More Music From Your Cash Register: American Pharmacy at the Turn of the Century

By Johanna Goldberg, Information Services Librarian

This is part of an intermittent series of blogs featuring advertisements from medical journals. You can find the entire series here.

Ad published in The Practical Druggist and Review of Reviews, volume 35, number 5, May 1917. Click to enlarge.

Ad published in The Practical Druggist and Review of Reviews, volume 35, number 5, May 1917. Click to enlarge.

By the late 1800s, a pharmacist (or druggist) stood at an interesting intersection in the marketplace. Both business person and medical professional, the pharmacist had to balance the responsibilities of dispensing medicine with the need to keep a business afloat.

This was in part due to changes in the field. As Gregory Higby explains in a Bulletin for the History of Chemistry article, “With most basic preparations now available from drug companies, anyone with enough courage and capital could open up a drugstore. The number of pharmacists grew enormously, and the quality of prescriptions dispensed declined accordingly.”1 Fortunately, this decline led to increased industry regulation.

The first pharmacy school in the United States, the Philadelphia College of Pharmacy, opened in 1821, a year after the formation of the U.S. Pharmacopeia.2 By the end 1870s, state laws began regulating pharmacy throughout the Unites States, including state licensing exams for pharmacists.1 Not everyone attended a pharmacy school before taking the exam; a correspondence course option existed, as advertised in The Practical Druggist in 1917.

Ad published in The Practical Druggist and Review of Reviews, volume 35, number 2, February 1917.

Ad published in The Practical Druggist and Review of Reviews, volume 35, number 2, February 1917.

Ad published in The Practical Druggist and Review of Reviews, volume 22, number 2, August 1907. Click to enlarge.

Ad published in The Practical Druggist and Review of Reviews, volume 22, number 2, August 1907. Click to enlarge.

Drugs, too, came under closer scrutiny. In 1848, Congress passed the Drug Importation Act, which aimed to prevent the importation of tainted drugs from abroad. In 1906, Congress passed the Food and Drug Act, setting up the regulatory charge of the Food and Drug Administration and requiring the listing of alcohol and opiates on ingredient labels.3,4 In 1912, the Sherley Amendment prevented drug labels from including false health claims.3 Cocaine was available over-the-counter until 1916; heroin and other opiates could be sold legally in the United States until 1920.5,6

The pharmacy had “developed the warmth and hospitality of a country store,” with tobacco counters, home goods for sale, and, beginning in 1835, soda fountains.7 The soda fountain business turned pharmacy shops into social centers; as they grew in popularity, store owners added seats and tables, devoting large parts of the store to the soda fountain business (a trend that lasted into the 1960s).7

Enjoy these ads showing the wide variety of merchandise available to pharmacists, presented chronologically. Click on an ad to enlarge the image.

Ad published in Omaha Druggist, volume 7, number 1, January 1894.

Ad published in Omaha Druggist, volume 7, number 1, January 1894.

Ad published in Omaha Druggist, volume 7, number 4, April 1894.

Ads published in Omaha Druggist, volume 7, number 4, April 1894.

The cover of The Practical Druggist and Review of Reviews, volume 3, number 1, January 1898.

The cover of The Practical Druggist and Review of Reviews, volume 3, number 1, January 1898.

Ad published in The Practical Druggist  and Review of Reviews, volume 5, number 5, May 1899.

Ad published in The Practical Druggist and Review of Reviews, volume 5, number 5, May 1899.

Ad published in American Druggist and Pharmaceutical Record, volume 36, number 2, January 25, 1900.

Ad published in American Druggist and Pharmaceutical Record, volume 36, number 2, January 25, 1900.

Ad published in American Druggist and Pharmaceutical Record, volume 36, number 2, January 25, 1900.

Ads published in American Druggist and Pharmaceutical Record, volume 36, number 2, January 25, 1900.

Ad published in American Druggist and Pharmaceutical Record, volume 36, number 6, March 25, 1900.

Ad published on the cover of American Druggist and Pharmaceutical Record, volume 36, number 6, March 25, 1900.

Ad published in American Druggist and Pharmaceutical Record, volume 36, number 6, March 25, 1900.

Ad published in American Druggist and Pharmaceutical Record, volume 36, number 6, March 25, 1900.

Ad published in American Druggist and Pharmaceutical Record, volume 45, November 7, 1904.

Ad published in American Druggist and Pharmaceutical Record, volume 45, November 7, 1904.

Ad published in The Practical Druggist, volume 22, number 2, August 1907.

Ads published in The Practical Druggist and Review of Reviews, volume 22, number 2, August 1907.

Ad published in The Practical Druggist and Review of Reviews, volume 22, number 4, October 1907.

Ad published in The Practical Druggist and Review of Reviews, volume 22, number 4, October 1907.

Ad published in The Spatula, November 1910.

Ad published in The Spatula, November 1910.

Ad published in The Practical Druggist, volume 35, number 1, January1917.

Ad published in The Practical Druggist and Review of Reviews, volume 35, number 1, January 1917.

Ad published in The Practical Druggist and Review of Reviews, volume 35, number 2, February 1917.

Ad published in The Practical Druggist and Review of Reviews, volume 35, number 2, February 1917.

Ad published in the Omaha Digest, volume 32, number 4, April 1919.

Ad published in Omaha Druggist, volume 32, number 4, April 1919.

References

1. Higby GJ. Chemistry and the 19th-century American pharmacist. Bull Hist Chem. 2003;29(1):9–17. Available at: http://www.scs.illinois.edu/~mainzv/HIST/bulletin_open_access/v28-1/v28-1%20p9-17.pdf. Accessed August 21, 2014.

2. pharmacy. Encycl Br. 2014. Available at: http://www.britannica.com/EBchecked/topic/455192/pharmacy/35617/History-of-pharmacy. Accessed August 21, 2014.

3. Food and Drug Administration. A history of the FDA and drug regulation in the United States. 2006. Available at: http://www.fda.gov/downloads/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm093550.pdf. Accessed August 21, 2014.

4. Baker PM. Patent medicine: Cures & quacks. Available at: http://www.pilgrimhallmuseum.org/pdf/Patent_Medicine.pdf. Accessed August 22, 2014.

5. Miller RJ. A brief history of cocaine. Salon. 2013. Available at: http://www.salon.com/2013/12/07/a_brief_history_of_cocaine/. Accessed August 27, 2014.

6. Narconon International. History of Heroin. Available at: http://www.narconon.org/drug-information/heroin-history.html. Accessed August 27, 2014.

7. Richardson LC, Richardson CG. The pill rollers: A book on apothecary antiques and drug store collectibles. Harrisonburg, Va.: Old Fort Press, 1992.

Registration Open for Vesalius 500 Workshops

Registration is now open for our hands-on art and anatomy workshops, presented as part of our Vesalius 500 celebrations on October 18, 2014. Create your own articulated anatomical figure or “exquisite corpse” at the Gladys Brooks Book & Paper Conservation Laboratory; learn Renaissance drawing techniques with medical illustrator Marie Dauenheimer; or explore the anatomy and art of the hand with physical anthropologist Sam Dunlap.

Spaces are strictly limited so register soon. Registration at one of the workshops includes free entry to the Festival. You can register for the Festival (without workshop attendance) here.

From the Cradle to the Grave: Session One: The Cradle

Moveable baby and female pelvis from one of NYAM’s 19th century obstetrics texts, Dr. K. Shibata's Geburtschülfliche Taschen-Phantom, or the Obstetrical Pocket-Phantom.

Moveable baby and female pelvis from one of NYAM’s 19th century obstetrics texts, Dr. K. Shibata’s Geburtschülfliche Taschen-Phantom (Obstetrical Pocket-Phantom).

Working with NYAM’s conservation team, celebrate Vesalius’s life with a hands-on workshop producing your own articulated anatomical figures in the Gladys Brooks Book & Paper Conservation Laboratory.

Time: 11am-1pm
Cost: $55
Includes: All materials, and free entry to the Festival.
Maximum participants: 12
Register here

During the morning’s Cradle workshop, we will construct paper facsimiles of a moveable baby and female pelvis from one of NYAM’s 19th century obstetrics texts, Geburtschülfliche Taschen-Phantom (or the Obstetrical Pocket-Phantom). The book was written by Dr. K. Shibata, a Japanese author studying in Germany, and was published first in German before being translated into English and Japanese.

Participants will have time to make at least one paper baby and pelvis, which can be produced as paper dolls or magnets.

From the Cradle to the Grave: Session Two: The Grave

An exquisite corpse made by staff of the Gladys Brooks Book & Paper Conservation Laboratory.

An exquisite corpse made by staff of the Gladys Brooks Book & Paper Conservation Laboratory.

Working with our conservation team, celebrate Vesalius’s life with a hands-on workshop producing your own “exquisite corpse” in the Gladys Brooks Book & Paper Conservation Laboratory.

Time: 2:30pm-4:30pm
Cost: $55
Includes: All materials, and free entry to the Festival.
Maximum participants: 12
Register here

During the afternoon’s Grave workshop, we focus on producing a Vesalian-themed exquisite (or rotating) corpse. Loosely based on the surrealist parlor game in which a picture was collectively created by assembling unrelated images, this workshop will employ a special, rotating binding structure and mix-matched facsimile images from NYAM’s rare book collections to allow students to create their own unique, moveable pieces of art.

Renaissance Illustration Techniques Workshop with Marie Dauenheimer, Medical Illustrator

Students at medical illustrator Marie Dauenheimer's workshop at last fall's Festival.

Students at medical illustrator Marie Dauenheimer’s workshop at last fall’s Festival.

Time: 10am-1pm
Cost: $85
Includes: All materials, and free entry to the Festival.
Maximum participants: 15
Register here

Artists and anatomists passionate about unlocking the mysteries of the human body drove anatomical investigation during the Renaissance. Anatomical illustrations of startling power vividly described and represented the inner workings of the human form. Leonardo da Vinci’s notebooks were among the most magnificent, merging scientific investigation and beautifully observed drawing.

Students will have the opportunity to learn and apply the techniques used by Renaissance artists to illustrate anatomical specimens. Using dip and technical pens, various inks and prepared paper students will investigate, discover, and draw osteology, models, and dissected specimens from various views creating an anatomical plate.

Understanding the Hand, physical anthropology workshop with Sam Dunlap, Ph.D.

Dr Sam Dunlop leading a workshop at last year's Festival.

Dr Sam Dunlop leading a workshop at last year’s Festival.

Time: 2:30pm-5:30pm
Cost: $75
Includes: All materials, and free entry to the Festival.
Maximum participants: 15
Register here

The hand as an expression of the mind and personality is second only to the face in the Renaissance tradition of dissection and illustration that continues to inform both art and science. Basic anatomical dissection, illustration, and knowledge continue to be fundamental in many fields from evolutionary biology to surgery, medical training, and forensic science. This workshop will offer participants the opportunity to explore the human hand and its anatomy, which will be demonstrated with at least three dissections.  Opossum (Didelphis virginiana) and orangutan (Pongo pygmaeus) forelimbs will be available along with other comparative skeletal material. We will discuss hand evolution, embryology, and anatomy, and the artistic importance of the hand since its appearance in the upper palaeolithic cave art. We will also analyze the hand illustrations of da Vinci, Vesalius, Rembrandt, and artists up to and including the abstract expressionists.

Aseptic Surgery: Innovation circa 1900

By Paul Theerman, Associate Director, Center for the History of Medicine and Public Health

In the middle of the 19th century, the greatest surgical innovation was anesthesia. In the time that the television show The Knick is set, around 1900, the greatest surgical innovation was aseptic, or sterile, surgery. Anesthesia allowed for longer and steadier operations; aseptic surgery allowed for more successful ones. It changed surgical techniques, training, procedures, and equipment alike.

Sterile dressings. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Sterile dressings. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

The Knick shows first the techniques not of aseptic surgery, but of antiseptic surgery—that is, surgery under conditions designed to combat germs. Spraying the operating room with carbolic acid, and dipping beards in the same chemical, were two such techniques. Aseptic surgery went farther, creating surgical conditions without germs. Thus aseptic surgery led to sterilizing instruments; swabbing down patients; robing, masking, and gloving surgeons; and dressing wounds with sterile dressings. Such procedures began in the 1880s, and by the early 1900s were becoming more and more standard.

Our colleague Jim Edmonson of the Dittrick Museum of Medical History in Cleveland, Ohio, has explored the effect of aseptic surgery on medical instruments and instrument making. Aseptic surgery led to the sale and use of instrument sterilizers, of sterile gauze and cotton, and most especially of instruments designed to be readily and effectively sterilized, as well as inexpensively made. Thus metal soon replaced the wooden and ivory handles of surgical instruments. Jim quotes a Chicago surgeon, Nicholas Senn, in 1902:

All attempts at ornamentation have been abandoned . . . . The modern surgical instruments are made as plain and smooth as possible. Knives and retractors are made of one piece of steel, all niches and crevices being avoided wherever possible. Scissors and forceps are made so that the two parts may be readily separated and joined again.1

Scalpels. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Scalpels. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

To take care of scissors and forceps, German instrument makers developed the “Aseptic Pin Lock,” patented in the United States by Paul Henger of Stuttgart in 1892.2 This design allowed the device to be easily disassembled, sterilized, and then reassembled. Since the pieces could also be mass-produced rather than handcrafted, these instruments swept through the market, dominating from the 1890s to the 1930s. The idea of aseptic surgery pushed innovation throughout the whole of the surgical enterprise.

We show here images of the equipment of aseptic surgery, taken from Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). One of the images is of “Halsted’s Plain Hemostatic Forceps,” developed by William Halsted, the surgeon on whom The Knick’s Dr. Thackery is based, and designed to clamp blood vessels to control the loss of blood during surgery.

Thermal sterilization. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Thermal sterilization. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Sterilizers. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Sterilizers. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Forceps. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Forceps. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Sterilized gauze. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

Sterilized gauze. From Charles Truax’s The Mechanics of Surgery, ed. James M. Edmonson (1899; reprint ed., San Francisco: Norman Publishing, 1988). Click to enlarge.

References

1. James M. Edmonson, American Surgical Instruments: The History of Their Manufacture and a Directory of Instrument Makers to 1900 (San Francisco: Norman Publishing, 1997), p. 14, quoting Nicholas Senn, Practical Surgery for the General Practitioner.

2. Idib, p. 137, and figure 170. U.S. Patent 474,130, issued May 3, 1892. You can also see this at the U.S. Patent and Trademark site: http://www.uspto.gov/patents/process/search/

Postures of Childhood: A Conversation

This blog post presents a discussion between Riva Lehrer, artist and anatomist and our “Art, Anatomy, and the Body: Vesalius 500” festival guest curator, and Sander Gilman, distinguished professor of the liberal arts and sciences and professor of psychiatry at Emory University. Dr. Gilman will present “STAND UP STRAIGHT: Toward a History of the Science of Posture” at our October 18th festival. Register here.

Riva Lehrer:

Sander, when reading a scholar’s work, I often wonder whether it relates to personal experiences that set them on the path of intellectual obsession. For me, your work is so empathetic on the subject of difference it’s as if you’ve lived in the bodies of those you’ve written about. It’s fascinating to find out where that path started for you.

Riva Lehrer as a young child. Photo courtesy of Riva Lehrer.

Riva Lehrer as a young child. Photo courtesy of Riva Lehrer.

It seems that both of us were confronted with the problem of difference beginning in elementary school. Mine began right away. From kindergarten through eighth grade, it didn’t matter whether I was in math class, or English, or social studies; I knew at some point an aide would show up at the classroom door and call my name. All us kids knew this; twice an hour, someone would get pulled out of class and sent to the big open room on the third floor. There, we’d get down on one of the vinyl mats on the floor and start following orders.

These were our daily physical therapy sessions. Almost every student at Randall J. Condon School for Handicapped Children went through this same routine. Most of us had some variety of orthopedic impairment. Condon punctuated our academics with treatments for these perceived aberrations. My brothers were not disabled. They went to regular schools, where their growing bodies were exercised in gym class. This may have been wretched on its own terms but was at least somewhat communal, being arranged around games and team sports. Here, in PT, it was isolating.

Sander Gilman:

Why is gym always the horror! When you are in third grade gym is a horror in most cases any way—except for the two guys you always get chose first for ALL the teams — but when you wear high boots with VERY long laces that had to be cross tied all the way to the top and those boots had metal braces in them, even going into the locker room was a horror. Last one in (on purpose) and last one dressed. And then gym itself—jump, climb, run. But you run like a duck, the gym teacher shouted: STAND UP STRAIGHT!

RL:

A class at the Condon School. Photo courtesy of Riva Lehrer.

A class at the Condon School, with Riva Lehrer kneeling, second from left. Photo courtesy of Riva Lehrer. Click to enlarge

Well, we never played any games together. Whenever I showed up, there’d be 8 or 10 kids already in the PT suite, mired in separate islands of exercise mats, or on high tables that put them at arm’s level with the physical therapists. We half-ignored each other, though if someone let out a loud enough squawk that faux-privacy would end. As a rule, we were an obedient lot; splaying like starfishes on huge medicine balls, lifting our knees, doing wobbly push-ups, clutching squishy objects to build up our hand strength. In the 1960s, most disabled children weren’t even given basic academic instruction; Condon was unusual in its goals to give us some kind of mainstream education. But it was clear that in the battle between teaching disabled children how to read and pushing our bodies towards normalcy, the toss would always land us back on a vinyl mat.

In that room, every weakness and failure of our bodies was brought to our attention, and then set upon by the therapists. I was told I walked as if I had a broken leg, dragging it a half-step behind me.

SG:

In truth, a duck was not wrong. I waddled without my shoes and indeed with them. Standing was hard, running was difficult and the worst part of it was being always the one who was different. I could never quite stand up the way the gym teacher or others wanted me to. Now I know that all third graders KNOW that they are too different, too visible, too comical, but somehow I knew I really was odd. STAND UP STRAIGHT! Still haunts me.

RL:

Kids at Condon used to be called abnormal. Condon was a refuge of sortsat least we weren’t called the brutal names people used outside of school. The PT suite was the only place when I ever saw some of my friends out of their wheelchairs. If a kid could stand at all, the PTs made us watch ourselves walk. (it turned our most of my friends were taller than me; my assumption that I was one of the taller kids in class was an illusion). The room was divided by long metal poles that formed a narrow corridor ending in a tall mirror. I’d start at the far end, clutching the steel poles and trying to get my legs to regulate themselves as instructed. My reflection swayed and bounced as if I were on a ship in my own personal storm.

Riva Lehrer teaching at the School of the Art Institute of Chicago, circa 2008. Photo courtesy of Riva Lehrer.

Riva Lehrer teaching at the School of the Art Institute of Chicago, circa 2008. Photo courtesy of Riva Lehrer.

Until I stopped growing (ending up at 4′ 9″), and my spine was less curved, my limp was most the obvious sign of my disability. Thing was, my limp didn’t hurt. I didn’t even feel it. I only saw it in that tall mirror, where I watched myself list and sway, buffeted by those invisible shipboard winds. I seldom thought about the way I walked at all, but my doctors did, and operated. Nothing made much difference. A year after surgery, my limp always came back, tenacious as malaria.

I am not one who thinks that impairments should not be treated, or that bodies should not be given the chance to experience individual interpretations of health. But health cannot take its bearings from the polestar of normal. Bodies should be supported and encouraged according to specific, idiosyncratic parameters. What was missing from those well-meaning treatments at Condon was any pleasure in the body itself. These were the bodies we’d had at birth. According to our parents, teachers, and doctors, we’d come ashore in broken vessels.

For us, posture regulation, gait repair, and physical therapy rested on a bedrock of shame. We were not given the option of simply loving our bodies as-is, and exercising those bodies out of delight and wonder for what our bodies could do.

SG:

The thing is that that sense of being odd never leaves you as, perhaps, we never stop being third graders when we look deep into our souls. When I started my new project on the history and meaning of posture, the title seemed obvious: STAND UP STRAIGHT! We all write autobiographies, even those who avoid writing autobiographies. That is true of artists as well as scholars.

RL:

Our early lives taught us both that crooked is a posture that tilts your head and gives you a most unexpected view of the world.

Patient Photographs and Medical Collecting

Heidi Knoblauch, the author of today’s guest post, is our 2014–2015 Klemperer Research Fellow. She is a Ph.D. candidate in the History of Science and Medicine Department at Yale University.

Tucked away in the New York Academy of Medicine’s special collections is a small green metal box, simply labeled “daguerreotypes.” The box contains twelve photographs and one painting. A few are images of doctors, but most are of patients.

The small green metal box, simply labeled “daguerreotypes.” Photo by Heidi Knoblauch.

The small green metal box, simply labeled “daguerreotypes.” Click to enlarge. Photo by Heidi Knoblauch.

You would not necessarily know these photographs were of patients unless you looked closely for a misshapen nose, outline of an excision, or nondescript facial scars. The subjects’ posing more closely resembles 19th-century photographic portraits circulated between family members than the poses we currently associate with a clinical image. These poses are accentuated by the fact that most of the photographs are housed in hinged frames with gold matting.

These photographs straddle the line between the medical and the personal that was becoming more defined during the 19th century. They blend intentional subjectivity with a new technology used to make what contemporary physicians described as a “more perfect record.”

During the 19th century, medical men collected photographs of patients and pasted them into personal scrapbooks, case records, and put them on display. These personal collections of notable cases represent not only the use of photographic technologies in consultation, but also the continuation of an engrained practice of collecting that began long before the advent of the daguerreotype. Like all archives and collections, they highlight the inclusion of things meant to be remembered and exclusion of things meant to be forgotten.

Another view of the special collection. Photo by Heidi Knoblauch.

Another view of the special collection. Click to enlarge. Photo by Heidi Knoblauch.

Tracking the social practices associated with amassing medical collections is crucial for understanding this small box of photographs, almost all of which lack identifying information. These photographs have the potential to help us sketch out the formation of communities of collecting and exchange during the middle of the 19th century and to think about how doctors interpreted their relationships with their patients.

The famed surgeon Valentine Mott was one of many physicians who collected surgical and pathological specimens—including the images in the small green box. His museum, which was located at the University Medical College, was composed mainly of pathological specimens from surgical operations, collected in part from his students, who submitted dissections through an annual competition. Like many of his contemporaries, Mott thought collecting would advance the surgical art. In 1858, he declared that his collection was “believed to be the largest that any American surgeon had the occasion to form.”

Mott also sought photographs from his students. Although most of the examples in the small box are unmarked, one of Mott’s students, Edward Archelaus Flewellen, labeled a photograph he sent Mott: “A.P Jackson, Thomaston, Georgia. A supposed case of subcutaneous aneurism by anastomosis. Referred to Dr. Mott by E.A. Flewellen.”

In 1856, Flewellen sent a letter with this daguerreotype to his instructor to obtain a consultation for his patient. Flewellen told Mott that he “did this reluctantly” because he was sure that Mott was “taxed by frequent consultation by many of the thousands of students who have had the pleasure and benefits of [his] instruction.” But, Flewellen added, he believed that Mott would find this an interesting and rare case.

Dr. Edward Archelaus Flewellen's note and photograph, sent to Dr. Valentine Mott. Photo by Heidi Knoblauch.

The note and daguerrotype Dr. Flewellen sent to Dr. Mott. Click to enlarge. Photo by Heidi Knoblauch.

Flewellen’s patient, A.P. Jackson, was a 33-year-old mechanic from Georgia who developed a tumor over his right eye when he was very young. Flewellen described the case in great detail, saying that he had watched the tumor grow for the past five years. Flewellen asked Mott what surgical treatment he would recommend to “rid this poor young man of this hideous deformity” and then promised to send Mott another daguerreotype of Jackson if the surgery was successful so Mott could contrast the before and after photographs. There is no record of Mott replying to Flewellen.

Patient photographs began to represent a new type of scientific aesthetic practice, aligned with graphs and charts, during the 1870s. Patients contributed photographs to their case records during the 19th century, but by the 1890s patients became less willing to actively participate in creating a photographic record of their disease. Today, many patients—especially in genetics, plastic surgery, and dermatology departments—have their photographs taken by a physician or technician (with a digital camera of course) to include in their electronic medical record. Yet employing a professional photographer to take a photograph with the express purpose of mailing it to a physician would seem odd to most people today.

Concerns about privacy surfaced at the end of the 19th century, which changed the way patients thought about photography in the clinic. Standards for clinical photography emerged during the 1920s and, because of this, we would find it strange to have a clinical photograph taken with a piece of bone or a bullet. Photographs are now more sterilized than they were in the 19th century and, unlike in the case of Flewellen, patients are rarely told to dress up before being photographed. The culture of photography has changed and, with it, the way physicians use photographs has shifted.

Global Celebrations of Vesalius’s 500th Birthday

By Lisa O’Sullivan, Director, Center for the History of Medicine and Public Health

From the frontispiece of Vesalius’ Fabrica.

Not in New York? Plan a trip and attend our “Art, Anatomy, and the Body: Vesalius 500″ Festival on October 18! You can read our guest curator Riva Lehrer’s thoughts on the Festival here, and get a sneak peak of a virtual dissection demonstration by Kriota Willberg; and Brandy Schillace on Naissance Macabre; as well as more information about Vesalius and his Fabrica. Keep an eye out for more Vesalius 500 guest posts to come.

But, much as we’d like to see you here on October 18, you don’t have to be in New York to celebrate Vesalius’ 500th birthday.

We always welcome visitors to make an appointment to visit our rare book reading room and examine our copies of the Fabrica and its companion volume, the Epitome (in addition to the rest of our collection). Those elsewhere can find beautiful colored digital versions of the Fabrica from the University of Basel Library and the Epitome at University of Cambridge Library’s digital library. The publishers of the new English language edition of the Fabrica also have some wonderful material online.

In addition, there are multiple birthday celebrations for Vesalius across the globe this year. Travelers can visit Leuven for the Unravelling the Body. The Theatre of Anatomy at the Leuven Museum, or the international conference Towards the Authority of Vesalius: Representations of the Human Body in Antiquity, the Middle Ages and the Renaissance (Dec 3–5); join the Vesalius Continuum Conference on Zakynthos, the Ionian Island on which Vesalius died (Sept 4–8 ); visit Down to the Bones: Celebrating 500 Years of Innovation (Jul 11–Oct 9) at the University of Utah libraries; see Discovering the Human Body at Anatomical Museum in Basel, as well as the only existing skeleton known to have been dissected by Vesalius (Sept 12–Mar 2015) and explore Vesalius and His Worlds: Medical Illustration during the Renaissance at the Huntington library (Dec 12–13). Vesalius was born on Dec 31, 1514; if the events of 2014 were not enough, keep an eye out for the St. Louis meeting celebrating Vesalius in 2015 (Feb 26-28). (Apologies to anyone whose event we’ve missed! The Karger Fabrica site has a great, and constantly updated list of Vesalius 500 events.)

“The Pest at the Gate”: Typhoid, Sanitation, and Fear in NYC

By Lisa O’Sullivan, Director, Center for the History of Medicine and Public Health

The relationship between medicine and public health could be a complex one at the turn of the last century. In particular, the question of how to deal with infectious disease epidemics demanded that medical professionals and city officials grapple with sanitation and cleanliness, city infrastructure, water supplies, and garbage and sewage. Epidemics also raised questions of individual autonomy and the proper role of government. In response to these issues, Boards of Health emerged in many American cities in the second half of the 19th century. The New York Metropolitan Board of Health was the first, founded in 1866 after a campaign by Dr. Stephen Smith and The New York Academy of Medicine.

Poultney Bigelow, The Pest at Our Gates, ([New York] : Merchants’ Association of New York, [1908])

Bigelow Poultney, The Pest at Our Gates, (New York: Merchants’ Association of New York, 1908)

Relations were often fraught between the different groups responsible for the city’s health. Many physicians resented the interference of city-nominated health officials (many of whom they considered corrupt and/or incompetent) into the medical domain; health officials blamed doctors for failing to report cases of infectious diseases; and families regarded hospitals with suspicion and did their best to keep their ill relatives out of them.

The diseases most feared by New Yorkers included cholera, typhus, and typhoid fever. Between 1898 and 1907, at least 635 New Yorkers died from typhoid, with cases of the disease in the thousands.1 Typhoid spreads through water supplies contaminated with infected fecal matter. It can be transmitted via contaminated food or water, and more rarely, through direct contact with someone infected with the disease. As such, sources of the illness in late 19th-century New York were many and largely invisible, as the investigative journalist and author Poultney Bigelow described in 1908 in “The Pest at Our Gates”: typhoid sources ranged from the “placid, perilous Potomac” to “the deadly house fly,” “the fish and oyster menace” and the “perils that lurk in ice.”2 Fear of typhoid pushed public health initiatives and legislation to ensure safe water and food, adequate plumbing, and proper sewage control.

The specters of cholera, yellow fever, and smallpox recoil in fear as their way through the Port of New York is blocked by a barrier on which is written "quarantine" and by an angel holding a sword and shield on which is written "cleanliness." Courtesy of the National Library of Medicine.

Cholera, yellow fever, and smallpox recoil in fear as a quarantine barrier and an angel holding bearing a shield of cleanliness blocks their way through the Port of New York. Image courtesy of the National Library of Medicine.

Fear of infectious disease often overlapped with fears about the changing face of the city and nation. As Alan M. Kraut explores in Silent Travelers: Germs, Genes and the Immigrant Menace, the relationship between immigration and public health in the United States has historically been informed by nativist debates about the identity of the nation and its ethnic makeup, fears about the potential limitations of scientific medicine, and the public health impact of immigration.3 As the gateway to America for hundreds of thousands of new immigrants, New York City became a focus for questions of quarantine and infectious disease. Epidemics, particularly of cholera, prompted many public health reforms in the city, especially increased scrutiny of immigrant arrivals at quarantine stations, including Ellis Island, where officials assessed arriving immigrants for their physical and mental health between 1892 and 1924.

In the case of typhoid, the specter of the foreigner as the reservoir of disease came to be personified by the Irish-born Mary Mallon, so-called “Typhoid Mary.” Mallon was a cook whose employment history in the kitchens of wealthy New Yorkers matched a spate of typhoid outbreaks in those same households in 1906. Mallon was a healthy carrier of typhoid, and was put under enforced quarantine by the Board of Health, which she vigorously resisted. On her release in 1909 she took multiple aliases and continued to work as a cook until 1915, when she was again detained and kept in isolation until her death in 1932. To some, Mallon was “the most dangerous woman in America”; to others, she was a symbol of the undermining of individual liberties by the government.4

In the case of typhoid fever, a combination of new vaccine technology and improved sanitation measures (particularly water chlorination) saw cases in the United States drop dramatically in the early 20th century. However, as is the case for many preventable infectious diseases, typhoid remains a problem in parts of the world with less developed public health infrastructure. On a global scale, medical and governmental responses to public health issues continue to exist in an uneasy tension with broader political and social concerns.

References

1. John Duffy,  A history of public health in New York City (New York: Russell Sage Foundation, 1968), p566

2. Poultney Bigelow, The Pest at Our Gates, (New York: Merchants’ Association of New York, 1908)

3. Alan M. Kraut, Silent Travelers: Germs, Genes and the Immigrant Menace (New York: Basic Books, 1994), pp 1-9

4. Judith Walzer Leavitt, Typhoid Mary: captive to the public’s health (Boston: Beacon Press, 1996); Alan M. Kraut, Silent Travelers: Germs, Genes and the Immigrant Menace (Baltimore: Johns Hopkins University Press, 1995), 97-104.

 

The Fabrica of Andreas Vesalius: Object of the Month

By Lisa O’Sullivan, Director, Center for the History of Medicine and Public Health

This year we are celebrating the 500th anniversary of the birth of Andreas Vesalius with our fall festival, “Art, Anatomy, and the Body: Vesalius 500” on October 18. So much has been written on the Fabrica and its importance that it can be difficult to know where to begin. Why do Vesalius and his work remain so important to contemporary scholarship and anatomical study? The answer lies in his first and most famous book, De humani corporis fabrica. The title is translated as On the Fabric of the Human Body, although the “fabrica” in the original title can be best understood in terms of “craft”, “workings,” or “fabrication.”1 In other words, in this book Vesalius is interested in the functions of the body as a living system. Seven “books,” or sections, lay out the different systems and functions of the body, beginning with bones and ligaments and ending with the brain and sensory organs.

The frontispiece to the 1543 Fabrica in our collection.

The frontispiece to the 1543 Fabrica in our collection. Click to enlarge.

As the frontispiece makes clear, Vesalius wanted the Fabrica to demonstrate the importance of reviving hands-on anatomy as central to medical knowledge and practice. The Fabrica was a landmark publication, representing a turning point in the European understanding of the body and a new level of beauty and accuracy in its depiction in anatomical texts. At the time of its publication in 1543, Vesalius was a professor at the University of Padua, one of Europe’s best known medical schools. Only 28, Vesalius came from a long line of physicians. Like many of his forebears, he subsequently entered the service of the Imperial Court of Charles V, to whom he dedicated the Fabrica. He worked closely with his printers, wood carvers, and artists to ensure the accuracy and beauty of the over 300 woodblock images in the book.2 The Fabrica was exceptional in terms of both production and content, and its iconography, principles, and pedagogical approach were rapidly incorporated into medical thinking and teaching.

While the Fabrica is now remembered as the point at which a new, “modern” emphasis on direct observation and experimentation replaced deference to ancient authorities, Vesalius was careful to ensure that his erudition in the classical tradition was on display. Quotations of Greek, Arabic, and Hebrew texts point both to his determination to show the breadth of his knowledge and to the expertise of his typesetters. Vesalius used such authorities to place himself in an established tradition, even as he questioned aspects of accepted Galenic thought.

The frontispiece to the 1555 Fabrica in our collection. Click to enlarge.

The frontispiece to the 1555 Fabrica in our collection. Click to enlarge.

Along with his systematic exploration of all aspects of human anatomy, Vesalius’s demonstration that authorities such as Galen had made errors in their claims about human anatomy (in part due to reliance on animal dissection) was one reason the book rapidly assumed such extraordinary significance (although not universal acceptance). Despite its detractors, the Fabrica had an immediate impact; even with Vesalius’ best efforts, it was plagiarized and copied throughout Europe.3

Covers of the two Fabricas in our collection. The 1543 volume, left, has alum-tawed pigskin over wooden boards with elaborate decorative tooling and stamped designs and two brass fore-edge clasps. The 1555 edition, right, is bound in a contemporary parchment binding over stiff pasteboards with a single panel stamp. Click to enlarge.

Covers of two Fabricas in our collection. The 1543 volume, left, has alum-tawed pigskin over wooden boards with elaborate decorative tooling and stamped designs and two brass fore-edge clasps. The 1555 edition, right, is bound in a contemporary parchment binding over stiff pasteboards with a single panel stamp. Click to enlarge.

We are in the enviable position of owning multiple copies of the Fabrica as well as its companion piece the Epitome, a briefer volume designed for students with enlarged illustrations to aid the identification of individual features. In addition, we also hold multiple copies of the Icones Anatomicae, an extraordinary 20th-century artifact created in 1934 by The New York Academy of Medicine and the University of Munich, using the original 1543 wood blocks to reproduce illustrations from the Fabrica and Epitome (this was the last time images were taken from the woodblocks; returned to Munich, they were subsequently destroyed by Allied bombing during WWII). All of these volumes will be available to view at the festival on October 18. You will also be able to learn more about Vesalius and his work: Daniel Garrison will discuss translating the Fabrica for the new English-language edition, Arlene Shaner will explore the story of the Icones Anatomicae, and Drs. Jeff Levine and Michael Nevins will provide a guide to the possible stories hidden in the changes made to the Fabrica frontispiece between the first and second editions.

References

1. Harvey Cushing, A Bio-Bibliography of Andreas Vesalius (New York, Schuman’s, 1943), p73; Daniel Garrison, “Why Did Vesalius Title His Anatomical Atlas “The Fabric of the Human Body”?” http://www.vesaliusfabrica.com/en/original-fabrica/inside-the-fabrica/the-name-fabrica.html

2. The identity of the artist responsible for the wood blocks remains unclear, although many have argued that Jan Stephan Calcar, a student of Titian, was responsible. See Vivian Nutton’s introduction at http://vesalius.northwestern.edu/.

3. More details about the life and impact of Vesalius can be found online in Vivian Nutton’s introduction and other essays at Northwestern’s Annotated Vesalius project: http://vesalius.northwestern.edu/ and in C. O’Malley, Andreas Vesalius of Brussels, 1514-1564 (Berkeley: University of California Press, 1964).

Calculating Lifetimes: Life Expectancy and Medical Progress at the Turn of the Century

By Paul Theerman, Associate Director, Center for the History of Medicine and Public Health

“We now live in a time of endless possibility. More has been learned about the treatment of the human body in the last five years than was learned in the previous 500. Twenty years ago, 39 was the number of years a man could expect from his life. Today, it is more than 47.”1

So says the fictional character Dr. John Thackery on the first episode of Cinemax’s The Knick, a show set in New York in 1900. So the years and ages are thus: in 1880 newborn boys could expect a life of 39 years; in 1900, 47 years. And that’s about right. The technical term is life expectancy—the number of years that one could expect to live, with no substantial change of conditions. Dr. Thackery refers, grandiloquently, to those substantial changes of conditions that caused a dramatic increase in life expectancy in the developed world in the late 19th and early 20th centuries, and a steady increase thereafter. By 2010 U.S. life expectancy at birth stood at about 76 years for men, 81 years for women, with an average of 79 years overall.2

William Farr. Courtesy of the John Snow Archive and Research Companion.

William Farr, circa 1850. Courtesy of the John Snow Archive and Research Companion.

The individual who put such statistical work on a firm footing, institutionally and intellectually, was William Farr (1807–1883), statistician in Great Britain’s General Register Office from 1839 to 1879. The British government set up the Register Office in 1837 as part of a reform agenda to provide for civil—rather than parish-based—registration of births, marriages, and deaths. Farr was a medical doctor of modest background who found statistics fascinating. Three times Farr prepared life tables for England and Wales, providing life expectancies divided along gender and geographical lines, and basing his work on the burgeoning data collected in his office and through the expanded decennial censuses beginning in 1841. He was also instrumental in checking and confirming John Snow’s famous geographical detection of the source of the London cholera outbreak of 1853, based on mortality statistics.3

Farr was not the first to determine how to calculate life expectancy: that feat is general accorded to Edmond Halley, the early modern astronomer who predicted the return of the comet that bears his name. But while not the first to approach the topic, Farr may have been the most serious and articulate advocate of life expectancy as a measure of national health:

Since an English life table has now been framed from the necessary data, I venture to express a hope that the facts may be collected and abstracted, from which life tables of other nations can be constructed. A comparison of the duration of successive generations in England, France, Prussia, Austria, Russia, America, and other States, would throw much light on the physical condition of the respective populations, and suggest to scientific and benevolent individuals in every country—and to the Governments—many ways of diminishing the sufferings, and ameliorating the health and condition of the people; for the longer life of a nation denotes more than it does in an individual—a happier life—a life more exempt from sickness and infirmity—a life of greater energy and industry, of greater experience and wisdom.4

A life table from Vital Statistics.

A life table from Vital Statistics. The table, published in 1843 as part of the fifth report, refers to the year 1841.

Farr expected “a noble national emulation,” that is, a competition for best life expectancy, to generate as much enthusiasm as “victories over each other’s armies in the field.” His vision—at least of comparative data—came true: today the World Health Organization provides life expectancies for 194 countries.5

The cover of the NYAM edition of Vital Statistics.

The cover of the NYAM edition of Vital Statistics.

The centrality of Farr’s work to the mission of The New York Academy of Medicine led to NYAM’s reprinting Vital Statistics: A Memorial Volume of Selections from the Reports and Writings of William Farr (1885) in 1975.

As for Dr. John Thackery’s paean to modern medicine: it is a bit misplaced. He was right in stating that medical treatments, and especially surgical techniques, made great advances in his time. But that fact didn’t account for the change in life expectancy. Instead, “old knowledge” was more important: people fell ill and died due to poor sanitation, inadequate diet, dangerous working conditions, and the risks of childbirth and infancy. For example, in 1850 life expectancy in Massachusetts for newborn boys was 38, while 20-year-olds could expect to live to 62, 40-year-olds to 68, and 60-year-olds to 76. By 1900, the comparable figures are: newborns, 48; 20-year-olds, 61; 40-year-olds, 67; and 60-year-olds, 74.6 The situation for newborns improved greatly over the course of 50 years, but for older cohorts, little changed. Over time, the great dangers in childbirth and the first years of life had been ameliorated, and better obstetrics was part of the story, but public health made the difference.

References

1. “The Knick,” Cinemax, Series 1, Episode 1 (aired August 8, 2014), as quoted in NPR, “A New Show about Doctors of Old,” broadcast August 3, 2014, http://www.npr.org/2014/08/03/337531248/a-new-show-about-doctors-of-old, accessed August 14, 2014.

2. The Henry J. Kaiser Foundation, “State Health Facts: Life Expectancy at Birth (in years), by Gender” http://kff.org/other/state-indicator/life-expectancy-by-gender/, accessed August 14, 2014.

3. This and other information on Farr are from the editors’ “Introduction” (pp. iii–xiv), and the original “Biographical Sketch” (pp. vii–xxiv, separately paginated), in Vital Statistics: A Memorial Volume of Selections from the Reports and Writings of William Farr, with an Introduction by Mervyn Susser and Abraham Adelstein, The History of Medicine Series Issued under the Auspices of the Library of the New York Academy of Medicine, no. 46 (1885; reprint ed., Metuchen N.J.: The Scarecrow Press, 1975).

4. Vital Statistics, 453, quoting the Registrar General’s Fifth Annual Report (August 1843).

5. World Health Organization, Global Health Observatory Data Repository, http://apps.who.int/gho/data/view.main.60080?lang=en, accessed August 14, 2014.

6. Historical Statistics of the United States, 1789–1945: A Supplement to the Statistical Abstract of the United States (Washington: United States Department of Commerce, Bureau of the Census, 1949), page 45, Series C 6 21. “Vital Statistics—Complete Expectation of Life: 1789 to 1945.” http://www2.census.gov/prod2/statcomp/documents/HistoricalStatisticsoftheUnitedStates1789-1945.pdf, accessed August 14, 2014.

Virtual Dissection

Kriota Willberg, the author of today’s guest post, explores the intersection of body sciences with creative practice through drawing, writing, performance, and needlework. She will present at our October 18th festival, Art, Anatomy, and the Body: Vesalius 500.

Artistic and clinical examinations of the body share many of the same processes. The artist and the clinician study the body’s mass, look for irregularities in its shape and color, locate bones, joints, and muscles, take notice of the breath. They watch the body and its parts move through space, assess joint alignment, and determine if their subject’s physical parts and relationships are assembled or functioning in a desirable form. The languages for and techniques of analysis vary by discipline but the object of exploration is the same.

"Dhanurasana illustration" by Kriota Willberg

“Dhanurasana illustration” by Kriota Willberg. Click to enlarge.

My careers are grounded in the exploration of the body. There was a time when I would take a morning ballet class, teach anatomy in the afternoon, and in the evening either work a shift as a massage therapist or go to a dance rehearsal. To relax on the weekends I would draw musculoskeletal anatomy illustrations for my class handouts.

Drawing, dancing, and massage all require skills in postural assessment. As a massage therapist I also palpate deeper structures, locating them under skin, fat, and other layers of muscle. As a dancer I learned to feel my musculoskeletal structures via movement exercises that isolate muscle groups or coordinate the body as a whole. Through years of building experiential and objective understanding of the body, physical assessment has become second nature to me.

Friction “…Bundle of Fibers” by Kriota Willberg.

“Friction” by Kriota Willberg. Click to enlarge.

Anatomy entertains and delights me everywhere I go. I study the foot and ankle alignment of strangers as they climb the subway steps. I monitor my two amputee cats for the development of functional scoliosis. I measure and palpate the skin and adipose of my husband, or myself, or the cats, as we sit on the couch and watch the Bond film Tomorrow Never Dies. I comment on Pierce Brosnan’s resemblance in the film to a dissected human subject illustrated in an Albinus anatomy text from 1749.

Tomorrow Never Dies from “The Anatomy of 007” by Kriota Willberg. Click to enlarge

Tomorrow Never Dies from “The Anatomy of 007” by Kriota Willberg. Click to enlarge

The world is an anatomical wonderland. Anatomy is all around us and all we have to do is see it and feel it.

"Pictorial Anatomy of the Cute" by Kriota Willberg. Click to enlarge.

“Pictorial Anatomy of the Cute” by Kriota Willberg. Click to enlarge.

I’m not unique in my perspective of the world of anatomy. There are many people in arts, sciences, and health professions who are skilled at virtual dissection. We can look at you, through your clothing, and through your skin and fat to see the muscle and bone beneath. We share the same skills and sometimes we share the same sense of humor. But our cohort is somewhat rarified. I intend to bring more people into the knowledge and skills that will enable them to join our “club.”

I train others in methods of seeing the body as a clinical or artistic tool. As a part of this instruction, I draw the body on a body. Using a live model, I locate bones and joints, tracing bony landmarks in rinseable ink. Then I locate a muscle’s attachment sites, connect them, and “flesh out” the muscle’s contours and fiber direction.

Willberg anatomy drawing. Model: Wendy Chu

Willberg anatomy drawing. Model: Wendy Chu

Willberg anatomy drawing. Model: Wendy Chu

Willberg anatomy drawing. Model: Wendy Chu

We watch levator scapula lengthen with upward rotation of the scapula. Or the hamstring elongate to seemingly impossible length as the model moves through deep hip flexion. The upper pectoralis major shortens as the lower part lengthens when the model brings her arms overhead. After 27 years of teaching, I am still entranced by these simple movements.

At the Vesalius 500 celebration on October 18, we will look at the body with the double vision of the anatomist. Part live-drawing performance, part slide show/lecture, part conversation, we will explore the (kin)esthetic relationships of our anatomy. I’ll present a narrated slideshow of artworks from A(lbinus) to V(esalius) to enhance and define actual and fanciful relationships of our parts to our whole. A live model and I will create associations between these illustrations and the living body by tracing superficial and deep connections of muscle to movement. The presentation will include opportunities for you (the audience) to ask questions and comment on your own experiences with the study of anatomy.

See you there!