Building The Knick: New Hospitals of the Turn of the Century

Posted on November 24, 2015 by nyamhistorymed

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

“In mid-nineteenth-century America it was well understood that, aside from an occasional emergency, none but the truly indigent would voluntarily enter a hospital . . . . By the First World War all this had changed. Respectable Americans were beginning to find their way into hospitals—especially, but not exclusively, for surgery. . . . The hospital was being integrated into medical care as it already had been into medical education and the structuring of elite careers. Hospital budgets, physicians’ practice patterns, attitudes towards science, charity, and the prerogatives of class . . . interacted to transform the early twentieth-century hospital.”¹

These factors—budgets, physicians, science, charity, and class—are all themes of The Knick, which focuses first on the hospital as a backdrop, then as an institution, and finally as a building. Part of the narrative arc in season two is the decision to build a new Knickerbocker Hospital uptown. This fictional plot point is in line with historical developments at the turn of the century.

For example, in the first decade of the 20^th century, the new Mount Sinai Hospital could stand in for the uptown Knickerbocker. Founded in 1852 in west Midtown, Mount Sinai Hospital moved in 1872 to the East 60s, and then to its current location on Fifth Avenue at 100^th Street in 1904, on the Upper East Side abutting Harlem. The city’s population moved north, and the hospital moved to follow the people, taking advantage of new buildings to advance hospital architecture generally. Under the guidance of one of America’s premier hospital administrators and builders, Dr. S. S. Goldwater, Mount Sinai developed state-of-the-art buildings to support modern, advanced medical care.²

Postcard showing Mount Sinai Hospital, 1910.

Mount Sinai Hospital is only one example of a great wave of hospital building at the turn of the century, not only in the United States, but also in Western Europe. The change can be seen through books and journal articles promoting and hoping to guide the process. At one end of the scale in hospital building was Alfred Worcester’s Small Hospitals: Establishment and Maintenance (1894, 1905, 1909), which included Suggestions for Hospital Architecture, with Plans for a Small Hospital, by William Atkinson. Worcester had no compunction about calling this “The New Hospital Movement,” and linking it to professional nursing and surgical advances. The detailed hospital plans in this book provided for an institution of about 50 beds, with possible expansion to about 75.³

The other end of the scale can be seen in The Planning of a Modern Hospital, by Dr. Christian R. Holmes, chairman of the Board of Hospital Commissioners of Cincinnati, Ohio. In an address given at Teachers’ College of Columbia University in 1911 and published in 1917, Holmes discussed the new large urban hospital.⁴ He promoted the virtue of hospital architecture as a separate study and competency, giving three reasons: “Hospital construction differs from every other kind of building,” due to the ever-changing and progressive nature of medicine and sanitation, and thus requires “unusual care and foresight”; often “the men placed in charge . . . have not the slightest knowledge of the needs of a hospital”; and “the architect is often selected for reasons other than his knowledge.” Holmes supplied a typology of hospitals—pavilion, block, corridor, and composite—and then went into detail on planning a patient ward, including lighting, heating, ventilation, and bed placement and spacing, and including a room for clinical teaching.

Mount Sinai ward unit design. Figure 21 in The Planning of a Modern Hospital.

In addition to general wards, he also provided specific modifications for patients with contagious diseases; neurological conditions, including alcoholism; and venereal and dermatological diseases. He included operating theaters—a major reason for seeking a hospital at the time, and an important source of income. And he went into the specifications for all the supporting structures: kitchens, dining halls, and dormitories for staff, laundry, power plants, and of course, administration. Holmes illustrated his book with 74 photographs, elevations, and plans of large, well-known hospitals from around the United States and Western Europe. Given his background, many illustrations showed the Cincinnati General Hospital, completed in 1915, but he also included classic institutions such as the Rudolph Virchow Hospital, Berlin (completed 1906), New Royal Infirmary, Manchester (completed 1908), the Johns Hopkins Hospital, Baltimore (completed 1889), the Mount Sinai Hospital, New York (completed 1904), and Hôpital Boucicaut, Paris (completed 1897).⁵

Hospital Boucicaut. Figure 29 in The Planning of a Modern Hospital.

Hopital Boucicaut. Figure 29 in The Planning of a Modern Hospital.

The Knick touches on issues of its time as well as of ours. The New Hospital Movement was in ascendancy more than a hundred years ago, when the show is set. But who can deny that our own time has witnessed a new hospital movement, characterized by consolidation and closures, as institutions and their buildings adapt to the new financial, social, and medical worlds of the 21^st century.

References

1. Charles Rosenberg, The Care of Strangers: The Rise of America’s Hospital System (New York: Basic Books, Inc., 1987), p. 237. See also Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (New York and Oxford, Oxford University Press, 1999).

2. “Two Hospitals, Two Presidents,” chapter 9 of The First Hundred Years of the Mount Sinai Hospital of the City of New York, 1852–1952, by Joseph Hirsh and Beka Doherty (New York: Random House, 1952).

3. Alfred Worcester’s Small Hospitals: Establishment and Maintenance, with William Atkinson, Suggestions for Hospital Architecture, with Plans for a Small Hospital (New York: John Wiley and Sons, 1909), pp. 1, 3, 114.

4. Christian R. Holmes, The Planning of a Modern Hospital (Detroit: The National Hospital Record Publishing Company, [1917]).

5. Holmes, The Planning of a Modern Hospital, pp. 3–13, and figures 1, 22–24, 27, and 33–74, which refer to the Cincinnati General Hospital, and figures 2, 7, 16, 21, 29, 30, and 31, which refer to the other hospitals mentioned.

Chinese Opium Dens and the “Satellite Fiends of the Joints”

Posted on October 13, 2014 by nyamhistorymed

By Anne Garner, Curator, Rare Books and Manuscripts

Dr. John Thackery (Clive Owen) visits an opium den. Cinemax, 2014

Dr. John Thackery (Clive Owen) visits an opium den in The Knick. Cinemax, 2014

Dr. John Thackery passes through a number of dimly-lit opium dens in the heart of New York’s Chinatown during the course of The Knick. What were these dens really like—and who frequented them?

In the mid-19^th century, the Chinatowns of America were largely isolated communities, populated by immigrants brought by labor brokers to work on the Central Pacific Railroad or other jobs. Many of these workers planned to return home after several years; there was little desire to assimilate. Scholar Gunther Barth has suggested that with the safety of a familiar culture came familiar vices.¹

A large number of Chinese immigrants came from Canton, a region with a rich history of opium-smoking. As the Chinese presence spread east, opium dens cropped up in the Chinatowns of every major American city.

American Opium-Smokers Interior of a New York Opium Den/ Drawn by J.W. Alexander. [New York] : Harper and Brothers, Oct. 8, 1881. Courtesy of Images from the History of Medicine (NLM).

H. H. Kane wrote in 1882 that the first white American to smoke opium did so in San Francisco’s Chinatown in 1868.² Until then, opium smoking had been strictly confined to the areas of Chinese settlement. By 1875, the practice was widespread enough that San Francisco passed a law prohibiting opium dens. This ordinance was America’s first anti-narcotics law.

The San Francisco ordinance coincided with an increasing anxiety among whites in large urban areas that the low-paid Chinese would threaten wages and standards of living. At the time, the country was mired in a deep recession. The federal Page Act, passed the same year as the San Francisco law, similarly targeted Chinese immigrants, aiming to “end the danger of cheap Chinese labor and immoral Chinese women.”³

Title page of The Demon of the Orient and his Satellite Fiends of the Joints.

Beginning with Virginia City the following year, local ordinances banning opium-smoking quickly passed across the U.S. These laws were largely ineffective. Law enforcement, focused on prosecuting Chinese dens known to attract white clientele, only drove whites deeper into Chinatown, and to smoke at higher rates.⁴

As opium use among whites increased, community leaders began to signal a concern about the morals of white women. Philadelphia missionary Frederic Poole cautioned that white women exposed by the Chinese to opium-smoking were at risk of “a life of degradation.”⁵ In 1883, Reverend John Liggins wrote of the dangers of the many New York City dens found in Mott and Pearl Streets (still the heart of Chinatown today), and quoted Kane that the habit, learned from the Chinese, contributed to “the downfall of innocent girls and the debasement of married women.”⁶ The same year, Allen S. Williams wrote in an early book on the opium-smoking habit about New York’s Chinatown dens:

Chinamen flit noiselessly by in ghostly, fluttering garments, and startle the Caucasian intruder by the very suddenness of their unsympathetic companionship…. the Chinese opium joint…is run for the sole purpose of pandering to a vicious taste whose indulgence is injurious to society.⁷

On the left coast, The Wasp, a popular San Francisco paper, sent two “reporters” to that city’s Chinatown in 1881, and published their findings:

In reeking holes ‘two stories’ underground, where the light of heaven and healthy atmosphere never penetrate, we found human beings living—if it may be called living, which is at best but an existence—as contentedly as rats in a sewer, whose habitation theirs so much resembles. The opium smokers’ resorts were among the first visited…a person once there, he may well desire to make himself oblivious of such surroundings and raise himself to a temporary heaven of his own, but how white men, and even white women, can bring themselves to descend to such filthy holes, where the reeking slime courses down the walls and the air is heavy with foetid odors, is a mystery to any well-regulated mind.⁸

The Wasp article offers an especially disturbing example of how many Americans implicated the Chinese as a group with standards and moral habits far inferior to those of whites. As early as the 1880s, opium dens run by the French and even white American-born women could be found in New York and Philadelphia, but the imagery continued to portray them as exclusively Chinese-owned and -operated. “It’s a poor town now-a-days that has not a Chinese laundry, and nearly every one of these has its lay-out [pipe plus accessories],” wrote one white traveler in 1883.⁹

Fig. 2—Smoker’s Outfit. In Opium-Smoking in America and China.

The framing of opium smoking as a Chinese problem continued as the century drew to a close. Temperance advocates and moral reformers identified opium smoking with indolence and passivity, qualities out of sync with a culture that emphasized hard work and a fast-paced industrial society. These kinds of characterizations became an important way to generate public revulsion for an immigrant group perceived to threaten both economic and social stability, and to gain traction for legislative action.¹⁰

The antagonisms toward the Chinese and attendant immigration restrictions resulted in a Chinese immigrant population that decreased by 1920 to less than half of what it was in 1890.¹¹ The last opium den in New York was raided in 1957. Decades before, many of Chinatown’s dens, largely abandoned because of the rise of opium derivatives morphine and heroin, had all but disappeared.

References

1. Courtwright, David. Dark Paradise. Opiate Addiction in America before 1940. Cambridge: Harvard, 1982. 68.

2. Kane, H.H. Opium-Smoking in America and China. New York: G.P. Putnam’s, 1882. 1.

3. Peffer, George Anthony. Forbidden Familes: Emigration Experiences of Chinese Women Under the Page Law, 1875-1882. Journal of American Ethnic History, Vol. 6 No. 1, Fall, 1986.

4. Courtwright, 79.

5. Courtwright, 78.

6. Liggins, John. The Spread of Opium-Smoking in America. New York: Funk & Wagnalls, 1883. 20.

7. Williams, Allen Samuel. The Demon of the Orient and his Satellite Fiends of the Joints. New York: [the author], [1883]. 12.

8. The Chinese in California, 1850-1925.

9. Courtwright, 73.

10. Musto, David F. The American Disease. Origins of Narcotic Control. New Haven: Yale, 1973. 294-300.

11. Courtwright, 85.

The Advent of the New York Surgical Society

Posted on October 6, 2014 by nyamhistorymed

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

In last Friday’s episode of The Knick, the main character, Dr. John Thackery, worries about being upstaged at an upcoming meeting of the New York Surgical Society. Indeed, that was (and is) a real society. It met at the New York Academy of Medicine, and NYAM’s archives hold its early minute books.

A portrait of Dr. Robert Fulton Weir.

The New York Surgical Society was founded in 1879 at the home of prominent surgeon Dr. Robert Fulton Weir, later a president of The New York Academy of Medicine. By the early 20^th century, membership had grown from an initial 12 members to 60. Its early founders were also instrumental in the establishment of the American Surgical Association in 1880. The surgeon on whom the Thackery character is based, Dr. William Halsted, was a member, as he worked in New York until joining the faculty at Johns Hopkins in 1889.

Schedule of papers in the New York Surgical Society Minutes, 1880-1897.

Schedule of papers in the New York Surgical Society Minutes, 1879-1897. Click to enlarge.

The rise of surgical societies reflected a two-fold movement: the increasing prominence of surgery within the medical profession, coupled with increasing medical specialization overall. That is, surgery was becoming glamorous, and more and more surgeons wanted to mingle, and learn from, like-minded professionals. General medical societies date at least from the 1840s—NYAM and the American Medical Association were both founded in 1847, and the College of Physicians of Philadelphia a full 60 years before that. But in the 1870s and 1880s, specialized medical societies began to flourish, motivated by sociability and professional advancement. Presenting papers on their work, members began building a publication record and a reputation. Societies prized innovation and skill—in some organizations, priority for one’s work could be established through the minute books of the meetings, even before publication.

The New York Surgical Society still exists. Find out more about it here.

A Medical Symphony: Celebrating African Americans in New York Medicine

Posted on September 22, 2014 by nyamhistorymed

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

The Knick’s Dr. Algernon Edwards struggles for acceptance as a medical professional, even when his expertise and knowledge outstrips many of his colleagues. How unusual was his experience as an African American practicing medicine in turn-of-the-century New York? As medical training and practice became more heavily regulated in the latter half of the 19^th century, access to the professions was constrained by issues of ethnicity, gender, class, and religion.

Gerald Spencer. From A Medical Symphony.

A slim green volume in our collections gives a small glimpse into some of the many stories of pioneering African American medical professionals. Our copy of the 1947 book Medical Symphony: A Study of The Contributions of The Negro to Medical Progress in New York is signed by author Dr. Gerald A. Spencer, a fellow of the New York Academy of Medicine. The volume brings together lectures and articles in which Dr. Spencer explores the attempt by African Americans to, in his words, join in “striving for medical symphony in which all races and creeds will be given the fullest opportunities to study and to make their unhampered contributions.”¹

As Dr. Spencer describes, in the last quarter of the 19th century, around 12 African American physicians had graduated from schools in New York and other northern states. Together, they founded the McDonough Memorial Hospital, which commemorated David McDonough. McDonough, born a slave, was selected for an education by his owner as part of a bet to establish the potential of African Americans for learning. McDonough not only succeeded in his studies, but went on to gain his freedom and practice on the staff at the New York Hospital and New York Eye and Ear Infirmary. While it only operated between 1898 and 1904, McDonough Memorial Hospital established itself as being open to physicians, nurses, and patients of every background and nationality. Also established in 1898, the Lincoln Hospital Training School for Nurses in the Bronx was the only place for African American nurses to train after the closure of the McDonough Memorial Hospital until the opening of the Harlem Hospital School of Nursing in 1923.

Lincoln Hospital Training School for Nurses, Class of 1907. From A Medical Symphony.

Integration in New York hospitals, public health agencies, and medical societies was limited in the first decades of the 20th century, but by the 1940s, when Dr. Spencer wrote his volume, integration was making inroads in the city’s institutions. Dr. Spencer wrote Medical Symphony to emphasize the many African American physicians rising to positions of prominence within the hospital system, the enormous public health impact of trained nurses, and acceptance into learned societies.

Dr. Aubre De L. Maynard’s recommendation letter of Dr. Spencer. Click to enlarge.

Dr. Spencer was from St. Lucia in the British West Indies and studied at the College of the City of New York before receiving a medical degree from the University of Lyon, France, in 1932. Many students of African descent found the barriers to an education less intractable in European medical centers. Dr. Spencer became a resident physician at the Skin and Cancer Hospital in New York, and visiting dermatologist at Harlem Hospital. He also became a fellow of the New York Academy of Medicine in 1942, described by one of his referees as a “man of excellent character, scholarly and profound.”²

Disparities in access to health care, and access to the health professions, have not disappeared over time. However, Medical Symphony reminds us of the many stories of success that can be celebrated. For those interested in learning more about who became a doctor in New York over time, join us at “Who Becomes a Medical Doctor in New York City: Then and Now – a Century of Change” on December 11.

References

1. Spencer GA. Medical symphony: a study of the contributions of the Negro to medical progress in New York. New York: 1947.

2. Spencer, GA. Application for fellowship form. Letter from Aubre de L Maynard, MD, March 10, 1942. New York Academy of Medicine Archives.

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

Posted on September 15, 2014 by nyamhistorymed

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.

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 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 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.

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.

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 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 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 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.

Aseptic Surgery: Innovation circa 1900

Posted on September 8, 2014 by nyamhistorymed

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

In the middle of the 19^th 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.

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.

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.

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.

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/

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

Posted on August 25, 2014 by losnyam

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 19^th-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 20^th 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.

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

Posted on August 18, 2014 by nyamhistorymed

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 19^th and early 20^th 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. 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 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.

Beard Dipping: New York Medicine 1900 Style

Posted on August 11, 2014 by nyamhistorymed

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

After episode one of The Knick, the question on everyone’s lips is of course: what was going on with the beard dipping? A commitment to getting the historical details right is the answer (although we hope for the actor’s sake the liquid wasn’t completely true to life).

Dr. Christiansen (Matt Frewer) preps his beard for surgery, assisted by Nurse Elkins (Eve Hewson). Courtsey of HBO-Cinemax.

Dr. Christiansen (Matt Frewer) preps his beard for surgery, assisted by Nurse Elkins (Eve Hewson). Credit: HBO-Cinemax.

The surgeons performing the emergency Caesarean early in the episode ran an operating theater following Listerian principles of cleanliness and antiseptic surgery. Joseph Lister (1827–1912) was a professor of surgery at the University of Glasgow in Scotland, who, influenced by Louis Pasteur’s germ theory, looked for methods to remove microorganisms from the environment during surgery. The introduction of chloroform and ether as anesthetic agents in the mid-19th century meant that surgery had become a much less painful process for patients (and allowed surgeons to focus on longer and more complex procedures). However, surgery remained dangerous, with postoperative infection continuing to be a serious, often fatal, problem.

Carbolic steam spray used by Joseph Lister, England, 1866-18. Courtesy of the Science Museum, London, Wellcome Images.

Carbolic steam spray used by Joseph Lister, England, 1866-1870. Courtesy of the Science Museum, London, Wellcome Images.

In 1867, Lister published an article in which he proposed using carbolic acid (already used to treat sewage) to sterilize the operating room, surgical instruments, bandages, and wounds. Surgeons were encouraged to dip their hands—and yes, their beards!—into carbolic acid before operating.

Working in the midst of a pungent yellow spray that smelled like tar was not ideal and inhaling too much carbolic acid could be dangerous. Lister continued experimenting throughout his career with new sterilization techniques. However he never embraced the idea of gowns, face masks, or gloves.

The use of gloves in surgery was introduced by William Stewart Halsted (on whom Clive Owen’s character Dr. Thackery is based) in the 1890s. A pioneer of antiseptic surgery, one of his surgical nurses (whom he later married) had a bad reaction to the mercuric chloride used as a disinfectant, so he commissioned Goodyear rubber to make her some gloves. The early use of gloves in surgery was not about patient safety, but protecting the medical team. Like any new innovation, reactions were mixed. Some individuals embraced the idea of gloves, while others continued to operate bare-knuckled.

We’re looking forward to the next episode. Let us know in the comments if you have any questions about what’s going on in the hospital and we will get back to you in a future post.

It’s All in the Details

Posted on August 8, 2014 by nyamhistorymed

By Arlene Shaner, Acting Curator and Reference Librarian for Historical Collections

“Male Ward E” at Hahnemann Hospital, from the hospital’s May 1901 report. Click to enlarge.

Advertising for The Knick, the HBO Cinemax series that begins tonight, is everywhere right now. The show, which centers on the world of a fictional New York hospital, The Knickerbocker, right at the turn of the 20^th century, has been in our sights here in the NYAM Library for months.

Long before the episodes of any historical drama are ready to air, a tremendous amount of research goes into making sure that the settings, costumes, and stories display a level of historical accuracy that will make the show believable. It is part of our mission as a library devoted to the history of medicine to help the show’s researchers discover where the information they need can be found. We don’t do our jobs alone, though, and colleagues at many other area institutions such as the Archives and Special Collections at the Health Sciences Library at Columbia University, the Museum of the City of New York and the Mount Sinai Archives, to name just a few, offered plenty of assistance as well.

There are lots of resources in our collections that Knick researchers explored while the show was under development. A particularly rich source for images and descriptions of hospitals in 1900, the year in which the show begins, are the annual reports produced by medical institutions here in the city. Illustrations of operating theaters, like this one from the Presbyterian Hospital, help designers build accurate sets in which the drama can unfold.

Presbyterian Hospital’s operating theater, an image from its 1901 annual report. Click to enlarge.

In some instances, written descriptions help answer questions that come up when the photographs themselves don’t provide enough information. The Hahnemann Hospital operating room in the picture below is quite distinctive in appearance, but the actual descriptions of the rooms from the Hospital Souvenir offer lots of extra details: room dimensions; lists of equipment along with information about what everything is made from and where it sits in the space itself; and explanations of how the different rooms are physically connected to each other or separated from other spaces.

A Hahnemann Hospital operating room, from its May 1906 report. Click to enlarge.

Descriptions of Hahnemann Hospital rooms, from the hospital’s 1900 Souvenir. Click to enlarge.

A group of nurses from the May 1901 Hahnemann Hospital report. Click to enlarge

Some of the photographs also show us how doctors and nurses dressed. The nurses with their long white pinafores and puffy hats certainly look more dated than the surgeons in their doctors’ whites. And if you look back at the 1901 image of the operating theater from the beginning of this post, you’ll note that even though the doctors are performing surgery that no one is wearing a mask or gloves. In the Hahnemann Hospital operating room image from 1906, only a few people have gloves on.

We’ll be posting more about early 20^th century medical practice on all of our social media platforms as The Knick gets underway, so be sure to follow us on Twitter and Facebook. And check our blog on Monday to learn more about the medical history behind The Knick.

Books, Health and History

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Tag Archives: The Knick

Building The Knick: New Hospitals of the Turn of the Century

Chinese Opium Dens and the “Satellite Fiends of the Joints”

The Advent of the New York Surgical Society

A Medical Symphony: Celebrating African Americans in New York Medicine

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

Aseptic Surgery: Innovation circa 1900

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

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

Beard Dipping: New York Medicine 1900 Style

It’s All in the Details