Ten Terrifying Knives from Medical History

I’m excited to announce that I’ve just finished filming the first episode of my new YouTube series, Under The Knife, and will be releasing it very soon (please subscribe to my channel for video updates). Unsurprisingly, that got me thinking about, well, knives. Here’s a list of some rather terrifying knives from our medical past.

  1. VALENTIN KNIFE, 1838. This knife was one of the few able to cut slices of organs and soft tissues for microscopic examination. The double-bladed knife worked best when the blades were wet – best of all when submerged in water. Named after its inventor, Professor Gabriel Valentin (1810-1883), a German-Swiss physiologist, the knife was invented in 1838. This example, however, dates from 1890.

  2. BISTOURY CACHÉ, c.1850. Invented in the mid-19th century, bistoury caché literally translates from the French as ‘hidden knife’. The device was used to cut internal organs or to open cavities, particularly during the surgical removal of a bladder or kidney stone – a practice known as lithotomy.
  3. CIRCUMCISION KNIFE, c.1775. Circumcision – the removal of the foreskin of the penis – is practised across the world often for cultural and religious reasons. In some countries it is also promoted for reasons of hygiene and health. This knife dates from the late 18th century.
  4. CATARACT KNIFE & NEEDLE, 1805. Georg Joseph Beer (1763-1821), an Austrian professor of ophthalmology, invented this cataract knife and needle around 1805. Cataracts cause blurred vision as the lens becomes cloudy and if left untreated can cause blindness. These instruments allowed for the surgical removal of some of the cloudy mass and, if necessary, part or all of the lens itself. Prior to effective anaesthetics, this was an excruciatingly painful process. This particular example dates from 1820.
  5. ORTHOPEDIC KNIFE, 1855. William Adams (1820-1900), an English surgeon, invented this type of knife for his new procedure called periosteotomy in 1855. This involved un-fusing the bones of the hip joint by cutting the neck of the femur (upper leg bone). He affectionately called it ‘my little thaw’, because the knife was used to cut through and ‘melt’ fused bones.
  6. LISTON KNIFE, c.1830. Robert Liston (1797-1847), a Scottish surgeon renowned for his speed and precision in surgery, invented this double-edged amputation knife in the 1830s. This particular example is made of steel with a nickel-plated handle. Nickel plating was introduced in the 1890s and meant that the knife could be boiled without it rusting and was therefore ideal for aseptic surgery. It was made by Down Bros, a leading surgical instrument maker, in the 1920s.
  7. SYRIAN SURGICAL KNIFE, c.900 AD. Most of the blade of this ancient surgical knife is rusty and part of it is broken. The steel blade is slotted into a brass handle. The loop at the end may have been used as a finger hole for gripping. This knife dates to a period when the Islamic world became a major centre for medical study and practice.
  8. PLAGUE LANCET, c.1600. Plague epidemics ravaged Marseilles in France throughout the 17th and 18th centuries. Lancets, such as the copy shown here, were used to open buboes in order to relieve pressure and also remove poisons from the body – an unsuccessful attempt to cure the patient. The lancet would have been stored in a brass case.
  9. DOUBLE BLADED LITHOTOME, 1812. This object was used to cut the bladder in order to remove stones – a practice known as lithotomy. Baron Guillaume Dupuytren (1777-1835), a French surgeon and pathologist, invented this double bladed lithotome for the bi-lateral lithotomy procedure he developed in 1812. This procedure became widely used from the 1850s onwards, and this example dates from 1825.
  10. FALCIFORM AMPUTATION KNIFE, c.1700. The curved shape of this amputation knife was common in the early 1700s. Amputation knives became straighter once the practice of leaving a flap of skin to cover the limb stump became the preferred amputation method. Ebony was a common material for handles as it is a hard-wearing wood. This knife was probably made by Eberle in Germany, as indicated by the inscription on the silver blade.

     

The Anaesthetized Queen & the Path to Painless Childbirth

L0058939 Clear glass shop round for Chloroform, United Kingdom, 1850-‘Did the epidural hurt?’ I ask Rebecca Rideal—editor of The History Vault—one morning as we sit outside the British Library.

‘Not really.’ She hesitates, clearly wanting to say more without divulging too much information. ‘I mean, it’s nothing compared to the labour pains. The hardest part was lying still while the anaesthesiologist administered the needle.’

Rebecca is one of many friends of mine who have now endured the pains of childbirth. Nearly all of them (with the exception of one) did so with the aid of anaesthetics and pain medication. Not one of them regretted it.

Of course, there was a time when women had no choice but to give birth naturally, and often did so while sitting up in a birthing chair. The experience was wrought with dangers, not least the risk of ‘childbed fever’ which claimed the lives of thousands of women, including Henry VIII’s wife, Jane Seymour.

But even if a woman escaped with her life, she couldn’t avoid the pain.

All this changed in November 1847, when Dr James Young Simpson—a Scottish obstetrician—began using chloroform as an anaesthetic. Earlier that year, Simpson started using ether to relieve the pains of childbirth, but he was dissatisfied with the smell, the large quantity needed, and the lung irritation it caused. Ether was also highly explosive, which made it dangerous to use in candlelit rooms heated by fireplaces. It was then that David Waldie, a chemist from Liverpool, recommended chloroform to Simpson.

On the evening of November 4th, Simpson and his two friends experimented with it. At first, they felt very cheerful and talkative. After a short time, they passed out. Impressed with the drug’s potency, Simpson began using chloroform as an anaesthetic, and indeed, the first baby born to a mother under the drug’s influence was named Anaesthesia.

M0003274 Sir J. Y. Simpson and two friends, having tested chloroform

It was soon after this that the Duchess of Sutherland sent a pamphlet on Simpson’s discovery to Queen Victoria who was then in her sixth pregnancy. The Queen’s distaste for pregnancy was well-known. She considered it ‘wretched’ and experienced ‘occasional lowness and a tendency to cry’ after the birth of her first two children. [1]

Unfortunately, it was also at this time that the first chloroform fatality occurred when 15-year-old Hannah Greener died within 3 minutes of inhaling the chemical. The Queen was hesitant, and decided to forgo the new drug during her delivery of Princess Louise in March 1848. But the labour pains were severe, and so when Victoria became pregnant again a year later, she wrote to the Duchess of Sutherland, enquiring after her daughter who had just given birth using chloroform. Further discussion followed amongst the Royal medical household, but the decision was made once more to abstain despite assurances from the the physician, John Snow, that chloroform was perfectly safe when administered correctly. And so on 1 May 1850, Victoria endured her seventh labour without the aid of anaesthetics.

L0000578 J. Snow, "Chloroform and other anaesthetics", title pageBy 1852—when Victoria became pregnant with Prince Leopold—attitudes towards the drug were beginning to change. Most importantly, the Queen’s husband, Prince Albert, had become an advocate of its usage. Albert, a long-time champion of the sciences and President of the Royal College of Chemistry, had had lengthy discussions with Dr Snow about the administration of chloroform and the distinctions between giving it to patients undergoing surgery (which required full unconsciousness) and women in labour. Wishing to ease his wife’s pains, Albert urged Victoria to submit to the drug.

On 7 April 1853, Snow was summoned to Buckingham Palace. A lot was at stake. If the good doctor were successful in using chloroform to ease the Queen’s delivery, he would silence critics of childbirth anaesthesia and help pave the way to painless labour for women everywhere.

Lucky for Snow, the birth was simple and uncomplicated. Prince Leopold was born within 53 minutes of his administration of the drug, which Victoria described as ‘that blessed Chloroform… soothing, quieting and delightful beyond measure’. [2] Snow later wrote in his medical casebooks that Queen was ‘very cheerful and well, expressing herself much gratified with the effect of the [drug]’. [3]

Not everyone was pleased with the outcome, however. Some protested on religious grounds; others for medical reasons. The Lancet questioned the veracity behind claims that the Queen had even used the drug in her last delivery.

A very extraordinary report has obtained general circulation [that]…Her Majesty during the last labour was placed under the influence of chloroform, an agent which has unquestionably caused instantaneous death in a considerable number of cases. Doubts on this subject cannot exist…In no case could it be justifiable to administer chloroform in perfectly ordinary labour…These facts being perfectly well known to the medical world, we could not imagine that anyone had incurred the awful responsibility of advising the administration of chloroform to her Majesty… [4]

These doubts aside, Queen Victoria’s use of the drug was overwhelmingly lauded, and led to a public fervour for painless childbirth. The editor of the Association Medical Journal called it ‘an event of unquestionable medical importance’, and hoped that this would remove ‘lingering professional and popular prejudice against the use of anaesthesia in midwifery’. [5] Women everywhere were requesting chloroform to ease their labour pains.

Dr Snow was discreet about the details of that fateful day in Buckingham Palace, though he was questioned often about the event. On one occasion, one of his patients refused to inhale the chloroform he was hopelessly trying to administer lest he tell her ‘what the Queen said, word for word, when she was taking it’. Snow cleverly replied that ‘Her Majesty asked no questions until she had breathed very much longer than you have; and if you will only go in loyal imitation, I will tell you everything’. [6]

Shortly after the lady gave birth, Snow slipped away, leaving his promise unfulfilled.

Queen Victoria was destined for one final pregnancy. In 1857, she gave birth to her ninth child, Princess Beatrice (pictured below with the entire family). Once again, Dr Snow successfully administered chloroform during the delivery, securing the path to painless childbirth for women everywhere.

B4

 

1. Roger Fulford (ed.), Dearest Child: Letters between Queen Victoria and the Princess Royal, 1858 – 61 (1964), p. 195, 162. Originally quoted in Stephanie Snow, Blessed Days of Anaesthesia (2008), p. 82.
2. Quoted in Matthew Dennison, The Last Princess: The Devoted Life of Queen Victoria’s Youngest Daughter (2007), p. 2.
3. Ibid.
4. Lancet I (1853), p. 453.
5. Association Medical Journal (1853), p. 318.
6. John Snow, On Chloroform and other Anaesthetics (1858), p. xxxi. Originally quoted in Snow, Blessed Days of Anaesthesia, p. 88.

*This article is dedicated to my dear friend, Marla Ginex, who any day will give birth to her second daughter. Good luck and lots of love.

Disturbing Disorders: A Brief History of Harlequin Ichthyosis

H2Last Saturday, I was lounging around on the couch watching 5 straight episodes of Forensic Detectives (don’t judge) when I heard my computer ping. Being the internet junkie that I am, I immediately checked my inbox and saw a message from my old school friend, Andy, who is currently studying medicine at Case Western. He had an idea for a blog post, he wrote, but worried it might be too disturbing for my audience. Naturally, my curiosity was piqued.

Turns out, Andy had reason to worry. In the next message, he attached a photo of a 19th-century fetus (left), which is now housed at Museum Vrolik in Amsterdam. The baby had died from a very rare genetic disorder known as Harlequin Ichthyosis, which causes the overproduction of keratin protein in skin. As a result, those with the condition are born with huge, diamond-like scales all over their bodies, and usually die young due to infections from cracks in the skin.

I have to admit, I’ve seen and researched many terrible diseases, and yet I had a gut reaction to this particular specimen. For me, there is always a deep sadness attached to a child’s death—and even more so when one considers the pain and suffering that brought on such a premature demise. But it wasn’t necessarily the fact that I was gazing upon a life cut short that most disturbed me. It was the extremeness of the deformity that gave me pause. Was this a subject I should tackle on my blog?

As you are reading this post, you will know what decision I finally made in the end. Although Harlequin Ichthyosis is a horrible condition, it is still part of our medical past, present and future (since we have yet to find a cure). For that reason, alone, it deserves contextualization here. More so, our own emotional reactions to the specimen above may help us understand why people in the past feared disfiguring diseases, like smallpox or leprosy, and why many people today continue to struggle when interacting with those who suffer from serious deformities and disabilities.

Harlequin Ichthyosis’s history begins on 5 April 1750, when Reverend Oliver Hart—a cleric from Charleston, South Carolina—became the first to document (but not necessarily observe) the condition. He wrote:

I went to see a most deplorable object of a child, born the night before of one Mary Evans in ‘Chas’town. It was surprising to all who beheld it, and I scarcely know how to describe it. The skin was dry and hard and seemed to be cracked in many places, somewhat resembling the scales of a fish. The mouth was large and round and open. It had no external nose, but two holes where the nose should have been. The eyes appeared to be lumps of coagulated blood, turned out, about the bigness of a plum, ghastly to behold. It had no external ears, but holes where the ears should be. The hands and feet appeared to be swollen, were cramped up and felt quite hard. The back part of the head was much open. It made a strange kind of noise, very low, which I cannot describe. [1]

Mrs Evans’s baby died 48 hours later.

Hart’s description was very accurate. Babies born with Harlequin Ichthyosis have poorly developed ears and nose (which are sometimes absent altogether). Their eyelids are turned inside out, leaving the eyes and area around them susceptible to trauma and infection. They often bleed when they are born, and their lips—pulled upwards by the dry skin—resemble a clown’s smile.

H1Those suffering from Harlequin Ichthyosis are also extremely susceptible to hyperthermia; and they are frequently dehydrated as their skin is not well suited to keeping water or heat in. They often have difficulties breathing due to their armor-like scales, which impede the chest wall from expanding and drawing in enough air. Sadly, this can lead to respiratory failure in many infants.

The disorder’s name alludes to the character Harlequin in the Italian Commedia dell’arte, which made its debut in the 1580s. The Harlequin is characterized by his chequered costume. As you can see, the disease mimics a similar pattern on the skin of the afflicted.

In the past, babies born with Harlequin Ichthyosis had no hope of living more than a few days. As a result, there is very little mention of it in 18th- and 19th-century medical books; and I have only come across two preserved specimens in anatomical collections: one from Museum Vrolik in Amsterdam (mentioned above), and the other from Musée Dupuytren in Paris (pictured below).

H3Advances in medicine, however, have made it possible for people with this condition to live into young adulthood. Improvements in neonatal care, combined with the use of topical retinoids such as Isotrex which enable the skin to shed cells faster than they are produced, are helping to make Harlequin Ichthyosis a chronic condition rather than a fatal disease.

Just last year, 20-year-old Stephanie Turner—who herself was born with the disorder—gave birth to a perfectly healthy baby boy. Hope springs eternal.

 

1. Qtd from J. I. Waring, M.D., ‘Early Mention of a Harlequin Fetus in America’, American Journal of Diseases of Children, Vol. 43 No. 2, February 1932.

*This is the first article in a series called Disturbing Disorders. If you would like to learn more about Harlequin Ichthyosis, or donate to research, please click here.