Object of the month: Drilling the head

Posted on 9 April, 2013 by Danny Birchall
Bronze Age skull from Jericho. Wellcome Images.

Bronze Age skull from Jericho. Wellcome Images.

Why do so many surviving skulls from the stone age bear the marks of early brain surgery? Muriel Bailly digs deeper into the history of one particular skull in our collection.

While studying archaeology I had always been fascinated by the impressive scientific knowledge of our ancestors, especially in medical sciences. As there is no better place than Wellcome Collection to study the history of medicine, I was very pleased when I first started working here and discovered that there is a trepanned skull from Jericho dated from 2200 BCE on display in the Medicine Man gallery.  This trepanned skull shows that our ancestors were already capable of practicing successful craniotomy 4000 years ago, and with access to neither anaesthetic nor antiseptic!

The word ‘trepanation’, or ‘trephination’ is derived from the Greek typaron meaning to bore, and it literally means to drill a hole into the skull. It is the earliest form of surgery known to us: the first evidence of trepanation has been dated from 6500 BCE for a specimen found in the French necropolis of Ensisheim (Alsace). All around the globe, archaeologists have found specimens dated from the Neolithic period (10 000 BCE/4000–2500 BCE) presenting evidence of trepanation. The hole would have been made by scraping the bone with sharp stones such as flint or obsidian while the patient was still conscious, although they would potentially pass out from the pain.

A large number of trepanned skulls have been found in Europe, Africa and Southern America, proving that this was a common technique. But why would our ancestors want to put themselves through this much pain?

Meticulous studies have shown that trepanation was essentially carried out on young men and that most specimens presented evidence of head injury. The percentage of those who recovered from the operation (including our specimen at Wellcome Collection, who survived repeated trepanations) shows the astonishing degree of technical skill of people from the Neolithic era, but leaves the question of motive open. Researchers today still have different interpretations of this practice. Indeed, since science and magic were – at that time – of the same nature, it is difficult to differentiate the ritual or magical motives of trepanation from the therapeutic or medical ones.

Because a large number of trepanned skulls also show evidence of head injury, some researchers see a therapeutic motive to this practice. This procedure was carried out to relieve the blood pressure underneath the surface of the skull, as well as to remove bone fragments from the wound. In that case, what about the other percentage of the population who underwent trepanation and do not have evidence of head trauma? It is strongly believed that trepanation may have been used to cure various diseases that are believed to have their seat in the head, such as headache, epilepsy and even depression.

Our specimen at Wellcome Collection suffered four trepanations and managed to survive all of them. There is evidence of regrowth of the bone, indicating that the individual lived on for many years after the operations. In addition to the trepanned holes, we can see evidence of head injury on the top of the skull, supporting the idea that this person had trepanations as a medical treatment following an intracranial trauma.

During the Neolithic period, Jericho was a very important settlement. Various city-states were established on the land, and the presence of large defensive walls suggest that the city-state kings were frequently attacking each other. Between 2400 and 2000 BC, the size of the settlements diminished under the pressure of Bedouin attacks. Could our specimen – dated 2200 BCE – have gained this injury during one of these battles? It is possible, although we will never be sure.

After the Neolithic period trepanation became much less common, to such a point that during the 18th and 19th centuries surgeons would reject the procedure outright, owing to its almost one hundred per cent chance of mortality! However, you’d be mistaken if you thought the procedure had died out altogether. It’s still practiced today in its early form – as opposed to our modern craniotomy – by medicine men in Kenya and Algeria.

Muriel Bailly is a Visitor Service Assistant at Wellcome Collection.

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Around the world in 80 days – Part 2: Kenya

Posted on 21 March, 2013 by Barry J Gibb
Gloves

A photograph by Miriam and James, exploring the juxtaposition of science and nature.

Over the course of four months, Barry J Gibb visited our major overseas programmes in Africa and Asia to make a film about the Art in Global Health project. In the second of his journal entries Barry arrives in Kenya.

Within minutes of arriving at Nairobi airport, en route to Mombasa, I was fleeced by two apparently well-meaning gentlemen. On arrival at the diminutive airport, I found myself needing to change planes quickly and, in the absence of clear signage, clearly looked like a confused and wandering target. This was my first important lesson when travelling alone – never look confused, never look lost. As I wandered aimlessly around, I was approached with the offer of help to carry my bags. Thinking this gentleman was staff (bright yellow jacket), I gratefully received his assistance. Thirty feet later, we had ‘arrived’, as had his friend who began badgering me for cash. Initially reluctant, their persistence veered towards light threats. From that moment on, no one carried my bags again.

Mombasa airport was an entirely different experience. Collecting my bags at this tiny airport, a charming woman asked if I worked for the Wellcome Trust. This was how I met Vicky Marsh, wife of Kevin Marsh, the Director of the KEMRI-Wellcome Trust Research Programme. Together, we shared a jeep ride for the hour’s journey to Kilifi, home of KEMRI, and my home for the next few days. Animals walked alongside the road, just as much as the people. And there were so many people, just walking. The drive passed quickly as Vicky explained how she and Kevin came to Kilifi, as young scientists, how the place had transformed from a quiet seaside village to a burgeoning town and holiday resort, the tremendous impact the building of a simple bridge had had for locals and the way its culture had embraced them. And, of course, the impact of building a state of the art research centre – the Kenya Medical Research Institute (KEMRI) – with around 700 employees right in the middle of it all. Read more »

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Around the world in 80 days: Filming Art and Global Health – Part 1

Posted on 20 March, 2013 by Barry J Gibb

Over the course of four months, Barry Gibb visited our major overseas programmes in Africa and Asia to make a film about Wellcome Collection’s Art and Global Health project. In the first of his journal entries from the trip, Barry discusses how the project came about and how a filmmaker plans a shoot spanning 6 countries.

In the latter half of 2012, I was asked to take part in something extraordinary.

Art in Global Health sees six sets of artists selected to take up residency in each of the Trust’s major research centres across the world. Danielle Olsen, curator of this ambitious venture, was looking for ways to somehow record their progress, their artistic process as they immersed themselves in the research centres, the science and scientists.

We discussed various possibilities, several of which she had already initiated, such as blogging, audio or video diaries. Then she mentioned the possibility of making a film, a globe-trotting visual delight, filled with art, science and exotic locations – a fantastic way to reveal the artists, the scope of what they were trying to achieve and the cultural nuances of each location. What I wasn’t quite prepared for was the moment Danielle casually asked, ‘So, will you do it?’. How could I refuse?

Of course, it’s never that simple. Working in any large organisation, on a project of this scale, you quickly discover there are layers of protocol and bureaucracy. This was, potentially, a massive additional undertaking alongside my usual work, involving visiting six different countries and six different institutions around the world: Kenya, Malawi, South Africa, Vietnam, Thailand and Germany. I’d be out of the office for weeks. Read more »

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Deer and the Human Voice

Posted on 26 February, 2013 by Danny Birchall

Dr David Reby, Senior Lecturer in Psychology at the University of Sussex, will be presenting a demonstration at The Voice on Friday 1 March at Wellcome Collection. In this post he explores the connections between the larynxes of deer and humans.

What can deer tell us about the evolutionary origins of our voice? We all know that, overall, men’s voices are lower-pitched than women’s, and most of the time we are able to recognise someone’s gender simply from listening to them, for example over the telephone.

In order to understand the basis of this difference, it is necessary to look at how the human voice is produced. According to the source-filter theory of voice production, we generate our voice in two stages. The first stage takes place inside the larynx (our “voice box”), where the vibrations of the vocal folds creates a sound wave characterised by its “fundamental frequency”. Men have lower pitched voices because they have much longer vocal folds that vibrate at a lower frequency.

Then, in the second stage, this source soundwave is filtered in the speaker’s vocal tract, whose resonance properties affect the timbre of the voice. In fact, changing the shape of our vocal tract to modulate its resonances enables us to produce different vowels when we articulate the sounds of speech.

Then, in the second stage, this source soundwave is filtered in the speaker’s vocal tract, whose resonance properties affect the timbre of the voice. In fact, changing the shape of our vocal tract to modulate its resonances enables us to produce different vowels when we articulate the sounds of speech.

But here too, because men have longer vocal tracts than women, their voice is characterised by lower resonances, giving them a more “baritone”, “deeper” quality, which is a key dimension of the gender of men’s voices.

Interestingly, men’s vocal tracts are on average 20% longer than women’s, giving them deeper voices than expected from the relatively small differences in body size between the two sexes. This suggests that over evolutionary time these differences may have been accentuated as a result of sexual selection. How can we investigate this hypothesis?

This is where deer can help us. Indeed, because their sexual calls are extraordinarily diverse, ranging from almost infrasonic low-pitched groans to extremely high-pitched bugles, deer provide an ideal model for understanding the evolution of mammal vocal signals.

For example, like human males, Scottish red deer stags have a longer vocal tract than females, and are even capable of extending it further when they roar (the arrows on the illustration point at the stag’s larynx or Adam’s apple):

clip_image002

clip_image003

This enables them to produce extremely low resonances, making them sound much bigger than they actually are. Experimental research suggests that sexual selection may have favoured males that were capable of extending their vocal tract to sound more attractive to females and more threatening to rival males.

These observations are interesting because they may provide an explanation for why human males have a longer vocal tract, and therefore deeper voices than women. And indeed, recent work has shown that in humans men tend to rate deeper male voices as more physically and socially dominant. This suggests that in our species too, size exaggeration in the context of male competition may be at the origin of voice differences between males and females.

Finally, this size exaggeration hypothesis may also help in understanding why, unlike most mammals, deer and humans have a descended larynx, an adaptation that may ultimately have facilitated the evolution of human speech in our species.

The Voice takes place at Wellcome Collection on Friday 1 March. Find out more about David Reby’s work

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Love, stress and broken hearts

Posted on 14 February, 2013 by Danny Birchall
Broken Heart by miguelpdl, on Flickr

Broken Heart by miguelpdl, on Flickr

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Can you die of a broken heart? Perhaps not, but heart attacks have been known to be triggered by intense emotion and mental stress. At a Packed Lunch event last month Malcolm Finlay, Senior Clinical Research Fellow at UCL, talked about investigating the electrical and physiological mechanisms behind this phenomenon. Nancy Wilkinson was there to hear how an increased understanding may help to identify those most at risk and reduce their chance of sudden death.

Valentine’s day. For some it is a romantic day filled with chocolates, flowers and teddy bears. For others it is an excuse to gorge on ice-cream whilesinging ‘All by myself’ in pyjamas. Whatever today means to you, it all revolves around our hearts.

Cynics may say that the heart has nothing to do with love, and is just the organ that keeps the blood pumping through our veins. But having a broken heart is real. Intense emotional stress is actually quite common in triggering heart irregularities I found out at a recent Packed Lunch event at Wellcome Collection.

Dr Malcolm Finlay, cardiologist at University College London, researches how the heart copes in stressful situations, and came to Packed Lunch to tell the audience all about it. Although a bad break-up can cause a broken heart, emotional stress can be caused by lots of things, and it all has an impact on our hearts.

Finlay told us about a few notable examples where during a stressful event the numbers of heart irregularities spiked. After an earthquake in San Francisco, there was a huge increase in the number of heart attacks, and during a football World Cup, there were spikes in the number of heart attacks in Germany every time their home team played a match.

The people who suffered these heart irregularities weren’t random; they were those who were pre-disposed to heart problems already. In each case there was a dip in the number of heart attacks following the event: the people who were going to have a heart attack, had it then.

To find out what happens when we are stressed, Dr Finlay and his team measure the heart when it is put in a stressful situation. The team find willing volunteers amongst patients who are already undergoing procedures on their heart. These patients have a catheter – a thin plastic tube, with a platinum end – leading from the upper leg, through a vein into a chamber of the heart. This platinum ended catheter can measure the electrical activity of the heart, and therefore if it is beating normally. Finlay brought along a catheter to show the audience, and I have to say it was a lot bigger than expected. He explained that veins don’t contain any nerves, and are extremely stretchy, so the patient doesn’t feel any pain at all.

To get the patients stressed, he first has to relax them. He dims the lights, gets them to think of themselves on a meadow or a beach and lie quietly for three or four minutes. Then “BANG”: the lights come on and Dr Finlay is saying, “wake up, we’re going to do some mental arithmetic”.

He then tries to crank up the pressure by asking the patients to imagine themselves in the most stressful situation possible. This often produces a heightened response: in one case, a woman actually suffered a heart irregularity right there on the operating table.

Finlay said he was surprised by the results he has seen: the heart exerts itself hugely, even when just imagining being under stress. It produces a similar response as it does when getting ready for some serious exercise, but then, of course, nothing happens. This can cause serious damage, particularly in these patients who already have heart problems.

The research aims to find out how and why our hearts react the way they do to these situations. Finlay wants to find out the mechanism of how the heart responds to stress, so it can be treated accordingly, rather than just treating symptoms. The research is still in its early days, but he has already seen more results than he thought. You never know, one day he could even find a cure for a broken heart.

Nancy Wilkinson is a graduate trainee at the Wellcome Trust.

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Voices of the Dead

Posted on 11 February, 2013 by Danny Birchall

In the video above, the composer, roboticist and sound historian Sarah Angliss demonstrates a contemporary voice recording made using an Edison phonograph, an entirely mechanical device that requires no wires or batteries. In the post below, she describes some of the ideas she will be exploring in her talk at The Voice on Friday 1 March at Wellcome Collection.

In 1933 Howard Flynn heard a dead woman speak. The strange encounter happened in his record company storeroom, where he found an old wax cylinder lying undisturbed in a sealed mahogany box. Flynn had seen cylinders like this before. In the earliest days of sound recording, sounds were stored as grooves etched into the wax. But this one was covered in mildew, which obscured its surface like moss on a gravestone. Undeterred, Flynn slipped the cylinder onto an old phonograph, wound the phonograph handle to make the cylinder spin, then placed the machine’s playback stylus onto the wax. At first, he heard nothing but rumbling and popping as the stylus skidded over the mildew. But a few seconds later, he heard a woman speaking clearly but faintly – a voice that had been lost for many years:

‘When I am no longer even a memory, just a name, I hope my voice may perpetuate the great work of my life.’

Flynn was listening to the only surviving recording of Florence Nightingale, a message she’d recorded on wax in July 1890 to raise funds for destitute veterans of the Charge of the Light Brigade. Nightingale left one other sentence: a blessing to her comrades at Balaclava. But today, it’s the opening 50 seconds of her message which are so striking. Working in the military hospitals of the Crimea, Nightingale knew better than anyone that the dead were dead. Yet, in the little time she had to leave a trace on the wax, she spoke about the prospect of her recorded voice surviving the grave.

Just as the photograph could keep a visible trace of someone after death, the phonograph could keep a vocal trace. Thomas Edison, its inventor, made his first public phonograph recordings in 1877 using cylinders covered in tin foil. Within a year, he was experimenting with recordings on wax. Although there had been earlier attempts to capture sound using soot on glass, his was the first device which could record and play back sound. Nightingale wasn’t alone in having a slightly morbid reaction to the disembodied voices that emanated from his machine. Shortly after hearing a tinfoil recording in Edison’s lab, a reporter for Scientific American remarked on ‘the startling possibility of the voices of the dead being reheard’, adding:

“When it becomes possible, as it doubtless will, to magnify the sound, the voices of such singers as Parepa and Titiens will not die with them, but will remain as long as the metal in which they may be embodied will last.”

As an electronic composer, I often work with disembodied voices, treating them more like plasticine or daubs of paint than vocal recordings as I cut, splice, timestretch, repitch, layer, retrograde and otherwise use them to create music. I’m part of a tradition that began with Edison’s early experiments in the 1870s. I’m fascinated by the time when people first heard a voice that was disembodied – the eeriness of this encounter. When their voices have been immortalised in sound recordings, the dead never seem to fully leave us. To the listener, they continue to exist in a disembodied, unresponsive limbo, only limited by the lifetime of the wax cylinder, vinyl record, hard disk or other medium where their sounds are captured. We are so used to hearing deceased strangers, we rarely stop to think about its oddity, for instance when we sing a teenage love song performed by someone buried 40 years ago. Or when we watch an old television sitcom and find ourselves joining in with the laughter of the dead.

The Voice takes place at Wellcome Collection on Friday 1 March. You can find out more about Sarah’s work at www.sarahangliss.com.

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Stories from the day hospice: A little less conversation

Posted on 8 February, 2013 by Danny Birchall
Illustration by Marianne Dear

Illustration by Marianne Dear

Throughout the summer of 2012, Chrissie Giles spent time at the day hospice at Princess Alice Hospice, Esher, running a creative writing group. In a series of posts accompanying our exhibition Death: A self-portrait, she reflects on her experiences there and showcases some of the writing produced by group members.

One of the nicest but potentially derailing aspects of the writing group was our love of chat. Towards the end of the course, I asked the writers to reflect on how the sessions had been. With characteristic insight, Guncho wrote: “the more we are asked to write, the more we want to speak. It’s like we are starved of company – myself included”.

Jo loves to chat. She’s someone who is as interested in you and what’s happening in your life, as she is in herself. One week, talking about the book her son has published, she breaks the conversation to ask if I have a new kitten, noting the scratches on my hand (inflicted, in fact, by a cat old enough to know better). In the group, she smiles as she writes, remembering the past. As she reads out her words, she paints great tales of the sixties, especially the fabulous clothing and shoes that she couldn’t even think about wearing nowadays.

One week I was circling the day hospice, corralling the writers into our room. In the corner, Jo was cocooned in a large chair that gave the appearance of almost swallowing her up. Puffy faced, she opened her eyes. Her left check was swollen with a dark, woolly-edged bruise. She spoke slowly and a little slurred, telling me she’s had a fall and is going to stay in the main room and rest today.

The day hospice has a fluid population – any given week, people could be absent because they’re on a break from day hospice, too ill to visit, on holiday or at a medical appointment. Even so, the week after, when I didn’t see Jo, I panicked a little. After the group, though, as people found their drivers and made their way out of the day hospice, I saw her in a wheelchair. I knelt down to say hi, noticing as I bent the white plastic wristband around her arm.

Her cheek was still dark grey and now (she reached up to take off her glasses) there were two black eyes to go with it. She tells me that she fell out of bed and has been in the hospice as a patient since last week. “I’d rather be here than at home, though,” she whispered conspiratorially. “Do you they treat you well then?” I asked. “Ooh yes,” she smiled.

Rose is a statuesque, elegant, white-haired woman. She is always immaculately dressed, often in brightly coloured suits. Even though one foot is bandaged, she wears a matching high-heeled shoe on the other. On our first meeting, the rest of the group dared me to guess her age. I was at least 20 years under the correct number and refuse, still, to believe she is in her 80s.

Jo’s friends from day hospice were delighted to see her, departing with heartfelt orders for her to take care and be well. On the way out, Rose passed behind the wheelchair and said goodbye. As Jo replied, cocking her head back, Rose cupped Jo’s face in her hands, kissed her on the forehead and left.

Listen to Chrissie read this piece:

Chrissie Giles is a Senior Editor at the Wellcome Trust. ‘Death: A self-portrait‘ is open until 28 February 2013. Find out more about Princess Alice Hospice at www.pah.org.uk.

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