Moulage and the medical student

Among the many curiosities held by the Gordon Museum of Pathology is a collection of fascinating (and often gruesome) moulage models that have been used as teaching tools by medical students at Guy’s Hospital for over 150 years. In the late 1820s Joseph Towne arrived at Guy’s Hospital Medical School to take up the post of wax modeller. Over the next 53 years he would produce more than 500 specimens modelled from the living patients and cadavers that passed through the hospital.

Towne’s work at Guy’s Hospital stemmed from a rich tradition of medical wax modelling, blending the skill of a sculptor with the knowledge of a surgeon, physician, and anatomist. As evidenced by various other collections (such as that held by the Museum of the History of Science, Technology and Medicine at the University of Leeds), such models were not only used to teach students about anatomy and dermatology but were also used in the teaching of pathology,  embryology, and the natural sciences.

There is little indication of the criteria used to select patients whose conditions would be modelled but Towne was certainly concerned with building up a collection of classic and uncommon conditions. Since I first stumbled across Towne’s collection whilst researching a chapter on the venereological education of medical students, I shall focus on those models (and there are a vast number of them) that represented the various dermatological manifestations of syphilis.

One of his many venereally diseased models demonstrated ‘early circinated syphiloderma’ of the face. Wax models were accompanied by brief descriptions of the patient’s condition, and the progression of that condition across the entire course of their treatment. Students presented with this model were also told that the patient had developed a chancre nine months before his facial lesions were modelled. The enlargement of inguinal and cervical glands followed this chancre and, at the time his condition was modelled, the patient’s whole body was covered in a ‘scattered macular and popular eruption’.

Image property of Collection Family Coolen, Antwerp.

Students at Guy’s Hospital from the 1830s to the 1860s were taught using models made from patients who were, potentially, still undergoing treatment in the hospital, thereby allowing for a dual study of wax model and living patient. Lecturers called their students’ attention to the symptoms depicted on models and to the wider trajectory of the respective cases, including discussion of the treatment employed and the effectiveness of that treatment. Towne’s extensive collection aided students at Guy’s Hospital in their understanding of the progression of diseases like syphilis, thereby developing their diagnostic and therapeutic skill.

Edwin Fenwick, surgeon to the London Hospital, commended the use of these models as teaching tools, claiming that ‘drawings in pencil, pen, or colour are most valuable if carefully taken, but they fall far short of clay or wax modelling in conveying to others an exact idea of the disease depicted.’ [BMJ (5 Jan. 1889), 13]

Yet despite their value, wax models could never be a complete substitute for the study of living patients. Some patients were modelled multiple times to show the progress of their conditions and their responsiveness to treatment. But even these multiple time-lapse casts provided little more than snap shots. For example, the venereal cases depicted were mainly those of secondary, tertiary (gummatous), and congenital syphilis. Gonorrhoea, primary-stage syphilis, and the neurological manifestations of tertiary-stage syphilis seemingly had few demonstrable symptoms that could be accurately captured in wax. Students might learn about the dermatological manifestations of syphilis from Towne’s models. But they still required flesh-and-blood patients if they were to learn how to diagnose a case of gonorrhoeal urethritis or (following the work of clinicians like Frederick Mott in the early 1900s) a patient suffering from general paralysis of the insane.

Living patients provided medical students with a more holistic understanding of the nature of venereal diseases, their ongoing and changing effects upon various structures and functions of the body, as well as the responses of individual patients to the treatments being administered.

Nevertheless, Towne’s meticulously moulded models have provided (and continue to provide) medical students, the general public, and the curious historian of medicine with an extraordinarily rich collection of conditions, the severity of which are not necessarily seen in living patients today.

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