064

Royal College of Surgeons Hunterian Museum, London, England

51° 30′ 55″ N, 0° 6′ 57″ W

Surgery Laid Bare

The squeamish should avoid this museum—its centerpiece is 18th-century Scottish surgeon John Hunter’s collection of over 3,000 anatomical and pathological specimens (Figure 64-1). Hunter’s collection includes gems like P 1051 (“Colon from a patient with dysentery”) and P 1056 (“Portion of a rectum with anus showing effects of a tuberculous infection”). There’s also a wide range of animal specimens, human skulls, and human (adult and child) skeletons.

Figure 64-1. Specimens in the Hunterian Museum; courtesy of
Joanna Ebenstein/www.astropop.com

In fact, the museum has such an extensive collection of pathological items that it’s probably got an example of any body part you can think of, showing the after-effects of a disease. Serious students of the body can access information about every single item in the collection via a computer in the museum (or on the Web, from the comfort of their own homes).

Not on display, but hidden away in the museum collection and accessible by special request, is half a human brain—that of 19th-century computing pioneer Charles Babbage, no less (see page 294). However, plenty of other brains (human and otherwise) are on display.

If the museum’s Crystal Gallery specimen collection doesn’t send you running for the door, there’s lots more to see. The Silver and Steel collection is an entire gallery filled with the instruments used by surgeons, both modern and ancient. And the Science of Surgery gallery explains the techniques and technologies used by surgeons in the past and today.

Among the interesting instruments is a 1957 heart-lung bypass machine that is used to take over the functions of the heart and lungs during heart surgery. There’s a display of apparatus for anesthesia (using ether, chloroform, and nitrous oxide), early equipment for infusing saline solution, and a big collection of scalpels and other sharp-edged instruments.

The museum holds a large collection of instruments used by Joseph Lister, who was best known for insisting on sterilizing instruments and cleaning wounds. On display are his antiseptic spray machines, which filled the air with carbolic acid. Lister used carbolic acid (or phenol, as it is commonly known) to sterilize instruments and wounds as well as the air.

A good way to get the most out of the museum is by inquiring about their talks and tours. Each Wednesday there’s a free tour led by the curator at 1 p.m. There are also regular free talks by expert volunteers.

William Hunter, brother of John Hunter, was a physician and anatomist who worked in Scotland and specialized in obstetrics. The Hunterian Museum in Glasgow (see Chapter 73) commemorates his life and the lives of other great Scots.

Practical Information

Visiting information for the Royal College of Surgeons is available at http://www.rcseng.ac.uk/museums/. Admission is free.

The Lymphatic System

John Hunter, despite having no formal training as a doctor, made significant contributions to the medical field through the study of teeth, inflammation, venereal diseases (he is rumored to have infected himself with gonorrhea so that he could study it), the digestive system, the placenta, and the lymphatic system.

As blood flows around the body, its fluid leaks through the walls of the capillaries into the surrounding tissue. This leakage provides oxygen and nutrients to the body and is caused by the pressure created by the heart. The fluid, called interstitial fluid because it resides between the cells, also contains the waste products of the cells.

Most of the fluid returns to the capillary by osmosis. As the water leaves the capillary, the remaining fluid becomes more concentrated. Eventually this results in a pressure imbalance (of osmotic pressure caused by the imbalance of liquid concentration), and the water returns to the capillary.

Nevertheless, some of the fluid remains in the tissue and must then be drained away. The drainage is achieved by the lymphatic system, which removes the interstitial fluid and filters it. The lymphatic system consists of tubular vessels similar to the blood vessels throughout the body (Figure 64-2). There are lymphatic capillaries almost everywhere, which connect to a network of ever-larger vessels.

The fluid in the lymphatic vessels (the lymph) is not pumped by the heart, but by a process called peristalsis. Peristalsis is the contraction of smooth muscles surrounding the lymphatic vessels that drives the lymph along. The vessels contain valves that prevent the lymph from flowing in the wrong direction.

The lymph finally reaches a lymph node, where it is filtered to remove materials foreign to the body such as micro-organisms. Each bean-sized lymph node captures these foreign organisms and exposes them to cells from the body’s immune system for destruction.

Eventually the lymph makes it way back to two major vessels—the right lymphatic duct (through which lymph from the righthand side of the body and head is drained) and the thoracic duct (which drains the rest from the lefthand side). These two ducts reconnect with the cardiovascular system in the subclavian veins behind the shoulder blades, where the filtered lymph reenters the bloodstream.

Figure 64-2. The lymphatic system