Specimen B.224 - From the Archives

Gout

“A left hand preserved intact to show advanced Gout. It is markedly shortened, mainly due to the changes in the fingers, and it is grossly deformed. Removed, at post-mortem, from a man aged 64 who had previousoly been a professional footballer”

Gout was once considered “The Disease of Kings” or “The Rich Man’s Disease” as it was highly prevalent within in social classes who could afford to binge on rich foods and wine. Because of this reputation, Gout was portrayed as a humorous disease and was satirised in many ways, such as these caricatures by James Gillray

The reality is that gout is an incredibly painful condition and, in today’s lazy junk food-laden society, it is on the rise.

Gout is a type of arthritis (inflammation of the joints) which is caused by high levels of uric acid in the blood. The main joint affected is the metatarsal-phalangeal one at the base of the big toe, and in this instance the disease is also called Podagra.

Early Gouty changes

Advanced Gout

However, many other joints can be affected by these uric acid deposits (heels, knees, wrists, elbows and fingers) and their placement can have a severe impact on independence and mobility. This specimen is one of five from the same patient. It is a hand, removed after death, to show the disfigurement that can be caused by severe Gout:

As well as this arthritis, (remember ‘arthro’ means JOINT which is why arthropods are jointed creatures like arachnids and crustaceans, and anything ending in ‘-itis’ is INFLAMMATION: appendicitis, colitis, tonsilitis etc) Gout will also present as tophi, renal calculi and renal insufficiency. Tophi and calculi are both types of ‘stones’ created in the organs and joints by these uric acid deposits (you can see them above in the 'advanced gout' picture. We have many examples of them here in the Pathology Museum. In fact, the first specimens ever introduced to Barts Medical school museum were urinary calculi or bladder stones. Renal insufficiency is poor kidney function, caused by the placement of these stones. Various other co-morbidities exist alongside Gout such as hypertension, diabetes and obesity. This list tells me straight away that Gout is usually caused by bad diet and lack of exercise, so you can see why it was labelled a silly disease that the rich brought on themselves. However, our diet nowadays is very rich in comparison to theirs and this is why gout is becoming increasingly common. The rates in the UK doubled between 1990-2010.

Men are six times more likely to suffer from it than women and it particularly affects those whose diets are rich in purines (natural substances which are metabolised into uric acid). The foods with the highest purine levels are anchovies, brains, kidneys, liver, sweetbreads and sardines. I have to say, I would reject any of those things from my daily menu anyway so I feel quite safe! Incidentally, has anybody made a movie yet about the blight of gout amongst zombies because surely they are at high risk?!

There are also high levels in bacon, beef, lobster, salmon, tuna, turkey and even legumes such as kidney beans and lentils – so even vegetarians aren’t safe (for once!) The consumption of alcohol and fructose-sweetened drinks is also responsible for the increase, as well as not drinking enough water. It makes you look at your steak, chips & beer in a different way, doesn’t it?

The good news (for fellow caffeine addicts) is coffee helps protect against gout, as do cherries both sour and sweet. As with all things, balance is key. Stick to a healthy diet 80% of the time and there’s no reason you can’t treat yourself 20% of the time. To me, the above sounds like a great excuse for a latte and a piece of Black Forest Gateau! And remember to stay active. Leading a sedentary lifestyle is one of the major causes of the comorbidities associated with gout, such as high blood pressure.

The Gin Lane Gazette - Adrian Teal

If you're a fan of the caricatures by James Gillray at the top of this post, then do check out the work of modern satirical cartoonist Adrian Teal. He is the illustrator of the Q.I annuals and will be chatting about his fictional Georgian 'newspaper' The Gin Lane Gazette at our final, gin soaked seminar here in the Pathology Museum in December.

He did the above cartoon of a gouty gent appearing in an advert for a gout remedy called 'Dr. Blenkensop’s Bilious Specific.' The bearded man is none other than Q.I's head of research John Mitchinson who actually suffers from gout!
- C

Specimen N.192 - From the Archives

"Tight-Lacer's Liver"

“A portion of a liver, showing the deformity produced by prolonged “tight-lacing”. From a woman aged 52, who died from chronic nephritis and diarrhoea. Post-mortem there was chronic renal disease, ulcerative colitis and a malignant new growth of the stomach” 

Perusing a recent issue of Grazia magazine I was very interested to see an article entitled Shock Rise of the 'Barbie Waist' as I have been researching this very topic after conserving specimen N.192.

N.192 before and after conservation

This pot contains a large portion of the liver of a 52 year old female. It is supposedly exhibiting the deformities caused by prolonged 'tight-lacing' of corsets (as you can see from the above catalogue excerpt) and is dated 1907. The liver is on its side in the glass pot, and the deformity can clearly be seen in the form of a sulcus or cleft splitting the right lobe of the liver in two. Turned on its side and placed next to a normal liver you can see this groove shouldn't be present. The theory by the doctor performing the autopsy is that it may have been formed by the upward pushing action of the corset on the liver during prolonged wear. (The depression in the top part of the right lobe is a cyst.)

The sulcus, circled, is an anomaly

In fact it's large enough to have created an 'accessory lobe' in the right lower quadrant (which you can see from the back)

This is an interesting pot particularly in light of the Victorian Body Parts Conference to be held in the museum in September. In fact they even have their own fascinating 'tight-lacing' post with video footage on their site here. However the jury is still out as to whether or not this damage is caused by corset-wearing.

Corsets were a popular addition to female attire from the 16th Century onwards, introduced from Italy to France by Catherine de Medici. It wasn't until later they became an integral part of every woman's outfit, and the term 'corset' was used in English around 1830. It was 10-20 years after this that 'tight-lacing' became incredibly popular in order to create an 'hourglass' figure.

A typical Victorian corset

At the time, the medical issues attributed to prolonged corseting included such conditions as 'hysteria' and 'fainting', but the reality is they were causing visceroptosis which is a prolapse or sinking of the abdominal viscera. However, visceroptosis is also caused by pregnancy. The corsets were, in extreme cases, leading to indigestion and heartburn, constipation OR diarrhoea, headache, vertigo and much more. But if these symptoms had been very common then perhaps corsets wouldn't have become so popular?

Our female in specimen N.192 had her cause of death declared as 'Chronic Nephritis and Diarrhoea'. She also had chronic renal (kidney) disease, ulcerative colitis (inflammatory bowel disease) and a malignant new growth of the stomach. However, cancer of the stomach is not caused by wearing a corset - it's coincidental that she suffered from this illness. Furthermore, the deformity has subsequently been identified by two different doctors as actually being Reidel’s Lobe or Accessory: a normal anatomical variant that is very rarely seen.

We've learned however, via Grazia, that the corset is not yet confined to history and there is a similar article here. A slim waist has once again become a status symbol for young females trying to attain the perfect figure, and despite the dangers cited, waist training is increasing in popularity. We tend to associate corsets with the Victorian era but they did of course continue into the Edwardian era when the popular S-shape (above) became a new female ideal. Then, despite the famous Campaign for Rational Dress they became popular again in the pin-up era (late 1940s to early 1960s) as epitomised by the beautiful Betty Brosmer. Her measurements were an incredible 38-18-36!

And of course one of the world's most famous corset wearers is currently burlesque artist Dita Von Teese. She looks quite healthy and in proportion as her measurements are 32-21-32 but in a corset she can squeeze her waist down to a miniscule 16 inches.

However, the current Guinness World Record holder for 'smallest waist in the world on a living person is Cathie Jung who is 39-15-39!!

Looking at the above picture I'm not sure the effort is worth it. My own thoughts on the subject are that while the corset may well cause deformity to the bones over several years (such as the floating ribs, below) it’s unlikely to cause deformities to the organs, like the one in our collection. In fact, the rarity of that specimen leads me to believe that surely if the corset caused so much deformity this wouldn’t be such a rare specimen?

Corset damage to rib cage, 19th Century London,
Hunterian Collection, RCSEng, Joakim Blockstrom

Specimen M.74 - From the Archives

M.74 Inguinal Hernia (The oldest in the museum)
"A congenital hernia from an adult. The roll of paper is passed through the inguinal canal into the cavity of the tunica vaginalis testis, in the place formerly occupied by the protruded intestine.
Dissected by Percivall Pott, Esq, circa 1750."

A hernia occurs when an organ (or part of an organ) protrudes through the wall of the cavity which normally contains and protects it. A hernia can therefore happen in many places on the body. This is an inguinal hernia which is very common and in fact my younger brother suffered two at different times – luckily they can now easily be treated with surgery and they are in fact the most common elective surgery.

In a hernia such as this, the small bowel descends through a weakness in the abdominal walls and manages to protrude into the tunica vaginalis of the testicle. (It may seem that something with the word ‘vaginalis’ in it would belong to a woman but the word ‘vagina’ actually comes from the latin meaning ‘sheath’, so in this instance it’s the sheath which covers and protects the testicle that we’re talking about. There are different factors which cause hernias, some congenital, but there are lifestyle choices which can make the likelihood of getting a hernia worse: obesity for example, or incorrect posture and incorrectly lifting heavy weights.

In this specimen, you can see a roll of paper which was placed there by the esteemed surgeon Percival Pott after dissection of the hernia and removal of the intestine portion that originally occupied that space. The pictures below will help to explain the pot:

What’s really remarkable about this specimen is that it’s the oldest in the collection and as you can see from the archive data it’s from around 1750. The fact that the roll of paper has still survived is quite amazing. Unfortunately the Perspex was leaking so I decided that for safety of the specimen and for aesthetic appeal, I would put the hernia into a glass pot with fresh fluid. I hope you think the results are worth it, and I’ll be chatting more about the legendary Percivall Pott in my October lecture (see our upcoming events )

 

New Specimen Arrived: Shellac Child

Just in case you missed it, today's blog info is via Morbid Anatomy as I did a guest post for the site last week. You can read it and see more photographs on the Morbid Anatomy Page and you'll be able to see the specimen up close if you come to our June event.

Specimen TE.230 - From the Archives

Bound Foot of a Chinese Woman - 1862

The practice of binding feet in China began during the Tang dynasty (circa 950 AD) and continued as late as the 1870s. I've often heard comparisons of this strange and extreme vanity practice with the modern day wearing of high, uncomfortable shoes by women. In reality there IS no comparison. Foot binding was incredibly painful and quite barbaric and caused long-term, irreparable damage. I mention that because if you do have a slightly queasy disposition then please don't read this post any further!



TE.230 Before and After

The process of creating these 'Lotus Feet' was started usually in the winter months when feet were numb and slightly less likely to feel pain. It began by soaking the feet of a young girl (around 2-5 years old – before the arch of the foot had a chance to develop fully) in warm animal blood in which herbs had been steeped. Toe nails were clipped, as far back as possible to prevent ingrowth and infection, and then a foot massage was given – possibly as a last attempt at comfort since the next step involved breaking every toe except for the big toe. The arch of the foot was also forcibly broken. This was all done by pressing toes tightly down and into the sole of the foot and then binding them even tighter with bandages soaked into the blood and herb mixture.

The procedure continued with unbinding (every couple of days), re-cutting toenails, soaking the feet to remove necrotic tissue, massaging broken bones then re-binding even tighter. As well as the more obvious problems of pain, the main issue with this techniques was infection due to ingrown toenails: many dropped off and were unable to grow back. Also, with circulation to the feet being compromised then complications such as necrotic flesh were rife. However, this could be considered a benefit as it meant that toes would drop off and 'unwanted' flesh could be removed. In certain instances, girls with fleshier toes or larger feet risked having shards of glass inserted deliberately to cause infection and ultimately necrosis of tissue which could be sloughed away. Unfortunately this form of infection could lead to septic shock and death.

The view from the back: The toes are bent underneath the sole
and the arch is high and broken

So why do this? Why was this a practice for nearly 1000 years?? It was simply so that a woman could be seen as desirable and 'aristocratic' – the tiny feet meant she couldn't be a labourer (she could barely walk – no chance of her going out to work!) so having lotus feet was a status symbol. Powerful, aristocratic men wanted their wives to have this deformity, and ultimately their daughters would have the process done so that they in turn married aristocratic men.
The special thing about the two pots in our collection is that this soft tissue specimen (above) allows you to see the folded toes under the feet and how they would look in life and the skeletal specimen (no. TE.229 - below) allows you to see the actual internal damage. The picture beneath it is a normal foot from Wiki Commons Images:

Bound Foot skeleton in our collection (TE.229) compared to 'normal' foot

From a pathology point of view this phenomenon is incredibly interesting and further reading will introduce you to information on the dangers of sepsis, the fusing of bones and other associated medical conditions. However it is also worth taking the time to read about the symbolism of these tiny feet, and how they represented the history and culture of the time. How do you think it relates to corset wearing for example, or to the current trends of body modification we see such as tattoos, scarification and others? This article is a good starting point- Carla