the trigger.’ Not all agreed about this hereditary influence, noting that the main point of interest in many cases of post-operative insanity was the pronounced lack of family insanity or previous attacks. It was precisely this absence of hereditary taint that made cases of post-operative insanity so interesting.

L0011590 Une laparotomie (a l'hopital Broca), by J. Heuse.

Doctors at a Parisian hospital perform abdominal surgery.
© Wellcome Library, London

A vocal critic of hereditary theory was Henry Cotton, who – in an interesting reversal of the operations = insanity equation – advocated surgical intervention to cure (and sometimes prevent) mental disturbances. In their quest to tackle the somatic origins of insanity, Cotton and his colleagues removed thyroid glands, ovaries, teeth, tonsils, and sections of intestine (an undertaking chronicled in Andrew Scull’s Madhouse).

Cotton’s solution to insanity was an alarmingly simplistic one that had predictably dire results: post-operative infection, sometimes resulting in death, and relapses of mental illness. His endeavours demonstrated precisely what his predecessors had worried about: in examining the links between surgery and insanity they had been cautious in assigning mental disturbance to a single cause like infected teeth or tonsils. Within discussions of post-operative insanity several factors might be cited to explain the phenomenon – often in collaboration – and the fact that it could affect people with no apparent hereditary predisposition somewhat blurred the boundary between ‘sanity’ and ‘insanity’. Identifying the definitive cause of mental illness is an enduringly attractive prospect, seen today in the hunt for a ‘schizophrenia gene’ for example. Just how far biology can provide a complete explanation, however, is a question equally enduring.

Further reading

On chloroform deaths, see Ian Burney, Bodies of Evidence: Medicine and the Politics of the English Inquest, 1830 – 1926 (Baltimore: Johns Hopkins University Press, 2000).

A.C. Butler-Smythe, ‘Acute mania following rupture of the rectum by enema thirteen days after ovariotomy. Recovery‘, Journal of Mental Science (Jul. 1893).

William Noyes, Review of Folie post-opératoire by Prof. Mairet, The American Journal of Psychology 4 (Dec. 1891).

J. Christian Simpson, ‘On post-operative insanity, with notes of a case occurring three weeks after laparotomy‘, Journal of Mental Science (Jan. 1897).

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Surgery in the asylum II: The craniectomy controversy

Posted on March 17, 2013 by | Leave a comment

In January 1895, The Strand Magazine published another instalment in its ‘Stories from the Diary of a Doctor’ series. The tales were written in a semi-fictional tone, ‘in collaboration with a medical man of large experience’ – ‘[m]any [were] founded on fact’. They presented a romantic vision of the doctor as saviour, accompanied by illustrations that echoed other Strand series such as Sherlock Holmes. January’s ‘Diary of a Doctor: Creating a Mind’, relates the situation of a titled family whose male head has been taken ill after an injury. The attending doctor, frequently present in the family’s castle, is there when the young male heir, Cyril, is brought to visit his grandfather on his sickbed.

Strand_Magazine_1891Two and a half years old, the boy is described as beautiful – almost angelic – yet the doctor relates that ‘one glance was enough to tell me that … the mind in that poor little casket was a sealed book. The beautiful boy was looking at no one: he was gazing straight out of the window…’ The grandfather is less poetic: “That boy’s an idiot,” said the Squire – “he’s a beautiful idiot – he’s no heir for me – don’t mention him again.” ‘Idiocy’ was a common term at this time used to refer to a condition present from an early age that made a person incapable of managing their own affairs; it was typically deemed incurable, and covered a range of conditions that are now generally referred to as learning difficulties.

The doctor, his curiosity aroused, examines the child and draws the family’s attention to

“how small his head is in proportion to the rest of his frame. That smallness is at the root of the mischief. The little fellow is suffering from premature ossification of the cranial bones. In short, his brain is imprisoned behind those hard bones and cannot grow. The bones I refer to should at his tender age, be open, to allow proper expansion of the growing brain.”

A little while later, he notes: “An idea has occurred to me – it is a daring one … I propose to open the casket where the child’s mind is now tightly bound up, and so to give the brain a chance of expansion.”

V0030048 Brain of someone described as an "idiot". Process print.

Brain of someone described as an ‘idiot’. © Wellcome Images

The parents of the child consent, and the operation is carried out. Lasting one and a half hours, the procedure is deemed a success. The tale ends triumphantly, with young Cyril like any ‘normal child’ by his third birthday, and presented to his grandfather (now recovered from his illness) with a dramatic flourish, eventually living in the castle and – presumably – a potential heir once more.

Whilst ‘Creating a Mind’ relied on fictional tropes for its effect, it raised very real concerns. T. Telford-Smith, Superintendent of the Royal Albert Asylum, described it as ‘a tale which I fear has given rise to exaggerated hopes in the minds of the parents of many idiot children’, suggesting that several had pursued the possibility of surgery after reading the piece. The procedure in question – craniectomy – involved removing bone from the skull to increase the space available for the brain. Telford-Smith estimated that over 200 such operations had been performed in Britain, America, and France since 1890. It was not something to be taken lightly, he emphasised, and was certainly not the miraculous cure that The Strand made it out to be. Similar concerns were voiced by G.E. Shuttleworth, who thought that craniectomy had ‘almost passed from the domain of science to the region of romance’ as a consequence of ‘Creating a Mind’.

This is not to say that medical practitioners deplored the operation completely. Telford-Smith had known it performed on several children who had been admitted to the Royal Albert. Relating the case of a six-year-old boy who had never spoken and often knocked his head violently against the wall – a practice that the parents found ‘most distressing’ – he said that the parents could see only limited difference after three procedures were performed in 1895. The child remained speechless, yet his parents said they would submit him to the operation again knowing the results, as his restlessness had decreased markedly and the head-knocking had ceased. The case was presented by Telford-Smith in direct response to ‘Creating a Mind’ – despite the slight improvements in the child, he said, ‘A mind has not been created’. His account, though, emphasised the need to look at each case individually, weighing up the risks and possible outcome. He also noted the need for dedicated education and training after surgery, reminding readers that a physical procedure was no substitute for love and attention.

Surgery on the brain (or that aims to affect the brain) is a highly emotive issue, especially when performed on children as in these cases. The Strand episode is an interesting example in which a popular representation of psychosurgery was positive – so much so that several doctors were moved to respond to it. ‘Creating a Mind’ sits in contrast to tales like Heart and Science (mentioned in this post) that portrayed surgery on the brain as a Gothic nightmare. It’s a reminder, then, that discussions about psychosurgery often extended beyond the asylum walls and that opinions on the matter were rarely straightforward: for some parents of the 1890s, a novel medical procedure such as craniectomy may have been perceived as a means of ‘cure’ for their children.

Further reading

L.T. Meade and Clifford Halifax, ‘Stories from the Diary of a Doctor: Creating a Mind’, The Strand Magazine (Jan. 1895).

G.E. Shuttleworth, ‘The Surgical Treatment of Idiocy‘, Journal of Mental Science (Jan. 1896).

T. Telford-Smith, ‘Craniectomy for Idiocy, with Notes of a Case‘, Journal of Mental Science (Jul. 1897).

T. Telford-Smith, ‘Craniectomy, with the After-History of Two Cases‘, Journal of Mental Science (Jan. 1896).

David Wright and Anne Digby (eds.), From Idiocy to Mental Deficiency: Historical Perspectives on People with Learning Disabilities (London: Routledge, 1996).

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Surgery in the asylum I: Which way to the operating theatre?

Posted on March 4, 2013 by | 2 Comments

On our lunch break a few weeks back, fellow postgraduate student Emily Andrews and I started to compare notes about post-mortem procedures in asylums (these are the kind of conversations you get into as historians of medicine – to our fellow diners, I can only apologise). Whilst both of us had uncovered quite detailed reports about the appearances of bodies at post-mortem, we had less information about the spaces in which post-mortems were performed. This led us to consider other medico-surgical spaces within the asylum.

There are many accounts in both archival and secondary literature of operations being performed on asylum patients. Alongside narratives of psychosurgery (covered previously on this blog) are tales of other types of operation: for cataracts, for removing foreign bodies ingested or inserted by patients, or for the excision of tumours. Rarely, though, are the practicalities of these operations mentioned. Where did they take place? Who performed them? Who benefitted (and who didn’t)?

The operating theatre of London's Metropolitan Hospital in 1896. © Wellcome Images

The operating theatre of London’s Metropolitan Hospital in 1896. © Wellcome Images. Is this perhaps what many asylum operating rooms looked like?

The need for surgical intervention within the asylum was graphically highlighted in an 1858 article by D.F. Tyerman, Colney Hatch Superintendent, in which he described various emergency situations involving suicide attempts by patients. In 1834, he had prevented the death of a male patient who cut his throat with a knife during dinner. Arriving at the scene, Tyerman ‘introduced into the wound [his] fore finger’ before plugging the wound with lint and tying the carotid artery. He was also called to attend situations in the immediate area beyond the asylum, including a man who had cut his throat in a nearby hotel. As institutions typically placed some distance from urban centres, Tyerman’s anecdote showed how basic medical skills possessed by asylum staff might be called upon by neighbours in an emergency.

This distance could be problematic for the asylum, however, especially if an institution lacked staff who were able undertake such heroic measures. J.H. Sproat, in 1899, related four cases of surgical intervention that had necessitated calling in outside help because staff at the Somerset and Bath Asylum lacked the necessary skills. In some cases, local doctors proved difficult to convince, being reluctant to operate in institutions lacking the usual facilities and no doubt fearing any ensuing coroner’s inquests. In large asylums, then, it was crucial to have, if not the staff, then at least the facilities to deal with medical emergencies, as well as to perform more routine operations. (Many asylum staff were able to perform minor procedures, though it appeared less common for them to undertake things such as amputation, as William Dudley had at the West Riding Asylum in the 1890s.) R.H. Steen, writing on asylum architecture, included an operating theatre in his plans of a model asylum; it should be located close to the wards and ‘centrally placed’.

Victor Horsley operating at Queen Square in the early 1900s. © Wellcome Images

Victor Horsley operating at Queen Square in 1906. © Wellcome Images

The importance of such facilities can be seen in accounts of the construction of Cardiff Lunatic Asylum, which opened in 1908 under the Superintendency of Edwin Goodall. Speaking at a meeting of the Medico-Psychological Association in 1908, he explained how ‘the object had been to give the Institution as much a hospital character as possible’ (indeed, he also considered the possibility of employing the term ‘mental hospital’ rather than ‘asylum’ – a change that did take place a few years later). In the original plans for Cardiff, an operating room was included at a cost of £600, then reconfigured to be accommodated within existing rooms for the lower cost of £500. A loan to cover the cost had been refused by the Commissioners in Lunacy, but ‘as the buildings were nearly completed at that time they went on with them, [reasoning that] the cost would have to be borne out of the rates’. The Commissioners, defending their refusal to provide the funds, ‘said the operations [undertaken in asylums] were few’ and ‘that operations were often done in private bedrooms’. Goodall countered by producing a telegram from Dr Bond at Long Grove Asylum ‘saying that he had an operating room, so that such had recently been allowed [by the Commissioners]’. Debates with the Commissioners aside, Goodall proudly reported that Cardiff now had a well-equipped operating room with ‘about £360 worth of … instruments’.

Though Cardiff still relied on outside expertise where necessary, the benefit of on-site facilities was soon evident: within two weeks of opening their operating room, ‘their Night Sister sustained a fracture of the base of the skull and … was operated upon [there]’. Evidently, then, staff as well as patients might be treated within the asylum. Many operations were described as urgent measures – to treat an injury or remove a life-threatening tumour – but for patients in particular, surgery might also be viewed as a route to improved quality of life. Robert Picqué in France considered this in a 1907 article ‘Ce que Doit Être à notre Époque La Chirurgie des Aliénés’ [‘The Needs of our Time in Respect of the Surgical Treatment of Insane Patients’]. As a review of his work related, Picqué suggested that ‘restoring the use of a limb [for example], may exercise an indisputable, though indirect, action towards the restoration of mental health’ by allowing the patient to resume a more active life.

All was not well, however. At the same time, doctors were increasingly expressing their concern about the often hasty recourse to surgery on asylum patients. A worrying faith in craniectomy as a ‘cure’ for idiocy was identified, as well as the phenomenon of post-operative insanity – insanity caused or exacerbated by surgery. Both of these though, will be stories for future posts…

- Jennifer Wallis

If you’ve found any information on surgical practices in an asylum you’re researching, we’d love to hear from you!

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(Anti)Vivisection and the Asylum

Posted on February 18, 2013 by | 1 Comment

As previous articles on this blog have highlighted, animals occasionally played an important part in asylum research in the nineteenth century. Their behaviours could be observed as part of the growing programme of comparative psychology, and they could be used to study the physiological or psychological effects of new drugs. They were also crucial in the development of cerebral localisation theory, being the experimental subjects of various stimulation and ablation procedures which aimed to locate different mental functions in distinct regions of the brain cortex. Tests on dogs, cats, monkeys, rabbits, etc, were a surrogate for human experimentation, and the results of animal studies were transferred to an understanding of the human brain.

David Ferrier. © Wellcome Images.

David Ferrier, a Scottish physician who began his animal research in the laboratory of the West Riding Lunatic Asylum in 1873, became the leader of cerebral localisation studies in Britain. His ideas were quickly accepted by most of the scientific community, but they were still highly contentious, and Ferrier, at the front of this programme, became the focus of various criticisms. His evidence was critiqued, and his work was attacked on its principles too. Cerebral localisation was not just reductive of empirical explanation, but reductive of the human soul. His “new phrenology,” as it was termed by its critics, was seen by some as an attempt to remove God from an understanding of the human mind.

In 1875, Frances Power Cobbe wrote that “the prevalent materialistic belief that the secrets of the Mind can be best explored in matter, undoubtedly account in no small matter for the vehemence of the new pursuit of original physiological investigations.” Cobbe, who founded the Victoria Street Society and was the single most influential figure of the anti-vivisection movement in Britain, saw experimental brain studies as unquestionably linked with materialism and the rise of animal experimentation. She believed in an independent, God-given mind, which the new cerebral localisation reduced to simple reflexive machinery. In the most macabre fashion, experimenters showed that volitional acts were not reliant on a conscious, immaterial mind: cats clawed and macaques kicked simply by stimulating a small region of the animals’ brain.

Frances Power Cobbe. © Wellcome Images.

Following a period of petitioning and canvassing, anti-vivisection protestors led by Cobbe succeeded in prompting a Royal Commission into vivisection in 1875. In the House of Commons, the MP James Maden Holt argued that Ferrier’s experiments manifested “a refinement of cruelty which renders the operator… quite unfit to be trusted with the care of an animal, much less of a human being.” He pointed out that “[w]hen it comes to the knowledge of the public that these are the practices of a medical man who has free access to the lunatic asylums of the West Riding, public indignation will know no bounds.” Anti-vivisection campaigners voiced the concern that allowing animal testing was a slippery slope that might eventually lead to human experimentation in asylums or other medical institutions. They had reason to worry. Across the Atlantic, an Ohio physician named Roberts Bartholow had already replicated Ferrier’s electrical stimulations on Mary Rafferty, a young cancer patient under his care at the city’s Medical College.

In 1876, Parliament passed the Cruelty to Animals Act (which lasted for 110 years). Under the Act, vivisection could continue, but only for original, useful purposes, with a license from the Home Secretary. Anti-vivisection campaigners saw the Act as a concession to the scientific lobby, and so whilst trying to alter the Act, they also sought to prosecute individuals under the new laws in place. Their main target was Ferrier. In a well-documented session of the 1881 International Medical Congress in London, Ferrier had presented a monkey which had its left motor cortex removed, leaving it with no voluntary control of its right-sided limbs. He was then summoned to court for operating on animals without an appropriate license, though the case was soon thrown out when it was revealed that Ferrier’s assistant had actually conducted all the experiments, and was in possession of a full license. Cobbe’s prosecution failed, and the scientific community breathed a collective sigh of relief. Anti-vivisection campaigners turned to reflect on their movement, and to repeat to their audiences the potential tragedies that lurked in a country that did not seriously resist animal experimentation. The incidence of such operations would undoubtedly continue to rise, and scientists would push the boundaries of decency further. Indeed, in a society openly tolerant of testing on animals, surely it was only a matter of time before scientists turned to other humans as their test material?

Front cover of Heart and Science. © Andrew Gasson.

Ferrier, localization and vivisection became topics for several prominent novels of the time. In Heart and Science (1883), written in response to Ferrier’s 1881 trial, Wilkie Collins tried to “drag the scientific English Savage from his shelter behind the medical interests of humanity.” H.G. Wells’ The Island of Dr. Moreau (1896), showed how vivisected animals, which jabber and are kept in conditions similar to asylum patients (at least in the imagination of the public), eventually turn on their tormentor. And in Dracula (1897), Bram Stoker drew attention to the way modern psychology construed humans as automata devoid of a soul. Dr. Seward, an asylum superintendent in the novel, wrote that had he “the secret of one such mind – did I hold the key to the fancy of even one lunatic – I might advance my own branch of science to a pitch compared with which Burdon-Sanderson’s physiology or Ferrier’s brain knowledge would be as nothing.” Asylum patients were perfect material for experimental investigations.

As Richard French has shown, anti-vivisectionism in the nineteenth century was part of a broader public movement against the creeping power of scientific and medical authority, alongside other crusades like the early anti-vaccination campaigns or protests against the Contagious Diseases Acts. The worry of potentially being experimented upon like vivisected animals also had a resonance with criticisms of asylums, which were remote, foreboding and obscure institutions, whose working practices were mostly misunderstood and often dreaded. Alienism – the profession of treating the insane – was as foreign to most men and women as were the grotesque experimental practices of Dr Moreau. Through Ferrier, and his work at the West Riding, vivisection and asylums became well associated, in the scientific community, and the public mind too.

Further Reading

R.D. French, Antivivisection and Medical Science in Victorian Society (Princeton: Princeton University Press, 1975).

S.L. Star, Regions of the Mind: Brain Research and the Quest for Scientific Certainty (Stanford: Stanford University Press, 1989).

A. Stiles, Popular Fiction and Brain Science in the Late Nineteenth Century (Cambridge: Cambridge University Press, 2012).

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Muscle and mind in the asylum

Posted on February 4, 2013 by | 3 Comments

The bodies of the insane held a particular fascination for the 19th-century asylum doctor. Actions might betray a person’s psychological state in the most striking ways, with bodies subjected to tics and spasms, and facial expressions revealing the deepest thoughts and feelings.

The late 1800s was a climate in which the relationship between body and mind was being ever more meticulously refined. In the 1890s, for example, Charles Sherrington discovered a feedback mechanism in muscles that was important for the regulation of posture and movement. Sherrington’s work suggested that bodily attitudes – such as seated posture, or how a person ‘carried’ themselves – could indicate inner psychology.

L0057988 Dynamometer, France, 1890-1910

A dynamometer, just one of a range of tests that might be used to assess patients’ bodies upon admission. © Wellcome Images

This was an idea that had obvious application within the asylum. At admission, patients were physically assessed, a process that often included testing of the reflexes and bodily strength using contraptions such as the dynamometer (to measure the grasping power of the hands). Thus, a doctor might note something like this: ‘Patellar tendon reflex absent in each limb, no cremasteric reflex. Tactile sensibility of lower limb is diminished.’ For this patient, his mental state was also found wanting; he showed ‘great obtuseness in understanding what [was] said to him’ and was characterised throughout his case notes as dull, unresponsive, and generally ‘diminished’. In a seamless melding of body and mind, both were in a state of decline. It was the body that succeeded in speaking for the patient, his appearance compensating for his difficulties with verbal communication (his articulation was ‘thick and indistinct’).

N0006653 Tabes dorsalis

Demyelination seen in tabes dorsalis. © Wellcome Images

Apart from indicating a general deterioration in a patient’s condition, the state of muscles and reflexes might also indicate the seat of a problem with surprising specificity. David Ferrier noted that the knee jerk was a crucial indicator of disease – it was absent in cases of tabes dorsalis, for example. (Tabes dorsalis is a neurosyphilitic condition characterised by nerve degeneration.) The importance of the muscular sense in health and disease was clear in many physiological and psychiatric tracts. ‘That the muscles possess a sensibility of their own’, wrote Ferrier in The Functions of the Brain, ‘…is proved beyond all doubt by their nervous supply and by physiological and clinical research’. He described a hierarchically-organised community of muscles, varying in strength, ‘thus the powerful extensors of the back, and muscles of the thighs keep the body arched backwards and the legs rigid’. Guillaume Benjamin Amand Duchenne de Boulogne (phew!) had also credited the muscular system with an independent intelligence, reasoning that coordination required a harmonious relationship between different muscle groups. The use of the term ‘muscular sense’ by many physiologists gave muscular tissue an almost anthropomorphic character – muscles were independent entities capable of action and reaction in response to external influences.

L0033543 Spasms in hysterical patients

Muscular spasms in ‘hysterical’ patients. © Wellcome Images

It was up to the patient, then, to keep their muscles in check. The will, an elusive but enduring concept in alienist science, was most forcefully expressed – or most notably absent – in the movements of the body. The view that only the will stood between order and chaos, as Roger Smith tells us, ‘translated easily to physiological descriptions of the economy and hierarchical arrangement of the nervous system’. Loss of control over bodily movements was viewed as a ‘de-education’, or erasure of learned automaticity, seen for example, in the tottery but energetic gait of tabes dorsalis patients.

The central explanations for such loss of control, by emphasising the co-existence of reflex action and the will, allowed mental science to move closer towards natural, biological science without discarding that essence of being human that marked men apart from other animals. Thus, as Stephen Jacyna points out, bodily actions could be explained in a mechanistic way, but also as a consequence of manipulation by the soul. If a person lost their powers of control, the body could descend into a state of chaos. In this way, the patient’s movements and attitudes frequently served as a diagnostic tool in the asylum, particularly if the patient’s own verbal testimony was unreliable or impossible.

Further reading

W.F. Bynum and F. Clifford Rose (eds.), Historical Aspects of the Neurosciences: A Festschrift for Macdonald Critchley (New York: Raven Press, 1982)

David Ferrier, The Functions of the Brain (London: Smith, Elder & Co., 1876)

L.S. Jacyna, ‘Somatic theories of mind and the interests of medicine in Britain, 1850–1879’, Medical History 26 (1982).

Roger Smith, Inhibition: History and Meaning in the Sciences of Mind and Brain (London: Free Association Books, 1992).

- Jennifer Wallis

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Notes on a scandal: infection control in the asylum

Posted on January 7, 2013 by | Leave a comment

We’re fast-forwarding 100 years today, out of our usual 1880s comfort zone  and into 1984, to look at an event that suggests something of a failure of science in the asylum. This was the year when an outbreak of Salmonella at Stanley Royd Hospital in Wakefield (formerly the West Riding Asylum) led to widespread criticism and investigation of hospital hygiene, also feeding into contemporary debates about deinstitutionalisation.

Salmonella enterica. © Mark Jepson/Wellcome Images.

Salmonella enterica. © Mark Jepson/Wellcome Images.

It was the August Bank Holiday weekend of 1984 that marked the beginning of what would become a significant event. On Sunday morning, a few patients were found to be suffering from sickness and diarrhoea – not a particularly unusual occurrence in the hospital – but it became clear something serious was afoot when, by 9.15am, 36 patients across eight different wards were affected.

In When Food Kills, Hugh Pennington describes the course of events and illustrates the frightening rapidity of the outbreak: by Sunday’s close it  had claimed its first fatality. Being a Sunday – and a Bank Holiday – staffing levels were already low and medical care fell to a junior medical officer who had only been at Stanley Royd for three weeks. By Tuesday, when the Environmental Health Department was contacted, several staff were affected, along with a staggering 240 patients. That day, the agent was identified as Salmonella, but it was a development that did little to alter the outbreak’s toll. Within days, around half of the hospital’s 788 residents had been ill and 19 died. All 19 were elderly and less able to withstand the fluid loss of severe diarrhoea.

Staff clean the wards. ITN news, 5 Sept. 1984 (click to view the report via JISC MediaHub).

Staff clean the wards. ITN news, 5 Sept. 1984 (click to view the report via JISC MediaHub; you’ll need an institutional login).

Stanley Royd was propelled into the media spotlight: TV news documented the frantic attempt to clean the wards, as well as the somewhat defensive attitude of public health officials. Blame was placed on everyone from managers to kitchen staff. The patients themselves also became a key part of the explanation for why the outbreak had taken hold so quickly: the difficulty of ensuring that patients ate the food intended for them, of policing special diets, and of maintaining adequate standards of personal hygiene, were all cited as hindrances to ‘barrier nursing’ methods that might reduce the risk of infection.

Stanley Royd’s kitchen and food preparation procedures turned out to be the heart of the matter. The outbreak was traced to roast beef that had been cooked, cooled, and left in the open for 10 hours before being served to patients in salads. The details of the hospital’s catering arrangements were meticulously scrutinised, and the results were far from acceptable: cleaning schedules not kept, dirty cloths soaked and re-used, a lack of cold storage facilities. The very fabric of the hospital was problematic, the Victorian architecture (described as ‘Dickensian’) and repeated ‘building-on’ hindering modernisation. The kitchens, built in 1865, had such high ceilings that it was impossible to clean them properly.

Indeed, the hospital had struggled for many years with the spread of infection, as demonstrated by Claire Jones at our recent conference, ‘Science in the Asylum’. A 1913 report by West Riding pathologist Harold Gettings claimed the asylum had never been free of diarrhoea since it opened in 1818, and annual reports of the 19th century frequently showed a concern for the quality of the water supply.

Photomicrograph from the 1890s depicting a diatom (form of algae). © WYAS C85/1111.

Photomicrograph from the 1890s depicting a diatom (form of algae). © WYAS C85/1111.

The inquiry that followed the Stanley Royd outbreak (also prompted by the discovery, in 1985, of Legionnaires’ disease at Stafford General Hospital) culminated in the 1988 ‘Acheson Report’ (Committee of Inquiry into the Future Development of the Public Health Function and Community Medicine). The Report pinpointed ‘a decline in available medical expertise’ in the control of communicable diseases, and a lack of forward planning in the event of an outbreak. The Salmonella outbreak had come at a time when food poisoning was increasingly on the agenda (Campylobacter, for example, had been isolated in human faecal specimens in the 1970s). Preventing the spread of food poisoning was a matter that concerned all levels of hospital staff; kN0029437 Scientist in a microbiology labitchen workers played a significant role, but the role of the microbiologist was repeatedly emphasised too. With medical training and knowledge of local epidemiology, consultant microbiologists began to play an increasing part in hospital infection control – an area that had previously relied on the cooperation of nurse/doctor/microbiologist for its success, and with few clear guidelines. Just as the asylum Superintendents of the late 19th century had stressed the uses of the laboratory in mental health care, the ‘behind the scenes’ scientific labour of the psychiatric hospital was once again brought to the fore.

What was suggested in the whole Stanley Royd scandal was a certain degree of apathy towards the psychiatric patient: it transpired that the kitchens had been described as ‘a culinary disaster area’ back in 1978, but that renovation proposals were steadily lost in local bureaucracy, the hospital not seen as a redevelopment priority. The public response to the episode, however, showed that people viewed it as far from a trivial issue. It was perhaps the final nail in the coffin for Stanley Royd: in the midst of moves towards deinstitutionalisation and community care, the Salmonella outbreak was a powerful argument for the inefficacy of the large, Victorian psychiatric hospital, and the hospital closed just over 10 years later. The far-reaching effects of the outbreak are reflected in its continued use as an example par excellence of how not to approach infection control – such as the title of Brian Keeble’s article ‘Sleep walking to another Stanley Royd?’ It was a rather sad and embarrassing end to an institution that was hailed in the late 19th century as a model of ‘scientific psychiatry’.

Further reading and viewing

Anon., ‘Stanley Royd: the epidemiological lesson’, BMJ (8 Mar. 1986).

H.S. Gettings, ‘Dysentry, Past and Present‘, Journal of Mental Science 59/60 (1913/1914).

Philip Johnston, ‘Defending 19 deaths from food poisoning’, BMJ (1 Feb. 1986).

Carol A. Joseph & Stephen R. Palmer, ‘Outbreaks of salmonella infection in hospitals in England and Wales 1978-87’, BMJ (29 Apr. 1989).

Mukesh Kapila & Roger Buttery, ‘Lessons from the outbreak of food poisoning at Stanley Royd Hospital: what are health authorities doing now?’, BMJ (2 Aug. 1986).

Brian Keeble, ‘Sleep walking to another Stanley Royd?’, BMJ (7 Sept. 2006).

T. Hugh Pennington, When Food Kills: BSE, E. coli, and disaster science (Oxford, OUP: 2003).

Debbie Weston, Infection Prevention and Control: Theory and Practice for Healthcare Professionals (Chichester: John Wiley & Sons, 2008).

Food Poisoning at Stanley Royd Hospital, ITN (7 Sept. 1984).

- Jennifer Wallis

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Happy Christmas, and some Christmas reading

Posted on December 22, 2012 by | Leave a comment
L0006981 The Christmas Tree at the Middlesex Hospital.

The Christmas tree at the Middlesex Hospital, as depicted in Illustrated London News, 1874. Wellcome Library, London.

Frankly, we weren’t sure how to combine Christmas with a blog about the history of science… Luckily, lots of other people have done the job for us, so here are some of the best bits from the web to guide you through the festive season.

  • First up, Robb Rutledge explains the science behind the perfect Christmas present (and how to avoid disappointment on Christmas morning) at the thInk blog.
  • Over at Scientific American, Hannah Waters relates the natural history of mistletoe (though it may seem less romantic when you learn of its reputation as a parasite…).
  • One to read before you put the turkey in the oven: how to cultivate perfect Christmas dinner chemistry from the Guardian.
  • If you’re feeling adventurous and have 48 hours to spare, Mad Science’s Easy Science Experiments guides you through making your own perfume. And, if the kids have tired of their presents by Boxing Day, you might want to consider an indoor snowman.
  • For those moments when you can stand no more of I’m-a-Celebrity-Dancing-on-Ice-X-Factor, you can’t go wrong with Michelle Ziegler‘s Contagions blog for your history of science and medicine fix. She’s compiled a very impressive ‘Sleigh Load of History’ to keep you informed and entertained over the holiday season.
  • If, like me, a large part of your Christmas involves watching festive ghost stories on TV – and you’re already planning your 2013 conference activities – you may be interested in an event coming up at UCL in January: Psychical Research and Parapsychology in the History of Medicine and the Sciences.
  • Also slightly – if unintentionally – creepy, are the recordings of what curators at the Museum of London believe to be the first audio records of a family Christmas: you can hear several extracts at BBC News. Happy listening, and Happy Christmas to all our readers!

- Jennifer Wallis

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A new blog from the Wellcome Trust: thInk

Posted on December 13, 2012 by | Leave a comment

L0025619 Phrenology: the human and animal brain, the location of its

Over the next few months, I’ll be acting as an occasional columnist for thInk, a new blog from the Wellcome Trust. thInk will bring together writers from a variety of backgrounds to examine neuroscience in medicine, art, and the everyday.

The blog has been set up to complement Wonder, a series of public events put together by the Wellcome Trust, the Barbican, and the British Neuroscience Association (BNA). Most of these will take place in March and April 2013, culminating in the BNA’s ‘Festival of Neuroscience‘ at the Barbican between 7-10 April 2013. It promises to be an exciting set of events, and I’m really looking forward to contributing to and reading the blog over the coming months. You can read more about Wonder and the Festival of Neuroscience now, over at thInk.

- Jennifer Wallis

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