The anatomy lesson of Dr Tulp - De anatomische les van Dr Nicolaes Tulp

I wrote this ages ago but for some reason never published it.   But here it is!

This painting by Rembrandt is in the Mauritshuis in Den Haag.  Last year on holiday I visited the gallery to see The Girl with the Pearl Earring (who in Dutch is just "The girl with the pearl", although it doesn't rhyme in Dutch), but De anatomische les van Dr Nicolaes Tulp is there too.  

This was Rembrandt's first commission on moving to Amsterdam, commissioned by the Surgeon's Guild.

Tulp gave annual anatomy lectures, open to the public (on payment).    The paper being held by one of the surgeons present at one point had the names of the sitters on it, now painted out.    I wonder who he is, and what the paper is (or is it a book - I had wondered, with no evidence, if it was an anatomy atlas, and the man holding it was comparing it with the dissection, or guiding it?).   Perhaps we can see that man as a prototype health librarian, there in the background of a procedure or intervention.  Perhaps he even was the guild's librarian, but that may be going a fanciful step too far!

As the information from the Mauritshuis points out, Tulp looks like he is seated on a throne, and is also the only one present who is wearing a hat, although originally one of the others wore one, till Rembrandt painted it out.  The man who had the hat painted out is Frans van Loenen, who is the man in the top left who is looking at us and pointing at the corpse (thanks to the Leiden site for that information).    If he had a hat it would have made a certain symmetry, but if, as the Mauritshuis site wonders, Tulp asked for his hat to be painted out because it would have given him more importance than he was due.

The name of the man whose body is being dissected is known, Adriaen Adriaensz, also known as Aris Kindt.   There is more about him if you scroll down on the Mauritshuis link.

The frontispiece of Vesalius' De humani corporis fabrica has on it a dissected arm - and perhaps that is why Tulp wanted to be shown dissecting an arm.

A PubMed search for tulp n[ps] finds 36 (the same number of results as in September 2022).   (tulp AND (nicolaas OR nicolaes)) OR tulp n[ps] finds 51 (again the same).      There are two possible spellings of Dr Tulp's first name.

There are two papers by FF IJpma, one in English, one in Dutch, which are in those 51.  The English language one was republished as the Dutch one, and the paper(s) tried to replicate what Tulp was doing, in a dissection, and couldn't.   That author does have two capitals at the start of their first name, as IJ is one letter.

One paper in the results (Masquelet, 2005) makes the case that Tulp is demonstrating the function of the flexor digitorum superficialis.  Another (and only one) names a Tulp Syndrome.  

Nicolaes Tulp published a book, Observationes medicae, available online via the Wellcome Library.  This is free to access in the UK.

There is more information about the painting from the Mauritshuis, in Nederlands and the Mauritshuis, in English

and, because Tulp trained in Leiden, on the website of the Universiteit te Leiden, in Nederlands and the University of Leiden, in English

Daniel Hale Williams

Daniel Hale Williams, born in 1858,  has been credited with performing the first open heart operation.

An article by W. Montague Cobb in the Journal of the National Medical Association in 1953 (1) records that Williams was famed as the first person to operate on the heart (rather than using the specific phrase "open heart surgery").  Cobb relates that a planned biography of Williams found that there were earlier cases, and as a result that biography was not published.   The heart operation performed by Williams was the suturing of a stab wound to the pericardium, published in 1897 (2).  Another article in the same journal in 1935 records investigations into whether Williams was the first to operate on the heart, investigations related in Cobb's article and involving a search in the Surgeon General's Library, now the National Library of Medicine. 

Williams also founded the first hospital to be run by African Americans, in Chicago, and its associated nursing school, which admitted African American students when other nursing schools would not.   He also cofounded the National Medical Association, a national organisation for African American physicians.    He was also the first African American admitted to the American College of Surgeons.    

References

1. Cobb WM. Dr. Daniel Hale Williams. J Natl Med Assoc. 1953;45(5):379-85.  This is in PubMed Central.

2.     Williams DH.  Stab wound of the heart and pericardium: suture of the pericardium, recovery - patient alive three years afterwards.  Medical Record. 1897;51:437.   Available through the Hathi Trust.

Other articles about Daniel Hale Williams

Dr. Daniel Williams takes priority in successful operation for Stab Wound of Human Heart. J Natl Med Assoc. 1935;27(4):162-3.

Daniel Hale Williams Cardiac Operation Priority. J Natl Med Assoc. 1960;52(6):447-9.

Beatty WK. Daniel Hale Williams: innovative surgeon, educator, and hospital administrator. Chest. 1971;60(2):175-82.

Beatty WK. Daniel Hale Williams--pioneer surgeon and hospital administrator. Proc Inst Med Chic. 1979;32(7):156.

Cobb WM. Daniel Hale Williams-Pioneer and Innovator. J Natl Med Assoc. 1944;36(5):158-9.

Gordon RC. Daniel Hale Williams: pioneer Black surgeon and educator. J Invest Surg. 2005;18(3):105-6, cover.

Olivier AF. Classics in thoracic surgery. In proper perspective: Daniel Hale Williams, M.D. Ann Thorac Surg. 1984;37(1):96-7.

Dr Jane Cooke Wright

I recommend Christie Watson's book about her experience of nursing, The language of kindness (1).  There is a chapter about cancer nursing, which mixes Watson's experience of nursing cancer patients with her experience of her father living with cancer, and being nursed by a Marie Curie Nurse.

In that chapter, Watson mentions Dr Jane Cooke Wright (1919-2013), clinical oncologist, who discovered the anticancer properties of methotrexate, and investigated anticancer agents in vitro.   She was one of the founders of the American Society of Clinical Oncology, which was started because the America Association for Cancer Research was too laboratory based.  African American, Cooke Wright's father was one of the first African American medical graduates from Harvard, and her step grandfather the first African American graduate of Yale.

Jane Cooke Wright is the subject of a 2016 article in the Journal of Medical Biography (2), and of a 2013 article in the Oncologist (3). Those two reference several of her 135 papers.   She was also the subject of obituaries in the BMJ (4) and the Lancet (5), and the New York Times.

She also has an entry in the National Library of Medicine's Changing the face of medicine: celebrating America's women physicians.

I did start thinking about this post in Black History Month, and even though the Month itself ended yesterday, it is not too late to read it.

References

1. Watson C. The language of kindness : a nurse's story. London: Chatto & Windus; 2018.

2. Crosby HL. Jane Cooke Wright (1919-2013): Pioneering oncologist, woman and humanitarian. J Med Biogr. 2016;24(1):38-41.

3. Swain SM. A Passion for Solving the Puzzle of Cancer: Jane Cooke Wright, M.D., 1919‐2013. The oncologist (Dayton, Ohio). 2013;18(6):646-8.

4. Newman L. Jane Cooke Wright. BMJ : British Medical Journal. 2013;346:f2902-f.

5. Watts G. Jane Cooke Wright. The Lancet (British edition). 2013;381(9875):1354-.

Dr James McCune Smith

James McCune Smith (1813-1865) was the first African American to gain a degree in medicine.   He was unsuccessful in gaining a place at medical school in New York state, his home state, so his friends and benefactors paid for him to travel to Glasgow, so he gained a degree at the University of Glasgow.  That university is building a new learning hub and naming it after him.

As well as being a physician, he was an abolitionist, working with Frederick Douglass, and made contributions to the fields of physiology and medical statistics.   

The Wikipedia page about him is a good starting point. 

I found two articles about him, in PubMed.   One is cited in the Wikipedia article and the other not.

The older one (1) describes a case report that was read on his behalf to the New York Medical and Surgical Society, and references a paper that he wrote in the New York Medical Journal (2).   

According to the newer one (3) these were the first case report by an African American, and the first paper by an African American physician based in the United States.   

McCune Smith has an entry in CHAAMP, from the University of Virginia.

References

1. Morgan TM. The education and medical practice of Dr. James McCune Smith (1813-1865), first black American to hold a medical degree. J Natl Med Assoc. 2003;95(7):603-14.  Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594637/ (Accessed: 15th October 2020)

2. Smith JM. On the influence of opium upon the catamenial functions. New York Journal of Medicine. 1844;2:56-8. Available at https://hdl.handle.net/2027/nnc2.ark:/13960/t1gj2984x?urlappend=%3Bseq=72 (Accessed 15th October 2020)

3. Lujan HL, DiCarlo SE. First African-American to hold a medical degree: brief history of James McCune Smith, abolitionist, educator, and physician. Adv Physiol Educ. 2019;43(2):134-9.  Available at: https://journals.physiology.org/doi/full/10.1152/advan.00119.2018 (Accessed 15th October 2020)

Dr Harold Moody

Dr Harold Moody was the subject of the Google Doodle on 1st September.   The image caught my eye as the designer intended, and I followed the link.

And then, I started reading Reni Eddo-Lodge's Why I am no longer talking to white people about race, and there he was again.

Moody was born in Jamaica, came to England to study medicine (at King's College London), and then worked in London as a general practitioner.   In 1931, he founded the League of Coloured Peoples, a civil rights organisation.

I could find nothing in medical journals about him, but did find this book chapter by David Killingray, published in Manchester Openhive.

And that linked Moody with another area of my life.   He was a Congregational Christian.   Congregational churches are each independent, with roots in 17th century England, when we broke with the Church of England because we wanted to have that independence to worship in the way we wanted.   Moody had attended a Congregational Church in Jamaica, and then in London, although the chapter does not say which London church.    He was chair of the London Missionary Society, and seems to have been on a list (real or in someone's head) of possible people to be chair of the Congregational Union, the national organisation of the time.   Moody sent a communication to the editors of the Journal of Negro History (Moody, H. (1933). Communications. The Journal of Negro History, 18(1), 92-101).  It reports an address he gave at Friends' House in London (headquarters of the Quakers),  describing the inaugural meeting of the League.  The League's inaugural meeting was held at Memorial Hall in London, which was the headquarters of the Congregational Union.    So Moody is definitely part of my church's heritage, but someone I had not come across before.

There is more about the League of Coloured Peoples on this page from the Open University series on the history of South Asians in Britain, "Making Britain", and this second page from the same project, which has a good reference list.  

The British Library have the objectives of the group.

And there is an article in the Oxford Dictionary of National Biography (subscription needed - the University of Leicester has one).

First in an occasional series of posts to mark Black History Month.   Watch for others!

A health librarian at the theatre: The Madness of George III

It's been several weeks since I "went" to the theatre, but I have just watched the Nottingham Playhouse's production of this Alan Bennett play, on the National Theatre Live YouTube channel.

I saw the film (called The Madness of King George) some years back and I was aware of the idea that the King was not mad, but had porphyria.   The clue was the blue urine, which none of the doctors (in the play) thought was important.

But I had not realised that view has been questioned.   There are several articles in the medical literature, many by Timothy Peters of the University of Birmingham (UK).   It is argued in those that the authors who advanced the porphyria theory were rather selective when it came to symptoms, and misinterpreted the ones they did choose, and did not consider the King's mental health.

There were several things that caught my health librarian eye while watching.

All of this is, of course, Alan Bennett's portrayal of the characters involved.

There were three doctors involved in the King's care, before Dr Francis Willis.    All seemed glued to their view of diagnosis and treatment.   One was sure that blistering was the treatment needed to draw out the bad humour that was the cause.  Another based all their diagnosis on the King's stools.    The third was set on prescribing a particular thing.    They, and the King's servants, noticed the blue urine, but it seems as it did not fit anyone's scheme of treatment, it was not thought relevant. 

It seems physical examination was the last resort, and not the first.   Perhaps that was a reflection of the class divide, in the context where no one addressed the King directly, and all conversations were carried out through someone else.

Then there was Dr Willis.   Dr Willis, who maintained an asylum in Lincolnshire, did address the King directly, and not only that, told him off for his random conversations and inappropriate talk.   Contact with others, including the Queen, was restricted, and if he misbehaved, he was put into a straitjacket.

The manoeuvring of politicians of the time was shown too, and obviously (in Bennett's view, anyway) had a role to play - who was Prime Minister, and whether the Prince of Wales should be Regent.

And the King got well.   The random talk and inappropriate talk subsided, and the urine went back to a more usual colour.

So, did Francis Willis cure him?   And what was it?

Searching PubMed for George III or King George III requires a specific search for George III porphyria, or George III[ps].     An earlier diagnosis, before the one of porphryia, was bipolar disorder (1,2). 

And searching PubMed for willis f[ps] finds a few including this one (3).  

This Patient article for professionals discusses symptoms and treatment of porphyrias.

1.           Peters T. King George III, bipolar disorder, porphyria and lessons for historians. Clin Med. 2011 Jun 1;11(3):261-4.

2.           Peters T. FitzPatrick Lecture: King George III and the porphyria myth – causes, consequences and re-evaluation of his mental illness with computer diagnostics. Clin Med. 2015 Apr 1;15(2):168-72. 

3.           Pearce JMS. The Role of Dr. Francis Willis in the Madness of George III. Eur Neurol. 2017;78(3–4):196–9.

 

Grinders' disease

What is the connection between the 1945 film Brief Encounter and Sheffield?   Not the setting, or the destination of any of the trains (although there are signs for trains to Skipton and Bradford).  But the interests of Dr. Harvey, the male character played by Trevor Howard.   There is a scene where he talks about pneumoconiosis, and mentions that it can be caused by metal dust.

And this is grinders' disease, common among Sheffield grinders.  Sheffield City Morris dance to a song about the Sheffield grinder, and a bit of further research uncovers this song, sung here by Roy Bailey. 

At what is now Abbeydale Industrial Hamlet, grinders ground scythe blades, using water powered wheels.  The blades were exported worldwide.  There is information at Kelham Island Museum as well about the grinders, many of whom ground cutlery blades.  One of the hazards was that the grinding stone would break and the grinder be injured by the pieces flying off.  This is why health and safety is important, to prevent this sort of thing happening! Another hazard was the dust.  Bailey's song records the thought that 32 was old for a grinder.  Sheffield is built on metal related industries, but the impact of these industries on the people who worked in them is quite thought provoking.  Working with hot metal and working to shape it were and are hazardous pursuits.

Searching PubMed for the phrase "grinder* disease" gives you a message that the quoted phrase is not found (although see below), but it does then find more than 80 references mentioning both words.  Some are about diseases caused by vibration, but the most recent are from July 2014, one about silicosis in agate workers in Iran and one about "cobalt asthma" in valve grinders in the English West Midlands.   The last item in the list is titled "Contributions towards the pathology of grinders' disease of the lungs", from the Provincial Medical Journal of 1843, by J.C. Waterhouse of Sheffield.   This quotes earlier work about the disease, including work that provides figures that back up Roy Bailey's song's observations about how long grinders live for.  Waterhouse's article is in PubMed Central.

A search of PubMed for sheffield grinder* turns up a series of five articles by John Charles Hall, in the British Medical Journal for 1857, about the diseases of the Sheffield grinder.   These articles were themselves the first in a series about "Diseases of special occupations" and are also in PubMed Central.

Steel City Science also has a piece about the issue.  There is much more about Hall in Plarr's Lives of the Fellows (of the Royal College of Surgeons of England), 

That was indeed a brief encounter with grinder's disease!

But it is not over yet.  Here is a photo taken in September 2015 at Shepherd's Wheel, on the Porter Brook in Sheffield.  This grinding wheel was reconstructed and is now open at weekends.  Like workers in the 19th century, no protective clothing, but unlike them, the demonstration lasted seconds, enough to show how it was done and how loud it was, another thing that affected grinders, perhaps.

Karl Bonhoeffer

Many years ago I read a lot about Dietrich Bonhoeffer, the minister and theologian.  His ideas about the church and Christianity I found interesting, and I was also interested in his involvement in plots to kill Hitler.  He was executed in 1945 for that involvement.  

And so I discovered that his father, Karl (1868-1948) was a psychiatrist.  And because at the time I worked at the Royal Society of Medicine Library in London, which was (and is) a research library of historical record which kept all sorts of things, and we had Index Medicus in print and Medline on CD Rom, I could find material about him and then find the actual articles.  

Karl seemed to have been a psychiatrist of some note.   People published Festschriften in his honour when he reached significant ages (and we had them, in German).  But what did he know about what his family were doing?   Two sons and two sons in law were executed by the Nazis.   I seem to remember reading in one biography of Dietrich that Dietrich had used Karl's car to transport material to use in an attempt on Hitler's life.    And what did he think of the Nazis' policy of sterilisation?   Was he involved?  I seem to remember material that indicated he was.  But why?  


I had at the time written an article about Jean-Paul Marat, the French revolutionary, who was a doctor, and meant to write something about Karl Bonhoeffer.  But other things happened instead, and I never did.  Perhaps this is it!   

Anyway, I have just looked again for material about Karl, using the University of Leicester Library search, and found a new thing, and a thing I am not sure I have found before.  

The new thing comes from a symposium about Karl's role in Nazism, and is an article by Hanfried Helmchen published in German this year in Der Nervenarzt, and asking about his position on sterilisation (1).   And a short piece in the American Journal of Psychiatry in 1944 (2), which seems to be a reprint of a Lancet obituary, reporting that Karl had died the previous year at the age of 75.   In fact, he did not die until 1948, which leaves me wondering where that report came from and why.

I hope this is a work in progress!

References

(1) Helmchen H. Bonhoeffers Position zur Sterilisation psychisch Kranker. Nervenarzt 2015;86:77-84.  doi: 10.1007/s00115-013-3999-x
 
(2)  Karl Bonhoeffer. Am J Psychiatr 1944;101:127-8.