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Sword Swallowing & Surgical Performance

By Gemma Angel, on 11 March 2013

Sarah Chaneyby 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.

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]

foreignbodies

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:

[1] Brian Witcombe and Dan Meyer, “Sword Swallowing and its Side Effects”, in British Medical Journal, 333 (2006), 1285-7, p. 1287.

[2] Mary Cappello, Swallow: Foreign Bodies, Their Ingestion, Inspiration and the Curious Doctor who Extracted Them, New York, London: The New Press (2011). Website: http://www.swallowthebook.com/

[3] Royal London Hospital Archives, Surgical Index 1903, LH/M/2/9, patient no. 4086.

[4] Chevalier Jackson, Lecture to the Kings County Medical Society, December 19 1911, quoted in Cappello, p. 208.

[5] Carole Anne Reeves, Insanity and Nervous Diseases Amongst Jewish Immigrants to the East End of London, 1880 – 1920 (Unpublished PhD thesis, University of London, 2001), p. 213.

Pulling Teeth: Ovarian Teratomas & the Myth of Vagina Dentata

By Gemma Angel, on 4 March 2013

  by Gemma Angel

 

 

 

 

 

In preparation for our upcoming exhibition, Foreign Bodies, several members of the engagement team went to visit UCL Pathology Collections, to have a look at a collection of foreign objects removed from the human body. We soon encountered a number of other specimens which resonated with the exhibition theme in various ways: From a liver infected with syphilis, to a ruptured oesophagus and the sword swallower’s sword that caused the fatal injury; to a feotus inadvertently discovered during a hysterectomy, which was performed to extract a large tumour on the uterus.

The UCL Pathology Collections comprise over 6,000 specimens dating back to around 1850, many of which have been absorbed from other London medical institutions over the past 25 years, and these are currently in the process of being re-catalogued and conserved. It is a fascinating, not to mention an educationally invaluable collection – not least because it contains many specimens that demonstrate gross clinical manifestations of diseases which are now very rare in the Western world. Some of these diseases, such as syphilis, are unfortunately making a comeback, so it seems more important than ever that medical students are able to recognise the clinical signs of these infections. Pathology collections are a highly valuable medical teaching resource; particularly since these kinds of collections are now unlikely to be expanded in the wake of the 2004 Human Tissue Act.

As with many historical pathology collections, UCL possesses its share of medical anomalies or curiosities. Fragments of preserved skin belonging to a tattooed man certainly seem to fall into the category of the anatomically curious – there is certainly nothing pathological about this specimen. One of the biggest surprises I encountered during my visit to the collections, was the revelation that the female reproductive anatomy can, and occasionally does, grow teeth.

Teratoma with Tooth and Hair

Dermoid cyst (cystic teratoma) with fully developed
tooth and hair. UCL Pathology Collections.

The specimen shown here (right) is a dermoid cyst, or cystic teratoma, which has formed inside an ovary. When I first came across it, I experienced a strong visceral reaction: I didn’t have to be a medical student to recognise that this tooth, entwined in long hair drifting in the liquid-filled vitrine, was out of place – so much so, that the sight of it provoked an immediate and simultaneous sense of revulsion and fascination. The term teratoma is derived from the Greek, tera, meaning monster, and literally means “monstrous growth”; it was easy for me to see how such biological anomalies could become the stuff of nightmares. Despite the ominous name, however, ovarian teratomas are usually benign, and arise from totipotent stem cells which are capable of developing into any type of body cell. One 1941 pathology text describes these tumours as follows:

Dermoid cysts are usually globular in shape and dull white in color. They contain structures associated with epidermal tissues, such as hair, teeth, bone, sebaceous material resembling fat … The following is a partial list of tissues which have been found in dermoids: Skin and its derivatives, sebaceous glands, hair, sweat glands, and bone, especially the maxillae containing teeth. Up to 300 teeth have been found in one cyst … Long bones, digits, fingernails, and skull have been found. Brain tissue and its derivatives, intestinal loops, thyroid tissue, eyes, salivary glands, may occasionally be found. Even rudimentary fetuses have been described, such as a pelvis with hairy pubes and a vulva and clitoris. Brains with ventricles, spinal cords and a few complete extremities, have been observed. [1]

Although teratomas can develop in almost any part of the body – including the brain, neck, bladder, and the testes in men – being confronted with a toothy tumour in the female reproductive organs brought to mind mythic archetypes of the sexually devouring and deadly woman. I was immediately struck by the parallels between this specimen and the image of the vagina dentata. I am not the first to make such an observation,[2] and whilst I am not suggesting that there is any explanatory relationship to be found between the biological phenomena and the myths, it is certainly an intriguing association. The toothed vagina appears in the creation myths and folk stories of many cultures, from Native America, Russia and Japan (amongst the Ainu), to India, Samoa and New Zealand. [3] Funk and Wagnalls Standard Dictionary of Folklore, Mythology and Legend records this entry concerning vagina dentata:

The toothed vagina motif, so prominent in North American Indian mythology, is also found in the Chaco and the Guianas. The first men in the world were unable to have sexual relationships with their wives until the culture hero broke the teeth of the women’s vaginas (Chaco). According to the Waspishiana and Taruma Indians the first woman had a carnivorous fish inside her vagina. [4]

Many 19th and 20th century European interpretations linked the motif to Freudian concepts of castration anxiety, in which young males are said to experience an unconscious fear of castration upon seeing female genitalia. Whilst a Freudian analysis is undoubtedly culturally and historically specific, many vagina dentata legends explicitly articulate male fears of castration in the act of normal sexual intercourse, and warn of the necessity of removing the teeth from women’s vaginas, in order to transform her into a nonthreatening and marriageable sexual partner. A particularly telling collection of stories comes from India, in which the ferocious sexual appetites of beautiful young women are tamed and ‘made safe’ to men through the violent breaking of the teeth hidden inside their vaginas. [5]

Lloyd, Charles Augustus, d 1930. Lloyd, Charles A fl 1880s-1912 (Photographer) : Maori wood carving of the goddess Hine-nui-te-po, and Maui. Original photographic prints and postcards from file print collection, Box 14. Ref: PAColl-6585-10. Alexander Turnbull Library, Wellington, New Zealand. http://natlib.govt.nz/records/22708288

Māori wood carving of the goddess Hine-nui-te-pō and Māui.
Photograph by Charles Augustus Lloyd, c.1880s-1912.
Alexander Turnbull Library, Wellington, New Zealand.

The toothed vagina motif is not exclusively associated with male fears of the ‘castrating female’, however. In some traditions, the terrible power of the vagina dentata lies principally not in fears of the sexual act, but in its associations with death. The Māori legend of Māui and Hine-nui-te-pō is particularly interesting in this respect. Hine-nui-te-pō was the goddess of death and gatekeeper of the underworld, whom the trickster demigod Māui sought to kill in order to win immortality for humankind. When Māui asks his father what his ancestress Hine-nui-te-pō is like, he responds by pointing to the icy mountains beneath the fiery clouds of sunset. He explains:

What you see there is Hine-nui, flashing where the sky meets the earth. Her body is like a woman’s, but the pupils of her eyes are greenstone and her hair is kelp. Her mouth is that of a barracuda, and in the place where men enter her she has sharp teeth of obsidian and greenstone. [6]

Undeterred by his father’s grave warnings, Māui sets off on his quest with a gathering of bird companions. He proposes to kill Hine-nui-te-pō by entering her vagina and exiting through her mouth whilst she is sleeping, thus reversing the natural passage into life via birth. Māui finds the great goddess sleeping “with her legs apart” such that they can clearly see “those flints that were set between her thighs”, and he transforms himself into a caterpillar in order to crawl through her body. But his bird companions are so struck by the absurdity of his actions, that they laugh out loud and wake Hine-nui-te-pō from her slumber. Angry at Māui’s impiety, she crushes him with the obsidian teeth in her vagina; thus Māui becomes the first man to die and seals the fate of all humankind, who were ever after destined to die and be welcomed into the underworld by Hine-nui-te-pō. In this version of the myth, the vagina dentata appears as an inverse manifestation of the generative, life-giving powers of woman, which Māui attempts to subvert – he endeavours to overcome the forces of life and death, and therefore “by the way of rebirth he met his end.” [7]

Ovarian Dermoid Cyst

X ray of a dermoid cyst, showing a cluster of teeth in the pelvic cavity.

The mythical theme of the vagina-with-teeth can in most cases be read as an attempt to render the potentially dangerous sexuality of women nonthreatening to patriarchal power, through heroic acts of “pulling the teeth”. Some authors have even suggested a correspondence between this mythic construct and practices of clitoridectomy and ‘female circumcision’ in some cultures. [8] Whilst there can be little correlation between ancient stories and the observation of biological phenomena such as dermoid cysts, the removal of these peculiar tumours and their retention in pathology collections nevertheless reminds us of the remarkable complexity and diversity of human understandings of the body, and their wider cultural significance. For those readers interested in the practical removal of teratomas such as those discussed here, a demonstration of the surgical procedure can be viewed in this educational film (contains scenes of graphic live surgery).


References:

[1] Harry Sturgeon Cross and Robert James Crossen: Diseases of Women, St. Louis (1941), p.685.

[2] See, for example, Bruce Jackson: ‘Vagina Dentata and Cystic Teratoma’, in The Journal of American Folklore, Vol. 84 No. 333 (July-Sept 1971), pp.341-342. Available on JSTOR: http://www.jstor.org/stable/539812

[3] Verrier Elwin: ‘The Vagina Dentata Legend’, in British Journal of Medical Psychology, (1943) Vol. 19, pp. 439-453.

[4] Maria Leach (ed): Funk and Wagnalls Standard Dictionary of Folklore Mythology and Legend, Volume 2 J-Z (1950), p.1152.

[5]  Verrier Elwin: ‘The Vagina Dentata Legend’, in British Journal of Medical Psychology, (1943), Vol. 19, pp.439-453. A particularly illustrative example of one of these stories is recounted by Elwin on pp.439-440:

There was a Baiga girl who looked so fierce and angry, as if there was magic in her, that for all her beauty, no one dared to marry her. But she was full of passion and longed for men. She had many lovers, but – though she did not know it – she had three teeth in her vagina, and whenever she went to a man she cut his penis into three pieces. After a time she grew so beautiful that the landlord of the village determined to marry her on the condition that she allowed four of his servants to have intercourse with her first. To this she agreed, and the landlord first sent a Brahmin to her  – and he lost his penis. Then he sent a Gond, but the Gond said, “I am only a poor man and I am too shy to do this while you are looking at me.” He covered the girl’s face with a cloth. The two other servants, a Baiga and an Agaria, crept quietly into the room. The Gond held the girl down, and the Baiga thrust his flint into her vagina and knocked out one of the teeth. The Agaria inserted his tongs and pulled out the other two. The girl wept with the pain, but she was consoled when the landlord came in and said he would now marry her immediately.

[6] Antony Alpers: Maori Myths and Tribal Legends, Pearson Education, New Zealand (1964), p.67.

[7] Ibid, p.70.

[8] See for example, Jill Raitt: ‘The “Vagina Dentata” and the “Immaculatus Uterus Divini Fontis”‘, in Journal of the American Academy of Religion, Vol. 48 No. 3 (Sept. 1980), pp.415-431. Available on JSTOR: http://www.jstor.org/stable/1462869

Art and Psychiatry: Henry Scott Tuke

By Gemma Angel, on 15 October 2012

by Sarah Chaney

 

 

 

 

Henry Scott Tuke was a student at the Slade School of Fine Art in the 1870s, winning a three-year-scholarship in 1877: sadly, this was twenty years too early for his prize-winning work to have made it into the UCL Art Museum. The Tuke family had a number of connections with UCL, however: Henry’s elder brother was a medical student at University College Hospital.

Although biographies of the Newlyn painter often mention his doctor father, little is made of this connection – Henry remains a figure of interest for art and cultural historians, and his father for historians of medicine. Yet parallels between art and psychiatry were often emphasised in the late nineteenth century. Daniel Hack Tuke, Henry’s father, was a governor at Bethlem Royal Hospital from the 1870s until his death in 1897, and art was an important topic at the asylum, for patients and staff alike. Daniel’s obituary in the Hospital Magazine, Under the Dome, concentrated on his well-known son, noting that:

The early death of his eldest son, who was a brilliant student of University College Hospital, was a painful blow to Dr. Tuke, but no doubt he found some amount of solace under this loss in the successful career as a painter of his other son, Mr. H.S. Tuke. The latter has been a foremost member of the Newlyn School, and like most of his brother artists of that school of painters, has lived a good deal on his boat on the coast of Cornwall, and, we remember, that about three seasons since, Dr. Tuke, upon his first visit to the Hospital, after his autumn holiday, said to the present writer that he had much enjoyed it, having in good part spent it with his son upon the latter’s studio-boat. [1]

From this remark, it would seem that Henry and his father were close. It may be interesting to pay closer attention to the fact that Henry Scott Tuke is best remembered today for his Impressionist style paintings of male nudes, becoming a cult figure in gay cultural circles. Was this connection also made in his life? Certainly, homosexuality (or ‘sexual inversion’ as it was more commonly known at this time) was a topic of interest for many psychiatrists, among whom Daniel Hack Tuke was extremely prominent. In Austria, for example, forensic psychiatrist Richard von Krafft-Ebing devoted much of his magnum opus, Psychopathia Sexualis (first published in 1886) to the topic, later becoming a fervent opponent of Paragraph 26, which outlawed homosexual acts in German and Austrian law.

English sexologist, Havelock Ellis, meanwhile, had been mentored by Hack Tuke during his own days as a medical student. In the early 1890s Ellis and writer (and self-confessed ‘invert’) John Addington Symonds corresponded about a book they wished to write together on the topic. Ellis complained about the lack of interest from his medical colleagues, in particular that Daniel Hack Tuke himself “wrap[ped] a wet blanket around it [the topic], with averted eyes”. Symonds had similarly been annoyed in a letter to his friend, Edmund Gosse, that when he tried to ‘draw’ Tuke on the topic of ‘sexual inversion’ he “found that he preferred to discourse on ‘hypnotism’.”[2]

Symonds and Gosse were both certain of the ‘character’ of Henry Scott Tuke’s art (i.e. homosexual). Perhaps this was also why Symonds felt that Daniel would be a natural ally, in addition to the doctor being an old friend of his father’s. In 1891, he sent the psychiatrist his philosophical text on homosexuality, A Problem in Modern Ethics, but informed Havelock Ellis that Tuke “shrinks from entertaining the question in any practical way.”[3] A year later, Symonds was made ‘angry’ by Daniel’s attitude, seeing it as evidence of the refusal of English Medical Psychologists to discuss the topic at all. Tuke, Symonds claimed, was “unscientifically prejudiced to the last degree.”[4] Today, we may well feel that Symonds’ anger was justified, and that Daniel Hack Tuke should have lent his well-known name to a project, in support of his son. Or we may feel that the “sentimental” psychiatrist (as his colleagues described him) was the very worst person for Symonds and Ellis to approach, and that the topic of sexual inversion might, to him, have appeared personally painful. He may have worried that his involvement might reflect badly on his son’s career or, alternatively, he might not have regarded the topic as falling into the field of pathology at all. We can conclude, however, that Ellis and Symonds felt that Daniel Hack Tuke’s personal connections should encourage a commitment to exploring homosexuality both medically and politically, and that the quiet, serious doctor did not.

He did, however, keenly support his son’s career, attending exhibitions at the Royal Academy of Art – and, perhaps, at the Slade before that. While there is no work by Henry Scott Tuke himself in the UCL Collection, the Art Museum includes work by his teachers. The artist studied under Sir Edward Poynter, depicted here in a portrait by Alphonse Legros, another of Henry’s teachers.

Sir Edward Poynter by Alphonse Legros (1837 – 1911) from the UCL Art Museum

 



[1] Anon. “Daniel Hack Tuke, M.D., F.R.C.P., LL.D.” Under the Dome, vol. 4, no. 14 (June 1895)

[2] Havelock Ellis, John Addington Symonds, and Ivan Crozier, Sexual Inversion: A Critical Edition, (Basingstoke: Palgrave Macmillan, 2008) , p. 39; Symonds to Gosse, 15 Nov 1890 in John Addington Symonds, The Letters of John Addington Symonds: Volume III 1885-1893, eds. Herbert M. Schueller and Robert L. Peters, ed.(Detroit: Wayne State University Press, 1969) , p. 518

[3] Symonds to Ellis, July 1891, Symonds, John Addington, 1969, p. 587

[4] Symonds to Ellis, July 7 1892, Symonds, John Addington, 1969, p. 710

Buried on Campus: When Are Remains Human?

By Gemma Angel, on 10 September 2012

by Sarah Chaney

 

 

 

 


Katie’s recent post on the ethics of displaying human remains in museums, along with the recent Grant Museum exhibition on the topic, raised some important questions about collection and display. Unsurprisingly, this is a frequent topic of concern in medical museums – particularly in hospital museums, teaching collections tend to focus around anatomy and pathology, a large part of which consists of specimens of human remains. But what exactly constitutes “human remains”? This is, on occasion, a surprisingly difficult question to answer.

Many medical collections were created in the eighteenth and nineteenth centuries, as anatomy schools grew and increasingly began to offer practical training for medical students, alongside lectures. One such fascinating collection can be found at Benjamin Franklin House, in Craven Street near Charing Cross. An ordinary Georgian townhouse, which was home to American Founding Father Benjamin Franklin for nearly sixteen years, the building also housed a private anatomy school. The school was run by the landlady’s son-in-law, William Hewson; who had previously worked with the well known anatomist William Hunter. Hewson sadly died young, of septicaemia contracted during a dissection, but the remains of his school were uncovered during the restoration of the house in recent years, in a pit where the back yard would have been.

It is not unusual for bones to be unearthed when foundations are laid for new buildings in London, something explored not so long ago in an exhibition at the Wellcome Collection, London’s Dead. These skeletal remains are what first springs to mind when we think about human tissue. It is skeletons that we often expect to see in museums; the absence of flesh suggests age and the process of decay. How long, though, do we continue to regard these skeletons as the remains of our loved ones? Cemeteries, for example, tend to offer burial plots for periods of only around fifty or sixty years. By this time, the body will have decomposed, and the land can legally be re-used. In Sheffield, part of the former city cemetery has been turned into a park. In London, memorial grounds are built over all the time. Once people have faded from memory, it seems that their remains do too.

But what other human remains do we find in medical collections? Many of the specimens are dissections of various sizes and complexity. It seems obvious which of these are tissue and which not, but even here the recent Human Tissue Act has struggled to define humanity. We might assume that any part of our physical form constitutes human tissue but, legally speaking, this is not the case. Body parts that regularly grow and are removed, for example, are something of a grey area; for example, locks of hair, often kept as mementos of a loved one, can legally be kept or displayed by any museum. But what about blood? The status here is uncertain. On the other hand, a tumour which has been surgically removed is considered human tissue, despite the fact that the person operated on may well have considered it to be alien to their own person.

Stained Brain Specimens in the UCL Pathology Collection. Courtesy of Bethlam Heritage.

One of the things that intrigues me most, however, is the place of foreign bodies in medical collections. Foreign bodies are objects that have been swallowed, inhaled or otherwise inserted into the human body. Often, particularly when these items end up in the bladder, the body creates deposits around these objects, protecting organs from sharp edges or corrosive material. When removed, the foreign body may be invisible within layers of mineral coating. These objects are faintly mysterious: created by the human body, they are nonetheless not considered to be human at all. They lie beyond the regulations on human tissue, but could not have come into existence in the first place without having had a relationship with that tissue.