PAIN AND PROGRESS or LESSONS IN INVENTION FROM A MEDICAL ARCHIVE

This post by Ronan Kelly RCSI (Royal College of Surgeons in Ireland) Library  was placed Joint First in the CONUL Training and Development Library Assistant Blog Award 2018. 

Earlier this year I joined the Heritage Collections team in the RCSI Library. On a daily basis I help with inquiries from within the College and from the general public. Another ongoing task has been the preparation of a booklet on medical instruments and innovations associated with figures from RCSI. From the College’s point of view, the booklet represents a moment of reputation enhancement: an opportunity to showcase one aspect of RCSI’s 234-year contribution to medicine in Ireland.

There will be ten entries in the finished booklet, all quite varied, ranging from the late eighteenth century – Samuel Croker-King’s (1728 – 1817; first President of RCSI) improvement to the trepan (basically, advice on how to drill a better hole in a head) – to the middle of the twentieth – Terence Millin’s (1903 – 1980; President of RCSI) retropubic approach to transurethral resection of the prostate (I’ll spare the reader an image of that).

Title-page and plate from Croker-King’s Description of an instrument… (Dublin, 1791), RCSI Heritage Collections

Individually, these stories are fascinating and distinct (although as I researched each one the overriding question in my mind was whether it dated from before or after the discovery of anaesthetic…). But as the project wraps up I’ve taken a step back to ask myself what the discoveries have in common – and it seems to me that three interesting themes, or lessons, emerge. Despite the RCSI origins, these lessons are not necessarily medical and so I submit them here in the hope that they will inspire others regardless of their field of endeavour.

Lesson 1: Stealing is good

Invention, or innovation, can often be the repurposing of something already in the world. Consider, for example, the case of Richard Butcher (1819 – 1891; Fellow and President of RCSI). Surgery in Butcher’s time involved a lot (really, a lot) of amputation; indeed, a surgeon’s reputation often rested on their speed with the blade. But the sharp edges of sawn-off bones were extremely painful and slow to heal – until one day Butcher observed how cabinet-makers executed intricate or curving cuts by using a particular implement whose blade could be rotated to any angle. In his mind, he swapped the nice piece of furniture for somebody’s mangled limb and lo, his adapted version – known somewhat unfortunately as Butcher’s saw – was born.

Plate from Butcher’s Operative and conservative surgery (Dublin, 1866), RCSI Heritage Collections

Plate from Butcher’s Operative and conservative surgery (Dublin, 1866), RCSI Heritage Collections

Another repurposing happened with that most universally recognised instrument of medical practice, the stethoscope. Its invention is credited to René Laënnec, who in 1816 was inspired by the sight of two children sending acoustic signals to each other using a length of wood. He found that mediate auscultation – using a rolled-up sheet of paper to listen to a patient’s internal organs – produced louder and clearer sounds than the previous practice of immediate auscultation (placing one’s ear directly on the patient). With the advent of rubber, Arthur Leared (1822 – 1879; Licentiate of RCSI) developed this into the binaural version – meaning it had two earpieces – that we know today. Leared brings me to the next lesson…

Lesson 2: Don’t be shy

Having invented his binaural stethoscope, Leared showed it off briefly at the Great Exhibition of 1851; he then sailed off to serve in the Crimean War. When he returned he found that someone who ‘admired’ his invention at the Exhibition was now manufacturing and selling very similar binaural stethoscopes. Belatedly, Leared wrote to The Lancet to set the record straight, but it is his rival’s version that set the industry standard (see Lesson 1).

Leared’s binaural stethoscope from Down’s catalogue of surgical instruments (London, 1906), RCSI Heritage Collections

Something similar happened to Francis Rynd (1801 – 1861; Fellow of RCSI), inventor in 1844 of the hypodermic syringe. He neglected to write up his work and soon enough near-identical inventions appeared in Edinburgh and London. Finally Rynd staked his claim in 1861, when he published in a Dublin medical journal a fuller account of his earlier innovation. Coincidentally, following his sudden death, the same issue of the journal also carried Rynd’s obituary. Don’t let this happen to you!

Rynd’s hypodermic needle featured in RCSI promotional material (©RCSI)

Lesson 3: Keep trying

Failure need not be failure – or, to put it another way, failure is only failure until it is a success. This cheering lesson is exemplified by the uncheering story of 14-year-old Mary Ann Dooley, who suffered an accident working in a paper mill. She was brought to Robert McDonnell (1828 – 1889; Fellow and President of RCSI), who performed Ireland’s first blood transfusion in order to save her. Sadly, Dooley died the next day (‘without pain, and quite conscious to the last’), but McDonnell remained optimistic about the practice. He designed his own transfusion apparatus and went on to save many lives.

McDonnell’s transfusion apparatus, RCSI Heritage Collections

Space precludes sharing the lessons learned from Tufnell’s bullet scoop, Daunt’s lithotome or O’Halloran’s cataract knives – except to say we should all be very thankful for anaesthetic. RCSI Heritage’s next project will be on the influenza pandemic of 1918; no doubt there will be lessons there too…

References 
Butcher, Richard. ‘Mr Butcher’s cases of amputation – use of a new saw’, Dublin quarterly journal of medical science 12.23 (1851): 209 – 23.
Croker-King, Samuel. A description of an instrument for performing the operation of trepanning the skull, with more ease, safety and expedition, than those in general use (Dublin, 1794).
Leared, Arthur. ‘On the self-adjusting double stethoscope’, The Lancet 2 (1856): 138.
McDonnell, Robert. ‘Remarks on the operation of transfusion and the apparatus for its performance’, Dublin quarterly journal of medical science 50.2 (1870): 257-265.
Millin, Terence. ‘Retropubic prostatectomy: a new extravesical technique’, The Lancet 249 (1945): 693 – 696.
Roguin, Ariel. ‘Rene Theophile Hyacinthe Laënnec (1781–1826): the man behind the stethoscope.’ Clinical medicine and research 4.3 (2006): 230–235.
Rynd, Francis. ‘Description of an instrument for the subcutaneous introduction of fluids in affections of the nerves’, Dublin quarterly journal of medical science, 32.1 (1861): 13.
Rynd, Francis. ‘Neuralgia – introduction of fluid to the nerve’, Dublin medical press 13 (1845): 167-168.