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Oct 9, 2016 - Wanderlust    No Comments

Surgical history and More Medical Museums

I LOVE all things related to medicine–especially the history of medicine and the science that goes along with it so given that I was ecstatic to visit 6! nerdy, science-y, medical-y museum in a span of two weeks. Not a super well-known fact, but IRL I am a registered nurse and before that I worked as a registered respiratory therapist. There isn’t a single area in a hospital that I haven’t spent time in as a professional… Emergency rooms, YEP. Operating Rooms, YEP. Morgue during autopsy, YEP. Pharmacy Prep areas, YEP. Delivery Rooms, YEP. Intensive Care Units, YEP, and regular ole patients’ room. I’ve worked in them all at some point or another. SO, it should come as no surprise to anyone, that I LOVE all things related to medicine. Enter the Operating Museum and Herb Garret, Science Museum, Hospital Museum, Pathology Museum, and Florence Nightingale Museum. All in London and all open to visitors. [However, they are not all free].  The Semmelweis Museum in Budapest makes up the sixth museum in this sext-fecta of historical medical museums.

First up… The Old Operating Theatre and Herb Garret aka one of the coolest and best museums in LONDON.

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In the shadow of the Shard, near all the cool and modern construction that is going on near London Bridge, lies The Old Operating Theatre and Herb Garrett.  It is a spectacular little museum filled with tons of historic and interesting items related to medicine, pharmacy, and surgery; it is also one of those museums that you don’t necessarily hear a lot about and even if you do, you are still not really sure where it is.  It’s hidden away in the roof space of what was once St. Thomas’ church. It was closed last time I was in London, so I made sure that I’d be able to go in this time. Missing the old Operating Theatre twice probably would have killed me. Thankfully, we won’t have to find out.

The Old Operating Theatre is a bit hard to find.  I found it as I find most things, by wandering, but that’s not the recommended way of getting there. It’s a bit off the beaten tourist path in London [still Zone 1, still in the city].  If you can find the fabulous Borough Market, which is celebrating 1000! [let that sink in a moment] years in Southwark, then you can find the old operating theatre. I whole-heartedly recommend visiting the market for food and drink and then some more food… [perhaps after the museum if you tend to be a bit squeamish] Anyway… you wander down St Thomas Street and as you do so, you are greeted by this ever-so-slightly alarming skull. And this is one of the many reasons I love London. It’s not often that a skull greets the visitor at a proper museum.

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What’s far MORE alarming, at least to me and my propensity to trip and fall on staircases and hurt myself, is the never-ending spiral of stairs [32 tiny, narrow stairs, in case you were counting] that lead up into the old operating theatre. It DOES take some effort, but it IS worth it.

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First is the herb garret. The heady scent from the big bowls of medicinal herbs and spices will smack you violently in the face the second you go inside, so be prepared for that. Once inside there are numerous displays of herbs, spices, medicinal plants, distillations, tinctures and powders, all with thoughtful hand-written explanations and thoughtful captions such as this description for Motherwort, taken from Maud Grieve’s A Modern Herbal (1931): “Especially valuable in female weakness and disorders… allaying nervous irritability and inducing quiet and passivity of the whole nervous system. Good against hysterical complaints.”  [because you know those damn Victorians were obsessed with curing ‘female weakness and hysterical complaints’].

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There isn’t a square inch of free surface space in the place – it’s an apothecary of chaos. The ambiance created by the smell is absolutely fantastic – there’s a sense of life and of discovery, purely down to the mixing aromas of all the ingredients in the room. It is visually stunning, and somewhat overwhelming, but it *feels* real. I can almost imagine I’m in the old-school apothecary where they just grab a little of this and a bit of that, call it a prescription and send you on your way. And whether or not they’re sure of which herb goes where, who knows? But you get a real sense for the magic and the experimental spirit that lead us to modern pharmacy we have today.

herb manual

 

Once you’ve had your fill of the apothecary [or if the smell starts to get to you], head on to the back to the Operating Theatre. This is the earliest surviving example of an operating room in Europe, [circa 1850 or therabouts] ,and it’s pretty impressive. This one was a teaching theatre, and you really feel that priority was given to the spectators in this environment.

At times, I tend to have an over-active imagination, and it is easy to picture the gruesome scene– well-attired medics sawing through flesh, blood squirting everywhere, scholars craning their necks for a closer look, and for those without strong stomachs– swooning, or making a mad dash for the nearest bed pan; and let’s not forget the blood-curdling screams of the patients…imagine this…a patient is lying on the operating table…wide awake and staring wide-eyed right back at the surgeon. Anesthetics hadn’t been discovered yet and patients were given the option of whisky, opium, or being knocked out by being hit on the head with a mallet.

Surgical technique was still a bit of an idiomatic expression; surgeons relied on swift amputation techniques, the faster you could remove a limb the better a surgeon you were. Most patients died of infection rather than the actual blood loss or surgery and the old frock coats worn by surgeons during operations were, according to a contemporary, ‘stiff and stinking with pus and blood.’

Read the caption–that’s a cervical dilator

Patients often had injuries which prevented them from taking the spiral staircase up to the theater, and were therefore transported into the theater via a pulley system and an opening in the wall behind the current chalkboard. The ground would also be covered in straw to help prevent blood from dripping on to the patrons of the church below the theater. [because that would be rude… taking communion to received the body and blood of Christ only to receive the ACTUAL blood of John Smith or some other mere mortal]

Museum visitors are also provided with a first-hand account for good measure:

The first two rows… were occupied by the other dressers, and behind a second partition stood the pupils, packed like herrings in a barrel, but not so quiet…The confusion and crushing was indeed at all times very great, especially when any operation of importance was to be performed, and I have often known even the floor so crowded that the surgeon could not operate until it had been partially cleared. There was also a continual calling out of “Heads, Heads” to those about the table whose heads interfered with the sightseers.

Having observed [and had!] surgery up close and personal as well as from a gallery [in the 21st century], I prefer the 21st century way of doing things.

Exit the theatre and one can examine the instruments of torture: tools for trepanning; row after row of blades, designed for every imaginable variety of amputation; and even a physician’s stick, used for walking, but also held across the patients mouth as a restraint during surgery – as evidenced by the surviving teeth marks. This was by far my favorite part of the museum.

Elsewhere, there are areas dedicated to the use of animals in medicine (leeches or maggots anyone?), bizarre Victorian contraptions for the hard of hearing, and a number of human organs pickled in formaldehyde, including a pair of lungs blackened by the London smog.

Oct 2, 2016 - Wanderlust    18 Comments

An Ode to Semmelweis

Medical Museums

I graduated nursing school last year and as a flashback to that time in history, I’m dedicating the month of October to my fascination with all things nursing, medical, and otherwise health related.

First up in my orgy of medical museums and such is the Semmelweis Museum in Budapest, Hungary.   I feel bad for Semmelweis.  He made a major medical discovery, yet couldn’t explain it, so all his colleagues mocked him mercilessly, and then he died… a broken man.  Only to have his discovery proven right a few short years later.  He is one of the reasons we do a 2-minute scrub prior to entering surgical delivery rooms.

Here it is:  my ode to Semmelweis and his discovery of germs…

It’s a tiny little thing; it’s hardly ever seen.

But once inside, it can turn you  green.

Germs are many; treatments are few

For many years no one knew

What they were or their effects

Sickness was caused by air or a hex

Then Semmelweis figured it out

“Wash your hands” he wanted to shout.

But no one listened; no one cared

And no one cared how patients fared

A crusade against the little beasts he undertook

He gave speeches; he wrote a book

When he died he was outcast

But twenty years later, a hero he was–at last

Today entire classes are taught how to wash their hands

To wash away beasts tinier than a grain of sand

Semmelweis is the hero; he’s the man

Except to the microbes; talk of him in banned

semmelweis museum

Semme;weis’ father’s apothacary shop

Semmelweis was a Hungarian doctor teaching medicine in Vienna. He noticed that the [male medical] students moved between the dissection room and the delivery room without washing their hands and their patients had a death rate of over 30%. [Oh, the infection control police at the hospital would be horrified] while the midwives’ patients, who didn’t do dissections, had a death rate of only about 2%. On a hunch, he set up a policy.  Effective immediately, doctors must wash their hands in a chlorine solution when they leave the cadavers.  Mortality from puerperal fever [aka childbirth fever] promptly drops to three percent and further drops to 1% after physicians began cleaning instruments in the same solution they washed their hands.

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The museum is also a medical history museum

Now here’s the part of the story where things grow strange. Instead of reporting his success at a meeting, Semmelweis tells his boss, but his boss orders him to ‘stand down’. Semmelweis says nothing. Finally, a friend publishes two papers on the method. By now, Semmelweis has started washing medical instruments as well as hands.

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The hospital director feels his leadership has been criticized [by Semmelweis]. He’s furious. Livid. Beyond angry. He blocks Semmelweis’s promotion. The situation gets worse. Viennese doctors turn on this Hungarian immigrant. They run him out of town. Finally, he goes back  home to Budapest.  He is an outcast among the “civilized” Austrian medical community. He brings his hand washing methods to a far more primitive hospital. He cuts death by puerperal fever to less than one percent. He does more. He systematically isolates causes of death. He autopsies victims. He sets up control groups. He studies statistics.  His has it all figured out.

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Requisite skull with a hole in it

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Finally, in 1861, he writes a book on his methods. The establishment gives it poor reviews. Semmelweis grows angry and polemical. He hurts his own cause with rage and frustration.  He calls his colleagues idiots and ignoramuses.  He bashes their stupidity. He turned every conversation to the topic of child-bed fever.

After a number of unfavorable foreign reviews of his 1861 book, Semmelweis lashed out against his critics in a series of Open Letters.  They were addressed to various prominent European obstetricians, including Spath, Scanzonia, Siebold, and to “all obstetricians”. They were full of bitterness, desperation, and fury and were “highly polemical and superlatively offensive” at times denouncing his critics as irresponsible murderers.  He also called upon Siebold to arrange a meeting of German obstetricians somewhere in Germany to provide a forum for discussions on puerperal fever where he would stay “until all have been converted to his theory.”

By mid-1865, his public behavior became irritating and embarrassing to his associates. He also began to drink heavily; he spent progressively more time away from his family, sometimes in the company of prostitutes.  His wife noticed changes in his sexual behavior. On July 13, 1865 the Semmelweis family visited friends, and during the visit Semmelweis’s behavior seemed particularly inappropriate.  Later in 1865 he suffers a mental breakdown. Friends commit him to a mental institution. Semmelweis surmised what was happening and tried to leave. He was severely beaten by several guards.  He was put in straitjacket and confined to a darkened cell. Apart from the straitjacket, treatments at the mental institution included dousing with cold water and administering castor oil. He died after two weeks, on August 13, 1865, aged 47, from a  gangrenous  wound caused by the beating. His autopsy revealed extensive internal injuries, the cause of death  pyemia–the very thing he spent his life trying to eradicate.

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Semmelweis was buried in Vienna on August 15, 1865. Only a few people attended the service.  Brief announcements of his death appeared in a few medical periodicals in Vienna and Budapest. Although the rules of the Hungarian Association of Physicians and Natural Scientists specified that a commemorative address be delivered in honor of a member who had died in the preceding year, there was no address for Semmelweis; his death was never even mentioned.

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A memorial to Semmelweis, savior of women and children

That same year Joseph Lister [the person whom Listerine is named after] begins spraying a carbolic acid solution during surgery to kill germs. In the end, it’s Lister who gives our unhappy hero his due. He says, “Without Semmelweis, my achievements would be nothing.”

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The anatomical Venus mad of wax… see I do see art from time to time

PS:  I don’t write poetry often; there is probably a reason for that

Mar 27, 2016 - Current Events    No Comments

Modern Medicine, circa 1900

 

Eric Johnson, Eve Hewson, Clive Owen in ‘The Knick’/Image © Mary Cybulski/Cinemax

I admit to being a nerd…especially when it comes to medicine, or more accurately the history of medicine.  Medicine today is strangled, but this is not about that.  I have recently discovered the TV show The Knick.  As per usual, I am late to the party as season 2 finished up last fall and it is uncertain whether of not, despite it’s good reviews, it will return for a season 3.  For those who have been living under a rock (much like myself) or completing nursing school (much like myself), here’s a quick synopsis:  Medicine, or more precisely surgery, in 1900’s New York City at a hospital  called The Knickerbocker or The “Knick” was a dangerous proposition. (To be fair, surgery anywhere in 1900 was a dangerous proposition.)  The Knick’s chief surgeron is a fellow named John Thackery (very loosely based on Dr. William Halsted, who happens to be one of my medical heroes). Thackery has a very serious cocaine addiction (because in 1900 cocaine was a wonder drug and it’s addictive properties were not known at all) as well as revolutionary – if not mildly terrifying – ideas that turn patients into guinea pigs at a time when doctors were only slightly more knowledgeable about medicine than barbers.

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I travel a fair amount, and not just to the beach for R&R, and in my travels, I’ve been to Semmelweis’ lab in Budapest, and the Old Operating Theatre Museum in London (you should totally go by the way, especially if you like The Knick)

you see, just like the TV show.

Summary:  The Knick is awesome.  It’s bloody; it’s gruesome.  It’s realistic.  But there’s only two seasons, and I have binged watched it in a whopping two days.  I have had to turn to books to get my fix.  A few I’ve discovered so far:

Fever by Mary Beth Keane: The search for Typhoid Mary, who is responsible for a massive outbreak of typhoid fever, is a fascinating side-plot during the first season, and Keane writes a great fictionalized account of the actual Typhoid Mary.

Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted by Gerald Imber: The character of Dr. John Thackery is loosely based on Dr. William Stewart Halsted, and this biography is a fascinating examination of his personal and professional life.

Blood and Guts: A History of Surgery by Richard Hollingham: Though it covers a broader period than The Knick, having a sense of where these surgeons and their work sit in the larger history of medical history is helpful for context. And it does shed some serious light on surgery during the Victorian era.

Dr. Mutter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine by Cristin O’Keefe Aptowicz: Often described as the P.T. Barnum of the surgical theater, Dr. Mutter’s flamboyant approach to medicine is a great primer for appreciating Dr. Thackery’s methods