Nineteenth-century English physician Reginald S. Southey (1835-99) studied medicine at The London School of Medicine and Dentistry while he was also a student at Christ Church, Oxford. He pursued further studies at St. Bartholomew's Hospital, as well as in Continental Europe, before an appointment to the Hospital for Diseases of the Chest in London, where he developed a special interest in treating diseases of the kidneys.
When Southey began practicing medicine, all the major cities had metalsmiths available to make surgical tools for individual surgeons on request. Doctors would experiment with modifications of their surgical tools to achieve better outcomes for their patients. After several successes, the doctor would then get an instrument maker to build a prototype. If the new instrument proved successful, or the doctor was influential, then instrument makers across the city would make copies of the prototype.
Dr. Southey spent the major part of his time as a working member of the "Lunacy Commission," a forerunner of a modern psychiatric department, but he had a large number of patients who suffered from anasarca, an accumulation of fluid in the interstitial space.
Anasarca results from capillary filtration in excess of lymphatic drainage. The condition frequently caused accumulation of fluid in the lower limbs in both sexes, scrotal swelling in males, and deep, weeping venous ulcers if it were left untreated. Before Southey, the most common treatment for the condition was to wrap the skin in tight cloth bandages, so tight that they made movement difficult or impossible.
Southey observed that skin blisters caused by anasarca leaked fluid. He reasoned that draining fluid from the tissues beneath skin ulcerations might relieve the disease. Southey inserted a rigid tube under the skin, attaching it to a rubber hose that drained fluid into a bowl. The procedure was successful, so he refined his design, adding a trocar and a very thin cannula. He replaced the rubber tubing with a silver pipette so it could be reused.
Subsequent modifications to the design made trocars even easier to use. They were miniaturized so doctors could carry them in their pockets. They became the standard of care for treating ascites.
Dr. Southey even used his invention on himself. The son of England's foremost authority on treating tuberculosis, Southey contracted the disease early in life. In 1879, Southey reported to the Clinical Society of London that he had used his trocar on himself, inserting drainage tubes into this chest that allowed him to continue working.
