From the Dissection Room: Smallpox

The lesions from these two specimens are from an early stage of smallpox in 1776. The disease is likely to have been contracted in utero. From the Hunterian Collection, Royal College of Surgeons, London.

DEFINITION: Smallpox is an acute contagious disease caused by variola virus, a member of the orthopoxvirus family. Smallpox, which is believed to have originated over 3,000 years ago in India or Egypt, is one of the most devastating diseases known to humanity.

For centuries, repeated epidemics swept across continents, decimating populations and changing the course of history. In some ancient cultures, smallpox was such a major killer of infants that custom forbade the naming of a newborn until the infant had caught the disease and proved it would survive…

Smallpox had two main forms: variola major and variola minor. The two forms showed similar lesions. The disease followed a milder course in variola minor, which had a case-fatality rate of less than 1 per cent. The fatality rate of variola major was around 30%. There are two rare forms of smallpox: haemorrhagic and malignant. In the former, invariably fatal, the rash was accompanied by haemorrhage into the mucous membranes and the skin. Malignant smallpox was characterized by lesions that did not develop to the pustular stage but remained soft and flat. It was almost invariably fatal. [World Health Organization]

Face of child who died from smallpox, 18th century [not related to infant specimens above]

DESCRIPTION: ‘December 30, 1776, I was sent for to Mrs. FORD, a healthy woman, about twenty-two years of age, who was pregnant with her first child. She had come out of the country about three months before. Soon after her arrival in town she was seized with the small pox, and had been under the care of Messieurs HAWKINS and GRANT, who have favoured me with the particulars here annexed.

I called upon her in the afternoon; she complained of violent griping pains in her bowels, darting down to the pubes. On examining I found os tinsae a little dilated, with other symptoms of approaching labour. I sent her an anodyne spermaceti emulsion, and desired to be called if her pains increased. I was sent for. The labour advanced very slowly; her pains were long and severe; she was delivered of a dead child, with some difficulty.’ [John Hunter, ‘Account of a Woman who Had the Small Pox during Pregnancy…’, Philosophical Transactions of the Royal Society 70 (1780): pp. 129-130.]

By | 2012-05-21T13:52:40+00:00 May 21st, 2012|The Dissection Room|8 Comments

From the Dissection Room: The Two-Headed Boy of Bengal

The skull of a young boy from Bengal with a second imperfect skull attached to its anterior fontanelle, 1783. From the Royal College of Surgeons, London. 

DEFINITION: Craniopagus parasiticus is a medical condition in which a parasitic twin head with an undeveloped (or underdeveloped) body is attached to the head of a developed twin. [Wikipedia]

DESCRIPTION: ‘The child was a male; it was more than four years old at the time of its death, which was caused by the bite of a cobra. It was very emaciated, a fact attributed to the parents having used it as a show, always keeping it covered up, except when payment was made for its exhibition. The woman who acted as midwife was terrified at the appearance of the additional head, and tried to destroy the child by throwing it on the fire; it was rescued after one eye and ear were considerably burnt. There was no trunk to the second head; but it was surmounted by a short neck terminating in a rounded tumour, which is stated by one observer to have been quite soft at the age of two, and by another to have been quite hard and cartilaginous at the age of four. Its external ears were represented by mere folds of skin, and there was no auditory meatus. The normal face and head were not malformed. The brains were distinct, each invested in its own membranes; the dura mater of each adhered to that of the other at the point of contact. The chief supply of blood to the upper head was by a number of vessels passing from the membranes of one brain to that of the other. The movements of the features of the upper head appear to have been purely reflex, and by no means to have been controlled by the feelings or desires of the child. The movements of the eyes of the accessory head did not correspond with those of the child, and the eyelids were usually open, even during sleep.’ [Philosophical Transactions, volume 80 (1790), p. 296].

By | 2011-10-21T09:08:30+00:00 October 21st, 2011|The Dissection Room|10 Comments

From the Dissection Room: Diseased Penis of Executed Criminal

Anterior part of penis with gonorrhea belonging to George Robertson at the time of his execution, 1753. Dissected by John Hunter. Specimen from the Royal College of Surgeons, London. 

DEFINITION: Gonorrhea (also colloquially known as the clap) is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain. In both men and women if gonorrhea is left untreated, it may spread locally causingepididymitis or pelvic inflammatory disease or throughout the body, affecting joints and heart valves. [Wikipedia]

DESCRIPTION: ‘Till about the year 1753, it was generally supposed that the matter from the urethra in a gonorrhoea arose from an ulcer or ulcers in that passage; but from observation it was then proved that this was not the case. It may not be improper to give here a short history of the discovery that matter may be formed by inflammation without ulceration. In the winter, 1749, a child was brought into the room used for dissection in Covent Garden; on opening of whose thorax a large quantity of pus was found loose in the cavity, with the surface of the lungs and the pleura furred over with a more solid substance, similar to coagulable lymph. On removing this from those surfaces, they were found entire. This appearance being new to Dr. Hunter, he sent to Mr. Samuel Sharp, desiring his attendance; and to him it also appeared new. Mr. Sharp afterwards, in the year 1750, published his Critical Inquiry, in which he introduced this fact, “That matter may be formed without a breach of substance;” not mentioning whence he had derived this notion. It was ever after taught by Dr. Hunter in his lectures. We, however, find writers adopting it without quoting either Mr. Sharp or Dr. Hunter. So much being known, I was anxious to examine whether the matter in a gonorrhoea was formed in the same way. In the spring of 1753 there was an execution of eight men, two of whom I knew had at that time very severe gonorrhoeas. Their bodies being procured for this particular purpose, we were very accurate in our examination, but found no ulceration. The two urethras appeared merely a little blood-shot, especially near the glans. This being another new fact ascertained, it could not escape Mr. Gataker, ever attentive to his emolument, who was then attending Dr. Hunter’s lectures, and also practising dissection under me. He published soon after, in 1754, a treatise on this disease, and explained fully, that the matter in a gonorrhoea did not arise from an ulcer, without mentioning how he acquired this knowledge; and it has ever since been adopted in publications on this subject. Since the period mentioned above I have constantly paid particular attention to this circumstance, and have opened the urethra of many who at the time of their death had a gonorrhoea, yet have never found a sore in any; but always observed that the urethra, near the glans, was more bloodshot than usual, and that the lacunae were often filled with matter.’ [John Hunter, Works, Volume 2, p. 168]. 

By | 2011-10-15T10:17:14+00:00 October 15th, 2011|The Dissection Room|5 Comments

From the Dissection Room: Broken Hearts (Myocardial Infarction)

A portion of the left ventricle of a woman’s heart showing the damage caused by myocardial infarction with evidence of superficial pericarditis. It was taken at the post-mortem of a female patient in 1765. Specimen from the Hunterian Museum of the Royal College of Surgeons, London.

DEFINITION: Myocardial infarction (MI) or acute myocardial infarction (AMI), commonly known as a heart attack, is the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (fatty acids) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death (infarction) of heart muscle tissue (myocardium). [Wikipedia]

DESCRIPTION: ‘The dissection of Mrs Knightbridge: In presence of Messrs Moffat and Irvine. She was an extremely fat woman; the fattest I ever saw. While alive, she drank spiritous liquors in great quantities.The fat on the belly cut five or six inches deep. On opening the belly we found the Liver of an immense size; larger than any two livers I ever saw; and on cutting into its substance, the knives were all besmeared with [fat] so that the cells of the liver were become an adipose substance. The Stomach and Gutts were in general pretty sound. The kidneys were extremely soft and pulpy: much more so than common. The Diaphragm was pushed very high, so as to diminish greatly the cavity of the thorax. The pericardium was loaded with fat. The heart was covered intirely with fat, so as not to see a bit of the muscular texture; and was extremely soft in its consistence. What I thought extremely odd or uncommon, was, that in the Cavity of the Heart, and in all the vessels, both veins and arteries, was a vast quantity of the Oil of [the] body, pure as if strained through a Cloth; and but very little of what might be supposed to be blood: and on opening the stomach, there was near a pint of pure oil in it, yet she had swallowed none. All the muscles of the body had lost their redness; were soft, as if half dissolved or rotten’. [John Hunter, Casebooks, pp. 347-8].

By | 2011-02-14T07:21:47+00:00 February 14th, 2011|The Dissection Room|2 Comments

From the Dissection Room: Cicatrix from Leg Amputation

The healing stump-end of an amputated leg, c. 1760-93. The new tissue (cicatrix) is nearly formed here, but the muscles surrounding the amputation sore have contracted to produce a ‘conical’ shaped stump, with the bones of the leg projecting beyond the skin. This would have reduced the probability of a complete heal. Specimen from the Hunterian Museum of the Royal College of Surgeons, London.

DEFINITION: A cicatrix is a scar resulting from formation and contraction of fibrous tissue in a wound. This typically resulted when limbs were amputated during the seventeenth century, as the preferred method required that a flap of skin remain after the limb had been removed. First known use: 1623. [Oxford English Dictionary]

DESCRIPTION [of amputation method which would result in formation of a cicatrix]: ‘Take your dismembering knife and with a steddy hand and good speed, cut off flesh, sinewes and all, to the bone around the member, which done, take a smaller incision knife and divide the panicle called the periosteon, from the bone, it is a tough thin skinne, covering all the bones of the boyd, also thrust your said incision knife betwixt your fossels or bones, cutting away whatsoever is to be found there with expedition…it were also very good that the saide party holding the member, the flesh and sinewes being cut asunder, should immediately draw or strip upward the flesh so much as he could, keeping his hold, that thereby the Sawe may come so much the neerer, which would occasion a quicker and better healing, the flesh being thereby made longer than the end of the bone’. [John Woodall, The Surgions Mate (1617), pp. 173-4]

By | 2011-02-03T15:27:43+00:00 February 3rd, 2011|The Dissection Room|0 Comments

From the Dissection Room: Inguinal Hernia

Eighteenth-century specimen showing an inguinal hernia, located in the groin. The preparation shows a contraction within the hernia which resulted in necrosis of part of its contents.

DEFINITION: An inguinal hernia (pronounced /ˈɪŋɡwɨnəl ˈhɜrniə/) is a protrusion of abdominal-cavity contents through the inguinal canal. They are very common (lifetime risk 27% for men, 3% for women), and their repair is one of the most frequently performed surgical operations [today].

There are two types of inguinal hernia, direct and indirect, which are defined by their relationship to the inferior epigastric vessels. Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through the external inguinal ring. Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by failure of embryonic closure of the processus vaginalis.

In the case of the female, the opening of the superficial inguinal ring is smaller than that of the male. As a result, the possibility for hernias through the inguinal canal in males is much greater because they have a larger opening and therefore a much weaker wall for the intestines to protrude through. [Wikipedia]

DESCRIPTION: ‘[T]he Patient must be laid on his Back, as aforementioned, and bound fast upon the place: then the Intestines being reduced, the Assistant shall retain them up with his hands, whilst the Operator maketh an oblique Mark in the Groin, to which place he thrusteth up the Testicle; then makes an Incision so deep and large upon it, as to take it out with the Spermatick Vessels, which he holdeth with the one hand, while the other he separates it from the Membranes. (In all which cases he must be careful not to lacerate them, for thereby he shall cause Convulsions, and hasten the death of the Patient.) That done, he maketh a Ligature above the Testicle upon the Vessels, and cuts it off. If there be fear of a flux of bloud, he cauterizeth the ends… then, re-placing them within the Belly, leaving the ends of the Ligature hanging out, he stitcheth up the Wound, dressing as above-said’. [Richard Wiseman, Eight Chirurgicall Treatises (1676), p. 154.]

By | 2010-10-10T16:19:04+00:00 October 10th, 2010|Casebooks, The Dissection Room|4 Comments

From the Dissection Room: Neurofibromatosis

A female skull dating from 1829 with the bony skeleton of a large facial tumour (possibly caused by neurofibromatosis) involving the right side of the face. The tumour arose in the right antrum, and during five years’ growth destroyed the right malar bone, the palate, and the maxilla. Specimen from the Hunterian Museum of the Royal College of Surgeons, London.

DEFINITION: Neurofibromatosis is a genetically-inherited disorder in which the nerve tissue grows tumors (i.e., neurofibromas) that may be harmless or may cause serious damage by compressing nerves and other tissues. The disorder affects all neural crest cells (Schwann cells, melanocytes, endoneurial fibroblasts). Cellular elements from these cell types proliferate excessively throughout the body forming tumors and the melanocytes function abnormally resulting in disordered skin pigmentation. The tumors may cause bumps under the skin, colored spots, skeletal problems, pressure on spinal nerve roots, and other neurological problem. [Wikipedia]

DESCRIPTION: [Facial tumour possibly caused by neurofibromatosis] ‘An old Gentleman, a Servant to the King below [the] stairs, brought his Son to me, an infirm Youth of about thirteen years of age, having a large Tumour behind his right Ear arising from a Crude Matter. It had been of some years growth. I applied [an] Emplastr. ad strumas cum stercore columbino… but it heated: whereupon I applied a Cataplasm…then opened it by Caustick [a substance which causes the skin to corrode], and discharged a mixt crude Matter [by scraping the inside with a stone]. The Ulcer being sordid, I laid it open more, and dressed it’. [Richard Wiseman, Eight Chirurgicall Treatises (1676), p. 51.]

By | 2010-10-03T13:49:25+00:00 October 3rd, 2010|The Dissection Room|0 Comments

From the Dissection Room: Tuberculosis

Eighteenth-century specimen of a larynx and trachea showing changes consistent with tuberculosis from the Hunterian Museum of the Royal College of Surgeons, London.

DEFINITION: Tuberculosis or TB (short for tubercles bacillus) is a common and often deadly infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis in humans. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air when people who have the disease cough, sneeze, or spit. Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease which, if left untreated, kills more than 50% of its victims.  The classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. Infection of other organs causes a wide range of symptoms. [Wikepedia]

DESCRIPTION: ‘The Hon’ble Mrs Dalrymple, aged Twenty-eight when she died. She was remarkable for her talents in music, especially vocal. She had been always of a Scrofulous habit; having the glands of the neck often swelling to a considerable size, from the ear to the clavicle. She caught cold, which fell upon her lungs, and not considering it to be serious, she regarded it but little, ’till it became very violent. The consumptive Symptoms increased, producing all the common Symptoms, excepting [that] what she spit [spat?] was more like the common mucus of the nose, than matter; although a yellowish substance was often mixed with it.Some months before she died, she lost her voice; could hardly articulate; could not get the sound above what is called her breath, or rough Whisper, which was extremely hoarse. There was also a difficulty is swallowing, but she could not swallow a solid much better than a fluid’. [John Hunter, Casebooks (c. 1760), No. 82, pp. 617-8]

By | 2010-09-25T18:08:39+00:00 September 25th, 2010|The Dissection Room|0 Comments

From the Dissection Room: Hydrocephalus

Eighteenth-century specimen of 25 year-old man suffering from hydrocephalus from the Hunterian Museum of the Royal College of Surgeons, London.

DEFINITION: Hydrocephalus, (pronounced /ˌhaɪdrɵˈsɛfələs/), also known as ‘water on the brain’, is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head, convulsion, and mental disability. Hydrocephalus can also cause death. The name derives from the Greek words ὑδρο- (hudro-) “water”, and κέφαλος (kephalos) ‘head’. [Wikipedia]

DESCRIPTION: ‘I was fetched to a little infant not ten days old that was born with two of the above-mentioned Tumours. They were of the shape of cupping glasses of the middle size…I felt the Holes they thrust out at; each Hole was round, I suppose of the compass of an Half-crown, and, as I afterwards found, had their Cystis from the Dura Matter. The infant seemed to be dying when I came; it died that night. The next day I opened it, and found it was as I have said. There was also great quantity of Water floating within the Meninges, and in the Ventricles of the Brain, and a gelatinous substance all about the Vessels on the upper part’. [Richard Wiseman, Eight Chirurgicall Treatises (1676) p. 134].

By | 2010-09-17T15:58:52+00:00 September 17th, 2010|The Dissection Room|3 Comments