University of Glasgow


Part of the Library and University Services

Please note that these pages are from our old (pre-2010) website; the presentation of these pages may now appear outdated and may not always comply with current accessibility guidelines.


Book of the Month

October 2003

Robert Carswell

Pathological Anatomy
Illustrations of the Elementary Forms of Disease

  London: 1838   
Sp Coll RF 110

This beautifully illustrated folio volume consists of forty four coloured lithograph plates with accompanying descriptions of various pathological conditions. The text and the drawings were undertaken by Sir Robert Carswell, who was both a distinguished practitioner of pathology and a skilled artist. Perhaps overshadowed by more well known anatomical atlases, this is a monumental work that deserves further study.

tubercle: plate 1

Pathology is the scientific study of disease: it studies the causes, origins and nature of diseases and injuries and their effects on the body. Through post-mortem examinations and the study of biopsy specimens, anatomical pathology examines changes in the function, structure, or appearance of organs or tissues. The first handbook on pathological anatomy, Morgagni's Seats and causes of disease, was published in 1761; in it, for the first time, patient's symptoms were explained in terms of anatomical changes observed at post-mortem. For many years, however, the discipline struggled to become respectable, hampered by the dreaded legacy of bodysnatchers and resurrection men who seemed willing to use any means to supply anatomists with bodies for dissection. But at the beginning of the nineteenth century, as it became clear that anatomy was an essential element in medical training, new legislation restricted the sale of bodies and provided medical schools with access to 'unclaimed' corpses from hospitals, prisons and poorhouses. A new scientific discipline flourished.

Robert Carswell was born in Paisley in 1793 and studied medicine at the University of Glasgow. His drawing skills were evident as a student and this ability brought him to the notice of Dr. John Thomson of Edinburgh, one of the foremost physicians of the day. Thomson employed Carswell to make a collection of anatomical drawings for his lectures on the practice of physic. To this end, Carswell went to France in 1822, spending two years working in hospitals in Paris and Lyons. He returned to Scotland and took his degree of MD at Marischal College, Aberdeen, in 1826. He then returned to Paris and resumed his studies in morbid anatomy under the celebrated physician Pierre C.A. Louis. At this time, Paris was a centre of brilliance for pathological research; anatomical lectures were conducted in large amphitheatres with easily obtained admission while, crucially, there was a good supply of cadavers to be obtained from state-run hospitals.  

hypertrophy: plate 1

haemorrhage: plate 4

melanoma: plate 2

At the age of thirty-five, Carswell was nominated in 1828 to become the first professor of pathological anatomy at the new University College, London. Before beginning his teaching duties, however, he was commissioned to prepare a collection of pathological drawings for the University. He therefore stayed in Paris until 1831, by which time he had completed over one thousand watercolours of diseased structures. Described as being unequalled for the skill and accuracy of their delineation, this collection of drawings is still in the care of UCL and may be examined in the Special Collections Department of the library there. 
On his arrival in London, Carswell took up his duties as a professor and was also appointed as physician to the University College hospital. He then set about publishing the great work upon which his reputation rests, Pathological Anatomy: Illustrations of the Elementary Forms of Disease. Carswell undertook its publication because of 'the great difficulty, and frequently the impossibility, of comprehending even the best descriptions of the physical or anatomical characters of diseases, without the aid of coloured delineations.' Originally produced in twelve parts (or 'fasciculi') in order 'to diminish the labour and expenses', the book was completed by 1838. It was dedicated to James Jeffray (1759-1848), Professor of anatomy and physiology at the University of Glasgow, in appreciation of the 'approbation with which you received my first attempts to represent, by coloured delineations, the healthy and diseased appearances of the human body, while attending your lectures'.

The volume's contents are arranged according to pathological states under the following headings: Inflammation, Analogous tissues, Atrophy, Hypertrophy, Pus, Mortification, Haemorrhage, Softening, Melanoma, Carcinoma (in two parts, with two sets of plates) and Tubercle. Each part includes a lengthy discussion of each condition and its characteristics before specific cases are illustrated by plates and described in accompanying text.  From the preface it is clear that Carswell intended to publish a second edition with additional parts on Calculi, Entozoa and Monstrosities; he states that subscribers to the first edition would be able to obtain these parts separately to form an appendix to the first. However, they never appeared.

atrophy: plate 2 (detail showing figure 4)

Shown above is an illustration representing 'a remarkable case of cirrhosis, in which the whole of the portal system of the liver was obstructed by coagulated blood, fibrine and bile'. The plate reproduced below left depicts polypus of the heart, while the plate to the right represents 'some of the more remarkable forms of carcinoma'; figure 2 (at bottom right) is  'one of the best examples I have met with of the presence of carcinomatous matter in the veins of the stomach' while figure 4 (at centre)  is 'a remarkable example of the cerebriform matter contained in the vena portae and two of its branches'.

analogous tissues: plate 2

carcinoma: plate 3

mortification: plate 2

While Carswell's work has been praised for the clear, detailed descriptions which display his considerable knowledge and understanding of pathology, it is undoubtedly the beautiful illustrations that make this such an exceptional volume. The plates were reproduced by lithography. Invented by Alois Senefelder in Germany in 1798, lithography is based upon the chemical repellence of oil and water. Designs are drawn or painted with crayons or greasy ink on specially prepared limestone. After the image is drawn, the stone is moistened with water, which the stone accepts in areas not covered by the crayon. An oily ink, applied with a roller, adheres only to the drawing and is repelled by the wet parts of the stone. The print is then made by pressing paper against the inked drawing. To produce coloured lithographs, multiple stones are used; one stone is needed for each colour, and the print goes through the press as many times as there are stones. Accurate reproduction of colour was obviously an important factor in reproducing medical illustrations. Since lithography could produce plates more cheaply and quickly than engraving, the early half of the nineteenth century saw something of a boom in the production of anatomical atlases.  Carswell, however, was fairly unusual for being an expert lithographer himself: he was responsible for putting the illustrations on to stone himself, while the colouring was done under his immediate supervision.

atrophy: plate 4 (detail showing figure 4)

One of Carswell's most celebrated achievements was being the first to portray the plaques of multiple sclerosis, although he did not identify them as such. Illustrated here in the section on atrophy is 'a peculiar diseased state of the chord and pons Varolii, accompanied with atrophy of the discoloured portions ... the atrophy was more conspicuous in some points than in others, and is particularly well seen in the figure at H, where it affects a portion of the right olivary body'. Carswell notes in the introductory section that 'I have met with two cases of a remarkable lesion of the spinal cord accompanied with atrophy. One of the patients was under the care of Mons. Louis in the Hospital of La Pitié, the other under the care of Mons. Chomel, in the Hospital of La Charité, both of them affected with paralysis. I did not see either of the patients, but I could not ascertain that there was anything in the character of the paralysis or the history of the cases calculated to throw any light on the nature of the lesion found in the spinal cord'. Although unaware of their cause, Carswell meticulously recorded these strange lesions; their distinctive patterns show a specific damaging of the spinal cord and clearly identify them as multiple-sclerosis lesions.

atrophy: plate 4

Carswell was also responsible for making the first coloured pictures of the pathology in Hodgkin's disease. Thomas Hodgkin recognised these in leafing through Carswell's 'unrivalled' collection of drawings and displayed them when he read his classic paper on the subject in London in 1832. These plates were first published in 1898 in the New Sydenham Society's atlas of pathological illustrations.

pus: plate 1 (detail showing figure 6)

As well as presenting some ground breaking work, this volume is also interesting for its perspective on medicine in the early nineteenth century. Presented, for example, are some conditions we would expect not to encounter today. For instance, shown to the left here is an illustration of small pox pustules in the larynx, trachea and bronchi. According to the accompanying text, 'the pus was situated in the mucous tissue; in some parts, as on the inferior surface of the epiglottis it presented a diffuse form and in others (in the larynx and in portions of the trachea and bronchi) it assumed the circumscribed pustular form, giving rise to that arrangement of pustule observed in discrete and confluent small pox. The mucous membrane of the larynx, but especially of the trachea and bronchi, was of a uniform deep red colour'. The patient, a female, is recorded as having been thirty years of age.

Shown to the right is 'a rare form of abscess of the brain' with two chronic abscesses of cellular tissue,  'one of them (A) being sufficiently large to contain a small hen's egg, the other (B), capable of receiving only the point of the little finger'.

pus: plate 1 (detail showing figure 1)

carcinoma: plate 2 (detail showing figure 3)

Sadly, Carswell's career foundered not long after the publication of his great work. Although he entered private practice in about 1836, this did not meet with much success, and in 1840 he was forced to resign his professorship due to ill health. He then accepted an appointment as physician to the king of the Belgians and moved to Laeken, near Brussels for the rest of his life. Here he was occupied in official duties as well as charitable works with the poor, but his work was often interrupted by journeys south in search of health. He made no further contributions to medical science, but was knighted in 1850 by Queen Victoria for his services to Louis-Philippe, King of the French, while in exile. He died in 1857 after a lingering illness caused by chronic lung disease.

softening: plate 1 

The 1886 entry for Carswell in the Dictionary of National Biography declares that his 'illustrations have, for artistic merit and for fidelity, never been surpassed ... perhaps no such anatomist was ever a better artist. His work has permanent value, and he had considerable influence as a teacher, though the abrupt termination of his scientific career prevented him from taking a leading place in the profession'. The article also describes the matter of the volume as representing the highest point which the science of morbid anatomy had reached before the introduction of the microscope. In fact, in the 1830s the study of morbid anatomy was revolutionised by the use of the microscope; perhaps, therefore, Carswell was unlucky in producing a work that was soon outdated by more modern techniques. Whatever the reason for Carswell's relative obscurity, it is perhaps now time for a proper re-appraisal of his work.

   carcinoma: plate 3 (detail showing figure 1)

I am grateful to Rachel Thomas of the Southern General Hospital for suggesting this volume as a book of the month and for initially providing some background information about it. Its publication in October coincides with a major medical conference being held at Glasgow University medical school.




Return to main Special Collections Exhibition Page
Go to Book of the Month Archive

Julie Gardham October 2003