Happy birthday to Andreas Vesalius

Vesalius

This year marks the 500th anniversary of the birth of anatomist Andreas Vesalius. Born in 1514 in modern-day Brussels, he was educated in France before taking up a position teaching surgery and anatomy at the University of Padua in Italy.

At the time, knowledge of the human body was based on the study of classical texts rather than empirical observations and medical practice relied heavily on the writings of the Greco-Roman physician Galen. Understandings of anatomy were limited, despite the rising interest in human sciences and popularity of naturalistic illustrations in the 16th century. Furthermore, many assumptions were inaccurate as they were based upon findings made in the dissection of animals such as monkeys and dogs.

Unlike many of his colleagues, Vesalius rejected this theoretical approach to medicine. Instead he taught anatomy through personal demonstrations and the dissection of human cadavers. From 1538 he began to publish anatomical illustrations and in 1543 released his famous work De Humani Corporis Fabrica (On the Fabric of the Human Body). This ground breaking book contained over 600 woodblock engravings and its 7 volumes detailed the skeleton, muscles, vascular system, nerves, abdomen, thorax and brain. While it was not the first time that the human body had been shown after autopsy the intricacy of the illustrations meant that it was the most accurate anatomy text to date. It disproved many of Galen’s theories and the integration of images with textual descriptions was considered highly innovative at the time.

Through his teaching and publications Vesalius revolutionised the study of anatomy by demonstrating the importance of first-hand observation for medical training and scientific discovery. De Humani Corporis Fabrica thus represents a radical change in the way anatomy was approached by promoting dissection as the most scientific way of studying form and function. Anyone who has seen images from the book will no doubt agree that it is also a work of great artistic value as it depicts bodies in dynamic poses against beautiful classical backgrounds.

Vesalius later left teaching to work as the imperial physician for Emperor Charles V. He continued to perform dissections and publish on anatomy until his death in 1564.

Image credit

R. C., C. (2005). Vesalius [Image]. Retrieved from https://www.flickr.com/photos/celesterc/415837587

References

Dominiczak, M. H. (2013). Andreas Vesalius: his science, teaching, and exceptional books. Clinical Chemistry, 59(11), 1687-1589.

Kemp, M. (1998). Vesalius’s veracity: implications of illustrations of surgical tools and anatomy by Andreas Vesalius. Nature, 393(6684), 421.

The phylogenetic origins of one of humanity’s biggest killers

Plague has been responsible for some of the most high-mortality pandemics in human history and has been studied extensively by both historians and scientists. Most laypeople are familiar with the Black Death and the demographic consequences it had on Europe in the Middle Ages. Less well understood however is the molecular history of Yersinia pestis, the bacterium that is the causative agent of penumonic, septicemic and bubonic plague. A post over at the Contagions blog details the phylogenetic tree of this bacterium to explain how scientists are using genomic sequencing to reconstruct the emergence of different strains of Yersinia pestis through history.

Scrubs: a tale of surgical attire

Medical/Surgical Operative Photography

Medical staff wear specially designed clothing to reduce the spread of disease in hospital settings. However, this wasn’t always the case, as up until the late 1800s most doctors performed surgery whilst dressed in ordinary clothing. The “scrubs” – so called because they are worn by those who have “scrubbed up” to prepare for surgery – that we see today didn’t appear until well into the 20th century.

For centuries doctors wore ordinary clothes in operating theatres and worked bare handed with non-sterile instruments. Having to wear special surgical attire was unpopular as uniforms were associated with the lower classes, but by the 1890s surgeons started to wear surgical gowns over their clothing to protect them from bloodstains. Yet these garments did little to reduce the spread of disease as they were rarely washed and usually stained with flecks of dried blood and pus.

After World War One and the outbreak of Spanish influenza in 1918, growing acceptance of the germ theory of disease meant surgeons and their assistants began to wear gowns, caps, rubber gloves and gauze masks. However, these practices were not universally adopted and the purpose of these measures was primarily to protect surgeons from catching diseases from their patients rather than for the prevention of intra-operative infections. It wasn’t until several decades later that medical professionals began to pay greater attention to maintaining a sterile environment.

By the 1940s, advances in aseptic techniques and better understandings of the aetiology of wound infection meant that more stringent measures were put into place to reduce the spread of germs in operating theatres. Instruments and dressing were routinely sterilised with steam and having standard surgical attire became regarded as an important way to prevent post-operative infections. White was associated with sterility and cleanliness and was used for surgical gowns until it was found that the glare it caused under the bright theatre lights created eye strain for surgeons. By the 1950s, most hospitals has switched to surgical attire in jade green or ceil blue instead as those colours reduce eye fatigue and provide a high contrast against the reddish colours of body tissues and blood.

Two-piece outfits consisting of a tunic shirt and pants were introduced in the 1960s and 1970s and have remained largely unchanged since that time. Worn by both men and women, scrubs are designed to be comfortable, durable and wrinkle resistant.  Their simple design aims to limit the places that pathogens can proliferate and the cotton/polyester blend of the fabric is able to withstand laundering at high temperatures for sterilisation purposes. Scrubs are also cheap enough to be easily replaced if they become badly stained or contaminated. The medical attire worn nowadays has come a long way from the unsanitary surgical practices of previous centuries.

Image credit

Ooi, P. (2012). Medical/surgical operative photography [Image]. Retrieved from https://www.flickr.com/photos/phalinn/8116024703

References

Belkin, N. L. (1998). Surgical scrubs – where we were, where we are going. Today’s Surgical Nurse, 20(2), 28-34.

Houweling, L. (2004). Image, function, and style: A history of the nursing uniform. American Journal of Nursing, 104(4), 40-48.

“Unhinged her nerves completely”: late Victorian attitudes towards female cyclists

Ever since the invention of the bicycle in the late 19th century, cycling has been promoted as a healthy and invigorating outdoor pursuit. However, concerns have also abounded about the potential health risks of engaging in the sport. As explained in a post by Professor Hilary Marland over at the Wellcome Trust history blog, in late-19th century Britain there were conflicting attitudes towards cycling. It was regarded by some as a therapeutic activity while others saw it as a dangerous pastime for women.

Dieting since the 19th century

A_corpulent_physician_diagnoses_more_leeches_for_a_young_wom_Wellcome_V0011771

Alarmingly high levels of obesity in western nations means that dieting and weight loss programs feature heavily (pardon the pun) in our popular consciousness. Yet an obsession with weight goes back at least 150 years to a period well before the current obesity crisis.

Prior to the mid-19th century, carrying a little excess weight was seen as a good thing. In the age before vaccinations and antibiotics it was commonly believed that being fatter enabled people to better withstand infectious diseases. Weight gain was also regarded as desirable because most people were thin as the result of not having enough to eat. Being overweight was a marker of prosperity as it signified that a person had the means to buy plenty of food and indulge themselves. Only wealthy merchants, businessmen or members of the aristocracy would have been able to afford to become corpulent, hence dieting to lose weight was relatively uncommon in this period.

The mechanisation and prosperity that accompanied the industrial revolution brought with it weight gain and the beginnings of modern diet plans. Reduced energy expenditure and increased access to (often poor quality) food meant that obesity began to rise in the working classes. The trend of previous centuries became reversed as obesity was increasingly associated with the lower classes while physical exercise fads and a quest for thinness became prominent amongst the wealthy upper echelons of society.

The social and economic changes that contributed to rising obesity influenced the emergence of the field of nutritional science. In the late 1800s balancing proteins, carbohydrates and fats featured in government health publications. Vegetarianism began to be promoted for good health from the early years of the 20th century. The food pyramid was created during the First World War. Calorie counting and diet pills emerged the 1920s and vitamins designed to correct nutritional deficiencies resulting from restrictive diets were sold from the following decade. Weight-for-height charts similar to the BMI charts of today first appeared in the 1940s and doctors began to advise their overweight patients to cut down on saturated fats in the 1950s.

As you can see, a concern with weight control has existed for quite some time. For a more in-depth look at the history of dieting you can read Louise Foxcroft’s entertaining and informative book Calories and Corsets: A History of Dieting Over 2000 Years.

Image credit

Numa, P. (1833). A corpulent physician diagnoses more leeches for a young woman, who lies drained and bedbound [Image]. Retrieved from http://commons.wikimedia.org/wiki/File:A_corpulent_physician_diagnoses_more_leeches_for_a_young_wom_Wellcome_V0011771.jpg

References

Rao, N. (2011). Dieting since the 1850s. The Journal of Health, Ethics, and Policy, 10(9), 38-39.

The hazards of shoe shopping in the past

1930s Shoe Fitting Fluoroscope

The most ground breaking scientific discoveries usually find their way into mainstream use and x-rays are no exception. Since they were discovered by German physicist Wilhelm Roentgen in 1895, they have been widely used in medicine, dentistry, security and other fields. However, not many people are aware that from the 1920s to the 1950s x-ray machines were common features in shoe stores.

Shoe-fitting fluoroscopes (also known as pedoscopes) were x-ray machines designed to check the fit of new shoes. They took pride of place in shops and would be positioned on specially lit raised platforms. Customers would place their feet into an opening at the bottom of a vertical wooden cabinet then look down though a viewing port to see a fluorescent image of the bones of their feet inside an outline of their shoes. Additional viewing ports allowed salespeople and companions to take a look. Visualising bones and soft tissues inside the shoes purportedly allowed salespeople to help their customers get a better fit by checking for toe room. This was especially pertinent to cash-strapped parents, who were concerned that their children would quickly outgrow poorly fitted shoes.

While the origin of the device is unknown, radiographic imaging was used in the First World War to examine foot injuries without requiring soldiers to take off their boots. After the war this technique was adapted for nonmedical use and fluoroscopes began to appear in shoe shops throughout Britain, Germany, Switzerland, Canada, America and Australia from the mid 1920s. The public response was initially one of enthusiasm and excitement, as people were delighted to see the effects of this seemingly magical x-ray technology first hand.

However, these feelings were gradually replaced by ones of fear and mistrust with growing public knowledge of the dangers of radiation exposure. Although it had long been known that scientists exposed to radioactive material suffered from severe side effects including burns, sterility and cancer, knowledge of the risks that x-rays posed to the general public took much longer to be recognised. Greater understandings of the effects of radiation after the Second World Ward led to the introduction of legislation stipulating that those who worked with radioactive material were required to wear protective shields and undergo periodic health checks. The fluoroscopes found in shoe shops came under fire from health departments and medical journals in response to public concerns that children were being regularly being exposed to harmful levels of radiation.

Testing of shoe-fitting fluoroscopes began in the late 1940s and the machines were found to be unsafe. They were discovered to emit dangerously high doses of radiation to anyone located in the near vicinity. Children who are about twice as radiosensitive as adults and salespeople who were chronically exposed were at the highest risk. Customers who tried on multiple pairs of shoes in one sitting or made several visits over the course of a year were exposed to cumulative doses. Anecdotal reports of salespeople suffering from radiation burns began to emerge as well as cases of bone damage in young children. Furthermore, shoe-fitting fluoroscopes were found to provide little benefit in ensuring a better fit as the soft fleshy part of people’s toes did not show up on the radiographic images of feet positioned inside new shoes.

Indeed, it appears that the fluoroscope functioned better as a sales promotion device than as a fitting aid. Children loved playing with the machines and they helped to reassure parents that they were not wasting their money. Fluoroscopes were widely promoted as the most scientific and accurate way of fitting shoes in an era when most people believed that having durable and high quality footwear was important to ensure good health. In reality, the machines were harmful and merely served to entice people into shops and confirm the judgement of salespeople.

By the mid 1950s, governments began to introduce legislation regulating the use of the devices. The passing of increasingly stringent regulations meant that by the early 1960s dangerous shoe-fitting fluoroscopes had been phased out altogether.

Image credit

National Museum of Nuclear Science and History. (n.d.) 1930s shoe fitting fluoroscope [Image]. Retrieved from https://www.flickr.com/photos/rocbolt/7375805180

References

Duffin, J., & Hayter, C.R.R. (2000). Baring the sole: The rise and fall of the shoe-fitting fluoroscope. Isis, 91(2), 260-282.