Ever wondered what a medical exam from 1874 would look like? Here’s an original copy of The Royal College of Surgeons 1874 final exam on “Surgical Anatomy and the Principles and Practice of Surgery”. Students were allocated three hours to answer 4 out of 6 questions. How do you think you would fare? Would you get top marks on this? Comments are welcome.
McGill campus is gearing up for Science Literacy Week 2016, happening all through next week September 19-25th. The Osler Library will host a special guided tour of Knowing Blood: Medical Observations, Fluid Meanings with curators Darren N. Wagner and Nick Whitfield on Monday, Septemebr 19th @ 11:30am. Registration is not required, but feel free to sign up to let us know you are coming.
For more details and a full listing of next week’s events click here!
Crafting a quality handwritten letter is an art form – especially nowadays when we so rarely take the time to put ink to paper, attach a stamp, and send our social messages by post. This week in the archives we came across some excellent examples of nineteenth century ‘crossed’ letters, in among new additions to the John Bell fonds.
The technique of crossing perpendicular lines (also referred to as cross-hatched) was a popular method to save on paper and postage costs back in the day.
Andreas Vesalius was born on the last hour of the last day of 1514 in Brussels to a family that had seen four generations of physicians before him. Of particular notoriety, his grandfather was the personal physician to the Emperor Maximilian. At an early age Andreas’s mother sent him to attend university in the neighboring city of Louvain, where he went on to develop an affinity for ancient languages and human anatomy. The few human dissections Vesalius witnessed at Louvain were his first exposure to the value of using cadavers to learn about the human body. He began his own anatomical studies by dissecting the bodies of mice, moles, rats, dogs and cats – the only readily available tissues he could practice with at the time. Vesalius travelled to Paris in 1533 to obtain a proper medical education from the world-renowned University of Paris, which had already established itself as a center for medical education. One of his mentors was Jacobus Sylvius, who is known for being the first professor of medicine in France to use a human cadaver for anatomical lessons. While his lectures were indeed well attended, he professed a kind of blind faith for the works of Galen. Whenever a body part in his demonstrations deviated from the ancient’s writings, he would simply say that the human body has changed since Galen’s time. Vesalius eventually came to the conclusion that the only way his knowledge could rival that of the Alexandrian teachers, those pioneers into the world of human dissection, would be if he also took human dissection into his own hands. He began by studying human bones taken from cemeteries around Paris. Eventually his knowledge of the skeletal system became so complete that he was said to be able to identify a bone while completely blind-folded. This ultimately won him the respect of the entire faculty and he, too, began to teach.
After some years of lecturing in Louvain and then Padua, Vesalius began his 3 years of tireless effort to compile the masterpiece De humani corporis fabrica libri septum. The first edition of the work, published in 1543, is upheld as the cornerstone of modern anatomy and holds a coveted place in the history of medicine. It has been said that in 1543, with the publishing of the Fabrica, a revolution of sorts occurred. While it was indeed the most accurate, best illustrated, and complete anatomical treatise that had even been produced, it also mostly rejected the teachings of Galen that had been accepted as medical fact for the thirteen centuries prior. The beautiful composition of De humani corporis fabrica libri septum was a huge step forward for both anatomists and artists, alike. This copy of the Fabrica, now housed in the Osler Library of the History of Medicine, was printed on the press of Johannes Oporinus of Basel in 1543 (when Vesalius was only 28 years old). While Johannes was also at the center of other noteworthy publications, such as the first Latin edition of the Koran in 1542/43, the Fabrica now certainly stands out as the most famous. Prior to Vesalius, human dissection was only conducted within universities by a professor who read aloud a Latin text (which at this time was almost always Galen) while a barber-surgeon handled the cadaver to show the body part being discussed. The purpose was not to verify these ancient writings, but rather to demonstrate their unquestioned knowledge. Medical illustration at the time was not based in a naturalistic representation of anatomy, but stylized schematic diagrams that correlated with the text rather than what was witnessed. When Vesalius published the Fabrica and scholars began to understand how he developed it, these tendencies began to radically change.
The illustrations of the Fabrica were so ground-breaking that plagiarized versions began to emerge in Western Europe almost immediately after the first print. Works appeared from various authors between the years of 1553 – 1564 that out-right copied the illustrations from Fabrica and substituted Vesalius’s text with words of their own. The publication of the first two editions of Fabrica didn’t go without controversy in terms of their contents. Sylvius, Andreas’s Galenist mentor from the University of Paris, had gathered a camp of supporters that drastically opposed Vesalius’s radical departure from the words of the ancients. These scholars claimed that Vesalius was effectively falsifying Galen’s words and regularly criticized him for his departures from the lessons of the ancients. After the publishing of the Fabrica, Vesalius continued to delve deeper into his own anatomical understandings by continuing with his human dissections until the end of his days (apart from a consultant physician job meant to support himself). However, the exact events of these last days are shrouded in mystery. Rumor has it that when Vesalius was conducting dissections in Spain, he opened the chest of one individual to only find that the heart was still beating. What he thought to be a dissection suddenly became a vivisection, which was entirely illegal to perform on a human being. Supposedly he was sentenced to death by the inquisition, but the king commuted his sentence on the grounds that he make a trip to Jerusalem to expiate his sins. While the journey to the Holy Land was accomplished safely, Vesalius fell ill on the return trip and died on the island of Zante (present day Zakynthos) on October 15th, 1564. He was survived by his wife and daughter but, due to the location where he died, he was buried in an unmarked grave rather than be returned.
Despite his inglorious death, his De humani corporis fabrica libri septum has allowed Vesalius’s name to live in infamy. The Fabrica holds a special place of significance in the history of science since illustrations and scientific text had never been brought together before in such a way. The use of the printed book as a medium for scientific knowledge in terms of both text and illustrations was considered to be ground-breaking at the time. Dr. Cushing, who published a biography about William Osler, also published a biography about Vesalius in 1943 to commemorate the 400 years since the creation of the 1st edition of the Fabrica. To be in possession of an original copy of the Fabrica is certainly a privilege, considering any surviving copies of the 1st edition prints are not extremely plentiful in contemporary times. Brown University’s John Lay Library is known to have received a copy which is bound in tanned human skin. Two other copies have been sold at auctions, one of which sold for $412,994 and the other – the only fully colored copy known to exist – for $1,652,500. Luckily William Osler came across many 1st edition copies of the Fabrica as they were plentiful around the turn of the twentieth century. In the Bibliotheca Osleriana, Osler explained that it would be a regular occurrence to see these masterpieces with price tags ranging from £10 to £20. Interestingly enough, Sir William didn’t entirely credit the emergence of modern anatomy to Vesalius. Rather, he gave that credit to the Alexandrians in making the claim that Vesalius “remade” their teachings. Osler explained that during his career 6 copies had come through his hands and were given away to various libraries. The importance he ascribed to a 1st edition Fabrica is simple: it is the manifestation of a moment when the production and dissemination of scientific knowledge underwent a critical turning point. In speaking about this copy of the Fabrica, Sir William wrote the following: “I am glad to be able to send this beautiful copy of the first edition to the library of my old school, in which anatomy has always been studied in the Vesalian spirit— with accuracy and thoroughness. William Osier. Rome, March 9th, 1909.”
Ball, James M. Andreas Vesalius, the Reformer of Anatomy. Saint Louis: Medical Science Press, 1910. Print.
Christie’s. Sale 8002, Lot 70. 23 November 2011.
Christie’s. Sale 8854, Lot 213. 18 March 1998.
Fulton, John F. Vesalius four centuries later: Medicine in the eighteenth century. Lawrence: University of Kansas Press. Print.
Hansen, Kelli. William Osler, W.J. Calvert, and MU’s Vesalius. University of Missouri. 2014. Online.
Oldfield, Philip. Vesalius at 500. Toronto: University of Toronto Press, 2014. Print.
Osler, William. Bibliotheca Osleriana: A Catalogue of Books Illustrating the History of Medicine and Science. Montreal [Que.: McGill-Queen’s University Press, 1969. Internet resource.
The Osler Library’s copy of a medieval medical text written by Johannes de Sancto Paulo (John of Saint Paul) is one of our manuscripts that are available digitally. Bibliotheca Osleriana 7627 is a small early 13th century Latin manuscript containing the Breviarium medicine (“Breviary of medicine”) written by Johannes de Sancto Paulo (fl. 1180), as well as an excerpt from the Liber Pantegni compiled and translated from Arabic into Latin by Constantine the African (1020?-1098/99?). It was rebound probably in the late 19th century in vellum over boards with beautiful marbled pastedowns. The volume belongs to William Osler‘s original donation to the library and is catalogued in his Bibliotheca Osleriana (1). Osler acquired the manuscript from the rare books dealer Luigi Lubrano of Naples in October of 1915.
Johannes de Sancto Paulo was a physician active in Southern Italy during the late 12th and early 13th century. He is thought to be among the masters of the Salerno school of medicine, a center for medical teaching and knowledge production well-known for bringing the work of Arabic medical writers into Europe through Latin translation. The breviary, one of four known works by Johannes de Sancto Paolo, is a general guide to practical medicine written probably around the third quarter of the 12th century.
The text is divided into five books. The first book discusses some practical issues about diagnosing and understanding disease, for example, recognizing signs of illness. It also discusses diseases that affect the entire body, like leprosy and skin conditions such as erysipelas. The second book contains conditions relating to the head and upper body, including the respiratory system. In this book are descriptions of and treatments for “psychological” conditions like mania and lethargy, head pain, eye pain, impaired vision, coughs, and asthma.
Book 3 concentrates on the digestive system with entries on vomiting, stomach pain, diabetes, and more. Book 4 is on the reproductive system and women’s issues like retention of menses and womb suffocation (two worrisome conditions for medieval doctors). Book 5 is on different types of fevers, which medieval people identified as a disease in itself rather than a symptom of illness, as we understand it today.
The second text bound in the manuscript appears to have been written somewhat later than the first. It was often a common practice to bind single texts together in the same binding.
The title of the manuscript’s second text, the Pantegni, comes from the Greek words pan and techne, meaning “all the art,” referring to the art of medicine, and was a large compendium of both practical medical treatments and medical theory. These pages are possibly the work of a student copying an extract of this well-known medical textbook for his own reference purposes. In the margin above where the writing begins, the scribe has scrawled in a short plea–sancti spiritus assit nobis gratia. Que cordi nostra sibi faciat, the opening (although slightly garbled) lines of a sequence hymn for the Christian holiday of Pentecost: “May the holy spirit be with us now. May he fashion to him our hearts.”
See a digitized copy of the oldest manuscript of the Pantegni (probably written under the supervision of Constantine himself) from the Dutch National Library here.
To find out more about medieval medicine in general, take a look at Nancy Siraisi, Medieval & early Renaissance medicine: an introduction to knowledge and practice (Chicago, 1990) or Faith Wallis, Medieval medicine: a reader (Toronto, 2010).
A great (and entertaining) resource on medieval manuscripts is the blog Medieval Fragments. A good intro to understanding and researching manuscripts is Raymond Clemens and Timothy Graham, An introduction to manuscript studies (Ithaca, NY, 2007).
(1) Sir William Osler, Bibliotheca Osleriana: a catalogue of books illustrating the history of medicine and science (Montreal, 1969).
(2) Monica H. Green, “Johannes de Sancto Paulo,” in Medieval science, technology, and medicine: an encyclopedia, ed. Thomas Glick, Steven J. Livesey, and Faith Wallis (New York, 2005).
The Osler Library recently acquired a short manuscript booklet containing one doctor’s medical advice for patients moving out of town. Labelled “Dr. C. H. Sanborn’s directions for preserving health in St. Louis, 1874,” this tiny treatise provides advice and recipes for treating day-to-day complaints and guidelines for stocking the family medicine cabinet with the essentials.
Dr Charles H. Sanborn was a physician practicing in New Hampshire. Born in Hampton Falls in 1822, he graduated with an MD from Harvard Medical School in 1856 (1). He practiced medicine for over forty years in his hometown, where he also served as a Justice of the Peace and in local government (2). This autograph booklet appears to have been written by him for a family of three moving from New Hampshire to St. Louis, Missouri.
During the second half of the 19th century, St. Louis was undergoing a population explosion that would make it the fourth largest city in the U.S. after New York, Philadelphia, and Chicago. Expanding sectors, such as the cotton industry, and new railroad connections attracted an influx of new residents, perhaps including Dr. Sanborn’s patients. The city was prone to cholera and had lived through an epidemic that killed more than 3,500 residents in 1866, just eight years prior to the writing of Dr. Sanborn’s pamphlet. (3)
Fittingly, Dr. Sanborn’s medical advice concentrates heavily on cholera and other, less acute gastro-intestinal complaints associated with moving to new climes. The first page of medical instructions deals with how to treat “Diarrhea, Dysentery or Cholera Morbus” in the youngest member of the family. Remedies include starch, castor oil, bismuth, and, in the case of feverishness, veratrum viride, a highly toxic plant sometimes used during the 19th century in the treatment of typhoid fever and yellow fever.
Up until the late 19th and early 20th century, the majority of medical treatment took place at home. Popular printed medical manuals would have been readily available for purchase and families would have expected to care for their sick themselves:
The skills, knowledge, and responsibilities of laypersons and physicians overlapped; trained physicians were in a functional sense always consultants–with the primary caregiver a family member, neighbor, or midwife.(4)
In the case of Dr. Sanborn’s patients, the father was perhaps the one responsible for making medical decisions and treating his family. Advice for particular ailments is oftentimes labelled “Baby” or “Self & Wife,” and includes detailed instructions for treating croup, “lung fever,” measles, the “Shakes,” “weakness sinking etc. etc.,” sore throat, painful menstruation, inflamed eyes, burns, and bug bites. A list in the back of the book ennumerates the items that should be kept on hand for medical usage.
One of the chemicals on this list attests to the persistence of the miasma theory of disease into the second half of the 19th century, even as germ theory was beginning to emerge in scientific circles around the same time. Disease, it was thought, was transmittable by poisoned air, marked by a bad smell. Dr. Sanborn suggests the use of bromo-chloralum, a harsh disinfectant, to “destroy most every poison in the atmosphere.” He urges it to be used liberally in the baby’s room and all around the house: “Don’t fail to use a pound of two in the first month or two.”
W. F. Bynum, Science and the Practice of Medicine in the Nineteenth Century. Cambridge: Cambridge University Press, 1994.
William G. Rothstein, American Physicians in the Nineteenth Century: From Sects to Science. Baltimore: Johns Hopkins University Press, 1972.
Charles E. Rosenberg. Our Present Complaint: American Medicine, Then and Now. Baltimore: Johns Hopkins University Press, 2007.
Charles E. Rosenberg, ed. Right Living: An Anglo-American Tradition of Self-Help Medicine and Hygiene. Cambridge: Cambridge University Press, 1992.
(1) Harvard University. Quinquennial catalogue of the officers and graduates, 1636-1930. (Cambridge, MA, 1930).
(2) Warren Brown, History of the Town of Hampton Falls, New Hampshire from the Time of the First Settlement within its Borders, vol. 1 (Manchester, NH, 1900.); The New Hampshire Register, Farmer’s Almanac, and Business Registry for 1871 (Claremont, NH, 1871).
(3) History of St. Louis, (1866-1904) http://en.wikipedia.org/w/index.php?title=History_of_St._Louis_(1866%E2%80%931904)&oldid=638231408
(4) Charles Rosenberg, ed. Right Living: An Anglo-American Tradition of Self-Help Medicine and Hygiene. (Cambridge, 1992), 4.
“In Flanders fields the poppies grow / Between the crosses, row on row”
John McCrae’s poem remains one of the most influential pieces of Canadian literature and gives us our most enduring World War I imagery: the red poppies. Born in Guelph, Ontario, McCrae was a career soldier and practicing physician. Before the war, he worked at the Montreal General and the Royal Victoria Hospital, and taught at McGill. Although McCrae was a trained physician, he joined an army fighting unit at the outbreak of the First World War. There, he experienced some of the first chemical weapons attacks during the second battle of Ypres in Belgium. The story goes that McCrae penned his poem after the burial of a close friend and medical school colleague, when he noticed the poppies growing over the graves. This manuscript, written in McCrae’s hand, was left to the Osler Library among the literary archives of fellow physician and McGillian John Andrew Macphail. In this manuscript, McCrae ends the first line with the word “grow.” This is a change from the published version, in which the line finishes “blow.” McCrae wrote out this copy of the poem in a 1916 letter to a friend, Carleton Noyes, modestly mentioning that this piece had achieved some notoriety.
The library also has a second early copy of the poem. It is found in the diary of Clare Gass, which recounts her experiences as a nurse with the Canadian Army Medical Corps in France and England in 1915 and 1916. Gass was born in Shubenacadie, Nova Scotia, on 18 March 1887. She left home for Montreal to train as a nurse at the Montreal General Hospital School of Nursing from 1909 to 1912, working afterwards as a private nurse. After a brief training period in Quebec, she left for Europe in May of 1915 as a Lieutenant nursing sister with the Canadian Army Medical Corps, No. 3 Canadian General Hospital (McGill). In her diary, “In Flanders Field” is copied out in an entry dated October 30th— nearly six weeks before the poem’s first publication in the magazine Punch on December 8, 1915. After that, it quickly became the most popular piece of poetry of the age.
This is part of a series of posts designed to expose readers to the range of materials we have here at the Osler Library and provide tips on how to find and use specific resources. These various installments will form the basis of a comprehensive Osler Library user guide. Your questions and feedback are welcome!
The Osler Library has a large collection of medical almanacs, for which we are still actively acquiring. The almanacs date from 1840 to 1977, with the largest number of holdings falling between 1900 and 1925. The almanac is an old genre of ephemeral—temporary or non-durable publications—that traces its history to the medieval period. These popular items originally consisted of calendars with events, religious holidays, moon phases, and astronomical tables that provided an outlook on the upcoming year. Medical almanacs in particular were an important facet of premodern medicine as doctors took astrological information into consideration in the diagnosis and treatment of their patients. By the mid-18th century in the US and towards the end of the 18th century in Canada, almanacs were popular household books that provided health and home tips along with calendrical features. As such, they are an important source of information on lay medical culture.
The majority of our almanacs are published in Canada, the oldest of which is Le livre de songes de Cléopâtre (Cleopatra’s book of dreams), published in French in Brocktown, Ontario, and Morristown, New York, sometime between the years 1857 and 1881. The oldest almanacs are American, such as The phrenological almanac for 1841, published in 1840. British almanacs make up a much smaller subset, with a few almanacs published
simultaneously in Canada and the U.K. and a couple homeopathic tractates from the 1970s. The majority of the almanacs in the collection are what is known as patent medicine almanacs, used by drug manufacturers as an advertising medium. Nearly 200 of the almanacs were originally purchased from a Montreal collector and acquisitions are ongoing.
Our medical almanacs can be located through the McGill online library catalogue. The almanacs have historically been kept in a separate database, accessible through this website. The database is now no longer updated and new accruals are being catalogued in the McGill Library catalogue. Most of the almanacs that were previously only findable through the Almanacs database have now been added to the McGill catalogue as well.
An easy way to find almanacs in the library catalogue is by using the Classic Catalogue (also linked to on the library homepage) and the name of Almanac Collection, Osler Library. Once in the Classic Catalogue, you can select an Advanced Search, which will give you the option of selecting either “Advanced,” “Expert,” or “Browse.” Select the “Browse” tab and enter in the name of the collection (inside quotation marks to indicate it is a phrase): “Almanac collection, Osler Library.” Click on the link to the collection that should appear on the top of the list. Once you are inside this list of almanacs, it is possible to modify your search by using the “Limit Results” function (accessed through the pink button above the results listing). From here, you can pare down the list of almanacs by entering a keyword, date range, year of publication, or language.
The almanacs may be used by in-house visitors only. Researchers are welcome during our opening hours. It’s recommended to make an appointment, but not necessary. You will be asked to leave coats and bags in our coatroom, fill out a form with your information, and leave a student card or other piece of identity with us during the time that you’re consulting materials. Only pencils can be taken into our reading rooms and staff will instruct you on proper handling of fragile materials.
Thomas A. Horrocks, Popular print and popular medicine: almanacs and health advice in early America. Amherst, MA: Univ. of Massachusetts Press, 2008.
Time, tide, and tonics: the patent medicine almanac in America. National Library of Medicine online exhibition.
John B. Blake, “From Buchan to Fishbein: the literature of domestic medicine.” In Guenter B. Risse, Ronald L. Numbers, and Judith Walzer Leavitt, eds., Medicine without doctors: home health care in American history, 11-30. New York: Science History Publications, 1977.
Elizabeth Hulse, “Almanacs.” The Canadian Encyclopedia
Welcome back! As an introduction, or reintroduction, to your friendly, neighborhood history of medicine library, here are some questions I get asked frequently in the tours and classes I do here in the library. I’ve answered them here for your enjoyment and edification!
Do people actually use the books here?
Absolutely! We have lots of readers come in to consult our rare books and archives, from various levels and fields. Many McGill profs use our collections in their research and McGill students use them for theses and research projects. We also receive visiting scholars from all over, some of whom are winners of our travel grants. You are not required to show academic credentials to use our collection, but if you are unused to working with fragile rare items, we will instruct you in how to use them in a way that doesn’t damage the books and contribute to their deterioration. Please feel free to write to us about your research project and make an appointment to consult our materials.
How did William Osler manage to collect all these books? Was he ridiculously wealthy?
Osler was a successful doctor, but certainly didn’t have the means it would take to accumulate a comparable collection today. 19th century physicians were generally paid according to what we would call a sliding scale. And since Osler was a famous physician in his day (he wrote one of the most famous medical textbooks), he had many well-to-do patients who remunerated him accordingly. Still, his love of books was so overwhelming that he describes in letters borrowing money from a rich brother to pay for his habit. Beyond that, though, the end of the 19th century and before WWI was something of a golden age for book collectors—rare books were still pricey items, but not nearly as expensive as they are today.
What is your oldest book?
Our oldest “book” is actually a clay tablet, probably written sometime during the 8th century BCE in Assyria (an ancient kingdom in modern day Iraq). The tablet is an example of one of the earliest forms of writing, done by forming tablets out of clay, impressing letters into them with a sharpened stick (called a stylus) in an alphabet called cuneiform, and letting the tablets bake in the sun so the writing is fixed. This tablet lists medical recipes made out of plants and animals. Here’s one particularly appealing example, a treatment for eye problems: “slay a scorpion, pull out its tongue, cut off its head, and with its blood anoint the inflamed eye; [the patient] will live.”
What is your most expensive book?
It’s hard to say exactly, but this might be a contender: have a look at what this first edition copy of Copernicus’s On the Revolutions of the Heavenly Spheres sold for at auction last year. We also have a first edition of this 1543 work in which Nicolaus Copernicus, the famous Polish Renaissance astronomer, describes for the first time in modern history the revolution of the planets around the earth. The Ptolemaic, or geocentric, model of the universe that dominated scientific had by the Renaissance period become extremely mathematically complicated in order to explain the movement of the planets that had been observed and recorded for generations. In this book, Copernicus demonstrated that his heliocentric model could simply and elegantly explain planetary motion.
Why is there one window in the stained glass that is different from the others?
Good question! This window was designed along with the rest of the Osler Room by Montreal architect Percy Nobbs in the 1920s. It features two symbols with medical significance. First is the staff of Asclepius, the Greek patron god of medicine. Asclepius was thought to be a son of Apollo. Temples to Asclepius were found throughout the classical world, and sick petitioners would visit them to sacrifice to the god, spend the night in the temple’s inner sanctum, and receive ritual healing from the temple priests. The symbol’s serpent and staff are thought to represent healing and rejuvenation. The second symbol is a book held out by a heavenly hand. The book represents the university, learning, scholarship, and the idea of medicine as knowledge transmitted through the ages. So why is there one book that has no writing on it? What do you think: mistake or message?
Why aren’t you wearing white gloves?
Generally, it’s no longer the accepted practice in the rare books world to wear white gloves when handling materials, except in some particular cases (like delicate photographs). The theory behind gloves was that the natural oils on peoples’ fingers would wear down the books over time. This may be true (we still try to avoid touching the written and printed text itself and only touch the blank margins of a book’s pages), but it’s counterbalanced by the fact that pages are a lot harder to turn in bulky gloves and the risks of tearing a page are a lot higher. Better to just come with clean hands.
Are Osler’s ashes really there?
Yes. But no, sadly, you can’t see them.
This tonsil guillotine (otherwise known as a tonsillotome) is one of hundreds of relics of the history of medicine housed in the Osler Library artifact collection.
Developed in the decades following the French Revolution, the tonsil guillotine has one glaring similarity to its much more sinister cousin: a sharp, fast-moving blade designed to cut the afflicted mass from its bulk. This much smaller blade is fastened in between two fixed steel plates, and attached to a moveable handle that slides it through an auxiliary ring intended to fit around the infected tonsil.
The instrument was originally developed as an adaptation to Benjamin Bell’s (1749-1806) uvulotome, which was similarly used to excise an inflamed and elongated uvula. Bell describes the use of this tool in his System of Surgery, “that part of the uvula intended to be removed being passed thro the opening of the body of the instrument, the cutting slider, which ought to be very sharp, must be pressed forward with sufficient firmness for dividing it from the parts above.”
The physician Philip Syng Physick (1768-1837) used this same device in treating a patient with a relentless cough in the spring of 1826. After noting the patient’s elongated uvula, Physick followed a popular treatment that involved partly removing the infected area. Up until that point, he, among other physicians, had used scissors or ligatures for such operations. Dr. Physick instead decided to try an old instrument in order to make the process easier. His design was very similar to that of Bell’s uvulotome: a sharp sliding blade would pass through two plates into a round opening at the end of the instrument to remove the uvula in one smooth motion. In subsequent years Physick adapted this instrument for use in excising infected tonsils, enlarging the aperture of the ring and making slight modifications to the steel body. The guillotine in our artifact collection follows Physick’s early design of a pointed and movable cutting blade between two steel plates. On one end of the device is a bone handle and ring used to position and slide the blade within the patient’s mouth. The steel hoop at the opposite end of the instrument may have been covered by a strip of wax linen to achieve a cleaner cut, and the thin needle lying flat above the blade would have kept the infected tonsil in place during the operation.
At this time, tonsillectomies were considerably restricted by inadequate anesthetic, so surgeons made every effort to perform the operation as quickly as possible. This is perhaps why the guillotine became a popular tool for the operation; contemporary alternatives involved the use of curved scissors (which often led to excessive hemorrhaging) or the use of a wire ligature to slowly separate the tonsil from the inside of the mouth (a long and excruciating process without viable painkillers). In contrast, the guillotine could perform the excision in one even movement.
Further modifications of the tonsil guillotine were made by Morel Mackenzie in the 1860s, popularizing the instrument for wider use. It remained the preferred method for tonsillectomy until the early twentieth century, until it became more common to perform complete rather than partial removal of the tonsil. A technique involving removal of the tonsil with a scalpel and forceps proved much more effective and precise, and tonsillectomy using the guillotine eventually fell out of favor with most physicians.
Benjamin Bell. A System of Surgery. Edinburgh: C. Elliot & T. Kay, 1789.
J. Mathews, J. Lancaster, I. Sherman, and G. O. Sullivan. “Guillotine tonsillectomy: a glimpse into its history and current status in the United Kingdom.” The Journal of Laryngology & Otology 116 (Dec. 2002): 988–991.
Neil G. McGuire. “A method of guillotine tonsillectomy with an historical review.” The Journal of Laryngology & Otology 81, no. 2 (Feb. 1967): 187-195.
Ronald Alastair McNeill. “A History of Tonsillectomy: Two Millenia of Trauma, Haemorrhage and Controversy.” The Ulster Medical Journal 29, no. 1 (June 1960): 59-63.
Philip Syng Physick. “Case of Obstinate Cough, occasioned by elongation of the Uvula, in which a portion of that organ was cut off, with a description of the instrument employed for that purpose, and also for excision of scirrhous tonsils.” The American Journal of the Medical Sciences 1, no. 2 (1828): 262-265.