Tag Archives: pulse measurement

Medical technology in the asylum – and plans for the blog

With the Science in the Asylum conference completed, we’re excited to begin a more regular blog schedule, with posts each Monday from myself, Mike, and guest contributors. Submissions are strongly encouraged – the conference brought us into contact with several people working on the history of science and medicine in relation to the asylum, and we’d love to find more of you! Please get in touch here.

This is the first of our Monday blogs, and takes up a theme we plan to revisit in some future posts: the use of medical technologies within the asylum.

By the 19th century, as doctors increasingly focused on bodily lesions as the site of disease, there was hope that disturbances of the mind might also have somatic origins. It was commonsensical, for example, that the activity of the brain depended upon its blood supply; thus, blood vessels were often identified as the starting point of disease. Daniel Hack Tuke’s Dictionary of Psychological Medicine noted that ‘capillary disorder could lead to a wide variety of dysfunctions’, and suggested that circulatory issues were the cause of many mental diseases. Indeed, during microscopical and post-mortem investigations, the poor state of patient’s blood vessels was often noted.

How could such bodily change be examined in the living patient though? In Medicine and the Reign of Technology, Stanley Reiser lists the new pulse-recording instruments that appeared in the 19thcentury. Among these, Étienne-Jules Marey’s sphygmograph of 1860 was crucial. By resting one end of a piece of metal on a pulsating artery, and attaching a pen to the other, the pulse could be made visible as each movement was traced onto a strip of paper.

Marey’s sphygmograph. © Wellcome Images

By the 1880s, Marey’s device had been eclipsed by Robert Ellis Dudgeon’s ‘pocket sphygmograph’, a smaller device that was especially useful for the asylum physician who dealt with restless or excitable patients.

Dudgeon’s less cumbersome ‘pocket’ sphygmograph. © Wellcome Images

Sphygmographs had their problems: each model might produce a slightly different result, or be further affected by the technique of the person using it. Nevertheless, George Thompson at Bristol Asylum said that he ‘implicitly trusted [the] instrument as a means of discovering at least one form of brain-disease’. He applied the sphygmograph to almost every form of mental disease found in the asylum, but found the most striking results in general paralysis (now understood to refer to neurosyphilis).

In the West Riding Medical Reports in 1871,Thompson described his experiments on the pulse of general paralytic patients at the West Riding asylum. He presented two tracings, one from his own research and one from W.B. Carpenter’s Principles of Human Physiology. They bore a remarkable resemblance. Whilst Thompson’s example represented the pulse of a general paralytic, Carpenter’s showed the pulse of a healthy person in a state of chill.

Thompson’s pulse tracing of a general paralytic patient.

…And Carpenter’s tracing of a healthy individual suffering from ‘chill’.

To Thompson, it was evident that in both cases a contraction of the vessels was being recorded. He concluded that general paralysis was ‘a disease … owing to a considerable extent to persistent spasm of the vessels’.

Could halting this spasm also halt the degenerative process that was characteristic of general paralysis? James Crichton-Browne was one of several alienists who used Calabar bean for this purpose. Calabar is a poisonous seed from an African plant, lethal if ingested in anything more than minute quantities. It was put to a number of uses in the 19th century due to its ability to paralyse muscle, and proved to be the first effective drug treatment for glaucoma. It was suggested that Calabar could lead to an improvement in general paralytic patients such as ‘S.M.’:

‘When admitted to the West Riding Asylum he had exalted ideas; there [was] inequality of the pupils, tremor of the lips, and awkwardness of gait. … [After three months of treatment with Calabar bean] there was such marked improvement in his condition that the use of the extract was discontinued.’

Calabar beans. © Wellcome Images

Calabar’s relative scarcity in the historical record suggests it was seen as an occasional palliative measure rather than cure, however. Writers on the subject were at pains to point out that they knew of no authenticated cases of cure; those patients who recovered enough to be discharged were often re-admitted later, any improvement proving only temporary.

These experiments with the sphygmograph in the Victorian asylum are interesting for a number of reasons. Many historians have emphasised how new medical technologies in the 19th century served to remove the patient’s subjective experiences from the picture, with doctors relying on supposedly ‘objective’ mechanical data. In the case of the sphygmograph, data didn’t necessarily eclipse the patient, with the tool employed alongside established methods of clinical examination including consideration of the patient’s own testimony.

Looking at the use of such technology in an asylum context can also expand our understanding of the asylum’s place within contemporary medical landscapes. Christopher Lawrence describes the sphygmograph as a tool with limited usage, partly because experimental physiology only developed as a specialty in the 1870s. The use of it in the asylum suggests that researchers there were drawing inspiration from a wide variety of medical disciplines – a spirit of innovation also evident in the invention of instruments and post-mortem tools by members of the alienist community.

Examining such research can also problematise wider assumptions about the development of the medical profession and the resulting impact on patients. As described above, post-mortem findings could raise questions that were investigated further in the laboratory, the findings of which then informed clinical intervention. The notion of an easy split between the laboratory and clinical contexts, then, is perhaps less applicable to the asylum at this time.

Forgotten episodes within the history of asylum research are often forgotten because they don’t involve a breakthrough discovery, a success story, or a bizarre intervention that raises our anxieties about patient care. Yet they can also be places where we might find alternative viewpoints to the pictures presented in broader histories of medicine. Perhaps then, unusual endeavours such as Thompson’s should grab our attention not as side projects in the historiography, but as narratives with wider historical significance.

Further reading

William Bevan Lewis, ‘Teachings of the Sphygmograph in General Paralysis of the Insane’, Journal of Mental Science 27 (1881).

T. Duncan Greenlees, ‘Observations with the Sphygmograph on Asylum Patients’, Journal of Mental Science 32 (1887).

Christopher Lawrence, ‘Physiological Apparatus in the Wellcome Museum. 1. The Marey Sphygmograph’, Medical History 22 (1978).

Christopher Lawrence, ‘Physiological Apparatus in the Wellcome Museum. 2. The Dudgeon Sphygmograph and its Descendants’, Medical History 23 (1979).

Alex Proudfoot, ‘The Early Toxicology of Physostigmine: A Tale of Beans, Great Men and Egos’, Toxicological Reviews 25 (2006).

Stanley Joel Reiser, Medicine and the Reign of Technology (Cambridge: CUP, 1978).

George Thompson, ‘On the Physiology of General Paralysis of the Insane and of Epilepsy’, Journal of Mental Science 20 (1875).

George Thompson, ‘The Sphygmograph in Lunatic Asylum Practice’, West Riding Lunatic Asylum Medical Reports 1 (London: J & A Churchill, 1871).

Keith Wailoo, Drawing Blood: Technology and Disease Identity in Twentieth-Century America (Baltimore: Johns Hopkins University Press, 1997).

- Jennifer Wallis