Exhibition design for St George’s University of London Pathology

Museum• This power point presentation contains work

currently displayed in the Pathology Museum at St George’s University of London.

• The audience: The exhibition was designed as an educational tool for A -Level, ‘Access to Medicine students’ and Medical students at St George’s.

• The exhibition: – Topic: TB– Method: Questions listed in the pamphlet, (see

word document) act to guide students through this interactive exhibition.

– Content: a poster (see subsequent slides), x-rays (mounted on a light box),‘handling specimens’ and specimen pots from the Pathology Museum collections (lungs, brain, liver, kidneys and a half skeleton).

– Each of the specimens pertains to the mode of disease suffered by the patient: ‘Sarah’ .

• See subsequent slides for exhibition content.

The pamphlet

(back and front)

Spec

imen

B

TB w

ith

'col

d ab

sces

s'

form

atio

n in

dor

sal

spin

e

A ‘c

old

absc

ess’

dest

roye

d se

vera

l of S

arah

’s ve

rtebr

ae,

caus

ing

them

to c

olla

pse,

be

nd a

nd fu

se to

one

ano

ther

, re

sulti

ng in

seve

re c

urva

ture

of

her

spin

e.

Spec

imen

C

Cere

bral

tub

ercu

lom

a - T

B m

enin

giti

s.

Whi

te g

ranu

lom

atou

s les

ions

in

side

the

brai

n ca

use

it to

be

com

e in

flam

ed a

nd sw

olle

n.

The

resu

ltant

incr

ease

in

intra

cran

ial p

ress

ure

acco

unts

fo

r Sar

ah’s

seve

re h

eada

ches

, na

usea

and

vom

iting

.

TB Q

uest

ions

How

is M

. tub

ercu

losis

tran

smitt

ed?

Whe

re is

prim

ary

infe

ctio

n es

tabl

ished

? W

hat i

s a tu

berc

ulou

s gra

nulo

ma?

Wha

t trig

gers

seco

ndar

y in

fect

ion?

How

doe

s TB

spre

ad th

roug

h th

e bo

dy?

Can

TB

be c

ured

?

Com

pare

the

spec

imen

s in

the

cabi

net

with

the

hand

ling

spec

imen

s on

the

tabl

eLo

okin

g at

the

lung

s

In li

fe o

ur lu

ngs a

re th

e sit

e of

gas

eous

exch

ange

.

Sque

eze

spon

ge 1

- im

agin

e th

is to

be

what

a

heal

thy

hum

an lu

ng fe

els l

ike.

Desc

ribe

the

text

ure

and

appe

aran

ce?

How

does

it re

late

to a

hea

lthy

lung

?

How

woul

d th

e pr

esen

ce o

f a g

ranu

lom

a aff

ect t

he lu

ng? (

Hint

– fe

el lu

ng 2

)

The

hip

join

t

Desc

ribe

the

appe

aran

ce o

f the

dise

ased

hip

?

Com

parin

g it

with

the

mod

el o

n th

e ta

ble,

ho

w wo

uld

Sara

h’s m

ovem

ent b

een

affec

ted

in li

fe?

The

spin

e

Can

you

see

the

‘S’-s

hape

of t

he sk

elet

on’s

spin

e.

Wha

t has

hap

pene

d to

the

infe

cted

ve

rtebr

ae?

How

may

this

have

effe

cted

Sar

ah’s

mov

emen

t in

life?

The

brai

n

Iden

tify

the

tiny

tube

rcle

s.

Spec

imen

ETB

of t

he lu

ngs

This

is M

iliary

tube

rcul

osis

- tin

y Gr

anul

omas

, res

embl

ing

mille

t see

ds, t

hrou

ghou

t the

lu

ng, c

ausin

g th

e po

rous

tis

sue

to h

arde

n. In

flam

mat

ion

woul

d ha

ve c

ause

d th

e su

rroun

ding

cap

illarie

s to

rupt

ure,

acc

ount

ing

for

Sara

h’s v

iole

nt, b

lood

stai

ned

coug

h.

TU

BER

CU

LOSI

S

The

Path

olog

y M

useu

m

D

isco

ver t

he w

orld

of

in

fect

ious

di

seas

e

Int

rodu

ctio

n

TB is

hig

hly

cont

agio

us.

It

curre

ntly

affe

cts o

ne th

ird o

f th

e W

orld

’s po

pula

tion.

Th

is m

akes

it o

ne o

f the

one

of

the

Wor

ld’s

mos

t im

porta

nt

infe

ctio

us d

iseas

es.

6,

500

case

s are

repo

rted

ever

y ye

ar in

the

UK.

TB

is c

ause

d by

Myc

obac

teriu

m

tube

rcul

osis.

Be

fore

the

disc

over

y of

St

rept

omyc

in in

the

1950

’s TB

was

in

cura

ble.

To

day

TB is

a c

ontro

llabl

e, b

y va

ccin

atio

n an

d cu

rabl

e by

Co

mbi

natio

n Th

erap

y un

der

Dire

ctly

Obs

erve

d Th

erap

y (D

OT).

Tube

rcul

osis

Th

e im

porta

nce

of T

B to

day

Ho

w TB

is tr

ansm

itted

Pr

imar

y in

fect

ion

Gr

anul

oma

form

atio

n

Seco

ndar

y in

fect

ion

Di

ssem

inat

ion

Sy

mpt

oms

Cu

re

Lea

rn m

ore

abou

t:

Cas

e st

udy:

Sar

ah F

inne

gan

Sara

h Fi

nneg

an w

as a

dmitt

ed to

St

Geor

ge’s

Hosp

ital,

on D

ecem

ber t

he 4

th

1945

(age

d 19

yea

rs),

with

a fe

ver,

seve

re

ches

t pai

n an

d a

viol

ent,

bloo

d st

aine

d co

ugh.

She

had

lost

wei

ght a

nd w

as su

fferin

g fro

m

diar

rhoe

a an

d pa

infu

l, fre

quen

t urin

atio

n.

Upo

n ex

amin

atio

n Sa

rah

was p

ale,

re

stle

ss, s

weat

ing,

and

com

plai

ned

of p

ain

in h

er c

hest

, bac

k an

d he

ad.

Ther

e wa

s a

larg

e sw

ellin

g ov

er h

er ri

ght h

ip.

Ches

t x-

ray,

cer

ebro

-spi

nal fl

uid

(CSF

), bl

ood

and

sput

um sa

mpl

es sh

owed

that

Sa

rah

was s

uffer

ing

from

syst

emic

TB,

spec

ifica

lly T

B m

enin

gitis

– in

flam

mat

ion

of

the

brai

n.

With

out e

ffect

ive

antib

iotic

trea

tmen

t, Sa

rah’

s hea

dach

es in

crea

sed

in fr

eque

ncy

and

seve

rity.

Sad

ly, S

arah

slip

ped

into

a

com

a an

d di

ed, f

our w

eeks

afte

r ad

miss

ion.

*Sar

ah F

inne

gan

is a

fictit

ious

cha

ract

er

On th

e ba

lcony

: Pap

worth

Hos

pita

l - A

TB

Sana

toriu

m

Why is TB an important disease to study? TB currently infecting ‘one third of the World’s population (2)’. The World Health Organisation (WHO) has ‘declared TB a public health emergency’ (4).

TB is highly contagious - if left untreated, each infected person will pass TB on to ‘between 10 and 15 people every year’ (7).

TB is not limited to the Developing World. Today, in the UK, over ‘6,500 cases are reported each year.’ (5)

For this reason TB is a ‘notifiable disease’ – by law an incident of TB must be reported to Governmental and Medical authorities to ensure effective treatment and control.

Most importantly - today, TB is both curable and controllable. But, less than 50 years ago, before the discovery of the antibiotic Streptomycin, this was not the case.

Follow the story of Sarah Finnegan to learn more about the transmission, Infection, control and cure of TB.

A Case Study: Sarah Finnegan

She had lost a considerable amount of weight, was suffering from diarrhea and painful, frequent urination.Upon examination Sarah was pale, restless, sweating, and complained of pain in her chest, back and head. There was a large swelling over her right hip.Tests• A chest x-ray • A cerebro-spinal fluid (CSF) sample, taken by lumbar puncture.• Blood sample was taken.• Sputum sample taken.Upon admission, Sarah was given a course of streptomycin. Initially her condition improved, but after a number of weeks Sarah’s headaches became more frequent and severe. Unable to combat the TB that had infected her brain, sadly, Sarah slipped into a coma and died, four weeks after admission.Sarah Finnegan is a fictitious character inspired by the specimens on display in the Pathology Museum. Examine the display specimens to see how Sarah's body may have been affected by TB

On December the 4th 1941 at 21:34, Sarah Finnegan*, aged 19 years, was admitted to St George’s Hospital with a fever (37.8ºC), severe chest pain and a violent cough.

Specimen B

TB with 'cold abscess' formation in dorsal spine

A ‘cold abscess’ destroyed several of Sarah’s vertebrae, causing them to collapse, bend and fuse to one another, resulting in severe curvature of her spine.

Specimen C

Cerebral tuberculoma - TB meningitis.

White granulomatous lesions inside the brain cause it to become inflamed and swollen. The resultant increase in intracranial pressure accounts for Sarah’s severe headaches, nausea and vomiting.

Specimen E

TB of the lungsThis is Miliary tuberculosis - tiny Granulomas, resembling millet seeds, throughout the lung, causing the porous tissue to harden. Inflammation would have caused the surrounding capillaries to rupture, accounting for Sarah’s violent, blood stained cough.

Poster depicting mode of infection in TB