INSTRUMENTS & INNOVATIONS RCSI HERITAGE COLLECTIONS
RCSI HERITAGE COLLECTIONS
RCSI is proud to be the custodian of a treasure trove of material relating to the history, practice and teaching of medicine and surgery in Ireland. The remit of the Library’s Heritage Collections is to curate, preserve and promote this diverse material, which includes archives, artefacts, manuscripts, antiquarian books, paintings and pamphlets. We also hold a rich selection of historical medical instruments, ten of which are highlighted in this booklet.
In the pages that follow there is trial and there is error. There is pain and its relief. There is life and death. There is discovery, adaptation and invention – and, we hope, future inspiration.
Susan Leyden, Archivist Dr Ronan Kelly, Library Assistant
Instruments & Innovations is a Library initiative, but in many respects it involved the whole RCSI community: it began as an undergraduate project for the 2017 RCSI Research Summer School, RCSI academic staff provided clinical insight, and the instruments themselves are largely gifts from alumni and their families.
INSTRUMENTS & INNOVATIONS
In ancient times the art of lithotomy – the removal of calculi, or stones, from inside certain organs – was considered so dangerous that Hippocrates’ oath forbade it for mere physicians (‘I will not use the knife, not even, verily, on sufferers from stone’); the practice was to be left to specialists (‘I will give place to such as are craftsmen therein’).
William Dease (1752 – 1798), founding member of RCSI & first Professor of Surgery
RCSI Heritage Collections has many instruments related to the procedure, particularly dating from the late eighteenth and early nineteenth centuries, when three figures associated with the College – Daunt, Dease and Peile – were responsible for a number of innovations and refinements. According to Abraham Colles, ‘These instruments had originally been invented by Mr Daunt; they were improved by the late Mr Dease and owe their present perfect form to the ingenuity of Mr Peile.’
George Daunt (1712 – 1786), surgeon in Mercer’s Hospital
The ancient art of lithotomy
Robert Moore Peile (1765 – 1858), President of RCSI
1700 17501725 1775 foundedRCSI 1784 1825 187518501800 1900
01. CUTTING FOR STONE
‘the expeditious working of the trepan with the safety of the trephine’
The traditional tools used to perforate the cranium – to treat haematoma, for example –were the trepan, which bored a hole, and the trephine, which cut a disc of bone.
Samuel Croker-King (1728-1817), founding member of the Dublin Society of Surgeons, first President of RCSI 1700 17501725 1775 1825 187518501800 1900 foundedRCSI 1784 02. A HOLE IN THE HEAD
reluctance he has submitted to) is well known to every operator.’ The trephine required less pressure, but was slower: ‘… not only fatiguing to the operator, but tiresome to the patient, especially if more than one perforation is to be made.’ Croker-King commissioned a Dublin cutler to manufacture an improved tool combining ‘the expeditious and equal working of the trepan with the safety of the trephine’.
In 1791 Samuel Croker-King noted that while the trepan was often faster, it was prone to slippage: ‘The difficulty of keeping a patient quiet (unruly from the effects of the accident, or impatient under an operation which perhaps with
(1728 – 1807), Honorary Fellow of RCSI
Sylvester O’Halloran (1728 – 1807), Honorary Fellow of RCSI
Sylvester O’Halloran
1700 17501725 1775 1825 187518501800 1900 foundedRCSI 1784
Proposals for the Advancementof SURGERY in Ireland
03.
In 1765 Sylvester O’Halloran published a treatise on gangrene, appended to which was a short document entitled Proposals for the advancement of surgery in Ireland At the time, Irish surgery was unregulated and inconsistent. Influenced by the Académie Royale de Chirurgie, which he had seen in Paris, O’Halloran’s Proposals advocated the creation of a list of competent surgeons, the appointment of professors and the establishment of suitable premises in Dublin. The document is considered a blueprint for what would become RCSI.
VISIONARY
O’Halloran had many medical interests, but his reputation was founded on early research in ophthalmology. At twenty-two he published A new treatise on the glaucoma, or cataract (1750), followed by A critical analysis of the new operation for a cataract (1755). His findings were based on patients he treated as well as experiments on freshly-killed calves and live dogs. RCSI Heritage Collections holds a variety of sets of cataract knives similar to those O’Halloran would have used.
The forerunner of the modern hypodermic syringe
Francis Rynd (1801 – 1861), Fellow of RCSI 1700 17501725 1775 1825 187518501800 1900 foundedRCSI 1784 04. TO THE POINT
In 1844 Francis Rynd attended to a middle-aged woman with severe facial pain (‘She thought her eye was being torn out of her head, and her cheek from her face’). His treatment involved the injection of morphine beneath the skin, for which he invented a new instrument, the forerunner of the modern hypodermic syringe. ‘In the space of a minute,’ he wrote in a short article in the Dublin Medical Press ‘all pain (except that caused by the operation, which was very slight) had ceased, and she slept better that night than she had done for months.’ Rynd’s instrument had a hollow needle but not a plunger and so relied on gravity. In
1853, a French surgeon, Charles Pravaz, added a plunger to Rynd’s instrument. Subsequent modifications were made in Edinburgh by Alexander Wood (who used the word ‘subcutaneous’) and Charles Hunter in London (who preferred ‘hypodermic’), giving rise to a long, fractious, public debate between the two. Rynd did not comment until 1861, when he published in the Dublin Quarterly Journal of Medical Science a fuller account of his earlier innovation. Coincidentally, following his sudden death, the same issue also carried Rynd’s obituary.
Sir William Wilde (1815 – 1876), Licentiate and Fellow of RCSI 1700 17501725 1775 1825 187518501800 1900 foundedRCSI 1784
‘In using it the cross bar is pushed forward, and a noose [is] made of the wire at the small extremity, of sufficient size to include the morbid growth, which it is then made to surround… the cross bar is then drawn up smartly to the handle… and it never fails of either cutting across or of drawing with it whatever was included in the noose.’
The field of otology was revolutionised by the publication of William Wilde’s Practical observations on aural surgery and the nature and treatment of diseases of the ear (1853). Among the many devices Wilde introduced was the aural snare – known since as ‘Wilde’s aural snare’ or ‘Wilde’s angled snare’ (the angle kept the operator’s fingers out of the line of sight). Used to remove polyps from deep within the ear, Wilde described the snare’s action as follows:
Wilde’s aural snare 05. FINE TUNING
1700 17501725 1775 1825 187518501800 1900 foundedRCSI 1784
‘it cuts more evenly than any other saw’
06.
BUTCHER’S SAW
by it… and lastly it cuts more rapidly than any other saw, owing to the extreme tension of the blade.’ Bones cut in curves were less likely to cause the pain associated with the sharp edges produced by other saws. RCSI Heritage Collections also holds Butcher’s own casebooks of his writings as well as several volumes of scrapbooks of articles, annotated with his thoughts, on a wide variety of medical matters.
Richard Butcher observed how cabinet-makers executed intricate or curving cuts by using a bow-saw whose blade could be rotated to any angle. His adaptation of the tool –known since as Butcher’s saw – was particularly suited to amputations. ‘From the extreme shallowness of the blade,’ he explained in 1851, ‘it readily cuts in a curve… it cuts more evenly than any other saw, and the bones cannot be splintered
Richard G.H. Butcher (1819-1891), Fellow and President of RCSI
‘War – what is it good for?’
Warfare and medicine have a long and complex relationship and this is reflected in the history of RCSI. Indeed, from 1851 to 1860 the subject ‘Military Surgery’ was taught in the College under the professorship of Jolliffe Tufnell. During the Crimean War (1853 – 56), Tufnell served as a surgeon in the field; among a number of new instruments he designed was a widely-used bullet scoop (‘not favourably regarded,’ was one early forensics textbook’s review). Until the advent of anaesthetics, a field surgeon’s reputation often rested on how speedily they could saw off an infected limb (pictured is a surgeon’s kit from the Crimean War). The subsequent use of antiseptics reduced the need for such amputations.
Historically, the fields that advance most in wartime are trauma surgery, emergency care and infectious disease (it was not until the 20th century that more combatants died from battle wounds than disease). The only people who gain from warfare – according to Ambrose Paré, the sixteenth-century ‘father of surgery’ – are young surgeons.
Jolliffe Tufnell (1819 RCSI Fellow and President
– 1885),
1700 17501725 1775 1825 187518501800 1900 foundedRCSI 1784 07.
BATTLEFIELD SURGERY
The stethoscope as we know it dates from 1851, when Arthur Leared presented his improvement
The stethoscope is perhaps the most universally recognised instrument of medical practice. Its invention is credited to René Laënnec, who in 1816 was inspired by the sight of two children sending acoustic signals to each other with a length of wood. He found that mediate auscultation – using a rolled-up sheet of paper to listen to a patient’s internal organs – produced louder and clearer sounds than the previous practice of immediate auscultation (placing one’s ear directly on the patient). Latterly, Laënnec refined his rolled-up paper to a simple wooden tube – essentially, the first stethoscope.
08.
The first stethoscope THE BODY’S VOICE
at the Great Exhibition in London. Using flexible gutta-percha tubes, Leared’s device was binaural – meaning it had two earpieces – as opposed to Laënnec’s monaural version.
Without pursuing the commercial potential of his invention, Leared left Britain to serve in the Crimean War; when he returned he found that a Dr Cammann of New York was manufacturing and selling binaural stethoscopes. Leared wrote to The Lancet to set the record straight, noting that ‘it is not only possible, but highly probable’ that his idea had been ‘pirated’. Nowadays Leared is generally given credit for the invention, but it is Cammann’s version that set the industry standard.
1700 17501725 1775 1825 187518501800 1900 foundedRCSI 1784
Arthur Leared (1822 – 1879), Licentiate of RCSI
1700 17501725 1775 1825 187518501800 1900 foundedRCSI 1784
09.
Unfortunately, Dooley died the next day (‘without pain, and quite conscious to the last’), but McDonnell remained optimistic about the practice and designed his own apparatus (pictured) to promote it. Curiously, his writings on the subject were a likely influence on another story of blood transfusion, Bram Stoker’s Dracula, as three of the author’s brothers were doctors, including William Thornley Stoker, who, like McDonnell, was elected President of RCSI.
Immediately following William Harvey’s discovery of the circulation of blood (1628), medical pioneers were drawn to the idea of blood transfusion. Early animal-to-animal transfusions were successful, but when animal-tohuman transfusions proved fatal such experimentation fell into disrepute.
‘She expressed herself as feeling an agreeable sensation, an undefined sensation of warmth pervading her.’
BLOOD WORK
In 1829 The Lancet published James Blundell’s account of the first successful human-to-human transfusions. An obstetrician, Blundell’s aim was to treat severe postpartum haemorrhage, but he also made the observation that wounded soldiers might benefit from similar transfusions. In 1865 Robert McDonnell performed the first blood transfusion in Ireland. His patient was a 14-year-old girl, Mary Ann Dooley, who had suffered an accident working in a paper mill. McDonnell drew blood from his own arm, which he stirred,
In 1865 Robert McDonnell performed the first blood transfusion in Ireland
strained and syringed into Dooley. ‘As the patient was quite conscious during the performance of this operation, she was able to describe accurately her sensations as the blood was thrown into her veins,’ McDonnell recorded.
Robert McDonnell (1828 – 1889), Fellow and President of RCSI
Terence Millin (1903 – 1980), Fellow and President of RCSI
18501825 1875 1925 197519501900 2000 foundedRCSI 1784 10.
MILLIN NEEDLEBOOMERANG
‘not only quite new, but also simpler, safer, and better than those now in use’
In 1945 Terence Millin published an article in The Lancet advocating a retropubic approach to transurethral resection of the prostate. An editorial in the journal described this technique as ‘not only quite new, but also simpler, safer, and better than those now in use.’ Compared to the previous, open procedure, the new method – ‘Millin’s prostatectomy’ – cut mortality rates by 90%. Millin’s approach was so revolutionary that he was obliged to invent or adapt several instruments to carry it out, many of which might only be used for seconds. Notable contributions are the Millin self-retaining bladder retractor and the Millin boomerang needle (pictured), whose speed – the eye is close to the point like a sewing machine –significantly reduced bleeding. As RCSI President, Millin rejuvenated undergraduate teaching, and Millin House and the annual Millin Lecture commemorate his legacy.
REFERENCES
01 Cutting for stone: quotation from Abraham Colles, Treatise on surgical anatomy (1831). Calculi detail from Samuel Pye, Some observations on the several methods of lithotomy (1724). Watermark image, William Dease, Observations on wounds of the head (1778); the first edition of Dease’s work was dedicated to George Daunt; the Library’s second edition is from the personal library of Robert Peile. Lithotomy instruments, made by Joseph Wood & Co., York, RCSI/MI/365.
05 Fine tuning: quotations, watermark and polyps engraving from William Wilde, Practical observations on aural surgery and the nature and treatment of diseases of the ear (1853). Portrait by Erskine Nicol (1854) courtesy of National Gallery of Ireland, NGI.2208. Aural snare, RCSI/MI/380.
All instruments, books and images are from RCSI Heritage Collections, except where noted
04 To the point: quotation from Francis Rynd, ‘Neuralgia – introduction of fluid to the nerve’ (1845), Dublin Medical Press vol. 13, pp. 167 – 168; see also ‘Description of an instrument for the subcutaneous introduction of fluids in affections of the nerves’ (1861), Dublin Quarterly Journal of Medical Science, vol. 32, no. 1, p. 13. Portrait from Davis Coakley, Irish masters of medicine (Town House: Dublin, 1992). Metal syringe in case, RCSI/MI/923.
02 A hole in the head: quotations and watermark from Samuel Croker-King, A description of an instrument for performing the operation of trepanning the skull, with more ease, safety and expedition, than those in general use (1794). Set of trepanning instruments, RCSI/MI/625. Boxed trepanning set, RCSI/MI/300.
10 Millin boomerang needle: Millin boomerang needle: quotations and images from TJ Millin, ‘Retropubic prostatectomy: a new extravesical technique’, The Lancet (1945), no. 249, pp. 693 – 696 and ‘Editorial’, p. 711. Inset: Terence Millin, Retropubic urinary surgery (1947). Portrait by Pan. Boomerang needle, RCSI/MI/644.
08 The body’s voice: quotation from Arthur Leared, ‘On the self-adjusting double stethoscope’, The Lancet (1856), vol. 2, p. 138. ‘On the sounds caused by the circulation of the blood’ (1861), RCSI/ PAMP/209f. Down’s Catalogue of surgical instruments (1906). J McNeven, ‘View of the nave, Great Exhibition 1851, from the American gallery’, courtesy of the V&A, museum no.: 19643. Monaural stethoscopes, RCSI/MI/585. Binaural stethoscope, RCSI/MI/590.
03 Visionary: Inset, Proposals for the advancement of surgery in Ireland (1765). Portrait, RCSI Heritage Collections. Sets of cataract knives, RCSI/MI/14, 414, 426, 684.
06 Butcher’s saw: quotations from Richard Butcher, ‘Mr Butcher’s cases of amputation – use of a new saw’, Dublin quarterly journal of medical science (1851), vol. 12, no. 23, pp. 209 – 23. Watermarks (left) from Butcher’s Essays and reports on operative and conservative surgery (1865); (right) from Butcher’s casebooks and scrapbooks, RCSI/IP/Butcher. Butcher’s saw, RCSI/MI/84.
Inside front and back cover: Antiquarian books collection, RCSI Library
Introduction frame: detail adapted from RCSI Charter (1784)
Booklet cover: Lithotomy instruments, made by Joseph Wood & Co., York, RCSI/MI/365
07 Battlefield surgery: ‘War’ by Norman Whitfield and Barrett Strong (first release, 1970). Text quotations from Sir Thomas Longmore, Gunshot injuries: their history, characteristic features, complications, and general treatment (1877) and Christopher Connell, ‘Is war good for medicine?’, Stanford Medical Magazine (Summer 2007), sm.stanford.edu/archive/stanmed/2007summer/main. html. Portrait by Thomas Alfred Jones. Inset books: Edmond Delorme, War surgery (1915), Chiriachitza Athanassio-Benisty, Treatment and repair of nerve lesions (1918). Watermark, Tufnell’s Introductory address delivered at the Royal College of Surgeons in Ireland, on the inauguration of the Military Surgery Chair, November 12th 1855 (1855), RCSI/PAMP/147/1u. Amputation instruments, RCSI/MI/1545.
09 Blood work: quotation and engraving from Robert McDonnell, ‘Remarks on the operation of transfusion and the apparatus for its performance’ (1870), Dublin Quarterly Journal of Medical Science vol. 50, no. 2, pp. 257 – 65. Portrait by Sarah Purser. Blood transfusion kit, RCSI/MI/224.
References: watermarks for reference pages from Sylvester O’Halloran, A new treatise on the glaucoma, or cataract (1750).
Design: www.insideoutconsulting.ie
RCSI Research Summer School (2017): Saif Al-Mandhari, Husam Alhuwaish
RCSI Heritage Collections is always interested in acquiring new material.
Please contact archivist@rcsi.ie
Instruments & Innovations © RCSI 2019
PROJECT
Further research, booklet text and references: Dr Ronan Kelly
Photography: David Davison, www.davisonphoto.com
Thanks to: Kate Kelly, Director of RCSI Library Services, Prof Clive Lee, Dept of Anatomy
CREDITS
Project team: Susan Leyden, Dr Ronan Kelly, Mary O’Doherty
RCSI www.rcsi.ie/heritagecollectionsarchivist@rcsi.ieHeritageLibraryCollections