Opium in the Library: Remedy & Reverie in the 18th and 19th Centuries

By Hannah Johnston, Library Volunteer

Writing on opium and opioids in the 20th century, particularly in the United States, was often characterized by an interest in the mechanisms of addiction, a growing concern for public health, and a widespread and a deep-rooted fear of the “dope evil.”[1] Only two centuries earlier, however, the “dope evil” was instead “a safe, and noble Panacea.”[2] While there was certainly an understanding of the addictive nature of opium and, to some extent, concern over its safety, many writers in the 18th and 19th centuries were simply fascinated by the drug.

Two works in particular, The Mysteries of Opium Reveal’d by Dr. John Jones (1645–1709) and The Seven Sisters of Sleep by botanist Mordecai Cubitt Cooke (1825–1914), showcase this interest in the origins, nature, and various uses of the drug. While differing in their goals and their opinions on the primary benefits of opium, both works demonstrate some of the ways eighteenth- and nineteenth-century writers grappled with a substance unlike any they had previously encountered. In conversation with each other, The Mysteries and The Seven Sisters can reveal how changing ideas in medicine, culture, and politics influenced the perception and use of opium in the 18th and 19th centuries.

Considered one of the first comprehensive works on the effects and mechanisms of opium, The Mysteries of Opium Reveal’d aimed to demonstrate how, when used effectively, the drug could be a reliable and incredibly useful medicine.[3] Dr. John Jones first explained the origins, nature, uses, and possible misuses of opium.[4] Jones’ book was what one might expect from an eighteenth-century English medical book—while he did devote time to discussing the history and recreational use of opium, he was most deeply invested in unearthing the mechanisms by which opium “lulls, sooths, and, as it were, charms the Mind ….[5]

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A table of opiate dosages to give to various populations of men and women from John Jones’s Mysteries of opium reveal’d (1701). NYAM Collection.

More than a hundred years later, in the mid-19th century, Mordecai Cubitt Cooke wrote a very different kind of opium book. The Seven Sisters of Sleep focuses on seven narcotic drugs – opium, tobacco, cannabis, betel nut, cocaine, datura (a genus of hallucinogenic plants), and fly agaric (a psychoactive mushroom) – allegorically described as the “sisters” of the Queen of Sleep, who each ruled over different portions of the world.[6] Six of Cooke’s twenty-six chapters were devoted to opium in various respects, and the appendix of the book included tables and information on the use and trade of opium on a global scale.[7] While Jones was more concerned with the proper way of producing opium, dosage for various ailments, and outlining the drug’s exact effects on the body (he noted that opium primarily impacted the stomach), The Seven Sisters was primarily focused on recreational or regular use of the drug, and offered personal accounts of experiences with opium as well as comprehensive reports of opium use, particularly in China.[8]

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A table of opium and its substitutes, from Mordecai Cubitt Cooke’s The seven sisters of sleep: Popular history of the seven prevailing narcotics of the world (1860). NYAM Collection.

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A table estimating the amount of people taking narcotics around the world, from Mordecai Cubitt Cooke’s The seven sisters of sleep: Popular history of the seven prevailing narcotics of the world (1860). NYAM Collection.

Writing on the possible pitfalls of opium use, Jones argued that opium “does not diminish or disable the Spirits by any means whatsoever… when duely and moderately used. Cooke, however, addressed several rather terrifying side effects of the drug.[9] He devoted his twelfth chapter to the dangers of opium, describing in vivid detail the horrifying dreams had by some opium users and noting the occurrences of violent psychotic breaks fueled by opium use.[10] While both works discuss the “noxious principle” of the drug, Cooke devotes far more discussion to its potential for misuse, perhaps reflecting a growing understanding and worry about opium’s addictive nature.[11]

Both works made a point to discuss the place of opium on the global stage; the differing ways each author approached the subject, however, reveal the rapidly increasing role of opium in British imperial activities around the world. Jones’ discussion of this subject is limited mostly to the origins of opium, where he notes the relative quality of opium sourced from different countries.[12] Cooke’s work, on the other hand, was published after the Opium Wars between Britain and China of the previous two decades, and reflects the importance of opium in British imperial growth. He described the ways that different ethnic groups used opium, particularly in Asia, and included reports on the rates of opium use throughout different parts of China.[13] Although largely refraining from the demonizing Chinese opium users, which often happened in late 19th century Britain and the United States, Cooke’s writing suggests a British fascination with opium as a cultural import as well as a recreational drug.

The Mysteries of Opium Reveal’d and The Seven Sisters of Sleep reflect the many ways in which views on opium have changed over the last three hundred years. All in all, both writers were invested in defending the use of opium, and noted the many pleasurable effects the drug had on mind and body. However, the ways in which these effects were described by each writer show how the changing political and cultural climate altered the place of opium in the public mind and on the global stage. These works can offer us a glimpse into the worldviews and events that informed the evolving understanding of opium, its uses, and its dangers.

This blog post was written to complement The New York Academy of Medicine’s  Opioid Symposium, held on Friday, September 20th, 2019. You can also “adopt” The Mysteries of Opium Reveal’d, featured in this blog post, and other related works, to help ensure their care and preservation. See more information about this here

References

[1] Several articles in [Lawrence Boardman Dunham clippings and correspondence albums], Dec 1926 to Sept 1932, Volume 1, Manuscripts, New York Academy of Medicine Library, New York, NY.

[2] Dr. John Jones, The Mysteries of Opium Reveal’d (London: 1701), 1. All emphasis original unless stated otherwise.

[3] Ibid; Richard J. Miller and Phuong B. Tran, “More Mysteries of Opium Reveal’d: 300 Years of Opiates,” Trends in Pharmacological Sciences 21 (August 2000), 299–304.

[4] Jones, 1.

[5] Jones, 216.

[6] Mordecai Cubitt Cooke, The Seven Sisters of Sleep: Popular History of the Seven Prevailing Narcotics of the World (London: 1860), 1–5.

[7] Ibid, 357–371.

[8] Ibid, 163–180, 357–371.

[9] Jones, 81.

[10] Cooke, 163–180.

[11] Jones, 1; Cooke.

[12] Jones, 6.

[13] Cooke, 132–148, 366–368.

Opium in the Library: A ‘Smorgasbord’ of Twentieth-Century Understandings of Addiction and Drug Use

By Hannah Johnston, Library Volunteer

“For sale in the open market — misery, degradation, crime, shame, disgrace, and untold suffering — who’ll buy, who’ll buy? … All the world, apparently.”[1] In her 1927 New York American article, “Disgrace and Crime Sold Openly in the Opium Market!”, Winifred Black bemoaned the toll that the opium trade and widespread use of the drug took on the American people.[2] She cautioned readers grimly of the fate of opium smokers, warning that using the drug would lead them to become “flitting shadows of men.”[3]

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Winifred Black’s article in the February 22, 1927 New York American. NYAM Collection.

Black’s alarming article sits with hundreds of companions in a handmade, three-volume collection of clippings of news articles about narcotics dating from 1926–1932. The articles may have been collected by Lawrence Boardman Dunham Sr. (1882–1959), who was heavily involved in efforts to stem New York City’s drug trade in the 1920s and 1930s.[4] The collection was acquired by the NYAM Library in 1950.

More than fifty years later, in 2013, Thomas Reed donated an assortment of his own. Aptly titled Smorgasbord for Newcomers, and compiled in the 1970s by Reed and his colleague Herschel Kaminsky, the four-volume collection contains various photocopied writings and pieces pertaining to New York’s controversial Addiction Services Agency (ASA) from 1967–1975.[5] Founded in 1967, the ASA coordinated and operated drug rehabilitation programs in the city.[6] The Smorgasbord covers the Agency’s history, therapeutic approaches, legal battles, and much more.[7] Together, the narcotics article clippings and the Smorgasbord showcase the changing ways the U.S. handled and conceptualized opioid use and addiction, and demonstrate how these kinds of collected materials are exciting historical artifacts in and of themselves.

Lawrence Boardman Dunham’s apparent understanding of the drug crisis of the 1920s and 1930s, as evidenced by the clippings he chose to collect, was colored by a morality-based concern for the consequences of drug use and the drug trade.[8] The articles expressed concern and even outright fear over specific drugs — morphine, heroin — as well as over the vague but terrifying catchalls “narcotics” or “dope.” Writers stressed the threats drugs posed to society, particularly noting the supposed relationship between drugs and criminal activity. Just one day after her “Disgrace and Crime” article, Winifred Black published again in New York American on the issue of opium, this time warning the public of addicts themselves. She asserted that “[many] of the most brutal murders in America have been committed under the urge for morphine.”[9]

To the modern eye, these articles seem highly sensationalized, but their use of what we might today see as fear-mongering suggests a vested interest in prevention (as opposed to treatment) of addiction, particularly through the “education” offered by the articles. “Ignorance is the ally of the Drug Menace,” quipped an article in the Boston Daily Advertiser. “Knowledge is its enemy — the ONLY enemy which can scotch the serpent, and, some day, slay it!”[10]

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“FEAR Narcotic Drugs!” in the February 23, 1927 Boston Daily Advertiser. NYAM Collection.

In the intervening years between the sensational news stories of the narcotics clippings and the politically fraught world of the Smorgasbord, New York City saw numerous political as well as medical changes in the way drug use was understood and managed on a citywide level. In 1944, at the request of Mayor Fiorello H. LaGuardia (for whose first mayoral campaign, it should be noted, Dunham was the campaign manager), a committee formed by the New York Academy of Medicine released a report on “The Marihuana Problem in the City of New York.”[11] Although the LaGuardia Report debunked claims that this particular drug caused “delinquency” and crime, it confirmed larger-scale prevailing ideas about drug use even as it refuted them — namely its social nature.[12]

This continuity with the world of the narcotics clippings, however, contrasts with the apparent growing government interest in more deeply understanding drugs — in particular opioids —  and those who used them. The contents of the Smorgasbord reflect this ongoing shift. In particular, the first volume of the Smorgasbord reveals the ways the Addiction Services Agency engaged with changing views of addiction — while many powerful figures in the early years of the agency clung to moral and social understandings of opioid addiction, the document makes clear the growing trend towards understanding addiction as a physiological affliction.[13] Reed and Kaminsky’s collections reveal an agency with changing and conflicting ideas, motives, and goals in the growing opioid crisis of the 1960s and 1970s.

The narcotics article clippings from Lawrence Boardham Dunham and the Smorgasbord are wonderful and rare sets of materials. Both collections offer a snapshot of the country’s (and particularly New York City’s) understanding of narcotic drugs. However, the collections also reflect the positions and motivations of the individuals who compiled them. As modern readers, we can learn much from them — both from what is in them and from what has been left out. The clippings and the Smorgasbord can show us how the U.S. grappled with addiction at different points in the 20th century, but can also reveal the ways in which the compilers’ own thoughts and feelings influenced the stories they put together.

This blog post was written in anticipation of The New York Academy of Medicine’s upcoming Opioid Symposium on Friday, September 20th, 2019. See more details and register here. You can also “adopt” the two works featured in this blog post, which will help ensure their care and preservation. See more information about this here

References

[1] Winifred Black, “Disgrace and Crime Sold Openly in the Opium Market!”, New York American, February 22, 1927, from [Lawrence Boardman Dunham clippings and correspondence albums], Dec 1936 to Sept 1932, Volume 1, Manuscripts, New York Academy of Medicine Library, New York, NY.

[2] Ibid.

[3] Ibid.

[4] Description for [Lawrence Boardman Dunham clippings and correspondence albums].

[5] Thomas Reed and Herschel Kaminsky (compilers). Smorgasbord for Newcomers, circa 1967–1975, Volume 1, Manuscripts, New York Academy of Medicine Library, New York, NY.

[6] “A Political History of the Addiction Services Agency,” Smorgasbord, Volume 1, Part ii, 23.

[7] Reed and Kaminsky, Smorgasbord.

[8] [Lawrence Boardman Dunham clippings and correspondence albums].

[9] Winifred Black, “Opium Held Accountable for All Drug Addict Evils,” New York American, February 23, 1927, [Lawrence Boardman Dunham clippings and correspondence albums]. It should be noted that Black, along with many of her contemporaries, use the word “opium” seemingly to refer to opioid drugs such as morphine as well as or instead of pure opium itself.

[10] “FEAR Narcotic Drugs!”, Boston Daily Advertiser, February 23, 1927, [Lawrence Boardman Dunham clippings and correspondence albums].

[11] Mayor’s Committee on Marihuana. The marihuana problem in the city of New York : sociological, medical, psychological and pharmacological studies.  Lancaster, PA: The Jaques Cattell Press, 1944.

[12] Ibid.

[13] “A Political History of the Addiction Services Agency,” Smorgasbord, Volume 1, Part ii.

Desegregating Harlem Hospital: A Centennial

This guest post is from Adam Biggs, faculty at the University of South Carolina Lancaster and panelist at the recent Academy Race & Health series event, “How Long Will We Wait? The Desegregation of American Hospitals.” Professor Biggs teaches courses in African American Studies and U.S. History, and his research explores the desegregation process at Harlem Hospital from 19191935.

“As I look back with charity at that period,” wrote Aubré Maynard in 1978, “I deplore the fact that I suffered more from the hostility and jealousy of some of my black colleagues than from the antipathy of whites, from whom I expected frank racial animosity.”[1] Lingering more than fifty years after he joined Harlem Hospital as one of its first black interns, Maynard’s feelings of resentment stemmed from acrimony that emerged during the desegregation process. After successfully overcoming white opposition, a heated debate broke out in Harlem over how best to utilize the facility in the interest of racial justice. But rather than a “magic bullet” for the problem of race, desegregation became a mirror of truth, exposing endemic obstacles to racial equality still deeply embedded within the medical profession and internalized within Harlem’s black medical community.

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Harlem Hospital ward, 1929. Image: Harlem Hospital records, 1887-1962, NYAM Collection.

Black civic activists had been advocating to desegregate New York’s municipal hospital system since the early 1910s.[2] But black practitioners would not gain entrance until the nation’s wartime effort placed a burden on medical staffing that could not be ignored. With a reluctant city administration, a small number of practitioners began acquiring low-level positions as early as 1917, and in August 1919, Louis T. Wright became the first black doctor to join the Harlem Hospital staff.[3] Continued advocacy over the next decade pushed the hospital to gradually incorporate black physicians and nurses into its ranks.

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Nurses of the class of 1929, Harlem Hospital, New York City. Image: Harlem Hospital records, 1887-1962, NYAM Collection.

This process, however, was not without challenges. For many of the established white staff, the presence of African Americans proved untenable. Shortly after their appointments, the hospital saw a mass exodus of white practitioners who transferred or resigned in protest. Many of those remaining displayed their discontent by acting with belligerence or passive aggression toward the new black hires.[4] Tensions reached a peak in 1927 when a hospital riot was barely averted after a junior white intern, dining in the cafeteria, threw water in the face of Aubré Maynard, a senior resident at the time.[5] Well publicized incidents such as this one amplified the hospital’s toxic racial climate and undermined the public’s trust.

In 1929, Mayor James Walker responded by reorganizing the municipal hospital administration. His reforms led to the dismissal of twenty-three white and two black physicians along with the appointment of twelve new black doctors and the promotion of Louis Wright to the Harlem Hospital board. Within a year, African Americans came to represent approximately forty percent of physicians on staff, making Harlem Hospital the first municipal institution of its kind to embrace the ideal of integration.[6]

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Louis T. Wright and colleagues at patient bedside, Harlem Hospital, New York, N.Y. From left to right: Dr. Lyndon M. Hill, Dr. Louis T. Wright, Dr. Myra Logan, Dr. Aaron Prigot, unidentified African American woman patient, and unidentified hospital employee. Image: Joe Covello (for Black Star), CC-BY SA 3.0

But, while meaningful, the celebration was short-lived. Conflicts soon emerged over who should receive the coveted appointments and whether to transform the hospital into a cutting-edge integrated research facility or an institution dedicated to the training of black personnel.[7] Harlem’s local black medical association, the North Harlem Medical Society, split in two between those supporting and those opposing the hospital administration.[8] Bitter rivalries formed between graduates of black medical programs and those from predominantly white medical schools.[9] Not isolated to Harlem, the conflict also attracted the attention of the national black press, the National Medical Association, and the NAACP. Prominent churches, political leaders, and labor organizations throughout the city got involved as well. Louis Wright became a focal point of contention. A representative of the hospital administration and graduate of Harvard Medical School, opponents labeled him an “Uncle Tom” while supporters characterized the attacks against him as petty envy.[10]

The conflict came to an end in March 1935 when a riot broke out in Harlem. E. Franklin Frazier, a prominent black sociologist, investigated the cause of unrest and determined the hospital’s perpetual discord was a contributing factor.[11] In the years that followed, Harlem’s medical community directed greater public attention toward matters of patient care.

Latent resentment, however, lingered for decades. In 1952, despite an illustrious career, when Wright was nominated for the National Medical Association’s distinguished service award, he received only one vote.[12] Public doubts about black doctors and Harlem Hospital also persisted. Maynard lamented that accepting black doctors onto its staff had the ironic side-effect of diminishing the hospital’s reputation among Harlem residents.[13] Local political figures and New York’s medical community held similar doubts. In 1958, when Martin Luther King, Jr., was taken to Harlem Hospital for emergency care, one nurse in attendance recalled, “a lot of time was wasted while they argued.…They didn’t want to take him to the black hospital.”[14]

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Coretta Scott King in children’s ward of Harlem Hospital with flowers sent to Martin Luther King, Jr., September 1958. Image: Harlem Hospital records, 1887-1962, NYAM Collection.

More than a celebratory centennial, the story of desegregation at Harlem Hospital raises meaningful questions about how best to address the problem of race in medicine. The conflicts that emerged within Harlem’s black medical community were not peculiar racial idiosyncrasies but, rather, emblematic of unresolved tensions evident in the profession at large and unaddressed in the hospital reforms. Desegregation proved not to be a miracle cure but instead led to a renewed call for black doctors to further interrogate the deeply embedded, protean forms of racial exclusion that endured in their profession and American society. Today, it reminds us that even watershed victories require continued vigilance and an unyielding commitment to the pursuit of racial justice.

References

[1] Aubré de L. Maynard, Surgeons to the Poor: The Harlem Hospital Story  (New York: Appleton-Century-Crofts, 1978). 51.

[2] Michael L. Goldstein, “Black Power and the Rise of Bureaucratic Autonomy in New York City Politics: The Case of Harlem Hospital, 1917–1931,” Phylon 41, no. 2 (1980): 191.

[3] Maynard, Surgeons to the Poor: The Harlem Hospital Story: 18-25.

[4] Louis Tompkins Wright. “I Remember….” In Louis T. Wright Papers, Box 130-1, Folder 12. Manuscript Division, Moorland–Spingarn Research Center, Howard University, n. d. p. 93–94; Maynard, Surgeons to the Poor: The Harlem Hospital Story: 23.

[5] Maynard, Surgeons to the Poor: The Harlem Hospital Story: 43.; “Barely Avert Riot at Harlem Hospital,” New York Amsterdam News, 6 July 1927, 1, 2.

[6] “Harlem Hospital Staff Is Reorganized, Giving Place to Nineteen Negro Doctors.” New York Age, 22 February 1930, 1.

[7] Ibid.

[8] “Doctors Quit North Harlem Society to Form New Medical Body; Old Body Repudiated,” New York Age, 24 May 1930, 1, 3.

[9] Maynard, Surgeons to the Poor: The Harlem Hospital Story: 53.

[10] “Plan City Hall March in Fight on Hospital,” New York Amsterdam News, 8 March 1933, 1, 2; Vanessa Northington Gamble, Making a Place for Ourselves: The Black Hospital Movement, 1920–1945 (New York: Oxford University Press, 1995), 58–66.

[11] Charles V. Hamilton, Adam Clayton Powell, Jr.: The Political Biography of an American Dilemma (New York: Cooper Square Press, 2002). 55–63.

[12] W. Montague Cobb, “Louis Tompkins Wright, 1891–1952,” Journal of the National Medical Association 45, no. 2 (1953): 3.

[13] Maynard, Surgeons to the Poor: The Harlem Hospital Story: 81–82.

[14] Ebony Magazine. “[IN MY LIFETIME] Goldie Brangman on Saving Martin Luther King’s Life.” 2016.

How Long Will We Wait? A Recap of Our Latest Race & Health Series Event

This guest post is by Dr. Danielle Laraque-Arena, the 2019 Scholar in Residence at the New York Academy of Medicine. She is the tenured Professor of Pediatrics, Psychiatric & Behavioral Sciences, Public Health & Preventive Medicine at SUNY Upstate Medical University (UMU), the Former President of UMU, and moderated the Race & Health Series event, “How Long Will We Wait? The Desegregation of American Hospitals” on July 10, 2019.

The Race & Health Series, a powerful series of presentations, was initiated early this year, envisioning a more just society, reviewing key lessons of the past, evaluating current status of health equity, and engaging in robust dialogue with the community on the social, economic, and systemic issues that keep all people from enjoying a healthy life. The first presentation in this series reviewed the history of the Tuskegee Syphilis Study and posed the question of whether Tuskegee could happen again. The second presentation, “How Long Will We Wait? The Desegregation of American Hospitals,” was prefaced by a showing of the documentary film, Power to Heal: Medicare and the Civil Rights Revolution, followed by a community-engaged discussion of the implications of the film for our current-day realities.

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The Academy Library displayed archival Harlem Hospital photos in the lobby.

Barbara Berney, Ph.D., M.P.H. produced the documentary film. Dr. Berney, a distinguished scholar in public health, environmental justice and the US healthcare system, joined us from the shores of California. Barbara was joined by Professor Adam Biggs, an American historian from the University of South Carolina. The two scholars spoke to the diverse audience of about 300 people from the Harlem area, New York City, and New York State at large. They took us on a historical journey of the deeply segregated United States of the Jim Crow period. Their focus was on recounting the impact of Jim Crow state and local laws that dictated every aspect of life for black Americans following Reconstruction. During this period, segregation was mandated in all public facilities such as restrooms, restaurants, hotels/motels, schools, and hospitals. Professor Biggs highlighted the period from 1919–1935, focusing on the desegregation of Harlem Hospital. The audience, many of whom work or have worked at Harlem Hospital, were on the edge of their seats for this important discussion.

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The author (left) with panelists Barbara Berney and Adam Biggs.

The background analysis of the Jim Crow period led to a focused discussion regarding the segregation of American hospitals and the dire conditions of health care for black Americans. The response from black physicians, the formation of the National Medical Association, the advocacy efforts of the NAACP, and the force of the conviction of people of conscience throughout the United States led to the partnering of the American government under John F. Kennedy and then Lyndon B. Johnson with activists, to begin to transform the landscape of American life and politics. The palpable national tone of the bitter struggles of the Civil Rights movement—with activities such as voter registration in the southern states that often led to the murders of civil rights activists—was ever real for many who in the audience had lived through those dark days.

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Audience members at the panel discussion respond to the speakers’ powerful remarks.

In fact, among the attendees were individuals such as Phyllis Cunningham and Roger Platt, both of whose efforts were shared in the film. I had the honor of working with both Phyllis (nurse, activist) and Roger (internist, hospital inspector) during my 24 years in the Harlem area, but had renewed respect when I witnessed—as demonstrated in the film—their immense courage during the dangerous times of the 60’s. Others featured in the film included David Satcher, M.D., Ph.D., former U. S. Surgeon General. I had the pleasure of speaking with Dr. Satcher a number of times. He spoke of the achievements of the Civil Rights movement, the passage of Medicare, and the continued aspiration for universal access for all: recognizing that health care is a right and not a privilege.

The film also reviewed the passage of the Civil Rights Act of 1964 and of Medicare in 1965. The intersection of these two landmark events leveraged their collective impact to amplify the message that health care is a human right. At the time of the passage of the Medicare legislation, the persistence of the “separate but equal” effect of Hill-Burton Act, providing for hospital construction, was alive. As Johnson noted, a hammer was needed to propel the desegregation of hospitals, and this was done by having the receipt of federal dollars in support of the care of the elderly be contingent upon desegregation of hospital services. The key lesson was that incremental progress, as had been imperfectly done in education, would not yield the fundamental results needed in health care. Civil rights were to be baked into the administrative process. Desegregation occurred through the brute application of the principle “follow the money.”

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Audience members lined up to ask questions at the end of the discussion.

The two-hour session engaged questions from the audience. Individuals lined up to ask the obvious: How do we learn from the courage of those who achieved so much in the past decades? Does such courage exist today? What was the effect of desegregation on the elimination of health disparities—and by implication, is desegregation sufficient? The importance of history, the importance of courage under fire, and the lifelong commitment to social justice and health justice was clear from the engagement of the audience and the resounding voices of our distinguished panel.

Members and Fellows of the Academy, please follow our blog—and show your strong support for The New York Academy of Medicine by making sure your membership/fellowship dues are paid and up to date. Post a response to this blog and let us know how the Academy can work for you and continue the struggle for social justice and health equity. Thank you!

“Filth is the Arch Enemy of Health”: The Committee on Public Health and Waste Management in New York City

This guest post is by Tina Peabody, 2019 Audrey and William H. Helfand Fellow at the New York Academy of Medicine, and a doctoral candidate in history at the University of Albany, SUNY focusing on the urban environment in the United States. She is currently completing her dissertation entitled “Wretched Refuse: Garbage and the Making of New York City”, a social and economic history of waste management in New York City between the 1880s and 1990s.

The Committee on Public Health at the New York Academy of Medicine is well known for their role in creating the Department of Sanitation in 1929, through the development of the Committee of Twenty on Street and Outdoor Cleanliness. However, the broader Committee’s activism on sanitation has a longer and more complex history. Soon after its formation in 1911, the Committee on Public Health decried the conditions of city streets. They held conferences on sanitation in 1914 and 1915 which included representatives of the Department of Street Cleaning and other municipal departments.[1] While Department of Street Cleaning Commissioner J. T. Fetherston claimed he could not update equipment nor flush streets with water, he nonetheless encouraged the Committee to educate the public about the connections between dirt and disease.[2]  With that in mind, the Committee wrote a report in 1915 which connected the pathogens in street dirt to illness.[3]

Two men hauling garbage into an open refuse truck.

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The Committee of Twenty was particularly concerned about open refuse trucks which could spew dust and debris. Images: Committee of Twenty, Committee on Public Health Archives, New York Academy of Medicine, ca. 1930.

In 1928, a subcommittee called The Committee of Twenty was formed, in part because conditions did not improve substantially after the conferences and report.[4]  Among their recommendations, the Committee of Twenty supported the creation of a unified sanitation agency with full control over street cleanliness.[5]  They envisioned themselves as educators for the Department of Sanitation as well as the public, and they researched the latest collection methods and equipment from Europe to recommend improvements.[6] The newly-created Department of Sanitation, however, resisted investing in the recommended equipment, partially due to the expense.[7] Still, the Committee monitored street conditions, and kept photographic evidence of city and private sanitation trucks spewing dust and debris on the streets or other violations of sanitary ordinances.

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Picture of overflowing refuse cans from the Committee of Twenty. Image: Committee of Twenty, Committee on Public Health Archives, New York Academy of Medicine, ca. 1930.

The Committee of Twenty also educated the public about outdoor cleanliness and especially the connections between dirt and disease. They issued pamphlets warning that “filth is the arch enemy of health,” and urged them to take personal responsibility for clean streets. “Do not put all the blame on the city administration,” one pamphlet read. “This is your city. A clean city means better health, better business; greater happiness for all; respect for law and order.”[8]  Along with educational literature, they placed litter baskets around the city, and posted signs which reminded New Yorkers of sanitary practices like “curbing” dogs.[9]  They also encouraged public participation in solving sanitary problem in novel ways, such as holding a contest for the best litter basket design in 1930.[10] 

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Educational Pamphlet from the Committee of Twenty. Image: Committee of Twenty, Committee on Public Health Archives, New York Academy of Medicine, ca. 1930.

The Committee was also influential in the citywide cleanup effort in preparation for the 1939 New York World’s Fair. Members of the Committee of Twenty and their allies argued that the Fair was the perfect opportunity for improving street cleanliness. Committee members Bernard Sachs and E. H. L. Corwin wrote that New York City was “the ‘Wonder City of the World,’ beyond a doubt; the ‘cleanest city,’ by no means. But we must make it that.”[11]  In line with the idea, Mayor Fiorello LaGuardia declared April 1939 “dress up paint up” month, and launched a broad beautification effort which included removal of litter, dog waste, and even “beggars, vagrants and peddlers.”[12]  Bernard Sachs was the representative for the Committee of Twenty on the Mayor’s Committee on Property Improvement, which was developed for the cleanliness campaign.

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Educational pamphlet from the Committee of Twenty. Image: Committee of Twenty, Committee on Public Health Archives, New York Academy of Medicine, ca. 1930.

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Educational pamphlet from the Committee of Twenty. Image: Committee of Twenty, Committee on Public Health Archives, New York Academy of Medicine, ca. 1930.

In 1950, the Committee on Public Health supported an initiative to introduce alternate side street parking to allow street cleaning unobstructed from parked automobiles, but otherwise was much less active on sanitation issues after the 1939 World’s Fair.[13]  At a meeting with Department of Sanitation Commissioner Andrew Mulrain in 1950, the Committee even debated whether unclean streets actually did cause disease.[14]  One Dr. Lincoln wondered if clean streets were not simply a matter of “public pride.” [15]  Still, the Committee’s early work on outdoor cleanliness would have a lasting legacy, particularly in terms of public education. The Outdoor Cleanliness Association, which was formed shortly after the Committee of Twenty [16], continued their educational work with regular cleanliness drives through the 1950s and 1960s in coordination with the Sanitation and Police departments.

References

 [1] “Minutes of the Meeting of the Public Health, Hospital, and Budget Committee October 26, 1914,” The Public Health Committee of the New York Academy of Medicine Minutes 1914–1915 (New York, NY), 74; “Minutes of the Meeting of the Public Health, Hospital, and Budget Committee Conference on Street Cleaning May 7, 1915,” The Public Health Committee of the New York Academy of Medicine Minutes 1914–1915 (New York, NY), 153–55.

[2] “Minutes of the Meeting of the Public Health, Hospital, and Budget Committee,” November 16, 1914, The Public Health Committee of the New York Academy of Medicine Minutes 1914–1915 (New York, NY), 84–85; “Minutes of the Meeting of the Public Health, Hospital, and Budget Committee Conference on Street Cleaning May 7, 1915,” The Public Health Committee of the New York Academy of Medicine Minutes 1914–1915 (New York, NY), 153-54 .

[3] Committee on Public Health, “Thirty Years in Community Service 1911–1941: A Brief Outline of the Work of the Committee on Public Health Relations of the New York Academy of Medicine” (The New York Academy of Medicine, 1941), 79.

[4] Committee on Public Health, “Thirty Years in Community Service 1911–1941,” 80.

[5] “Minutes of the Meeting of the Executive Committee of the Committee on Public Health Relations,” May 14, 1928, The Public Health Committee of the New York Academy of Medicine Minutes 1927–1928 (New York, NY), 134; Committee on Public Health, “Thirty Years in Community Service 1911–1941: A Brief Outline of the Work of the Committee on Public Health Relations of the New York Academy of Medicine,” 10.

[6] Committee on Public Health, “Thirty Years in Community Service 1911–1941,” 80.

[7] Committee on Public Health, “Memorandum of a Conference between Dr. William Schroeder, Jr., Chairman, Sanitary Commission…..May 19, 1931,” 1–4, Committee on Public Health Archives, Box 4, Folder 50c.

[8] Committee of Twenty on Street and Outdoor Cleanliness, “Why Clean Streets? Because Filth Is the Arch Enemy of Health” (New York Academy of Medicine, n.d.), Special Collections, New York Academy of Medicine Library.

[9] Committee on Public Health, “Thirty Years in Community Service 1911–1941: A Brief Outline of the Work of the Committee on Public Health Relations of the New York Academy of Medicine,” 80.

[10] Committee of Twenty on Street and Outdoor Cleanliness, “Prize Contest for the Design of a Litter Basket For New York City” (New York Academy of Medicine, n.d.), Special Collections, New York Academy of Medicine Library.

[11] Bernard Sachs and E. H. L. Corwin, “Fair Offers Opportunity: City Is Urged to Institute a Program of Outdoor Cleanliness,” New York Times, July 4, 1938.

[12] Marshall Sprague, “Clean City for Fair: Public and Private Groups Hard at Work Dressing Up New York for April, 1939 Mayor Is Enthusiastic Keeping Waters Pure Refurbishing Statues Beautification Drives,” New York Times, September 18, 1938; Elizabeth La Hines, “Drive Is Begun For a Tidy City During the Fair: Outdoor Cleanliness Group to Ask Wide Aid in Fight on Sidewalk Rubbish One Nuisance Abated Aid Through New Equipment Model for Other Cities,” New York Times, April 9, 1939.

[13] Committee on Public Health, “Pioneering in Public Health for Fifty Years” (The New York Academy of Medicine, 1961), 62.

[14]  “Minutes of the Meeting of the Subcommittee on Street Sanitation,” June 21, 1950, The Public Health Committee of the New York Academy of Medicine Minutes 1949–1950 (New York (N.Y.)), 473.

[15]  Ibid.

[16]  George A. Soper, “Attacking the Problem of Litter in New York,” New York Times, November 5, 1933.

 

 

 

 

 

The Medical Journals of U.S.-Occupied Haiti

This guest post is by Matthew Davidson, a doctoral candidate at the University of Miami and the 2019 Paul Klemperer Fellow at the New York Academy of Medicine. His research examines public health in Haiti during the 1915-1934 U.S. occupation.

During the nineteen years of the early twentieth century that the United States occupied Haiti (1915-1934), U.S. officials liked to claim that they had brought modern medical thought to the Caribbean country. Their contention was bunk, but it apparently felt very real when the Haitian physician, Dr. François Dalencour, received a letter from a French colleague asking for copies of any Haitian medical publications. “I was ashamed,” Dalencour later wrote, “of being obliged to tell the truth, to say that there were none. [i] He would have been able to send along reports authored by the occupation medical service, but there was apparently nothing current otherwise. Haiti, Dalencour decided, needed a medical journal.

Soon after, he established one.

LeJournalMedicalHaitien_May1920_1_watermark

The first issue of Le Journal Médical Haïtien (NYAM). 

The occupation, it turns out, was indeed an important period for Haitian medical thought. As was the case in other fields, it provoked a flurry of intellectual production. Consequently, whereas doctors such as Dalencour lamented the lack of Haitian medical publications at the start, by the end the local medical establishment could boast of several. U.S. officials claimed this was a sign of how far medicine in Haiti had “progressed” under their tutelage, but it was truly more the product of Haiti’s own medical tradition. [ii] Meant to advance medical practice and public health policy, the journals provided a forum for Haitian practitioners to debate and discuss all sorts of matters related to health and medicine in the country.

Dalencour’s periodical, Le Journal Médical Haïtien, was arguably the most important of the occupation-era publications. Not only was it the first, founded in May 1920, but it also did the most to open up space for the Haitian medical profession to articulate ideas and positions about their field. With U.S. personnel otherwise completely dominating all aspects of medicine and public health in Haiti, Le Journal Médical Haïtien was the only venue (outside of individual private practices) actually controlled by Haitians. It accordingly brought together “all members of the Haitian Medical Corps, without any distinction”: doctors, pharmacists, dentists and midwives. [iii] In doing so, the journal bridged longstanding divisions within the medical corps and laid the foundation for further independent initiative.

As Le Journal Médical Haïtien facilitated the reorganization of the Haitian medical profession, it also laid bare the lie that the occupation brought medical modernity to the country. After all, it was not because the U.S. introduced “scientific medicine” or any other set of ideas to Haiti that the journal appeared. Rather, it had its genesis in the pre-occupation period. As Dalencour wrote in the first issue, the project was first conceived in 1903. He was still a medical student at the time, so establishing a journal for medical reform was a “somewhat pretentious idea.” [iv] Nonetheless, it was then, well before the Americans landed, that the first steps were taken to establish a “general review of the medical movement in Haiti” (as Le Journal Médical Haïtien was later billed). The principles laid out by Dalencour and his collaborators in 1920 were even the same as those declared in 1903. All that had changed was the name. Dalencour had originally chosen the title Haïti Médicale, but – further reflecting the strength of Haiti’s pre-occupation medical and intellectual traditions – another journal had taken that name in 1910. [v]

The next to emerge was Les Annales de Médecine Haïtienne. Established in 1923 by two young doctors, Drs. N. St. Louis and F. Coicou, Les Annales was associated with a newly reorganized union, le Syndicat des Médecins. Much more oppositional in outlook, the journal was conceived as an “organ for the expansion of medicine in Haiti and for the defense of the interests of the medical corps.” [vi] Explicitly anti-occupation, it actively contested the U.S. health project in Haiti and worked to organize Haitian doctors against it under the auspices of le Syndicat des Médecins. It was not merely a political publication, though, for it also carried articles dedicated to public health education and research in the medical sciences. Over time, such articles became more and more prominent, and as the occupation ended Les Annales de Médecine Haïtienne essentially transitioned to purely scientific journal. U.S. medical sciences, however, continued to be received coolly.

LesAnnalesDeMedecineHaitienne

May-June 1932 issue of Les Annales de Médecine Haïtienne (Schomburg Center, NYPL).

The last of the occupation-era publications was the only one that owed its existence to the occupation health project. The Bulletin de la Société de Médecine d’Haïti, founded with that society in 1927, was the sole journal fostered by U.S. officials, and it was the only one to have U.S. practitioners on its editorial board or to publish articles authored by occupation doctors. The society itself was organized and controlled by the occupation health service, the Service d’Hygiène. Accordingly, most independent doctors (i.e., those not directly employed by the Service d’Hygiène) tended to find the Société “too American” and remained outside of it. [vii] Nonetheless, the Bulletin was more than just an American journal based in Haiti.

BulletinDeLASocieteDeMedecineDHaiti_Jan1927_1_watermark

The first issue of the Bulletin de la Société de Médecine d’Haïti (NYAM).

The Bulletin de la Société de Médecine d’Haïti was an important register for the medical sciences in Haiti. From 1927 until the end of the occupation, it published an impressive array of scholarship, much of it by Haitian practitioners. With an emphasis on medical specialization, it tended to be more concerned with the medical sciences than with public health policy or practice, and it accordingly developed a reputation for being the most scientific of the journals. As a project, however, the Bulletin mostly just brought to fruition ideas and proposals first put forth in the pages of Le Journal Médical Haïtien (or by the 1890 Société de Médecine de Port-au-Prince before that). In form as much as in content, then, the Bulletin was as Haitian as it was American. Consequently, when the American editors shuttered the journal in 1934 with the end of the occupation, the Haitian medical establishment remained committed to the project: it lived on as the Bulletin du Service d’Hygiene et d’Assistance Publique – Medicale et Sanitaire.

BulletinDuServiceDHygieneEtDAssistancePublique_Jun1934_1_watermark

The first issue of the Bulletin du Service d’Hygiene et d’Assistance Publique – Medicale et Sanitaire (NYAM).

Each of these journals have largely been overlooked by historians, despite being incredibly rich sources. With their debates about public health policy, research on various health matters, clinical notes, correspondence between doctors and medical officials, translated articles from abroad, social commentary, and more, they offer significant insight into the state of medical care and the politics of health during the occupation. They would also be of interest to anyone thinking about Haitian social and intellectual history more generally. Few copies of each journal still exist, but they – with the exception of Les Annales – can be found at the New York Academy of Medicine library.

References

[i] Dalencour, François, « En Manière de Programme. » Le Journal Médical Haïtien (Première Année, No. 1, May, 1920; New York Academy of Medicine Library).

[ii] See, for instance, Parsons, Robert P., History of Haitian Medicine (New York: Paul B. Hoeber Inc., 1930).

[iii] Dalencour, François, « En Manière de Programme. » Le Journal Médical Haïtien (Première Année, No. 1, May, 1920; New York Academy of Medicine Library).

[iv] Dalencour, François, « En Manière de Programme. » Le Journal Médical Haïtien (Première Année, No. 1, May, 1920; New York Academy of Medicine Library).

[v] Haïti Médicale was published from 1910-1913, and then was briefly revived again in 1920.

[vi] Les Annales de Médecine Haitienne (9eme Année, No. 3 &4, Mars-Avril 1932; Schomburg Center for Research in Black Culture, New York Public Library).

[vii] Bordes, Ary, Haïti Médecine et Santé Publique sous l’Occupation Américaine, 1915-1934 (Haiti: Imprimerie Deschamps, 1992), 300.

Death, Deformity, Decay: Memento Mori and the Case of the Colloredo Twins

This guest post is by Rach Klein. Rach is an art history Masters Candidate at McGill University whose research focuses on the early modern grotesque, medical illustration, and print. She is a current recipient of a Joseph-Armand Bombardier grant, as well as a Michael Smith Foreign Studies scholarship.

Throughout the last month I have had the privilege of working in the NYAM Library, looking directly at their remarkable collection of broadsheets and rare books.  The opportunity to closely examine the objects and images that I am studying is unparalleled. My research locates a framework for viewing 17th-century non-normative and “freakish” bodies in the memento mori traditions of the previous century. Memento mori, a Latin phrase meaning, “remember you will die,” became shorthand for a host of visual imagery and cultural objects rooted in medieval Christian theory, which permeated the European early modern.  With a specific focus on the culture of spectacle employed by early modern “shows of wonder” and touring freak shows, the research that I have been doing at NYAM combines visual analysis with medical history and disability studies to suggest that integral to the creation of early modern “freaks” is a manipulation of non-normative persons into objects that spark mortuary contemplation. Guiding this research is the case of Italian conjoined/parasitic twins Lazarus Colloredo and Joannes Baptista Colloredo (1617–1646). Their journey, which is remarkably well-documented in both text and image (for example, see Fig. 1), showcases the duality of the so-called “freak body” and its links to mortuary philosophy.

Historia Ænigmatica, de gemellis Genoæ connati

Fig. 1. Mylbourne, R. (Publisher). (1637). Historia Ænigmatica, de gemellis Genoæ connatis, [Engraving]. © The Trustees of the British Museum. Licensed under CC-BY-NC-SA 4.0.

In 1617, Lazarus and Joannes Baptista Colloredo were born into a life of spectacle and uncertainty. Protruding laterally from the breast of Lazarus was his twin brother, Joannes Baptista, whose malformed body lived partially inside him. Unable to speak or move independently, Joannes Baptista was deemed a “parasitic twin”.  As living persons that defy expectations of the “normative,” visual documentation of the Colloredo twins’ spectacular bodies/body provides insight into anxieties about the boundaries between animate/inanimate, normal/abnormal, beauty/ugliness, soul/body, and, ultimately, life/death. Jan Bondeson calls attention to how remarkable their story is, even within the history of conjoined twins. He says:

Conjoined twins are the result of imperfect splitting of a fertilized ovum and the site of conjunction depends on which part of the splitting has not occurred. Lazarus and Joannes Baptista Collerado represent one of the very few convincing cases of viable omphalopagus parasiticus twins (who lived).[1]

The words in parentheses here, “who lived,” iterate the challenges of piecing together a history of marginalized persons such as those who are disabled and deformed, and the gentle surprise provoked by the twins’ survival.

Perhaps the most interesting discovery found throughout my research is the nonlinear timeline in scholarship about these twins due to a misattributed/incorrectly labelled print from Giovanni Battista de’Cavalieri’s series of engravings, Opera nel a quale vie molti Mostri de tute le parti del mondo antichi et Moderni (Monsters from all parts of the ancient and modern world), published in 1585 (Fig. 2). This image, which is reprinted in Fortunio Liceti’s 1634 De Monstrorum Caussis (Fig. 3), is captioned with the twins’ names and place of birth, despite having been created thirty-years prior to their birth. As with many “freakish” bodies, the accuracy of their experience exists separately from its visual history.[2]

Although these contradictions of dates and attributions make reproducing a clean narrative difficult, they reflect a larger theme of teratology: that bodies are detached from persons, and imaginative ideals misaligned from lived experience. The image by de’ Cavalieri was likely a representation of an earlier set of conjoined twins in the 16th century, perhaps based on conjoined twins mentioned by Ambrose Paré in 1530. This image is subsequently reproduced in Liceti’s 1665 edition of his work, now titled De Monstris. Hence, the twins’ image has been collapsed into a narrative that took place well before their birth, and which frames them as simultaneously alive and dead.

 

Liceti_DeMonstrorumCaussis_1634_117_watermark

Fig. 3. Liceti, F. (1634). [Rueffo puer Amiterni natus uno brachio, fed pedibus tribus in hanc effigiem] (p. 117). De monstrorum caussis, natura, et differentiis libri duo … Padua, Italy: Apud Paulum Frambottum.

Worries and uncertainties over death and the body make themselves known in images and stories documenting the “freakish” body. Art that has been traditionally deemed “grotesque,” “macabre,” or more colloquially, simply “disturbing” is part of a symbolic system that expresses metaphysical anxieties about what lurks beneath the surface of the body. I am not attempting to medicalize nor romanticize the history of those who are or have been designated as disabled, deformed, monstrous, and freakish. Rather, my aim is to provide a critical and historical study of how non-normative bodies have been catalogued as a memento mori for its witnesses and used by able-bodied viewers as tools of self-reflection and meditation, a practice that actively erases personhood in favour of objectification.[3]

References

[1] Bondeson, Jan. The Two-headed Boy: And Other Medical Marvels. Ithaca, NY: Cornell University Press, 2000.

[2] Jillings, Karen. “Monstrosity as Spectacle: The Two Inseparable Brothers’ European Tour of the 1630s and 1640s.” Popular Entertainment Studies 2, no. 1 (2011): 54–68.

[3] My work is particularly indebted to the disability, feminist, and race scholarship of Tobin Siebers (Disability Aesthetics), Rana Hogarth (Medicalizing Blackness: Making Racial Difference in the Atlantic World, 1780-1840), and Elizabeth Grosz (Volatile Bodies).

Further Reading

Bates, A. W., Emblematic Monsters: Unnatural Conceptions and Deformed Births in Early Modern Europe. Amsterdam: Rodopi, 2009.

Benedict, Barbara M. Curiosity: A Cultural History of Early Modern Inquiry. Chicago, IL: University of Chicago Press, 2002.

Daston, Lorraine, and Katharine Park. Wonders and the Order of Nature, 1150-1750. New York: Zone Books, 2012.

Thomson, Rosemarie Garland. Freakery: Cultural Spectacles of the Extraordinary Body. New York: New York University Press, 2008.

Remembering the Syphilis Study in Tuskegee

This guest post is by Dr. Susan Reverby, the Marion Butler McLean Professor Emerita in the History of Ideas and Professor Emerita of Women’s and Gender Studies at Wellesley College. This year she is a fellow at the Project on Race and Gender in Science and Medicine at the Hutchins Institute for African and African American Research at Harvard University. Reverby is most recently the author of the multiple prize winning book, Examining Tuskegee: The Infamous Syphilis Study and its Legacy and the historian whose work on immoral U.S. led research in Guatemala in the late 1940s led to a federal apology in 2010. She is currently completing her latest book, The Revolutionary Life of Brother Doc: A 20th Century White Man’s Tale (University of North Carolina Press, 2020).

Conspiracy theories and myths, medical and otherwise, often reflect ways to cope with racism in its multiple nefarious forms.   Many such tales focus on destruction of the black body: from the fears that Church’s chicken, now Popeye’s, put something in their frying that caused Black men to become sterile to the beliefs in South Africa that the HIV virus was spread by false vaccinations funded by the C.I.A. and British intelligence. Did you hear the one about the U.S. government letting hundreds of black men in and around Tuskegee, Alabama with syphilis not get to treatment that went on for four decades between 1932 and 1972?  Or that the government actually gave the men the syphilis and you can see it in the photographs, especially if you cannot differentiate between a blood draw and an injection?

Photograph of Participant in the Tuskegee Syphilis Study

Centers for Disease Control: Venereal Disease Branch. (ca. 1953). Photograph of Participant in the Tuskegee Syphilis Study. Image from https://catalog.archives.gov/id/824612

Only the fact that the government tried to make sure the men who already had late latent syphilis did not get treatment for forty years is true among these tales, and horrendous enough. Now we have to consider the meaning given to this Study over the nearly fifty years since it became widespread public knowledge.

The exposure of the Study came at the end of the modern Civil Rights era and after the medical community was beginning to acknowledge that even the “good guys” did immoral work. Along with the unethical studies at Willowbrook [1] and the Jewish Chronic Disease Hospital [2], the experiment in Tuskegee led to the federal Belmont Report [3] and the modern era of institutional review boards and regulations surrounding informed consent.

Kenan Thompson Hugh Laurie

King, D. R. (Director).  (2006, October 28). Modern Medicine: Hugh Laurie/Beck [Television series episode].  In L. Michaels (Producer), Saturday Night Live. New York, NY: NBC.

For many in the health care community and general public the words “Tuskegee” became symbolic of racism in medical research and care, making its way into popular culture in songs, plays, poems, rap, and cultural imagination.   In 2006, Hugh Laurie (T.V.’s irascible Dr. House) hosted Saturday Night Live and played the wife in a skit with patient Kenan Thompson. When the doctor offers care to Thompson, Laurie and Thompson both look at one another and yell “We know what this is: Tuskegee, Tuskegee, Tuskegee.” Others have done academic studies that prove and disprove that it is the memory of Tuskegee that keeps African American patients from seeking care or participating in research trials.  What we do know is that the subtle, and not so subtle, forms of racism create an aura of distrust that affects the kind of health care African Americans both seek and receive whether they know the details of what happened half a century ago or not.

So can there be another Tuskegee?  If by this question we mean the misrepresentation in informed consent, the danger of scientific hubris, and the misuse of patients of color:  probably in some form. Just as importantly, we need to ask what meaning is given to these experiences once they become public? How can the health care and public health communities create what historian Vanessa Northington Gamble calls “trustworthiness.”  It is the meaning of the study in Tuskegee that needs to be assessed, taught and considered. For it is this meaning that reverberates long after the men caught in its grasp wandered in the medical desert for 40 years, and long after any knowledge of its facts actually fade.

Join Susan Reverby along with moderator Aletha Maybank and Monique Guishard for our panel on February 26th, Could Tuskegee Happen Today?, addressing the history and legacy of the study and why it remains relevant today.

Footnotes

[1] J.D. Howell, R.A.Haywood, “Writing Willowbrook, Reading Willowbrook: The Recounting of a Medical Experiment. In: J. Goodman, A. McElligott and L. Marks, eds. Using Bodies: Humans in the Service of Medical Science in the 20th Century (Baltimore: Johns Hopkins University Press, 2003), pp. 190-213.

[2] Barron H. Lerner, “Sins of Omission—Cancer Research without Informed Consent,” New England Journal of Medicine 351 (2004): 628-630.

[3] Office of the Secretary, The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research, April 18, 1979.

Looking Out for the Health of the Nation: The History of the U.S. Surgeon General

By Judith Salerno M.D., M.S., President; and Paul Theerman, Ph.D., Director of the Library

It is widely recognized that the role of the U.S. Surgeon General is to set the national agenda for health and wellness. In describing the position, the Surgeon General’s website states that: “As the Nation’s Doctor, the Surgeon General provides Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury.”

The position, and the role of today’s U.S. Public Health Service, evolved from very modest beginnings. The story begins in 1798, during President John Adams’ term, with the passage of a law that created a fund to provide medical services for merchant seamen. The following year military seamen were included as well, with the cost of their care paid through a deduction from the seamen’s wages. Over the next 60 years, the government built hospitals in the country’s seaports and river ports.

Fast forward to the Civil War, in the course of which the Federal marine hospitals almost ceased to function. In the aftermath of the War, the Marine Hospital Service was established in 1870 to revitalize them as a national hospital system. Administration was centralized under a medical officer, the Supervising Surgeon, who was later given the title of Surgeon General. The first Supervising Surgeon, Dr. John Woodworth, set about creating a corps of medical personnel to run the Marine Hospital Service. In 1889, Congress officially recognized this new personnel system by formally authorizing the creation of the Commissioned Corps. These public health workers, all of whom initially were physicians, were organized along military lines, with the Surgeon General as their leader. The Surgeon General was given a rank equivalent to a three-star Admiral.

MarineHospital_StatenIsland

“Aerial View U.S. Marine Hospital Stapleton, Staten Island, N.Y.” From the collection of Dr. Robert Matz, New York Academy of Medicine Library.

In the decades following the Civil War, the federal government began to assume many duties and responsibilities that heretofore had been undertaken by the states. The Marine Hospital Service took over the administration of quarantines and the health inspection of immigrants. It established a bacteriological lab on Staten Island (the “Hygienic Laboratory”) to better understand infectious diseases, and it ran a hospital on Ellis Island. The Service also coordinated state health efforts and standardized and published health statistics. In 1878, it began the publication of Public Health Reports (the official journal of the U.S. Surgeon General and the U.S. Public Health Service).

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“Doctor’s Examination.” From Quarantine Sketches.

At the turn of the previous century, as part of the progressive era reforms, the Service was given responsibility for controlling the quality of newly developed vaccines. And in 1912, the Service was given a new name—the U.S. Public Health Service (USPHS). Its mission was to:

“Investigate the diseases of man and conditions influencing the propagation and spread thereof, including sanitation and sewage and the pollution either directly or indirectly of the navigable streams and lakes of the United States.”

Throughout the first half of the 20th century, the Public Health Service took on an increasingly important role. Its staff grappled with the Spanish Flu Pandemic of 1918 and, for a time, it attended to the needs of injured veterans who were returning from World War I. It also undertook research into endemic diseases. For example, a USPHS physician, Dr. Joseph McMullen, did pioneering work in controlling trachoma (an infectious eye disease) and another USPHS doctor, Joseph Goldberger, made the discovery that a dietary deficiency causes pellagra.

The Service set up hospitals for the treatment of narcotics addiction in Lexington, Kentucky, and Fort Worth, Texas. Its efforts to control malaria in the American South led to the establishment of the Centers for Disease Control and Prevention, and the move of the Hygienic Laboratory from New York to Washington was the precursor to the establishment of the National Institutes of Health. USPHS also assumed responsibility for providing medical services to Native Americans and federal prisoners and, regrettably, it also oversaw shameful medical experiments in Tuskegee, Alabama, and in Guatemala.

From the 1930s onward, the role of the Surgeon General became more and more public. In 1964, Surgeon General Dr. Luther Terry took the campaign against tobacco use to the American public with the publication of Smoking and Health. This led in due course to major changes in the way cigarettes were advertised and eventually to tobacco regulation.

Prior to 1968, the Surgeon General was the head of the USPHS and all administrative, program, and financial responsibilities ran through this office, with the Surgeon General directly reporting to the Secretary of Health, Education and Welfare (HEW). Following a departmental reorganization that year, the USPHS’s responsibilities were delegated to HEW’s Assistant Secretary for Health (ASH) and the Surgeon General became a principal deputy and advisor to the ASH. In 1987, the Office of the Surgeon General was reestablished and the Surgeon General again became responsible for managing the Commissioned Corps.

Over the past 40 years, the Surgeon General has increasingly become the public face of health for the country. In the 1980s, Dr. C. Everett Koop made information about AIDS available to every American—in the form of an unprecedented direct mail campaign—as he sought to frame the disease as a public health threat demanding public health measures. In recent years, the Surgeons General have sought to publicize and address disparities in health care and outcomes among the nation’s increasingly diverse population. As the Commissioned Corps itself has become more diverse, so too have those holding the position of Surgeon General, with the appointment of the first female, African American, and Hispanic Surgeons General.

The New York Academy of Medicine was honored to host four illustrious former U.S. Surgeons General, Drs. Joycelyn Elders, David Satcher, Antonia Novello, and Richard Carmona, in conversation with Dr. Freda Lewis-Hall on October 15. They shared their reflections on what it takes to ensure the health of the nation. Above they are exploring with Curator Anne Garner our current exhibition on public health, “Germ City: Microbes and the Metropolis,” co-curated with the Museum of the City of New York, on view through April 2019.

References:
Parascandola, John. “Public Health Service,” in A Historical Guide to the U.S. Government, ed. George Thomas Kurian (New York: Oxford University Press, 1998), pp. 487–93.
Quarantine sketches : glimpses of America’s threshold. New York: Maltine Co., 1903.
 “The Reports of the Surgeon General,” Profiles in Science, https://profiles.nlm.nih.gov/NN/, accessed September 14, 2018.

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The First Yellow Fever Pandemic: Slavery and Its Consequences

Today’s guest post is by Billy G. Smith, Distinguished Professor in the Department of History, Philosophy, and Religious Studies at Montana State University. He earned his PhD at University of California Los Angeles. His research interests include disease; race, class and slavery; early America, and mapping early America.

Bird flu, SARS, Marburg, Ebola, HIV, West Nile Fever.  One of these diseases, or another, that spread from animals and mosquitoes to humans may soon kill most people on the planet.  More likely, the great majority of us will survive such a world-wide pandemic, and even now we have a heightened awareness that another one may be on the horizon.  This blog focuses on these issues in the past, outlining a virtually unknown voyage of death and disease that transformed the communities and nations bordering the Atlantic Ocean (what historians now refer to as the Atlantic World).  It traces the journey of a sailing ship that inadvertently instigated an epidemiological tragedy, thereby transforming North America, Europe, Africa, and the Caribbean islands.  This ship helped to create the first yellow fever pandemic.

1-Hankey

The Hankey. From “Ship of Death: The Voyage that Changed the Atlantic World.”

In 1792, the Hankey and two other ships carried nearly three hundred idealistic antislavery British radicals to Bolama, an island off the coast of West Africa, where they hoped to establish a colony designed to undermine the Atlantic slave trade by hiring rather than enslaving Africans.  Poor planning and tropical diseases, especially a particularly virulent strain of yellow fever likely contracted from the island’s numerous monkeys (through a mosquito vector), decimated the colonists and turned the enterprise into a tragic farce.

1-Bulama

 From “Ship of Death: The Voyage that Changed the Atlantic World.”

In early 1793, after most colonists had died and survivors had met resistance from the indigenous Bijagos for invading their lands, the Hankey attempted to return to Britain.  Disease-ridden, lacking healthy sailors, and fearing interception by hostile French ships, the colonists caught the trade winds to Grenada.  They and the mosquitoes in the water barrels spread yellow fever in that port and, very soon, throughout the West Indies.  This was only a few months before the British arrived to quell the slave rebellion in St. Domingue (now Haiti).  The British and subsequently the French military had their troops decimated by the disease—one reason why the slave revolution succeeded.  The crushing defeat in the Caribbean helped convince Napoleon to sell the vast Louisiana territory to the United States.  He turned eastward to expand his empire, altering the future of Europe and the Americas.

A few months after the Hankey arrived in the West Indies, commercial and refugee ships carried passengers and mosquitoes infected with yellow fever to Philadelphia, the nation’s capital during the 1790s.  The resulting epidemic killed five thousand people and forced tens of thousands of residents, including George Washington, Thomas Jefferson, and other prominent federal government leaders, to flee for their lives.  The state, city, and federal government all collapsed, leaving it to individual citizens to save the nation’s capital.  Meanwhile, doctors fiercely debated whether “Bulama fever” (as many called it) was a “new” disease or a more virulent strain of yellow fever common in the West Indies.  Physicians like the noted Benjamin Rush fiercely debated the causes of and treatment for the disease.  They mostly bled and purged their patients, at times causing more harm than good because of the rudimentary state of medicine.

Among those who stepped forward to aid people and save the city were members of the newly emerging community of free African Americans. Led by Absalom Jones, Richard Allen, and Anne Saville, black Philadelphians volunteered to nurse the sick and bury the dead—both dangerous undertakings at the time.  Many African Americans and physicians, exposed to yellow-fever infected mosquitoes, made the ultimate sacrifice as both groups died in disproportionately high numbers.  When a newspaper editor subsequently maligned black people for their efforts, Jones and Allen wrote a vigorous response—among the first publications by African Americans in the new nation.

A Refutation_internetarchive

For one of the first times in American history, blacks responded in print; Revd.s Allen and Jones published a pamphlet answering the charges; Courtesy of the Internet Archive.

During the ensuing decade, yellow fever went global, afflicting every port city in the new nation on an annual basis.  Epidemics also occurred in metropolitan areas throughout the Atlantic World, including North and South America, the Caribbean, southern Europe, and Africa.  Among other consequences, this disaster encouraged Americans to fear cities as hubs of death.  The future of the United States, as Thomas Jefferson argued, would be rural areas populated by yeomen farmers rather than the people in teeming metropolises.  The epidemics also helped solidify the decision of leaders of the new nation to move its capital to Washington D.C. and away from the high mortality associated with Philadelphia.

After the Hankey finally limped home to Britain, its crew was taken into service in the Royal Navy; few of them survived long.  More importantly, the image of Africa as the “white man’s graveyard” became even more established in Britain and France, thereby providing a partially protective barrier for Africa from European invasion until the advent of tropical medicine.  The “Bulama fever” plagued the Atlantic World for the next half century, appearing in epidemic form from Spain to Africa to North and South America.  The origins and treatment of the disease drew intense debates as medical treatment became highly politicized, and the incorrect idea that Africans enjoyed immunity to yellow fever became an important part of the scientific justification of racism in the early nineteenth century.

Join Billy Smith along with epidemiologist Michael Levy on October 24 for Sickness and the City for a conversation that uses both science and history to understand the intersection of urban development and the spread of contagions.

References
Billy G. Smith. Ship of Death: The Voyage that Changed the Atlantic World. New Haven, CT: Yale University Press, 2013.