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Materialised medical history
Materialised medical history Berlin Medical Historical Museum A review of the Berlin Medical Historical Museum, Berlin, Germany, based on an interview with museum director Thomas Schnalke.
the idea of cellular pathology, was given a professorship in pathological anatomy in Berlin in 1847. In 1848, he had to leave Prussia for Würzburg hat can be done with of anatomical-pathological specimens after active involvement in the 1848 thousands of old medical began in response to an epidemic: revolution. He returned in 1856 and specimens and instruments? this time because of the “Bengalian it was then that the pathologicalHow can such a rich and impressive cholera” that reached Berlin in 1831. anatomical collection began to grow history be incorporated into the world of To develop appropriate prophylactic substantially. Beginning with about modern clinical medicine and corporate and therapeutic measures, a new post 1500 specimens in 1856, Virchow’s culture? What can the history of mediof Prosektor was set up to provide maxim of nulla dies sine praeparatu cine offer to current debates about teaching and research material gained (no day without a specimen) led cloning, euthanasia, and other to an assembly of about contentious issues? Probably 21 000 objects in 1900. every medical museum faces Based on plans developed by these questions to a greater Virchow, a museum edifice or lesser extent. In Berlin, the was erected in 1899—the unification of Germany with first of its kind in the world. its subsequent overhaul and Money came from the sale reorganisation of almost every of the grounds of the old public institution in the botanical garden, which had eastern part has aggravated been set up in the 17th these problems. It is, therefore, century outside of Berlin, but of interest to explore the by then was a prime location ideas and solutions that are for city development. Shortly envisaged for the Berlin before World War II, the Medical Historical Museum. collection was at its height, This museum is part of the with about 26 000 specidepartment of pathology at the mens. However, in the final Charité, the clinical faculty of Virchow’s desk at the old Institute of Pathology, the Charité months of the war the Humboldt University, and one museum was seriously damof Berlin’s three universities aged and 90% of its content located in the eastern part of was destroyed. the city. The history of the It was only in the 1970s Charité goes back to 1709–10, that interest in the collection when, in response to the great was revived. Progress was Silesian plague that threatened slow, but new specimens Berlin, a hospital was erected. were constantly added. The cholera never actually When the Berlin wall came hit the city and the edifice down, the combined efforts was transformed into a poorof the east and west Berlin house and a hospital for the institutes for the history of indigent. Friedrich Wilhelm I, medicine lead to a new unified the soldier’s King, therefore conception of the Berlin named it Charité (charity Medical Historical Museum, in French, which was an which centred around the influential and fashionable Vichow’s collection of pathological specimens building and its remaining language at the time). specimens. The museum was from post-mortem examination. There In 1810, when Humboldt University finally reopened in 1998, and a major were continuing debates about how was founded, various existing scientific extension is about to be completed. to reorganise and systematise these collections were gradually acquired, Thomas Schnalke, a professor of different collections. such as the celebrated anatomical the history of medicine and medical Rudolf Virchow (1821–1902), the and physiological collections of museology, is the new director of the eminent pathologist, anthropologist, ohann Gottlieb Walter and Johannes Berlin Medical Museum. He believes social reformer, and originator of Müller. The first systematic collection the museum has three main functions. Berlin Medical Historical Museum/photo Christa Scholz
W
THE LANCET • Vol 359 • January 26, 2002 • www.thelancet.com
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For personal use. Only reproduce with permission from The Lancet Publishing Group.
DISSECTING ROOM
Its first role is as a place where people can learn about medical ideas and techniques over the past 400 years, and also find out about current topics, ranging from biotechnology to clinical ethics. Another function is as an expanding exhibition space. There are plans to form a network between the Berlin Medical Museum and other exhibitions in the Charité hospital, for example the dermatological wax moulages, the Robert Koch museum, and the hospital’s collections of anatomical and forensic medicine specimens and physiological instruments. In addition to the permanent exhibits, there will be an expanded series of short-term exhibitions on specific topics in the future; special exhibitions in the past few years have included the history of industrial medicine and a WHO sponsored art project to support antismoking campaigns. Finally, the museum’s genius loci—Virchow’s old lecturing room—acts as a place for
reflection and engagement and is a forum for discussions. The lectures that are held at the museum cover diverse subjects—it was at this venue that Jeanne-Claude and Christo presented their model of the Wrapped Reichstag, while Ian Wilmut gave one of his first presentations about the cloned-sheep Dolly here. The museum has a lot to offer. In addition to a wide range of typical pathological findings, there are rare and sometimes amazing anatomical specimens on display that are of interest to the public and physicians alike. There is probably no larger example of megacolon congenitum (Hirschsprung) available than that on display here. A skull with a mothholelike structure caused by syphilis and a femoral tumour that reveals the effects of tuberculosis on bone give an idea of how devastating long lasting infections must have been in the preantibiotic era. A cylindroma from
Tools of the trade The London Hospital survival predictor t’s a grey box of electronics with a single indicator dial. If the needle swings one way, it points to the word “survive”, the other, and it points to the letters “IBD”. The device is a survival predictor for comatose patients, and IBD stands for irreversible brain damage leading to death. This survival predictor was devised in the UK at the London Hospital, Whitechapel (now the Royal London Hospital) in 1972, and was related to that family of instruments known as cerebral function monitors: machines subsequently used to provide information about the electrical activity of the brain during, for
example, anaesthesia or cardiac surgery. But the London Hospital survival predictor was not for monitoring, it was for predicting whether patients in coma would recover. The brainchild of medical physicist Douglas Maynard, the device was an application of the burgeoning science of computing to the problem of pattern recognition. The software—an early form of artificial neural network— was “taught” which electroencephalography features indicated a more or less favourable outcome, with a large series taken from patients who had either died from, or recovered completely after resuscitation for, myocardial infarction. It still required the clinician to interpret the traces from the electroencephalogram, and enter scores for multiple features that the survival predictor then used to compute a result. Rights were not granted to Maynard worked closely include this image in electronic with the clinical neurophysiologist Pamela Prior media. Please refer to the and, in the early stages, printed journal. with Colin Binnie of St Bartholomew’s Hospital. Consistency in scoring was judged so important that the device was never intended for use outside London Hospital survival predictor the London Hospital, Science Museum/Science and Society Picture Library
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the 1980s, which covers the whole of the scalp, depicts the sometimes astonishing coping abilities of human beings. Several whole heads show the inadequate results of surgery during World War I after injuries to the lower jaw from bullets—these exhibits also remind us of the atrocities of war. The various congenital and acquired deformities sometimes look grossly exaggerated, but they are all real! Examples of so-called “monsters” date back to the 18th century. Some rare types of Siamese twins can be viewed, alongside the skeletons of children with expanded skulls caused by hydrocephalus, and the heads of two brothers with microcephaly. Don’t miss this fascinating medical museum if you come to Berlin. Konrad Obermann Galvanistrasse 15, 10587 Berlin, Germany e-mail: [email protected]
where it was devised. Staff were well aware of its potential for misrepresentation. An early account in Computer Weekly had prompted one correspondent to write “the precise prediction of survival horrifies me. Big Brother, 1984 and euthanasia have arrived in the ultimate form: there is no hope left”. The survival predictor was never, in fact, used to determine whether life support should be withdrawn. Maynard was especially concerned about the legal implications if the device were to be used to determine whether organs could be removed for transplantation. But its existence was a reflection of the wider situation in hospital medicine in the 1960s. Techniques such as positive pressure ventilation, the continuous monitoring of vital functions, and the creation of specialised units for the care of seriously ill patients, made reliable life support a reality. But with the success of intensive care came new dilemmas. Knowing what was going on in the comatose patient’s brain became of increasing interest, and ensuing decades were to see the formation of an advanced body of knowledge on the definition of brain death, and the ethical issues involved. The survival predictor was one of the first steps towards creating that knowledge. Ghislaine Lawrence Clinical Medicine, The Science Museum, London SW7 2DD, UK
THE LANCET • Vol 359 • January 26, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
the idea of cellular pathology, was given a professorship in pathological anatomy in Berlin in 1847. In 1848, he had to leave Prussia for Würzburg hat can be done with of anatomical-pathological specimens after active involvement in the 1848 thousands of old medical began in response to an epidemic: revolution. He returned in 1856 and specimens and instruments? this time because of the “Bengalian it was then that the pathologicalHow can such a rich and impressive cholera” that reached Berlin in 1831. anatomical collection began to grow history be incorporated into the world of To develop appropriate prophylactic substantially. Beginning with about modern clinical medicine and corporate and therapeutic measures, a new post 1500 specimens in 1856, Virchow’s culture? What can the history of mediof Prosektor was set up to provide maxim of nulla dies sine praeparatu cine offer to current debates about teaching and research material gained (no day without a specimen) led cloning, euthanasia, and other to an assembly of about contentious issues? Probably 21 000 objects in 1900. every medical museum faces Based on plans developed by these questions to a greater Virchow, a museum edifice or lesser extent. In Berlin, the was erected in 1899—the unification of Germany with first of its kind in the world. its subsequent overhaul and Money came from the sale reorganisation of almost every of the grounds of the old public institution in the botanical garden, which had eastern part has aggravated been set up in the 17th these problems. It is, therefore, century outside of Berlin, but of interest to explore the by then was a prime location ideas and solutions that are for city development. Shortly envisaged for the Berlin before World War II, the Medical Historical Museum. collection was at its height, This museum is part of the with about 26 000 specidepartment of pathology at the mens. However, in the final Charité, the clinical faculty of Virchow’s desk at the old Institute of Pathology, the Charité months of the war the Humboldt University, and one museum was seriously damof Berlin’s three universities aged and 90% of its content located in the eastern part of was destroyed. the city. The history of the It was only in the 1970s Charité goes back to 1709–10, that interest in the collection when, in response to the great was revived. Progress was Silesian plague that threatened slow, but new specimens Berlin, a hospital was erected. were constantly added. The cholera never actually When the Berlin wall came hit the city and the edifice down, the combined efforts was transformed into a poorof the east and west Berlin house and a hospital for the institutes for the history of indigent. Friedrich Wilhelm I, medicine lead to a new unified the soldier’s King, therefore conception of the Berlin named it Charité (charity Medical Historical Museum, in French, which was an which centred around the influential and fashionable Vichow’s collection of pathological specimens building and its remaining language at the time). specimens. The museum was from post-mortem examination. There In 1810, when Humboldt University finally reopened in 1998, and a major were continuing debates about how was founded, various existing scientific extension is about to be completed. to reorganise and systematise these collections were gradually acquired, Thomas Schnalke, a professor of different collections. such as the celebrated anatomical the history of medicine and medical Rudolf Virchow (1821–1902), the and physiological collections of museology, is the new director of the eminent pathologist, anthropologist, ohann Gottlieb Walter and Johannes Berlin Medical Museum. He believes social reformer, and originator of Müller. The first systematic collection the museum has three main functions. Berlin Medical Historical Museum/photo Christa Scholz
W
THE LANCET • Vol 359 • January 26, 2002 • www.thelancet.com
361
For personal use. Only reproduce with permission from The Lancet Publishing Group.
DISSECTING ROOM
Its first role is as a place where people can learn about medical ideas and techniques over the past 400 years, and also find out about current topics, ranging from biotechnology to clinical ethics. Another function is as an expanding exhibition space. There are plans to form a network between the Berlin Medical Museum and other exhibitions in the Charité hospital, for example the dermatological wax moulages, the Robert Koch museum, and the hospital’s collections of anatomical and forensic medicine specimens and physiological instruments. In addition to the permanent exhibits, there will be an expanded series of short-term exhibitions on specific topics in the future; special exhibitions in the past few years have included the history of industrial medicine and a WHO sponsored art project to support antismoking campaigns. Finally, the museum’s genius loci—Virchow’s old lecturing room—acts as a place for
reflection and engagement and is a forum for discussions. The lectures that are held at the museum cover diverse subjects—it was at this venue that Jeanne-Claude and Christo presented their model of the Wrapped Reichstag, while Ian Wilmut gave one of his first presentations about the cloned-sheep Dolly here. The museum has a lot to offer. In addition to a wide range of typical pathological findings, there are rare and sometimes amazing anatomical specimens on display that are of interest to the public and physicians alike. There is probably no larger example of megacolon congenitum (Hirschsprung) available than that on display here. A skull with a mothholelike structure caused by syphilis and a femoral tumour that reveals the effects of tuberculosis on bone give an idea of how devastating long lasting infections must have been in the preantibiotic era. A cylindroma from
Tools of the trade The London Hospital survival predictor t’s a grey box of electronics with a single indicator dial. If the needle swings one way, it points to the word “survive”, the other, and it points to the letters “IBD”. The device is a survival predictor for comatose patients, and IBD stands for irreversible brain damage leading to death. This survival predictor was devised in the UK at the London Hospital, Whitechapel (now the Royal London Hospital) in 1972, and was related to that family of instruments known as cerebral function monitors: machines subsequently used to provide information about the electrical activity of the brain during, for
example, anaesthesia or cardiac surgery. But the London Hospital survival predictor was not for monitoring, it was for predicting whether patients in coma would recover. The brainchild of medical physicist Douglas Maynard, the device was an application of the burgeoning science of computing to the problem of pattern recognition. The software—an early form of artificial neural network— was “taught” which electroencephalography features indicated a more or less favourable outcome, with a large series taken from patients who had either died from, or recovered completely after resuscitation for, myocardial infarction. It still required the clinician to interpret the traces from the electroencephalogram, and enter scores for multiple features that the survival predictor then used to compute a result. Rights were not granted to Maynard worked closely include this image in electronic with the clinical neurophysiologist Pamela Prior media. Please refer to the and, in the early stages, printed journal. with Colin Binnie of St Bartholomew’s Hospital. Consistency in scoring was judged so important that the device was never intended for use outside London Hospital survival predictor the London Hospital, Science Museum/Science and Society Picture Library
I
362
the 1980s, which covers the whole of the scalp, depicts the sometimes astonishing coping abilities of human beings. Several whole heads show the inadequate results of surgery during World War I after injuries to the lower jaw from bullets—these exhibits also remind us of the atrocities of war. The various congenital and acquired deformities sometimes look grossly exaggerated, but they are all real! Examples of so-called “monsters” date back to the 18th century. Some rare types of Siamese twins can be viewed, alongside the skeletons of children with expanded skulls caused by hydrocephalus, and the heads of two brothers with microcephaly. Don’t miss this fascinating medical museum if you come to Berlin. Konrad Obermann Galvanistrasse 15, 10587 Berlin, Germany e-mail: [email protected]
where it was devised. Staff were well aware of its potential for misrepresentation. An early account in Computer Weekly had prompted one correspondent to write “the precise prediction of survival horrifies me. Big Brother, 1984 and euthanasia have arrived in the ultimate form: there is no hope left”. The survival predictor was never, in fact, used to determine whether life support should be withdrawn. Maynard was especially concerned about the legal implications if the device were to be used to determine whether organs could be removed for transplantation. But its existence was a reflection of the wider situation in hospital medicine in the 1960s. Techniques such as positive pressure ventilation, the continuous monitoring of vital functions, and the creation of specialised units for the care of seriously ill patients, made reliable life support a reality. But with the success of intensive care came new dilemmas. Knowing what was going on in the comatose patient’s brain became of increasing interest, and ensuing decades were to see the formation of an advanced body of knowledge on the definition of brain death, and the ethical issues involved. The survival predictor was one of the first steps towards creating that knowledge. Ghislaine Lawrence Clinical Medicine, The Science Museum, London SW7 2DD, UK
THE LANCET • Vol 359 • January 26, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.