Biomedicine on Display

We have tried many different ways of marketing our exhbitions to the prospective audience (posters, direct-mails, postcards, you name it) — with varying success. One of the problems with posters and postcards is the one-way communication; if people want more information, they have to make an extra effort.

In connection with the new extra-mural exhibition ‘Healthy Aging: A Lifespan Approach’ that opened two weeks ago in the main building of the Faculty of Health Sciences (see here). we tried out a more personal way to get in contact with our prospective audience.

The idea was to give students and staff at the University’s Southern Campus (Faculty of Humanities) and the Faculty of Health Sciences an opportunity to put a human face on Medical Museion. So some of our student docents were sent out to hand out flyers in the main buildings of the two faculties and to answer whatever questions people they met might have.

All in all, this ’in-your-face marketing’ operation was a success. It gave us a nice opportunity to have conversations about our collections and hear how students and staff responded do the exhibition. If any other museums has had similar experiences. wse would very much like to hear about it.

Here’s student docent Andreas handing out flyers in the main building of the Faculty of Health Sciences. In the background you can see a part of  ‘Healthy Aging – A Lifespan Approach’:

More pictures here.

Recently I announced a quiz to get more information about a historical syringe that a couple of friends had bought for me. This quiz was far from easy since we had no information on the syringe whatsoever. Medical Museion’s guest researcher and former chief physician Sven Erik Hansen was the first to make a suggestion on our Danish blog — he thought it might had been be used to treat haemorrhoids.

Sven Erik’s was a qualified guess, but it seems like the area of expertise that we are dealing with here is rather odontology. Thomas put a query about the syringe on rete, the mailing list for curators, historians, students, collectors, dealers, etc, interested in the history of scientific instruments, and immediately received some very interesting answers. First out was Frank Manasek: 

This type of syringe was common in dentistry or in minor surgery where local anesthetics (such as lidocaine) would be used. Later syringes of this style were designed to use disposable ampoules of anesthetic, and disposable needles. (This one predates both.) The needle on this example is long, suggesting its use in mandibular blocks.

Following Franks lead Alistair Kwan elaborated:

I was just about to write almost the same thing. The last time I asked a dentist about the move away from these, he said that patients are more scared of them because they are big and shiny, and harder to
keep out of sight — convenience and cost of disposables did not play into his decision, though they are primary issues in debates between surgeons, surgical nurses and hospital administrators.

If you compare with today’s common disposables, the plunger design involves a different handhold that increases control through tight spaces and increases pressure on the contents. If you try them out, you can experience how the palm-grip hold is much less subject to little wobbles in the finger and thumb joints. (A high-stability grip for the disposables is to wrap them in all four fingers of a fist, which limits where you can work.)

You can also experience how the palm-grip hold and the lighter two-finger hold are suited to injecting targets at different heights and orientations. You cannot comfortably inject straight down with the
palm grip hold unless you are leaning right over the patient. But your forearm is positioned for easy aiming sideways or forwards or upwards, as into the nerves in the mandibular joint.

For times when you want a pistol or palm grip (e.g. in veterinary medicine), there are handles for disposable syringes. The handles derive from earlier syringes in which they were inbuilt. In recent years (decades?) they have simply had the syringe removed, leaving a hollow or brackets in which to insert a disposable. Similarly with ring grips, now marketed for use by non-medical people with frail hands who need to administer to themselves or family members, and for cake decorating.

Easy disassembly makes cleaning easier but it sometimes owes more to manufacturing processes than concern for scrubbing and autoclaving. A device like this is often cheaper to mass-produce from standard stock than by building all components from scratch. If it goes together easily, it often follows that it comes apart easily as well. Today’s one-way barbed fasteners and sonic welders have of course
cancelled that rule.

Now what began as an artefact without a history suddenly had spawned a fascinating insight into the world of dentistry. Peter Morris continued (still on the rete list):

These syringes are still in very common use by dentists in the UK. I don’t recognise the disposables mentioned by Alistair. Personally I always try to avoid the jab if I can which provokes friction between me and the dentist. I would say the needle is a little bit thicker than it appears in the photograph, but it may just be a matter of the scale of the photograph (and the psychological effect of it going into your mouth). A quick look on the web throws up JS Dental Manufacturing Inc of Ridgefield Connecticut. I cannot find out how long it has been in business but it seems well established.

And back to Alistair:

I should clarify a bit though: the common disposables are less stable than the big dental model when used in the mouth owing to how they  have to be held. What I originally wrote (in a low-energy moment at the end of work yesterday) was unclear, though I’m sure that your exhibit writers will have no trouble doing better. (I’m now at the start of the day so am more critical of what I write!)

And that critical attitude might be what made Alistair return with one last comment:

It might also be worth indicating that some anaesthesia techniques begin with aspirating by withdrawing the plunger to suck a little on the tissue that the needle has entered. This tests whether you are in the right place: the colour of the liquid obtained indicates the extent of blood supply. If you get blood, you know to withdraw the needle and start again. (I find needle-guiding techniques very clever. Other common rules are to locate external markers for guidance, and to hit bone or a sudden resistance change as an indicator for depth. Some markers for mandibular anaesthesia are in the ear which is why the dentist puts his finger there — as target to aim for — while inserting the needle.)

Aspiration is reflected in some plunger handles: they have a ring for the thumb.

It’s more difficult to aspirate with pistol-grip and palm-grip syringes because pulling and pushing require different holds. That may entail having an assistant steady the patient’s head.

Following Peter’s post, I had a quick look at some on-line catalogues and saw that both metal and disposable plastic syringes are sold by dental equipment suppliers.

So thanks to our fellow histrorians and curators on the rete list, we’ve been able to construct a much more detailed curatorial story about the syringe than I ever imagined when I first posted the original quiz.

And so we need a winner. The stern panel of judges (who will remain anonymous) has decided to a name Alistair Kwan the winner. So Alistair, whenever you come to Copenhagen, please visit us here at Medical Museion and claim your prize.

Since the snow descended upon Copenhagen a month ago everybody has been walking around wrapped up in scarfs and woollen clothing, trying to avoid the snowdrifts. Personally, my thoughts wander off to a warmer place — more specifically Southern France, where I took some needed holiday last summer and visited, among other things, the two medical museums in Toulouse.

Being a foreigner in France is not easy. The lingua franca in France is French which can be quite a challenge if one is far from a native French speaker. Not many people in the region speak English, and all signs (even in museums) are written in the native tongue. That’s a shame — there is a fascinating culture and history to be told, but unfortunately much of this history is missed if one does not speak or read the language.

Using my terrible French with a lot of pardon and merci I finally made it to Le musée des instruments de médecine des Hôpitaux de Toulouse and Le musée d’histoire de la médecine de Toulouse. Both museums are situated right on the edge of the beautiful Pont Neuf bridge and the exhibition rooms are situated in the old hospital building, l’Hôtel-Dieu. When searching for travel directions I had stumbled on the Hôtel-Dieu but I did not understand exactly what it meant. Two quotes:

The common phrase necator pauperum or ‘assassin of the poor’ was used for those who neglected their duty to succour those in need and guilty prelates could lose their status as a result. The bishops therefore built xenodochia near their cathedrals, of hospitaliae at the entrance to the cities. The former gave shelter to the poor and the sick of the town, who were known as the matricularii and were registered and maintained by the church. The hospitaliae, also called ‘maison—Dieu’ or ‘hôtel-Dieu’ flourished during the Carolingian Renaissance and took in mainly pilgrims and travellers.

and:

Most of the present-day Hôtel-Dieu hospitals originate in the episcopal domus Dei or the domus pauperum.

(both from Frexinos 2001, p. 19; see reference below)

Why place a hospital in Toulouse? Well, the city is one the road to the famous pilgrimage site Santiago de Compostela. The pilgrims came from all over Europe to pray at the tomb of St. James, and for the keen observer the St. James’ shell (seen in the centre of the picture below) is a dead give away.

Here’s the old hospital of Toulouse. The museums are located in the left part of the building. In the centre of the picture one sees the St. James’ shell:

The two museums have slightly different focus. One is about medical history in general. When you enter the building you step into a general reception area, where posters give a general introduction to the history of the museum (at least I believe they do; no signs in English!). One thing that really speaks in favour of the museum is the friendly staff. Even though the receptionist didn’t speak a word of English she was very friendly and we did manage to communicate. At least our conversation went so well that I was handed a brief description of the collections in English. It reminded of how important a museum reception staff is; they make the first impression so it has to be a good one.

The museum basically consists of three showrooms. The first, and smallest one, is on pharmaceutical history. From a museological point of view it is not impressive. The objects are placed in their display cases with a short description of their use, but there is very little context to be found.

In the next showroom the objects are roughly divided into different specialities, such as surgery and obstetrics. This part of the museum is definitely the best. It’s quite small though. Some of these instruments are quite impressive and even though I had seen most of them before there was one that stood out — the tobacco cloister seen in the picture below. Sure I had seen cloisters before (we have some here at Medical Museion) but this type was new to me. I have told so many visitors in Copenhagen about how the cloister was used to rid the body of black gall, but this one was different. Normally you would have needed another person to use it, but this one was designed so that it could be self-administered. The patient simply straddled over the cloister, activated the pump and let the tobacco smoke act as a laxative:

I also fell very much in love with the beautiful object below (for more on Theriac see here):

The third part of the museum is situated in the basement, and I had a hard time figuring out exactly what the organising principle was. There was a microscope and some x-ray equipment but exactly what the connection was escaped me — maybe becuase I didn’t know the language well enough.

The other museum — Le musée des instruments de médecine des Hôpitaux de Toulouse — is placed in the same building and right next to the one on the medical history of Toulouse. It is disappointingly small: only one single room and a couple of podiums outside. The custodian was extremely nice, however, and between her English and my horrible French we did manage to get a conversation going.

The best part of the experience was the moulages:

Below is a selection of some of the other objects displayed:

Drills used to perform trepanation:

Pacemakers:

And an instrument used to perform an abortion (Thomas actually wrote about these kind of instruments a year ago):

Both museums were indeed interesting and there was a great feeling in the old historical buildings. One of the best things about my visit though was that I bought a book by Jacques Frexinos entitled The Hospitals of Toulouse. A Thousand Years of History (2001), an excellent introduction to the topic of hospital history. I strongly recommend you to get a copy before visiting the Toulouse museums (the French version can be bought here.)

Toulouse is a beautiful city and if one is interested in medical history I would recommend a visit. Not so much for the museological experience, but the objects in themselves are interesting.

At the picture above you can see the Pont Neuf and in the background the old hospital buildings that house the museums.

I seem to have acquired a strange interest in therapies involving animals. Especially if they trigger ‘the yuck factor‘. Leeches and maggots have been used for centuries and are also used in biomedicine today. Whereas these tiny crawling creatures are used externally (fixed on or in the skin), parasitic worms are used internally — the patient drinks a cocktail of worm eggs.

Why? Well, most people have heard of MS (see here), but how many have heard of this particular experimental treatment:

Once the eggs are inside the body, they will hatch into worms that live in the gut. It is hoped they will then stimulate the release of a certain type of immune system cell that will allow the body to heal the damage done by MS

 Interesting but also … yuck!

A couple of friends who know about my interest in the history of disease recently gave me a historical syringe as a gift. They bought it in a flea marked, so unfortunately I don’t have any information about its provenance. Ion Meyer (conservator and head of collections here at the Medical Museion) suggests, with some help from catalogues of medical equipment, that it might have been made in 1940’s or 1950’s, but unfortunately we could not get any closer.

And this is where you, dear reader, might be of assistance:

• Where and when is it from?
• How common was this particular type of syringe?
• When did it go out of style?

The syringe is marked JS and is easily dismantled as seen below.

This quiz will continue until January 31. There will be a small prize (a guided tour of Medical Museion by yours truly) to the person that can give me the most detailed story about the syringe. The winner will be elected by a judging panel assembled for the occasion and announced on 1 February. Good luck!

Did you know that even bacteria are annoyed by the music of Engelbert Humperdinck? (Yes, you are not the only one). E.coli bacteria can’t stand it. It’s all (sort of) true:

Adam Zaretsky once spent 48 hours playing Engelbert Humperdincks’s “Greatest Hits” to a dish of E.coli bacteria to determine whether vibrations or sounds influenced bacterial growth. Watching the bacteria’s antibiotic production increase, Zaretsky decided that perhaps even cells were annoyed by constant subjection to “loud, really awful lounge music.”

Quoted from here. Any questions? :)

Many mysteries and fascinating aspects from the field of medicine have been discussed on this blog but I can’t remember that this interesting site has ever been mentioned. James G. Mundie’s Cabinet of Curiosity is a fascinating site and there is no doubt that the man behind is a skilled artist. 

But what is it all about? A quote might be in order:

What one will see here is not a random collection of bones and things in jars, but a record of an important segment of our shared medical heritage. These anatomical preparations represent the intersection of science, culture, emotion and myth. Through these oddities, one may catch snippets of the evolution of modern medicine based on science rather than superstition.

I wonder what he would get out of a visit to Medical Museion? Maybe we should invite him?

In one of his last blog posts Thomas argued that university museums are basically elitist institutions. 

Thomas argues that the basic success criterion for museums is the popularity of their exhibitions and number of visitors where on the other side the success criterion for a university museum is the quality and originality of their research. Of course I can’t speak on behalf of all the museums out there but I could easily imagine that many museum professionals could be offended by that statement. Actually I’m quite certain that a lot of great research is done by curators who are not employed by a university museum.

Anyways, as to quality and originality I totally agree. That is a worthy goal but something still troubles me. Especially the following sentence:

In other words, in contrast to museums in general, which are institutions with a broad, popular appeal, ’university museums’ are basically elitist institutions.

What does that actually mean and what happened to the idea of research to the benefit of the people? Was that just a crazy idea that some students back in the sixties and seventies used as a slogan?

When I hear the word elitist it triggers some very unfortunate associations. Who is the elite? What notions of power are we operating with here?

At the Medical Museion we have some fantastic collections. Don’t we have a duty to open them up for the general public in a way that could be understood also by people who are not college educated? There is a democratic principle in this that I fear might be lost if we chose to communicate in a way that only the elite can understand.

Also I really don’t buy the following sentence:

Better provide original solutions to small but fundamental display problems than build big and popular exhibitions.

There is absolutely no reason why these two should be in opposition to each other. Let’s make innovative and popular exhibitions. Access to the medical cultural inheritance should be as democratic as possible and not just something that is withheld for the elite.

When I was working at the Medical Museion as a docent, I often introduced visitors to our fabulous pharmacy. Here the visitors are introduced to such interesting objects as a jar containing moss from a human skull and a container for leeches. Leeches were used to draw blood from patients to restore their blood balance. The theoretical basis for this procedure was of course humoral pathology.

The use of animals is not something that is restricted to pharmacies in medical museums like ours. Animals are also used in biomedicine today. I’ll get back to that.  

One of the advantages of being a museum docent is that one gets an opportunity to see the facial expression of visitors when they listen to stories like the one about the leeches. It’s interesting but hard to describe. It’s like if they had just chewed on a piece of lemon — actually a quite common emotional reaction.

The reason why I came to think about this is because a year or so ago one of our visitors claimed that maggots are being used today to clean infected wounds, a procedure I realised is known as biosurgery. Googling ‘biosurgery’ I found out that it stands for a variety of different procedures, but one is actually the medical procedure of cleaning wounds. As usual one can find a YouTube video of the procedure being executed. Take a look here:

I’m quite sure my own facial expression was the exactly same as our visitor expressed when I told them about the use of leeches  :)

While searching for more info on biosurgery I also stumbled upon this article where I found this great quote:

Despite its effectiveness, maggot therapy — or biosurgery to the squeamish — must overcome the “yuck factor” with physicians to gain widespread acceptance. “In my experience, patients are very trusting. The ‘yuck factor’ is with practitioners,” Ms. Jones said. Internal Medicine News, 1 Feb. 2005

The ‘yuck factor’ seems to be an accurate description, which I guess can also be applied to other biomedical procedures.

One thing that I was unable to discover was how often maggot therapy/biosurgery as a technique is used around the world. Does anybody know?

I performed my fist knee operation today. Not in real life though but on my pc. Videogames inspired by medical practises or diseases has been discussed on this blog before but I don’t think that this particular game has been mentioned. In the game one takes on the role of a surgeon (or a surgeon’s assistant, I’m a bit in the dark on that one) and I must admit that I found the game to be surprisingly unpleasant.

I guess that working at a place like Medical Museion one gets hardened by telling stories of how the medieval surgeons performed their work or how the cholera epidemic infected people in the middle of the 19th century. Nevertheless this game, where one gets to perform surgery on a knee, really struck me. One thing is the images of the opened knee but I believe that it’s really the sound on the game that gets to me. Especially the sound of the saw going through the knee is really disturbing. Urg!

I must admit that I found it rather educational and apparently my patient survived. To be quite honest I’m not sure that it’s possible to actually ever fail. The game also reminded me of an article I read recently (”Inscribing surgery in digital culture” by Jan Eric Olsén, Årsskrift for Medicinsk Museion, vol. 3, 2006: 49), in which he links computer gaming and virtual surgery:

Future surgery may not require knowledge in handling the scalpel but rather familiarity with computers. It has also been suggested that surgeons who often play computer games sharpen their ability to coordinate the senses of vision and touch, when performing keyhole surgery (Satava ed 1998: 143-144)

That might be right, but I’m quite sure that the above-mentioned game does not train the necessary skills :) (For an online article about the link between surgery and computer gaming click here)

I have often been amazed by the steps taken to prevent people from smoking and I have found two gadgets to keep people from the habit quite fascinating: A year’s worth of tar and Smoking Sue.

It now seems that the Danish government wants to play hardball. For quite some time smokers have been used to having warning signs on packages stating that cigarettes are dangerous and potentially deadly. I find it surprising to what extent even the size and font of the letters of the warning are regulated by law. Here’s a quote from § 10:”The general warning […] must cover 30 pct. of the surface of the relevant side.” And a bit further down in § 11, part 1: “Printed in black, bold characters in font Helvetia on white background.” Here taken from the Danish law regulating tobacco.

There is just something fascinating about public health in the language of bureaucrats. One can imagine how the fight over the exact percentage has been waged and a compromise made.

Anyway, the reason I bring this up is because the Danish government has just proposed putting images on cigarette packages. Pictures that show what smoking will do to you. And they are quite nasty as one can see from this article in the Danish newspaper Politiken. I know that this is practised in other countries also (take a look at these from Brazil but be warned – they are really disgusting), but I’m really in doubt as to the effect of these images. Do they really work?

Human anatomy is a fascinating thing and apparently there is something fascinating about wearing it also. I thinking especially of clothes with pictures or images that resemblance the human anatomy. As an example I often wear a T-shirt with a cranium on in. I don’t really know why or give it much thought. Really, it’s just a T-shirt.

Just now when I was searching for info on The Visible Human Project I accidently stumbled onto this website on The Visible Embryo. What really struck me wasn’t really The Visible Embryo itself it was the merchandise one could by from their online store entitled: Shop The Visible Embryo. Here one can buy T-shirts, aprons, a pregnancy timeline full colour tote bag or (my personal favourite) a birth spiral ceramic travel mug.

I’m not quite sure who the intended buyers are. Medical students? Pregnant parents-to-be? I guess that there really isn’t any difference between wearing a T-shirt with a cranium and a cap with a pregnancy timeline but somehow the latter sort of freaks me out and I don’t really buy the following statement: “Look cool on bad hair days or when shading your eyes from the sun”. Well, I most seriously doubt that.

Look cool in your Birth Spiral Black Cap

From left to right: Kirsten Rosenmay Jacobsen, Camilla Schumacher-Petersen, Splice and yours truly

Maintaining an exhibition like ‘Split and Splice: Fragments from the age of biomedicine’ is quite a job. Not many of us who frequently visit museums consider the time and effort put into maintaining the shows that we visit. We kind of take it for granted that the display cases are polished and we properly rarely think about it – unless the general maintenance is lacking.

Admittedly maintaining a show can sometimes be a tedious job but never the less it is extremely important. Changing light bulbs and keeping the dust levels down are some of the more mundane tasks but as Split and Splice is a special exhibition – it also requires special maintenance. Especially the two stars of the show, the rabbits Split and Splice named, of course, after the show itself. Deciding to have live rabbits in the show was a long process and something that we discussed over and over again. Knowing fully well that having rabbits in the exhibition required special care we decided to go through with it. Feeding the rabbits, cleaning their cage, ensuring a steady supply of hay, ensuring that the room temperature is at an acceptable level are just some of the challenges we face every day – and the rabbits are alive and kicking. Especially the younger audience seem to be responding well to the presence of live animals within the show. Just the other day a couple of sixth graders had had enough of the (admittedly) sometimes frightening stories of medieval surgery and had retreated to the front lobby of the Museion were I found them while going through the exhibition showrooms. Introducing the kids to Split and Splice immediately cheered them up and turned what could have been a bad museum experience into a positive one.

Anyways … maintaining the rabbits requires special care which is why we have just had a visit by veterinarian Camilla Schumacher-Petersen and her assistant Kirsten Rosenmay Jacobsen (both from The Department of Experimental Medicine, University of Copenhagen). There had been no indication of any health problems what so ever but I very much wanted a professional opinion just to be sure. Camilla inspected both Split and Splice and found them to be in good shape. She cut their nails and was all in all satisfied with their living conditions.