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The temporary exhibition The Struggle with Normalcy, was curated by Lauren Romijn in 2016. Lauren came to us for a two-month work placement as part of her University of Leicester Museum Studies Masters degree. She wanted to focus on the very human struggles with both mental and physical health, and what we do to ourselves (and others) to be seen as ‘normal’. After a great deal of time searching our collections of equipment, books and archives, Lauren put together a very sensitive display showcasing the kit used for a minor plastic surgery procedure, and the equipment used for electroconvulsive therapy (ECT).
Lauren also wrote a fantastic exhibition catalogue which is included below within the exhibition texts. While we do not have images of all of the objects displayed, each one and its use is explained thoroughly.
on normality
Criteria for normality are common today but the concept is actually a novelty which came about in the 1800s. Before then, bodily malformations were not viewed as medical issues in need of treatment or correction but as either God’s will or a play of nature. Anatomical researchers and universities started to research physical oddities during the Enlightenment as a means to discover the secret to a healthy body which led to the idea of normality. According to these scientists, normality could be defined in a qualitative or quantitative manner. The first method indicated that body parts were compared to medical models or samples which represented an example of normality. The quantitative definition for normality was measurement.
Francis Galton, a cousin of Charles Darwin, attempted to define normality through qualitative and quantitative measures with composite photos. His goal was to establish different types of criminals and diseases. By comparing and superimposing photos of criminals and odd looking people, Galton tried to compose a pattern of what ‘abnormal types’ would look like. Contrary to his expectations, he found that these types looked just like everybody else.
It is not easy to define normality and past attempts have led to serious social consequences. Galton’s ideas formed the basis for the theory of eugenics. Eugenics would lead in various European countries to the forced sterilisation and murder of people who were considered non-normal. The American civil service used lie detectors to track homosexuals in the army. It was widely believed that gay soldiers posed a danger to the national security because they were ‘abnormal.’ Even today, boys and girls are expected to behave in a certain way because of the gender they are born with. In the Victorian era, gender-based ideas of normality led to the institutionalisation of women who protested against their restrictions. Married couples were often at odds with each other because both men and women couldn’t fulfill the expectations of their spouses.
A great example of how we use normality today is in medical diagnosis. Doctors can discover abnormal blood cells in the human body which may lead to an early diagnosis of cancer. Thanks to the early diagnosis, the patient has a better chance of survival. Today we can also recognise tumours as abnormal and intervene to protect our bodies through surgeries. In a similar fashion, therapists can diagnose mental health problems and recommend treatments to their patients.
Sources: The Science Museum, Normality, 2016. http://www.sciencemuseum.org.uk/broughttolife/themes/science/normality. [Accessed: 11 August 2016].
on normal bodies
George Bankoff (1952) tells us that reconstructive surgery is the oldest type of medical procedure, used to ‘restore the damaged human body to its original form’. Methods for repairing broken noses were known and written down in Ancient Egypt by 1600 BC, and an Indian doctor named Susrata developed rhinoplasty to reform noses that were cut off as a form of punishment or hacked off during battle. The Branca family was a family of surgeons from Sicily who first developed new suturing techniques and surgical methods to repair wounded ears and lips. The first successful skin craft was carried out in 1817 by Sir Astley Cooper.
War in the early 1900s led to significant changes in reconstructive surgery. Horrific injuries were common to many soldiers. Soldiers with disfigured faces would often stay inside in order to avoid the shocked looks of others. Doctors like Harold Gillies and Archibald McIndoe developed new techniques to repair disfiguring wounds as a way to improve the quality of life of these soldiers.
Reconstructive or plastic surgery makes a huge difference in the quality of life for a lot of people. Cosmetic surgery is very different because it is an elective procedure that alters the appearance of somebody. People can choose to undergo this procedure for various reasons: to conform to modern notions of beauty, to preserve a youthful appearance or for other personal reasons. These procedures used to be viewed as examples of vanity. The norms of beauty that exist today can make many people feel inadequate. Cosmetic surgery is seen by many people as a way to solve a physical problem but maybe it is a symptom of a larger issue. This issue is by no means new; people have done all sorts of things throughout the ages to gain an appearance that was fashionable at the time.
Sources: The Science Museum, Archibald McIndoe, 2016. http://www.sciencemuseum.org.uk/broughttolife/people/archibaldmcindoe. [Accessed: 11 August 2016]'; The Science Museum, Harold Delf Gillies, 2016. http://www.sciencemuseum.org.uk/broughttolife/people/haroldgillies. [Accessed: 11 August 2016]; The Science Museum, Reconstructive surgery, 2016. http://www.sciencemuseum.org.uk/broughttolife/themes/surgery/reconstructive. [Accessed: 11 August 2016].
LAUREN ROMIJN SHOWING THE KIT USED IN THE REMOVAL OF A SMALL BENIGN TUMOUR IN THE UPPER ARM
EQUIPMENT used in the removal of a small benign tumour in the upper arm
The information on the objects will be given in the order of their use in the operating theatre, and the objects represent a surgical set for minor reconstructive or plastic surgery. Our surgery is the removal of a small benign tumour in the upper arm, and each item is explained thoroughly as to its use.
Small Kidney Dish (GM2003.2.24) First we need a kidney dish. This particular dish is one from a set of nine. The dishes in the set are all different sizes and are made of enamel with blue rinses. They were the precursors to the stainless steel kidney dishes that are used today. At the beginning of the operation, it contains the cleansing swabs and during surgery the dishes are used to collect retrieved specimens or used instruments.
Swabs (loan) These swabs are used as a sponge that sterilise the site prior to the operation. This is done by soaking the swabs in an antiseptic solution and then rubbing it on the site. The swabs are held with a sponge holder. They are also used to cleanse the wound and to block internal bleeding during the operation. They come in different sizes but for our cosmetic surgery we only need small ones.
Sponge holder (GM2004.24.1) In the kidney dish you will find a Rampley’s sponge holder. This instrument was designed by Charles Rampley who worked as a Theatre Supervisor in the London Hospital. He passed away in 1932. The sponge holders are used in every kind of surgery to hold the swabs with which the operative site is cleansed.
Gallipot (RM1230) The gallipot would be used as a container for antiseptic solution which is used for the sterile preparation of the operative site. Today the antiseptic solution would be a Betadine and Hibitane solution. In the 1940s, surgeons would use the then-common Cetrimide solution.
Dressing towel (GM2005.64) We have cleansed the skin so we can now apply a dressing towel. The green dressing was placed around the operative site on the sterilised skin to keep the area sterile. This particular dressing towel is made of linen and it would be washed and reused after each surgery. A modern dressing towel is made of waterproof paper and is disposable.
Towel clip (GM2005.8) This Mayo towel clip was used to retain the dressing towel around the operative site. It was made by a London-based company called Hawkins. The name of the manufacturer is also inscribed in the handle of the clip. This particular instrument and other instruments named ‘Mayo’ were devised by Dr. W. J. Mayo, a surgeon at the Mayo clinic of Rochester in the United States of America. Dr. Mayo died aged 74 in 1939.
Cartridge syringe (GM2012.22.1) Now that the area is sterile and secured, the local anaesthetic is administered. The cartridge containing the anaesthetic is put into the central channel with the piston of the syringe extended. To administer the anaesthetic, the piston is pushed down against the cartridge which engages with the needle which is thus inserted into the skin of the operative site which numbs the area. This particular cartridge syringe was actually used in dentistry. However, cosmetic surgery has roots in this branch of healthcare. This syringe was made by the Pharmaceutical Manufacturing Company, Epsom. The syringe came with needles so one is attached.
Bard-Parker handle (GM2006.97.5) This Bard-Parker handle was used to hold the blade to make the first incision through the skin and to excise diseased tissue. This handle is a size 3. Size 3 and 5 carried fine blades for fine surgery whilst sizes 20 and 22 were large blades. This handle carries the inscription BS2982. Another inscription reads ‘Swann Morton made in England.’ This instrument is part of a large operating set that was used in operating theatres in war casualty stations. Cosmetic surgery is rooted in plastic surgery. The first plastic surgery operations were carried out on soldiers who were left disfigured after fighting in the First World War. This handle brings that history between war and cosmetic surgery together. The attached number 15 blade is on loan.
Tissue forceps (GM2004.171) These tissue forceps are also called Allis tissue forceps. Dr. Allis was the surgeon who designed these forceps. They are used in surgery for holding skin edges, unlike the dissecting forceps which held delicate tissue. The maker was a London-based company named Downs. This object is made of stainless steel and has small teeth in the two tips.
McIndoe Skinhook (GM2004.22.1) This stainless steel skinhook was used in fine surgery. Skinhooks are used once the skin is cut to retract the edges of the skin for further exploration of the area. Skinhooks are also used to pull the skin edges together for suturing. Mr Archibald McIndoe designed this type of skinhook for the fine surgery in which he specialised. McIndoe was a plastic surgeon and he came to prominence during the Second World War because he performed plastic surgery on soldiers mainly from the RAF who had been badly burned and disfigured. The nature of their injuries was so distinct that McIndoe had to experiment with different treatments in order to restore their skin. He did so by taking uninjured parts of skin from their bodies which gradually improved as a method by trial and error. These patients were mainly treated in the East Grinstead hospital. It is believed people who lived in the area were told not to stare at the patients so they could regain their confidence.
Dissecting scissors (GM2009.79.8) These McIndoe dissecting scissors are made of stainless steel with a matt finish. They can be used for any kind of fine surgery. This includes plastic surgery and abdominal surgery. Dissecting scissors are used to cut through muscles and tendons that are underneath the skin and the subcutaneous layer.
Dissecting forceps, non-toothed (GM2004.65.4) These dissecting forceps were used together with the dissecting scissors as they held the tissue in place that was being cut. They were also used to hold delicate tissue like the specimen that is meant to be removed (or subcutaneous tissues). They are, therefore, a foil to the tissue forceps which hold the skin edges. We will use this tool to remove the benign tumour. These particular forceps were part of a surgical set used for minor operations performed ‘in the field’ or at a patient’s home. The set was made by J. Weiss & Son, a company from London. This type of forceps was originally designed in 1875 by a surgeon who worked in the hospital for sick children in London.
Artery forceps (GM2004.92) These artery forceps are also called Spencer Wells artery forceps. It was a multi-purpose instrument during surgery as it could hold non-viable tissue and clamp small blood vessels. The maker was Medical Supply, a London-based company. These forceps were designed by a Sir Thomas Spencer Wells, a surgeon at the Samaritan hospital in London and he passed away in 1897. These type of forceps is still used today.
Retractor (GM2004.65.5) If you work with a large area that you need to view, you can use this retractor in combination with the skin hook. The skin hook was not always strong enough to keep the skin edges apart during large surgery. However, we are doing a small surgery. This retractor is from the same set as the non-toothed, dissecting forceps. The set travelled with the surgeon along on visits for minor operations in ‘the field’ or at home. The set was made by J Weiss & Son.
Dermatome blade with box (GM2005.140) The tumour has been removed but the skin edges are too far apart and cannot be pulled together. We need to do a skin graft by using a dermatome blade. This blade was used to excise skin from a donor area of a patient for application to a skin graft site of the same patient. The skin will be taken from the thigh or the abdomen because the skin there is similar to the skin on the arm. The skin graft technique was first developed by Dr. Karl Thiersch. He passed away in 1895. This particular blade was made by Allen & Hanbury Ltd in London. A handle has to be attached to the blade for use.
Sutures (RM1751, RM1729, RM1679, MBI0800) The skin edges are now ready for suturing. First, we stich the subcutaneous layer for which we will use plain cat gut threaded to a curved, round-bodied needle. The skin edges will be stitched with sutures made of either silk, nylon or Dexon. Those sutures would be on a curved, cutting needle. Any deep sutures would be made of chromic cat gut but we don’t need those for our surgery.
Needle holder (GM2006.13) This needle holder is a Halstead type. It was used to hold and secure a surgical suture needle while stitching during surgical operating procedures. It is made of silver.
Kidney bowl (GM2004.72) This kidney dish has the same purpose as our first kidney dish. In a real surgery, by now this dish would be full of used equipment. It would also contain a specimen pot in which our tumour would be stored so that it can be sent to the pathology lab.
Toothed dissecting forceps (GM2004.12.1) These were used to hold non-viable tissues and organs. However, in this surgery they would be used to hold the skin while suturing. The maker is Thackray, Leeds. It is made of stainless steel and has 2 to 3 teeth in the tips.
Mepore bandaging (Loan) After suturing, the wound is cleaned and a skin dressing is applied. Mepore bandages come in different sizes, depending on the size of the wound.
ON MENTAL HEALTH AND MENTALITY
According to Roy Porter, the history of mental health is as old as humanity. The very idea of mental illness raises broad questions. What behaviour is normal? What behaviour is rational? Opinions have always differed on ways to define and treat mental health. Throughout the years, societies have found ways to do so. We will focus on the Victorian era and the 1960s.
Many people in the Victorian era, including psychiatrists, believed that women were naturally weak-minded and that they were better off as subordinates to husbands. Women were supposed to dedicate themselves to maternal and domestic duties only. This belief had ingrained itself within Victorian society. Women who rebelled against this constructed normality were often declared insane. Victorian psychiatry claimed that male dominance was therapeutic for these abnormal women. The author Charlotte Perkins Gilman addressed this patronising attitude in psychiatry in her short novel ‘The Yellow Wallpaper.’ The protagonist of this story suffers from “mild hysteria” and is sent on a “rest-cure” by her well-meaning but misunderstanding husband. Whilst there, she is ordered to rest and not to do anything that would stimulate her nerves. The under-stimulation affects her mind as she becomes obsessed with the yellow wallpaper in her bedroom and descents into psychosis. This story shows that there is a real danger in viewing one set of characteristics as normal and regarding everything outside of those norms as abnormal, strange or dangerous.
Around 1900, a great deal of books were published on relations between men and women. One of these books was ‘Married Love’ by Dr. Marie Stopes which is on display in this case. Dr. Stopes was a British author, palaeobotanist, and campaigner for women’s rights and eugenics. She tried to change the traditional way in which husbands and wives regarded each other. Her approach touched upon several issues that appear in marriages when spouses are not honest with each other about their expectations and intentions. These issues could lead to feelings of inadequacy, depression and ‘frigidity’. Until the 1960s and 1970s, psychiatry was seen by many feminists as a means to control women. Feelings of dissatisfaction were treated as a medical problem rather than as a spur to political changes. Many women who felt dissatisfied were given tranquilisers by their male doctors. Since the 1970s, more doctors and therapists were women who were very aware of male-dominance in psychiatry and its consequences and tranquilisers were replaced with anti-depressive medications and treatments.
Sources: The Science Museum, Mental health and illness, 2016. http://www.sciencemuseum.org.uk/broughttolife/themes/menalhealthandillness. [Accessed: 11 August 2016]; The Science Museum, Minor tranquilizers, 2016. http://www.sciencemuseum.org.uk/broughttolife/techniques/minortranquilizers. [Accessed: 11 August 2016]'; The Science Museum, Moral treatment, 2016. http://www.sciencemuseum.org.uk/broughttolife/techniques/moraltreatment. [Accessed: 11 August 2016]; The Science Museum, Weak nerves, 2016; http://www.sciencemuseum.org.uk/broughttolife/themes/menalhealthandillness/weaknerves. [Accessed: 11 August 2016]; The Science Museum, Women and psychiatry, 2016. http://www.sciencemuseum.org.uk/broughttolife/themes/menalhealthandillness/womanandpsychiatry. [Accessed: 11 August 2016].
on lsd and ect
There were two treatments that gained controversy in the 1960s and later. The first treatment was Electroconvulsive therapy which began in the 1930s when doctors started to experiment with the drug metrazol to induce epileptic-like convulsions in schizophrenic patients. The theory was that schizophrenia and epilepsy were opposed illnesses. The induced convulsions were so severe that it led to life-threatening injuries in the patients such as fractured spines. Ugo Cerletti was an Italian epilepsy specialist who wanted to produce a similar effect in a more controlled manner. He adapted electric shock techniques to stun animals and created ECT. This technique applied brief but powerful shocks via two electrodes called paddles which were placed on a patient’s forehead. It was tried on a wide range of patients including patients with schizophrenia or severe depression. Despite improvements, it remained an aggressive treatment. All sorts of restraints and anaesthetic drugs had to be used to protect the patient from pain. Another side effect was amnesia which raised troubling questions about informed consent. ECT was heavily criticised from the 1960s onwards. Psychiatric drugs become more available and ECT became less popular. However, it is still used today on patients with severe depression.
The second controversial treatments were LSD trials. These treatments were also used in Powick Hospital in the 1960s. Many psychiatrists believed that LSD could unlock problems that patients were suppressing subconsciously, but the drug causes strange hallucinations and was controversial at Powick because a few people claimed that the drugs were administered without consent. It was also an experiment and many doctors were still deciding on what the best procedure was. Many members of the public believed that the drug was used to keep the patients quiet rather than to actually help them.
Sources: The Science Museum, Electroconvulsive therapy, 2016. http://www.sciencemuseum.org.uk/broughttolife/techniques/ect. [Accessed: 11 August 2016].
equipment used in Electroconvulsive Therapy (ECT)
ECT headpiece with instructions (RM1236) The headpiece has a white cross-bar made of plastic. The instructions give a good impression of ECT treatments in the 1960s. The instructions are very clinical as it focusses primarily on preparing the patient (no food or drink for two hours proceeding treatment) and the machinery. The company was started by Dr. Russell with the specific goal of making medical equipment for use in psychiatry; Ectron still make medical devices for the neurological sector today.
Ectronolyte powder (RM1239) Consistent results of ECT depended on a good electrolyte solution. This powder is a mixture of chemicals which produces a low resistance solution which won’t damage the headgear and also cleanses the skin. It was said to reduce the skin resistance of patients, making it easier to treat them with ECT.
Archive: “How to Give ECT” (GM2012.17.8) These instructions provide a technical explanation of the procedure without addressing the ethical implications of ECT. These instructions are somewhat enlightened as they discuss the role of the doctor who has to speak words of encouragement, support the patient and keep a calm, humane, unhurried and caring atmosphere throughout treatment.
Archive: The Powick Digest (GM2012.17.4) This is a newsletter that was published by the patients and staff of Powick Hospital in June, 1961. It includes details of LSD trials. The author of the first paragraph believed that the drug could return the patient to childhood memories and behaviour: ‘LSD in Powick is now accepted as part of the modern hospital treatment centres.’
Books The Story of Plastic Surgery, G. Bankoff 1952 (GM2012.10.3) This book details the history of plastic surgery from Ancient Egypt up until the 1950s. It also explains surgical procedures along with pictures. The author, George Bankoff, takes his time to demonstrate the importance of reconstructive surgery and how it may evolve in the future. Since it is a book that was written in the 1950s it contains sections that would be highly inappropriate in print today. For instance, Bankoff writes that ‘the tragedy of children doomed to grow up into twisted, unsightly men and women has passed for ever from our midst.’
Book: Married Love, M. Stopes 1932 (RM0698) You may know it from Downton Abbey. The book caused a lot of controversy in the UK and in the USA for its descriptions of sexual relations between men and women and birth control. However, the book was very popular and it had to be republished many times. Dr. Stopes was a campaigner for women’s rights and eugenics and founded the first birth control clinic in Britain.