The scientific study of disease: Specimens in the Gordon Museum
One of the greatest leaps forward in the history of medicine was made in the nineteenth century when scientific method was applied to the study of illness, coupling together the study of living patients and the findings of post-mortem examinations. Thomas Addison, Richard Bright and Thomas Hodgkin, sometimes called ‘the three great men of Guy’s’, worked simultaneously at Guy’s Hospital. Their historical reputation is not just for their eponymous diseases but also for being three of the first to adopt scientific methodology in the study of diseases.
The Gordon Museum collection contains the significant specimens and instruments of these men that have impacted significantly on the development of medical studies. The specimens which have been assimilated into the collection over the past 400 years show ‘classic’ and ‘rare’ cases of many diseases and are arranged systematically by organ or as ‘topics’. Each of the specimens is fully documented and all the relevant details of the condition and medical history of the patient are on show with the specimen.
Thomas Hodgkin’s stethoscope
Thomas Hodgkin (1798-1866), appointed Lecturer in Morbid Anatomy and the first curator of the Gordon Museum then called the anatomy museum, was an early advocator of the stethoscope, having taken a year out of his medical studies to visit Paris, where he met Laënnec, the inventor of the instrument. Whilst still a student in 1822, Hodgkin delivered a lecture on the stethoscope at a meeting of the Guy’s Hospital Physical Society, where it was initially received with scepticism. The stethoscope is displayed in Aesculapius Room on the ground floor of the Museum.
The first stethoscopeused in the UK. Hodgkin encountered the new instrument in Paris and presented a paper on its use to the Guy's Hospital Physical Society in 1822
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Thomas Hodgkin’s disease specimen
This specimen, studied by Hodgkin, shows a portion of the abdomen from a case of Hodgkin’s disease. Thomas B was admitted with a two year history of enlarged glands in the neck axillae and groins with progressive emaciation. Autopsy revealed mediastinal and abdominal lymph node enlargement. The specimen, part of the Gordon Museum collection, shows the aorta encased in enlarged lymph nodes.
In 1832 Hodgkin published On Some Morbid Anatomies of the Absorbent Glands and Spleen, a description of seven cases of enlargement of the lymph glands and spleen. Hodgkin’s name was attached to this condition by Guy’s physician, Samuel Wilkes (1824-1911) who making similar, independent observations in 1865, became aware of Hodgkin’s work. The specimens of Hodgkin’s Disease are on display in Aesculapius Room on the ground floor of the Museum.
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Thomas Addison's Disease specimen
The Gordon Museum contains a number of specimens and wax models associated with the work of Thomas Addison (1795-1860). This model, by Joseph Towne (1806-1879), records the case of Robert B, admitted aged 12 with abdominal pain, vomiting and discoloration of the skin. Robert B died eight months later. At autopsy the only abnormalities were the skin colour and the adrenal glands shown, also on display in the Museum, which were converted into fibrocaseous material. Microscopy showed giant cells indicating tuberculosis, a common cause of Addison’s disease at the time. The specimens showing Addison’s Disease are on display in Aesculapius Room on the ground floor of the Museum.
Thomas Addison was the son of a grocer and was educated at Newcastle. He qualified in Edinburgh in 1851 then moved to London to start his practice. In 1817 he enrolled as a pupil physician at Guy’s and was eventually appointed physician in 1837. For a period he was a joint lecturer with Richard Bright, with whom he was to write the well known textbook, Elements of the Practice of Medicine.
Addison’s name is attached to two diseases, pernicious anaemia (Addisonian Anaemia) and adrenal insufficiency (Addison’s Disease). At the outset he did not distinguish between them, until his findings of post-mortem abnormalities in the adrenal glands made him realise that disease of the adrenals could not be related to the patients with anaemia. Addison made several other original descriptions: of the pathology of pneumonia (showing that inflammation was actually in the airways, in the alveoli, and not confined to the interstitium), and of skin disorders such as xanthoma diabeticorum, morphea and xanthomata in hyperlipidaemia. His lifelong interest in dermatology led him to found the department of skin diseases at Guy’s in 1824. Wax models of skin disorders are still in the Gordon Museum today.
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Bright’s Disease specimen
This specimen shows the kidney of Mary B, aged 34, a patient of Richard Bright, who was admitted with proteinuria of five years duration. She died in a fit and at autopsy the heart was healthy and of a moderate size. The kidney is of normal size and has a granular surface. Histologically there is interstitial fibrosis and destruction of the glomeruli.
Richard Bright (1789-1858) advocated careful clinical descriptions based on a ‘chemical test’ to be carried out during the patient’s life, combined with postmortem examination findings. He attributed oedema and albuminuia to be the consequence of kidney disease. His descriptions of pathological dieases were known as the syndromes of Bright’s Disease.
Bright had studied medicine at Edinburgh, Guy’s and Cambridge (briefly), qualifying from Edinburgh in 1813. He settled and began to practise in London and was appointed physician at Guy’s in 1844.
In his studies of morbid anatomy Bright was inspired by the surgeon and anatomy teacher Sir Astley Cooper. Between 1827 and 1836 Bright published three works describing and linking dropsy (oedema), urine which coagulated on heating and postmortem changes in the kidneys. His work clearly differentiated between renal and cardiac dropsy, i.e. cardiac failures. He described subsets of postmortem renal changes and recognised that the clinical appearances in his patients could be due to a number of differing renal pathologies. For his early observations, Bright is known as the ‘father of nephrology’. The specimens showing Bright’s Disease are on display in Aesculapius Room on the ground floor of the Museum.
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Sir Astley Paston Cooper’s ligation of the abdominal aorta
Sir Astley Paston Cooper (1768-1841) was an authority on the pathology of aneurysms and in particular of aneurysm of the aorta. One of these specimens is an injected, dried and varnished specimen showing the collateral circulation of the first successful experimental ligation of a dog’s aorta. There is a large display of the original specimens of Sir Astley Cooper’s, including this example, in the Aesculapius room on the ground floor of the Museum.
Having qualified at Guy's in 1789, became Anatomy Demonstrator at St. Thomas's and Guy's Hospitals. He had studied the French methods of surgery by a visit to Paris during the Revolution. Appointed surgeon to Guy's in 1800, he operated on George IV in 1821 and was rewarded with a baronetcy. The prestige of Sir Astley Cooper was such that Guy's Medical School, opened in 1825, was an immediate success with his appointment as lecturer in anatomy and surgery.
He instituted the organised system of case recording by students, and was appointed lecturer in comparative anatomy at the Royal College of Surgeons, where he restricted himself to four and a half hours sleep in order to dissect animals to enhance his knowledge. Cooper continued to serve both hospitals with ever increasing distinction until his resignation of both appointments in 1825.
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