by Sarah Chaney

We know sadly little about the sword swallower’s sword that resides in the UCL Pathology Collection: not even how long it has been here. What we do know is that this performer was very unlucky. Perhaps he (or, indeed, she) didn’t tilt his head back far enough. Perhaps he moved during the process of insertion. Whatever the case, the sword pierced the flexible tube of the oesophagus, leading to the performer’s death. The heart and oesophagus were preserved – perhaps as a warning of the dangers of such feats – alongside the weapon that led to his demise.

Fatally ruptured oesophagus, caused by the sword swallower’s sword. Photograph Gemma Angel, UCL Pathology Collections.

Sword swallowing seemingly originated in India some 4,000 years ago, but reached the western world of Ancient Greece and Rome in the first century AD. The performer tilts his or her head back, extending the neck, and learning to relax muscles that usually move involuntarily. A rigid weapon can then be passed down as far as the stomach, usually for just a few seconds, before removal. It is dangerous, certainly, but few performers suffer the fate of the individual preserved in the UCL collections. According to one recent article in the British Medical Journal, most serious incidents occur owing to distraction or attempts at exceedingly complex feats:

For example, one swallower lacerated his pharynx when trying to swallow a curved sabre, a second lacerated his oesophagus and developed pleurisy after being distracted by a misbehaving macaw on his shoulder, and a belly dancer suffered a major haemorrhage when a bystander pushed dollar bills into her belt causing three blades in her oesophagus to scissor. [1]

In many ways, sword swallowing is the opposite of the ingestion of other foreign bodies: rather than swallowing, the performer maintains absolute control over the process of consumption, taming the body’s reflexes and realigning the organs. As Mary Cappello notes in her fascinating literary biography of surgeon Chevalier Jackson (1865 – 1968), who was an expert in foreign body removal, sword swallowing was recognised by doctors as inspirational to their own techniques. Jackson took his lead from German professors Alfred Kirstein and Gustav Killian, who lectured that sword swallowing proved the possibility of passing a rigid tube into the oesophagus, in order to remove lodged objects. Jackson, who developed his own oesophagoscope in 1890, admitted that the abilities of circus performers had opened his eyes to the opportunity of removing foreign objects without dangerous surgery. He even taught his children how to “scope” themselves.[2]

In an intriguing parallel, the insertion of some foreign objects into the human body thus assisted with the removal of others. At the turn of the 20th century, the removal of foreign bodies lodged in the throat and airways frequently required an incision to be made into the trachea or oesophagus, an operation which could prove fatal. In the records of the Royal London Hospital, from 1890 to 1910, we find no mention of oesophagoscopy or bronchoscopy: instead, surgery or the probang or “coin-catcher” was the norm. This latter instrument was generally a simple hook, inserted without any kind of viewing device or illumination. The practitioner would feel blindly for the object, and either attempt to hook it out, or push it into the stomach. This might lead to numerous complications. In 1903, surgeons at the Royal London attempted to remove a halfpenny from the throat of a five-year-old boy by pushing it into the stomach. However, it was subsequently reported that the coin catcher broke off in the boy’s throat, necessitating a major operation from which the child did not survive.[3] Small wonder that, less than a decade later, Jackson declared such objects “rough, unjustifiable, brutal”.[4]

UCL Pathology Collections contains many examples of foreign objects removed from the
human body: this purpose built display showcases many such objects, some with
small x-rays of the objects prior to removal.

X-ray imaging techniques aided the removal of foreign objects by instruments, and foreign body specimens are often accompanied by photographs showing the item’s location in the human body. The above set of items is found in the UCL Pathology Collection, the objects having been gathered by several surgeons in the 1920s – ‘50s. At some point, the individual boxes made for each specimen were mounted together, in a specially designed plastic surround. Fittings on the back indicate that the case was made to hang on a wall. But why? To decorate the office of a surgeon, showing off his achievements? To offer a warning to others to take care (particularly parents, for all these objects were removed from children and infants)?

Chevalier Jackson claimed that his collection of more than two thousand foreign bodies (now housed in Philadelphia’s Mutter Museum) was not a curiosity, but indicative of the everyday nature of foreign body ingestion and inspiration. Yet many of these specimens are not everyday. The two boxes of multiple objects in the bottom right, for example, were removed from the vaginas of young girls (six and eight years old respectively). The case notes do not indicate how these objects arrived in their location. Did the girls insert them themselves, or might it be a sign of sexual abuse? In her research into the medical histories of Jewish immigrants to the East End of London in the late nineteenth and early twentieth centuries, Carole Reeves came across a case of multiple foreign body insertion in a young woman, whose vagina was found to be tightly packed with pins. Reeves speculated that Leah G. might have inserted these items in an effort to ward off potential (and actual) abusers.[5]

In most instances, we can uncover little about the motivations of those in the late 19th and early 20th centuries whose foreign bodies are recorded in medical records: surgeons were often little interested in how the object came to be in its current location, but only in its removal. Yet this may often make such displays still more intriguing than otherwise. As Mary Cappello put it, in a video discussion of the UCL artefact pictured above for the Damaging the Body website: “What is the border or boundary between human flesh, between human life and the object world?”

References:

  by Sarah Chaney

A visit to the current Museum of London exhibition, Doctors, Dissection and Resurrection Men (on until 14 April 2013), brought to mind the recent Buried on Campus exhibition in the Grant Museum. Several of us have previously blogged about reinstating the stories of the forgotten dead, as well as the issues around the display and interpretation of human remains in a museum context. As I myself wrote, the disinterrment of human remains is not unusual during building work: the Museum of London exhibition focuses on the excavation of the former Royal London Hospital burial site, during recent improvement works. The bones found showed traces of a variety of practices, including dissection for autopsy, as well as marks made during surgical practice and articulation for the creation of teaching specimens.

Dissection, particularly in the case of medical teaching, was often linked to artistic practice. Doctors, Dissection and Resurrection Men opens with the grisly plaster cast of James Legg, hanged for murder in 1801. Legg was subsequently flayed and posed as if crucified: a collaborative project between artists Benjamin West and Richard Crossway, and sculptor Thomas Banks, who believed that most depictions of Christ’s crucifixion were anatomically incorrect (for more on the Anatomical Crucifixion see Gemma Angel’s post). Rather less theatrically, anatomical drawings and textbooks were also created directly from dissection practice. During a recent session in the Art Museum, I discussed with visitors the way in which anatomy textbooks create stylised images, removing certain body parts in order to emphasise others. Students re-created these images for themselves: first with the corpse, then in their own sketches, re-interpreting the body in a way that made sense for their practice.

Joseph Lister – Side of the Neck and Floor of the Mouth (1850), UCL Art Museum #4801

Amongst the UCL Art Collections are a number of student sketches of the famous surgeon Joseph Lister (1827 – 1912), well-known for his introduction of antiseptic techniques into surgical practice. Born in Essex, Lister came to UCL in 1844, initially as a student of the arts. After graduating, however, he subsequently turned his attention to medical studies, continuing at UCL until he gained his M.B. in 1852. The sketches in the collection mainly date from 1849-50, produced as part of Lister’s studies. The techniques used indicate some of the interesting artistic choices available to anatomical illustrators: perhaps also the influence of Lister’s varied education and interests. The sketch above, for example, was made on tinted paper, which enabled the young Lister to highlight structures using white chalk. This emphasis, along with the effective use of colour (in this instance, major blood vessels are depicted in red, standing out clearly in an otherwise monochrome drawing), enables quick and easy recognition of bodily structures, adding depth to the sketch. For an un-trained eye, the mass of tissues within the human body could not be read in such a manner. The ability to render the three-dimensional body in a series of recognisable images – and then understand the physical body through such images – was as important as surgical skill.

Box Viewer from the UCL
Physiology Collections (080:RFH)

The huge variety of techniques for anatomically representing the human body is also evident elsewhere in the UCL Collections. The Physiology Collection includes a volume of the Edinburgh Stereoscopic Atlas of Anatomy, published in 1905. Stereoscopy became a popular technique of representing three-dimensional structures from its inception in the 1840s. Two offset photographs or other images are presented to the viewer which, when viewed through the stereoscope, are seen separately by the left and right eye. As occurs in ordinary vision, the brain combines the images perceived by both eyes; in the case of stereoscopy, giving the illusion of three-dimensional depth. The Edinburgh Atlas aimed to use this technique to represent photographs of dissections in a manner closer to that seen in the three-dimensional human body than simple sketches. Bulky and expensive, the success of the Atlas was relatively limited. It still serves, however, as an unusual reminder of the way in which the human body has continued to require anatomical translation.

by Sarah Chaney

So ran one particularly enthusiastic nineteenth century advertisement for the animal that has had the most enduring association with medical history. So much so, that one inspired individual decided to make a mechanical version of the creature. During my public engagement sessions in the Grant Museum, I’ve tried asking various visitors to guess what animal the fist-sized metal box was designed to emulate: no one has yet hit on the right answer, even though I usually stand right in front of the leech cabinet. Shiny, clean and angular, where the leech is squat, wet and slug-like, there would appear to be little comparison between the two.

Indeed, that was the claim of certain nineteenth century leech advocates, who deemed the miraculous little creature itself far gentler than lancet, fleam or scarifier (also called a scarificator: the “mechanical leech” in the illustration, left). The leech secretes a substance called hirudin, which stops the blood from clotting, meaning that one small bite will continue to bleed for around 12 hours after the leech has been removed. I know this well, for, in the pursuit of medical history, I have been leeched not once, but twice, and still have the (tiny) scars to prove it!

Testing out ancient cures is an intriguing – but by no means recommended – practice. For myself, it gave me a far greater appreciation of the unique abilities of a creature that had previously seemed to me only a particularly ugly vampire. The movements of leeches are surprisingly elegant – they stretch out, entwine around each other, and swim rapidly with a characteristic s-shaped wiggle. They create very little trauma when they bite and, although the process is lengthy (I never in my wildest imaginings thought it would take as long as an hour and a half for the leech to drink its fill, but it did), it isn’t as unpleasant as might be expected. It’s easy to see why the leech might have been a more popular choice in the widely prescribed practice of bloodletting than its viciously-bladed mechanical twin. And bloodletting had, since ancient times, been adopted for an extremely broad variety of ailments: and even as a regular “tonic” (to be carried out in the spring) to ensure continued good health.

Since the scarifier did not have the leech’s hirudin to prolong the bleeding, it required rather a lot more (and larger) blades than the leech’s tri-radiate jaws. To use it, you would turn the lever to ready the spring mechanism, place on the skin, and press the switch to release. The blades whip round with a satisfying click, leaving twelve shallow wounds. Of course, you’d then need a bleeding bowl to measure the amount of blood lost. This is not necessary with live leeches, which effectively have a built in mechanism for this; one leech generally takes one ounce (about 30ml) of  blood. What’s more, the leech tidily disposes of the blood removed, efficiently recycling it to fuel its own existence.

Despite efforts to emulate it, or extract its natural hirudin, the leech has not been improved upon by science. Leeches themselves are thus still used in clinical practice today, particularly in reconstructive and cosmetic procedures. The scarifier, meanwhile, is now only a curious reminder of an era obsessed with mechanism: much as our own is obsessed with computer-based technology.