Plagiarising the past

an extraordinarily large calculusIn 1850 a doctor from New Buckenham in Norfolk, Horace Howard, submitted this short case report to The Lancet:

The patient, Maria N— aged twenty-three years, had experienced for a long time much irritation about the kidneys and urinary apparatus, for which different palliative remedies were administered, but with little relief. The patient was lost sight of for some time, and I was again applied to; and upon introducing a sound, I found a stone, evidently of considerable magnitude.

A ‘sound’ is a type of probe.

As soon as I could get the patient into a fit condition, I succeeded, with the aid of Weiss’s dilator and forceps, after about two hours’ gradual dilatation, in extracting, without cutting, a stone of oblong form, and rather rough, weighing two ounces, four drachms, and twelve grains; the longest circumference six inches and a quarter, shortest, five inches and a half; longest diameter, two inches and a quarter; shortest, one inch and 5/12ths.

The doctor used an special instrument to dilate, or gently force open, the woman’s urethra until the stone could pass through it. This very substantial object had been slowly growing inside her bladder. It is no wonder she had ‘much irritation’; it’s surprising she was able to urinate at all.

The patient rapidly recovered. Incontinence of urine continued for some time, but she can now retain about half a pint, and is in good health.

There’s nothing particularly remarkable about this case, except possibly the size of the bladder stone. But while reading a journal article published twenty years earlier, I discovered that the instrument used by Dr Howard has an astonishing pedigree. The tale begins with the editor of the Medico-Chirurgical Journal, Dr James Johnson, going on his summer holidays in 1829:

In a late excursion to Pompeii, and examination of the various antiquities rescued from the oblivion of two thousand years beneath the ashes of Vesuvius, the Editor of this Journal was much interested by the numerous chirurgical instruments of our Pompeian forefathers collected in the Museum of Naples.

One of the most celebrated sites in Pompeii is known as the House of the Surgeon, on account of the large collection of surgical instruments found in one room.

His attention was particularly arrested by Weiss’s Dilator, the original of which may there be seen, so precisely similar to that manufactured in the Strand, that, excepting the handles (one of which is in bronze and the other in ivory) it would be extremely difficult to distinguish the ancient from the modern invention.

The ‘Weiss’ was John Weiss, a German immigrant who founded a surgical instrument-manufacturing company in London in the 1780s.  John Weiss and Son became renowned for the quality and innovation of its products, operating from prestigious premises in the Strand in central London. The company still exists today.

Dr Johnson expressed his surprise at this strange coincidence – two almost identical surgical instruments, separated by seventeen centuries – to the museum curator, who replied that it was probably not a coincidence at all:

He informed Dr. Johnson that, about ten or twelve years ago, a French gentleman took a memorandum of the instrument in question, and soon afterwards brought out at Paris a modification of the Pompeian Speculum or Dilator. Now Mr. Weiss, while improving on the Parisian invention, did actually stumble upon the plan of the original instrument, so that, if the handles were of the same materials, it would be impossible to say which was the elder.

Amazing. So a French instrument maker based his own design on a 1700-year-old surgical instrument. But wait – it gets better:

It appears from this that of the two modern inventors, Mr. Weiss is the more original and ingenious. The Parisian disguised the model from which he worked, and made a clumsy  instrument—Weiss, in his endeavour to improve on the furtive copy, ascended, unconsciously, to the merits of the original.

So the French instrument-maker tried to conceal his inspiration – and in doing so, managed to make the instrument worse. Weiss improved the design, and unwittingly returned it to the form of the instrument found in Pompeii. The editor took great delight in relaying this news to the man himself:

Dr. Johnson called on Mr. Weiss a few days ago, and mentioned the circumstance of his dilator being a precise copy of that found in the ruins of Pompeii—at which the ingenious mechanic was not less astonished than gratified. That he did not benefit by the original is quite evident by the number of modifications which he manufactured (and which he still preserves, before he arrived at the present form.

The two are indeed strikingly similar. Here’s a nineteenth-century engraving of the instrument found in Pompeii (you’ll also find a modern photograph here). It’s believed to be a vaginal speculum.

Pompeii speculum
Vaginal speculum found in the Surgeon’s House, Pompeii

And here’s Weiss’s dilator, from an 1860s surgical catalogue.

Weiss's dilator
Weiss’s dilator, from the Weiss surgical catalogue, 1863

The basic design is almost identical: both have three blades, which are brought apart gradually by means of a screw mechanism attached to the bottom blade. The Weiss dilator was widely used in obstetrics and urology for at least half a century. It’s fascinating that its design was based on a surgical instrument from almost two millennia earlier.

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