Special Archives,       Artifacts and Images
    Highlights of the BML
     1835-1899
 

Physicians and surgeons at the last turn of the century were apt to be fairly practical. Their efforts to help their patients, who were often their friends and neighbors, frequently involved some tinkering around on their own. These elements surely contributed to their personal career choices. And in some cases, a medical person’s name has come down to us more on account of the tinkering than any other particularly professional skills .

Occasionally one hears, for example, of an English physician named Reginald S. Southey. Doctor Southey lived from 1835 until 1899. His father had been a physician, and he was a nephew of the famous poet Robert Southey. Although he spent most of his life in London he influenced both the comfort of patients and the success of medical people throughout Britain and its Empire. Indeed, his name remained well known in Europe (where Southey had studied following his being at Oxford & St. Bartholomew’s Hospital) as well as in the Americas.

This man’s clinical interest, while a member of the staff at London’s Hospital for Diseases of the Chest, had been in the kidney. In those mid-century days there were quite a number of medical and surgical instrument makers in the major cities, and they were eager as well as equipped to make special pieces for individual practitioners. Usually the doctor would try out some idea using either home made equipment, or else something modified on the spot. Eventually it would be discussed with one of the makers of instruments, who might thereafter be engaged to make one or two well-finished prototypes. If the particular instrument had any merit (or sometimes if its developer were prestigious), copies might become available through the maker. Thus, probably, it developed that Southey’s Tubes became common.

Dr. Southey was familiar with the distress and problems caused by anasarca, and perhaps severe edematous swelling of a patient’s lower extremities was the motivation for his wish to find some practical remedy. He had undoubtedly frequently observed the steady trickle of fluid from a blister on a foot or leg. Wrapping the part with cloth was a tedious and uncomfortable approach which severely limited the patient’s mobility and resulted in laundry requirements which must have been simply daunting. Southey simply inserted a rigid tube subcutaneously, and allowed the fluid to run off through a piece of red rubber tubing into a basin beside the person’s bed or chair. An early improvement was to provide a trocar to introduce the skinny little cannula and a later one was to make holes along the tube which supplemented the open end. Perhaps the ultimate form, and certainly the most elegant, in which you can find a set of Southey’s Tubes, is as a set of four to six tubes plus a turned ivory-mounted trocar and handle, all presented in a fitted plush-lined leather pocket-case.

It is hardly surprising to note that the tubes themselves were often made of silver. And recalling that house-calls were considered a normal part of a doctor’s day it is even less remarkable that one available form was that of a trocar handle with screw-on top, and holes drilled inside to carry a few tubes as well as the trocar itself. A nifty gadget, it could be whipped out from your waistcoat pocket when required, and just as easily as a catheter from under a top hat!

In Edinburgh, between 1906 and 1911, William Green & Sons published an Encyclopedia and Dictionary of Medicine and Surgery. It ran to eleven volumes and remains one of the most useful windows available for easily viewing practice between the end of the Victorian era and the Great War. In addition to a simple description of the Tubes, it offers additional information on their uses, and in very human terms. Paracentesis, for instance, is addressed and the text is quite graphic:

"Paracentesis may be carried out by a quick process ---- the use of a large trocar and cannula when it is desirable to promote the very gradual escape of the fluid, a much finer trocar, cannula, and drainage tube are employed (Southey’s tubes). This latter process has the merits of simplicity, it is less terrifying to the patient, and the tendency to syncope is reduced. Southey’s apparatus consists of a very fine cannula, about two inches long, perforated laterally by minute openings, and surmounted by a small shield. Over this shield is passed one end of the rubber tube, the other end of which extends to the receiving basin under the patient’s bed. The whole operation should be carried out with strict aseptic precautions. After withdrawal of the needle, the cannula is fixed in position by strapping and may be kept in for twelve to twenty four hours. The use of an abdominal bandage will be found helpful, and it is better to gradually tighten the binder, as the fluid escapes. A many-tailed bandage may be used. After withdrawal of the cannula a collodion dressing is applied. Speaking generally, Southey’s tubes are distinctly preferable to the aspirator for cases of ascites."

One other use of the tubes --and the chronological order of the clinical uses is not clear --was for drainage of pleural effusions. Tubercular himself, Dr. Southey must have made a real impression on his audience when, in 1879, he described his method of chest drainage at a meeting of the Clinical Society of London. His father, Henry Herbert Southey (also a physician (MD,FRS,DCL; 1783-1865) lived to know of Reginald Southey’s illness and of his subsequent return to a full professional schedule as an Assistant Physician at St. Bart’s.

In time, this fairly inexpensive, simple, mechanical device joined artificial leeches, cupping glasses, sutures and other components of 19th Century medical armamentarium. General practitioners in the country became as familiar with "Southey’s Tubes" as were their city-dwelling cousins. And by the time of the inventor’s death a few weeks before 1900, his gadget was stocked by most of the leading medical supply houses. The passage of a few more decades saw the development of the option of a single injected diuretic agent as an alternative to semicontrolled chronic drainage; and next came a number of effective tablets which could be taken by mouth. These pretty much erased Southey’s Tubes from all of the medical dictionaries and left the remaining instruments to gather dust.


FURTHUR READING


    Bailey, Hamilton & W. J. Bishop
    Notable Names in Medicine and Surgery (3d ed)
    London: H. K. Lewis & Co. Ltd., 1959

    George Pilling & Son Co.
    1921-1922 Illustrated Catalogue
    Philadelphia

    James L. Hatrick & Co., Ltd.
    Illustrated Price List, 1911
    London

    A. Kettner Fabrik Chirurgischer Instrumente
    Jubilaums-Ausgabe
    Berlin, 1911


Prepared by Dr. Adam G. N. Moore (30 May 98)agnm@massmed.org