Titled ‘Saved by SMS’, the panel debate is about a worldwide healthcare system in crisis and the future prospects of bringing health care practitioners and patients into the digital information age:

From tracking malaria drugs in the developing world by SMS, sharing information about disease outbreaks via social networking sites, to empowering patients and doctors to share diagnosis and treatment ideas, significant changes to the digital and social infrastructure of the global healthcare system could revolutionise the way we look after own health, and other peoples.

Bertalan Meskó (Science Roll) and others have been instrumental in putting medicine 2.0 on the agenda. Historians of medicine and medical museum could play a much more active role in these crucial discussions. The fact that Richard Barnett will chair the meeting on Thursday is a good sign — hopefully he will also infuse some historical perspective into the discussion.

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.

Which made me quite excited to read Jim Edmonson’s travel report from Paris and the Musée des moulages de l’hôpital Saint-Louis on Avenue Claude-Vellefaux:

Read more here.

Now the program has been finalised — and it looks very good! After a plenary discussion on ‘Schauplätze der Schönheit: Klinik, Kunst, Medien und Museen’ on Thursday evening, there follows two days of presentations, most of which seem to be very relevant for the future of medical and science museums:

• ‘Körperspuren im Deutschen Hygiene-Museum. Strategien und Objekte’ (Susanne Roeßiger, Deutsches Hygiene-Museum, Dresden)
• ‘Auf Biegen und Brechen. Zur (In)Formierung des Körpers’ (Stefan Rieger, Ruhr-Universität Bochum)
• ‘Der Körper und seine Teile. Vom Präparat zum transplantierten Organ’ (Katrin Solhdju, Zentrum für Literatur- und Kulturforschung, Berlin)
• ‘Vom Körper zum Maß. Zur Geschichte der Konfektionsgrößen’ (Daniela Döring, Humboldt-Universität zu Berlin)
• Vermessene Menschen. Vom Fingerabdruck bis zum Ganzkörperscan’ (Erika Feyerabend, BioSkop-Forum zur Beobachtung der Biowissenschaften e.V.)
• ‘Prothesen exponieren. Sichtbarkeiten neuer Technologien’ (Karin Harrasse, Kunsthochschule für Medien Köln)
• ‘Design in der Orthetik. Innovative Prinzipien der Körperanformung’ (Andreas Mühlenberend, resolutdesign; Hochschule Magdeburg-Stendal)
• ‘Wie sieht der bionische Mensch aus?’ (Friedrich Ditsch, Technische Universität Dresden)
• ‘”It’s a Material World”´: Situiertheit, Verkörperung und Materialität in der neueren Robotik’ (Jutta Weber, Universität Bielefeld)
• ‘Von der Nasen- zur Gesichtstransplantation: Zur Geschichte und Zukunft der kosmetischen Chirurgie’ (Sander L. Gilman, Emory University, Atlanta)
• ‘Science Fashion´: TechnoNaturen und deren alltagskulturellen Umdeutungen im System der Mode’ (Elke Gaugel, Akademie der Bildenden Künste, Wien)
• ‘Wie kommt die Seele ins Museum? Medizinische Museen und das Transzendentale’ (Robert Bud, Science Museum, London)
• ‘Den biomedizinischen Apparat ausstellen: Materialität und Digitalität in “Split + Splice” (Kopenhagen)’ (Susanne Bauer, Humboldt-Universität zu Berlin)
• ‘Die Schärfung des Blicks. Kunstinterventionen in anatomischen Sammlungen’ (Ingeborg Reichle, Berlin-Brandenburgische Akademie der Wissenschaften)
• ‘Körperwissen in der Kunst’ (Ute Meta Bauer, Massachusetts Institute of Technology, Boston)

As you can see, all presentations are in German — so the germanophilically challenged may have problems.

More here and here.

The topic of the webinar is ‘SARS: Learning from an epidemic of fear’, and it takes place this upcoming Wednesday 17 February, 12:30-2:30 pm (Central European Time):

The 2003 outbreak of SARS, a deadly new infectious disease, sparked worldwide alarm. It caused more than 8 000 cases and almost 800 deaths in at least 25 countries. Its spread was halted only by emergency international action.

In the opening presentation of this new seminar series, health psychologist Professor George Bishop describes his studies of how ordinary people respond to illness threats. He focuses particularly on the impact of SARS in Singapore, public responses to the epidemic, and the lessons learned.

Dr Cathy Roth, a WHO expert on the disease, explains the role of WHO in leading the struggle to contain this unprecedented threat.

The WHO’s webinar system only allows up to a thousand users logged-on simultaneously, so you’d better reserve access now — register here. After registering you will receive a confirmation email containing information about how to join.

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.

Now it has materialised with a programme. As expected most talks are about 19th and early 20th century, with one exception — Katherine Angel (Warwick University) who will speak about “A Very Simple Answer: Causal Reasoning in the Last Twenty Five Years of Peptic Ulcer”.

For more information or to register, contact michael.liffey@ucd.ie.

Part of my work, therefore, is going to conferences like this one, held in Copenhagen last week:

The conference was arranged by the Danish research center GNOSIS, and featured both neuroscientists and philosophers – as an attempt to bridge the disciplinary boundaries and maybe produce some kind of synergy.

The first day especially had that feeling. Themed under the headline ‘Brain Plasticity’ and featuring, among others, the English philosophical-minded neuroscientist Steven Rose, German phenomenological philosopher and psychiatrist Thomas Fuchs, and Danish biologist and anthropologist Andreas Roepstorff, there was a real feel of cross-disciplinary science communication. A science communication which was also a communication of the immense complexity of the brain and of the production of knowledge concerning it.

As Steven Rose pointed out, neuroscience is ‘data rich, but theory poor’, needing some theorizing on how best to manage the complexities of the huge amount of collected data. One common perspective to most of the talks at the conference were that the brain’s workings can best be understood viewed as a complex, irreducible and indeterminate, continuously developing process. This was conceptualized from both phenomenology, developmental systems theory (or autopoiesis, as Rose termed it), and biosemiotics – all in one way or the other emphasizing the brain as embodied (or the body as ‘embrained’, as someone smartly put it), and emphasizing the body’s embeddedness in the world (emworlded). Dichotomies and dualisms, determinacy and reductionism were (with maybe one exception) not only forcibly opposed, they were long left behind, it seemed.

But still there was a sense that, despite agreement on the general perspective, this did not solve the concrete methodological challenge of, for instance, going from correlates to causality, inducing from the particular to the common, or explaining the relationship between brain and mind/consciousness/awareness/attention etc. Neuroscience, it seems, brings new attention to a lot of old philosophical problems. The multidisciplinary collaborations within the field of neuroscience, and the demand for new theoretical developments and new conceptualizations, may not find a solution to these problems, but it sure sets the stage for interesting theoretical developments in the years to come.

As for the link to my project on successful aging, this development in neuroscience seems to run almost parallel to the overall development of the field of gerontology and aging research in the last couple of decades from around the time that the concept of successful aging was introduced. Many of the same philosophical problems are also seen in other parts of aging research than the parts including the neurosciences.

Aging research (as well as maybe most other fields in the health sciences?) is becoming a multidisciplinary field where dichotomies and dualisms between brain-mind, body-world, and individual-society are being tested and challenged.

Neither do many museum curators give much thought to the historicity of their display techniques. How have display practices changed over time and how do these practices reflect museum culture, politics and technologies?

Such question wil hopefully be discussed at the 29th symposium of the Scientific Instrument Commission, which will be held in Firenze, 4-9 October 2010 on the theme ‘Instruments on display’, i.e., how instruments have been presented in scientific collections, museums and permanent and temporary exhibitions throughout modern history up to the present:

Did didactic, scientific, celebrative, propagandistic and rhetorical considerations significantly influence the manner of displaying instruments? How were instruments presented in a Wunderkammer of the Renaissance, in a 18th-century cabinet or in a 19th-century exhibition? How and why are they shown in contemporary science museums?

This year’s symposium is sponsored and organized by Istituto e Museo di Storia della Scienza (Museo Galileo) and Fondazione Scienza e Tecnica. The meeting is open to “anyone interested in the history, preservation, documentation of use of scientific instruments”, whether academic scholars, curators, collectors or students.

Send abstract before 1 June, 2010 by filling in this template.
More info on the symposium website.