by Kiara White and Laura Sellers
Pathologists study the causes and effects of diseases, with the aim of improving diagnostics. The Pathology collection at the University of Leeds includes pathological specimens, wax models, microscope slides, illustrations and photographic glass plate slides. These were all important for teaching and research within the University, the Leeds General Infirmary and the wider pathology community.
The pathological specimen currently featured in Hidden Histories is a trichobezoar; a compact masses of hair that forms in the gastric cavity. They are the result of a psychological condition called trichophagia, a psychological disorder which drives suffers to compulsively consume hair. The first description of these is thought to have been in 1779, but there are still few accounts in psychiatric literature (Santos, 2012, p43). This example was removed from the stomach of a teenage girl, c.1930. The patient had become severely underweight, as the hair had filled her stomach completely, meaning there was no room left for food, and so surgical removal was required.
It is displayed in front of X-ray and photographic images (date unknown) relating to another patient who compulsively ingested metal pins. Surgeons removed a total of 1188 pins that had accumulated in the patient’s stomach. These images were taken from glass plate negatives, which were used to store and make copies of images. Glass plates were once a common photographic medium, but declined in popularity over the early decades of the 20th century, superseded by flexible film.
Also on display are two pathological illustrations by Miss Ethel M. Wright, selected from the collection of approximately 50 of her works held by the museum, dating from the 1900’s to the 1950’s. We have been unable to establish where Ethel was employed, but she produced numerous illustrations for distinguished scientists, including the surgeon Lord Berkeley Lloyd Moyniham and the pathologist Professor Matthew Stewart, both of whom worked at the University of Leeds and the Leeds General Infirmary.
Illustrations like these were used to communicate knowledge between scientists and from professors to students, in books, journal articles and lectures. Those in our collection all relate to Matthew Stewart (1885-1956), who was Professor of Pathology at the University of Leeds between 1918 and 1951 and editor of the Journal of Pathology and Bacteriology, from 1934 to 1956. Stewart was also devoted to the Institute of Pathology’s Charles Brotherton museum, in the Algernon Firth building. (Various, 1956, p.1054) He gained a reputation as a highly knowledgeable morbid anatomist and histologist, and correspondence from the collection shows that his expert diagnostic opinion was often sought by other pathologists struggling with difficult cases.
The examples were have chosen here nicely illustrate this, as well as the value of such illustrations in sharing pathological knowledge. The first shows a case of malignant spheno-occipital chordoma. A chordoma is a rare form of slow-growing tumour that can occur at the base of the skull or along the spine. In this case the tumour is situated at the joint between the spine (spheno) and base of the skull (occipital). The patient was a 30 year old male, an ex-soldier who had suffered from phosgene gas poisoning in 1917. He was admitted to hospital in 1921, having suffered for the past three years with symptoms including headaches, sight problems, muscle weakness and loss of balance, and died the following month. The tumour, about the size of a hen’s egg, had caused damage such as the stretching and flattening of the optic nerves. This case is described as being both pathologically and histologically (microscopically) characteristic, but it is thought to have been only the seventeenth case ever recorded, and the first record published in the British Isles. (Burrow and Stewart, 1923)
The second illustrates a case of myeloid sarcoma in the radius of the left forearm of a six year old girl, admitted to the Leeds General Infirmary in March, 1922 with a swelling that had been first noticed three years before. After examining a portion of the tumour, it was decided that the arm should be amputated, and the girl recovered successfully. Bone tumours were one of Stewart’s specialisms, and this case is significant because of certain unusual features. A maroon colour to at least part of the tumour was commonly held to the most characteristic feature of myeloid sarcomas, to the extent that most surgeons would regard this as diagnostic. This tumour however, was to the eye “not at all like the usual appearance of a myeloid sarcoma”; it was white throughout. However, “the microscopic characters were quite unmistakable” as a case of myeloid sarcoma. It was because of the rare feature that Stewart felt this account required “a full and adequately illustrated case report.” (Stewart, 1923)
In addition to their ability to communicate essential diagnostic knowledge, these illustrations draw our attention to the historical links between art and science and in particular the interdisciplinary nature of art and medicine, especially before advancements in photography. The illustrator was required and able to draw an accurate representation of the object or specimen in front of them but also needed an informed approach in order to draw attention to specific details of that case. This, it could be argued, moved illustrations from purely anatomical to pathological.
There are varied opinions on when medicine and medical illustration became fully intertwined, but there is evidence as far back as the ancient Greeks, though Da Vinci and Vesalius are hailed as the early-modern experts. It appears that many were either medical or artistic and then had to learn the other skill (Donald, 1986). Modern medical illustrators are required to complete specialist training that combines both of these areas. We do not yet know what training Ethel Wright undertook in order to produce the illustrations displayed.
Burrow, J.Le.F., and Stewart, M.J., “Malignant Spheno-Occipital Chordoma”, The Journal of Neurology and Psychopathology, Vol. IV., No. 15, 1923, pp.205-217
Donald, G., “The history of medical illustration”, Journal of Audiovisual Media in Medicine, 9, 1986, pp.44-49
Santos, T. et al, “Trichophagia and Trichobezoar: Case Report”, Clinical Practice & Epidemiology in Mental Health, 8, 2012, pp.43-45
Stewart, M.J., “Large Myeloid (Myeloma) of the Radius in which the tumour is white throughout”, The British Journal of Surgery, Vol. 10, Issue 39, 1923, pp.322-325
Various Authors, “Obituary; Matthew John Stewart, C.B.E., M.B., LL.D. Glasg., Hon. M.D. Melb., F.R.C.P., F.R.F.P.S.”, The Lancet, Nov. 17, 1956, pp. 1054-1055