Robert L. Dickinson: Doctor and Artist

Today’s guest post is written by Rose Holz, Ph.D., historian of medicine and sexuality at the University of Nebraska – Lincoln where she serves as the Associate Director of the Women’s & Gender Studies Program and Director of Humanities in Medicine.  She is the author of The Birth Control Clinic in a Marketplace World (Rochester, 2012). Her current project investigates the intersection of medicine and art by way Dr. Robert L. Dickinson (1861-1950) — gynecologist, sexologist, and artist extraordinaire — and his prolific ten-year collaboration with fellow artist Abram Belskie (1907-1988). Not only did it yield in 1939 the hugely influential Birth Series sculptures but also hundreds of medical teaching models about women’s and men’s sexual anatomies. On Thursday, April 13, Rose will give her talk, “Art in the Service of Medical Education: The Robert L. Dickinson-Belskie Birth Series and the Use of Sculpture to Teach the Process of Human Development from Fertilization Through Delivery.” To read more about this lecture and to register, go HERE.

My interest in Dr. Robert L. Dickinson began many years ago when I was in graduate school, working on my Ph.D. in history and writing my dissertation on the history of birth control clinics in America. And, as has been the case with so many other scholars who have written about matters related to women, medicine, and sexuality in the twentieth century U.S., Dickinson made his brief cameo entrance into my story, though not without leaving behind a lasting impression.

For me it was the images — because, like me, Dickinson was compelled to color and draw. Early on, while pouring over Planned Parenthood records, I remember chuckling over a letter he had written to a contraceptive manufacturer complaining about the poor quality of one of their products, to which he then attached a drawing to illustrate his case.

Then there were the birth control manuals Dickinson wrote in the 1930s. Not only did he illustrate all the contraceptive methods then available, but he also offered birds-eye-view, architectural-style drawings to visualize how best to lay out gynecological clinics. More intriguingly still was what he included at the center of this architectural drawing, a tiny woman lying on the gynecological table with her legs spread wide open as the doctor conducted the physical exam.

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Pages from “Control of Contraception (2nd edition)” by Robert L. Dickinson.

As somebody who also loves small things—especially miniature worlds populated by miniature people—I could not help but find myself be smitten by this unusual man. However, at the time I had a different story to tell, a Ph.D. to defend, and a new job as a professor to pursue. And as the years passed, Dickinson slowly receded into the background.

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Drawings of the location of Embryo and size of Fetus. Source.

But Dickinson is not one to be denied, and that he has remained in obscurity for so long somehow explains to me why he has resurfaced—with a glorious vengeance—into my imagination. Indeed, he has made it clear to me that his story will be told; his skills as a doctor and artist properly recognized. And he has made it further clear that this story will begin with what he created in the twilight of his life: The 1939 Birth Series sculptures.

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Dickinson and Belskie’s “Sculptured Teaching Models Collection.” From the unprocessed Abram Belskie Papers, Belskie Museum, Closter, NJ.

Join us on Thursday, April 13 to learn more about Dr. Robert L. Dickinson and his Birth Series sculptures. To RSVP to this free lecture, click HERE.

War Wounded

Paul Theerman, Associate Director

On April 6, 1917, the United States entered the Great War on the side of the Allied powers. By the following fall, those powers were victorious, in part due to the American presence, adding industrial might and men to the stalled conflict and making up for the Russian withdrawal after the October Revolution.

Combat is the most vivid part of war. Victory often depends, however, on maintaining the military effort, and this meant mobilization, training, logistics, supply, and above all, the “medical front.” Armies had to take the wounded soldier, help him heal, and return him to battle. For World War I, that front was where men’s wounds met the medical machine.

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From a training book for stretcher bearers. Image source.

How were men wounded in the war? The strain and the boredom of trench warfare are part of our collective memory; the drama of that war comes from two sources: mustard gas and machine guns. The use of chemical weapons and the mechanization of shooting brought horror to men’s lives at the front. Yet they were not the greatest source of casualties. By far, artillery was the biggest killer in World War I, and provided the greatest source of war wounded.

In his book Trench: A History of Trench Warfare on the Western Front (2010), Stephen Bull concluded that in the western front, artillery was the biggest killer, responsible for “two-thirds of all deaths and injuries on the Western Front.”[1] Of this total, perhaps a third resulted in death, two-thirds in injuries. Artillery wounded the whole body. If not entirely obliterated, the body was often dismembered, losing arms, legs, ears, noses, and even faces. Even when there was not superficial damage, concussive injuries and “shell shock” put many men out of action. Of course, shooting—in combat as well as from snipers—was another great source of wounding. Gas attacks were a third. Phosgene, chlorine, mustard gas, and tear gas debilitated more than killed, though many ended up suffering long-term disability. Overall the war claimed about 10 million military dead, and about 20–21 million military wounded, with perhaps 5% of those wounds life-debilitating, that is, about a million persons.[2]

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Moving the wounded. Image source.

Outcomes depended on getting treatment quickly. Evacuation and triage became watchwords of the war-wounded. For the British Army, for example, the Royal Army Medical Corps developed an extensive system to move the wounded from the front to the rear, with triage at each step. Stretcher bearers evacuated the wounded to Regimental Aid Posts (RAP)—or at least those that they had the means to move, for when stretcher-bearers were few, the worst cases were left on the field of battle.

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The path from the front to the hospital. Image source.

In one report of a man severely wounded in the abdomen, “Since ‘death awaited him with certainty . . . I gave him a hypodermic of morphia and we propped him up as comfortably as we could’ and left him there.”[3] Behind the RAPs were Advanced Dressing Stations, then further back Main Dressing Stations, and finally, Casualty Clearing Stations. Each move to the rear—always challenging in itself—was based on an assessment of the injury and the chances of survival. The lightly wounded—those likely to recover quickly—and the “moribund”—those likely to die—were kept, and the others sent on. Each station provided stabilization and immediate care, with some basic surgeries, such as amputation, at Casualty Clearing Stations. More advanced treatment occurred at hospitals, either back in Britain or in France. As the war wore on, more of the wounded were kept in France, at hospitals far back from the lines. This was to use less transport and to maintain military morale, with the goal of returning the men to the front as quickly as possible. And indeed, American medical entry into the war came first in the form of hospitals. “The first six [mobile hospitals] to arrive in France took over British General Hospitals and provided hospital level care for the British. Other American hospitals arriving later in the summer of 1917, remained assigned to the American forces.”[4] The Allied pattern of medical triage and evacuation became the model for American efforts.

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The fracture ward; the term “machine shop” likely refers to the frames and power belts that characterized such shops at the turn of the last century. Image source.

How well did the system work? “War is a matter of expedients.”[5] The medical operation was persistently understaffed and under-resourced. In the latter part of the war, as the static front changed to a dynamic one, some medical units had difficulty achieving the mobility needed. And inevitably, given the need continually to evaluate the severity of wounds, and the difficulty of transport, some men ended up in the wrong place, some facilities were too crowded, and others were underused. Finally, in 1918 the medical system began to be overrun with influenza cases. Overall, though, the magnitude of the challenge needs to be kept in mind. In just the American experience, for an army that numbered almost 2 million men in France at the end of the war, 1.2 million men passed through the medical system, with about quarter million military wounded.[6] That is an astounding number for which to provide medical services under severe stress.

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Surgery in a Belgian field hospital. Image source.

References:
[1]“Krilling for Company.” Mud Feud [Review of Trench: A History of Trench Warfare on the Western Front, by Stephen Bull (Osprey Publishing 2010)]. Papyrocentric Performativity. Published July 14, 2014. Accessed March 21, 2017.
[2] The total number of killed from the Allied Powers exceeded that of the Central Powers by over a million; the total wounded exceeded by perhaps 4 million. Accurate statistics are hard come by; these are based on Antoine Prost. War losses. 1914-1918-online: International encyclopedia of the First World War. Published August 10, 2014. Accessed March 21, 2017.
[3] Carden-Coyne A. The Politics of wounds: Military patients and medical power in the First World War. Oxford: Oxford University Press; 2014. P. 65.
[4] Jaffin J. Medical support for the American Expeditionary Forces in France during the First World War. Published 1990. Accessed March 31, 2017. Pp. 95–96.
[5] Helmuth Karl Bernhard Graf von Moltke. Wikiquote. Published October 7, 2006. Updated September 1, 2016. Accessed March 31, 2017.
[6] Jaffin J. P. 166.

Lady Mary Wortley Montagu and Immunization Advocacy

Today’s guest post is written by Lisa Rosner, Ph.D., Distinguished Professor of History at Stockton University. Recent publications include The Anatomy Murders (University of Pennsylvania Press, 2009) and Vaccination and Its Critics (ABC-Clio, 2017). She is the project director and game developer for The Pox Hunter, funded by an NEH Digital Projects for the Public grant.  On Thursday, April 6, Lisa will give her talk, “Lady Mary’s Legacy: Vaccine Advocacy from The Turkish Embassy Letters to Video Games.” To read more about this lecture and to register, go HERE.

In a letter dated April 1, 1717 – 300 years ago — Lady Mary Wortley Montagu (1689–1762), the wife of the British ambassador to Turkey, provided the first report from an elite European patient’s perspective of the middle-eastern practice of inoculation, or ingrafting, to prevent smallpox. She wrote to her dear friend, Sarah Chiswell:

“I am going to tell you a thing that will make you wish yourself here. The small-pox, so fatal, and so general amongst us, is here entirely harmless, by the invention of engrafting, which is the term they give it. There is a set of old women, who make it their business to perform the operation, every autumn, in the month of September, when the great heat is abated. People send to one another to know if any of their family has a mind to have the small-pox; they make parties for this purpose, and when they are met (commonly fifteen or sixteen together) the old woman comes with a nut-shell full of the matter of the best sort of small-pox, and asks what vein you please to have opened. She immediately rips open that you offer to her, with a large needle (which gives you no more pain than a common scratch) and puts into the vein as much matter as can lie upon the head of her needle, and after that, binds up the little wound with a hollow bit of shell, and in this manner opens four or five veins…

The children or young patients play together all the rest of the day, and are in perfect health to the eighth. Then the fever begins to seize them, and they keep their beds two days, very seldom three. They have very rarely above twenty or thirty in their faces, which never mark, and in eight days time they are as well as before their illness. Where they are wounded, there remains running sores during the distemper, which I don’t doubt is a great relief to it. Every year, thousands undergo this operation, and the French Ambassador says pleasantly, that they take the small-pox here by way of diversion, as they take the waters in other countries. There is no example of any one that has died in it, and you may believe I am well satisfied of the safety of this experiment, since I intend to try it on my dear little son.”

Lady_Mary_Wortley_Montagu_with_her_son_Edward_by_Jean_Baptiste_Vanmour

Mary Wortley Montagu with her son Edward, by Jean-Baptiste van Mour. Source: Wikimedia Commons.

This is probably the most famous passage in all Lady Mary’s voluminous correspondence. It deserves even more attention than it usually gets, because it is the first example, in the western history of medicine, of a mother’s perspective on the practice of immunization. We tend to hear a great deal from scientists like Jenner about their discoveries, but much less from mothers who adopted their techniques for children.

But Lady Mary was not just a mother, she was also an acute observer with an inventive and inquisitive mind, and a particular interest in what we would now call public health practices. She had lost a beloved brother to smallpox; she had also contracted the disease, and though she survived, she carried the scars for the rest of her life. As she traveled from London to Constantinople, she was particularly interested in innovations and cultural attitudes toward hygiene and domestic health, especially as they affected women’s lives.

Her enthusiasm for light, clean, airy environments comes through in her very first letter, written from the Netherlands. She wrote:

“All the streets are paved with broad stones and before many of the meanest artificers doors are placed seats of various coloured marbles, so neatly kept, that, I assure you, I walked almost all over the town yesterday, incognito, in my slippers without receiving one spot of dirt; and you may see the Dutch maids washing the pavement of the street, with more application than ours do our bed-chambers.”

For that reason, she noted:

“Nothing can be more agreeable than travelling in Holland. The whole country appears a large garden; the roads are well paved, shaded on each side with rows of trees.”

She was much less pleased with Vienna, for though there were certainly many magnificent sights, the city itself was dark and crowded. She complained:

“As the town is too little for the number of the people that desire to live in it, the builders seem to have projected to repair that misfortune, by clapping one town on the top of another, most of the houses being of five, and some of them six stories … The streets being so narrow, the rooms are extremely dark; and, what is an inconveniency much more intolerable … there is no house has so few as five or six families in it.”

As her travels continued throughout the fall and winter, another custom, neglected in England, caught her attention: the stove, valuable for warmth and for lengthening the growing season. At one of the formal dinners she attended, she was offered oranges and bananas and wondered how they could possibly be grown in Austria. She wrote:

“Upon inquiry I learnt that they have brought their stoves to such perfection, they lengthen their summer as long as they please, giving to every plant the degree of heat it would receive from the sun in its native soil. The effect is very near the same; I am surprised we do not practise [sic] in England so useful an invention. This reflection leads me to consider our obstinacy in shaking with cold, five months in the year rather than make use of stoves, which are certainly one of the greatest conveniencies [sic] of life.”

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Mary Wortley Montagu in Turkish dress. Souce: Wikimedia Commons.

When she arrived in Constantinople and spent time with ladies of the court, both Turkish and European, Lady Mary continued to pursue her interest in gardens, in baths, in the light airy spaces found in both European and Turkish households. She was not the first European to report on the practice of “ingrafting”: her family physician in Constantinople, Dr. Emmanuel Timoni, had previously sent a report to the Royal Society of London. But seeing a disease, so dangerous in Europe, treated as an excuse for a children’s party turned her into an advocate. As she wrote:

“I am patriot enough to take the pains to bring this useful invention into fashion in England, and I should not fail to write to some of our doctors very particularly about it, if I knew any one of them that I thought had virtue enough to destroy such a considerable branch of their revenue, for the good of mankind. But that distemper is too beneficial to them, not to expose to all their resentment, the hardy wight that should undertake to put an end to it. Perhaps if I live to return, I may, however, have courage to war with them. Upon this occasion, admire the heroism in the heart of your friend.”

After she returned to London, she kept her promise “to war” with the physicians in support of inoculation. When smallpox broke out in her social circle in 1722, she decided to inoculate her daughter, and the operation was performed with great success. Physicians who visited her found “Miss Wortley playing about the Room, cheerful and well,” with a few slight marks of smallpox. Those soon healed, and the child recovered completely. The visiting physicians were impressed, and they began to incorporate inoculation into their own practices.

As the epidemic raged, Lady Mary convinced her most prominent friend, Caroline, Princess of Wales, to inoculate the two royal princesses, Amelia and Caroline. Having received the royal seal of approval, smallpox inoculation became fashionable practice among British elites throughout the 18th century.

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Memorial to the Rt. Hon. Lady Mary Wortley Montague erected in Lichfield Cathedral by Henrietta Inge. Source: Wikimedia Commons.

In 1789, Mrs. Henrietta Inge, Lady Mary’s niece, erected a memorial to her accomplishments in Litchfield Cathedral. The text reads:

“[She] happily introduc’d from Turkey, into this country the Salutary Art Of inoculating the Small-Pox. Convinc’d of its Efficacy She first tried it with Success on her own Children, And then recommended the practice of it To her fell-w-Citizens. Thus by her Example and Advice, We have soften’d the Virulence, And excap’d the danger of this malignant Disease.”

We can recognize in Lady Mary – and in Mrs. Inge — advocates of a kind met with very frequently in the history of vaccination: mothers whose personal experience led them to champion the discoveries that preserved their family’s health and well-being.

Bibliography:

  1. Grundy, Isobel. Lady Mary Wortley Montagu. Oxford: Oxford University Press, 1999.
  1. Montagu, Lady Mary Wortley. Letters of Lady Mary Wortley Montagu. Written during her travels in Europe, Asia, and Africa. Paris: Firman Didot, 1822. Available in many editions online.
  1. Rosner, Lisa. Vaccination and Its Critics. A Documentary and Reference Guide. Santa Barbara, CA: Greenwood, 2017.

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Annette Smith Burgess: Ophthalmological Illustrator

By Arlene Shaner, Historical Collections Librarian

An earlier blog post of ours highlighted the work of Gladys McHugh, a medical illustrator who used transparent acetate sheets to create her illustrations for The Human Eye in Anatomical Transparencies and The Human Ear in Anatomical Transparencies.  McHugh studied medical illustration with Max Brödel at Johns Hopkins in the Department of Art as Applied to Medicine, one of a significant number of women who trained with him to become well-known medical illustrators.

Annette Smith Burgess (1899-1962), was another of Brödel’s students.  Burgess studied with Brödel for three years starting in 1923 before becoming the first ophthalmic illustrator for the Wilmer Eye Institute, a position she held for the next 35 years, until her retirement in 1961.  Beginning in 1946 (and more officially in 1948), she took on an additional role as an instructor in the Art as Applied to Medicine program.

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Portrait of Annette Smith Burgess.[1]

In 1934, William Holland Wilmer published his Atlas Fundus Oculi, illustrated with one hundred color plates, all of which were reproduced from paintings made by Burgess.  These lushly colored lithographs took quite a bit of work to make.  As Wilmer states in his foreword to the atlas, “The accurate printing of fundus drawings in colour is a very laborious and costly undertaking; sometimes in offset-lithography from eight to sixteen impressions (one mat for every colour) are required to produce one plate.  The cheaper processes are far from satisfactory…”[2]

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“Papillo-retinitis, with Papilledema, Toxic and Mechanical” (plate 30), from Atlas Fundus Oculi (1934).

Burgess was more than qualified to take on this challenge.  To make her paintings, she became a skilled user of the ophthalmoscope and the slit lamp.  Writing about the process by which she created her illustrations, Dr Alan C. Woods explained that to show the ocular lesions related to a particular disease “she would make six drawings from different eyes depicting the various lesions and gradations thereof, rather than paint and sign her name to any drawing which was not a faithful portrayal of the lesions actually present in the eye under study.”[3]  This meticulous work increased the value of the illustrations for users of the atlas, as their level of accuracy was extraordinary, rendering the experience of looking at the illustrations very close to that of looking through an ophthalmoscope itself.  Some of Wilmer’s descriptions also include detailed half-tone illustrations of particular features he wanted to highlight; these, too, were drawn by Burgess.

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“Choroiditis, Diffuse, with Ascending Perineuritis” (plate 34) from Atlas Fundus Oculi (1934).

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“Choroiditis, Diffuse, with Ascending Perineuritis” (plate 34) halftones from Atlas Fundus Oculi (1934).

Burgess also collaborated with Woods, providing the illustrations for Endogenous Uveitis (1956) and Endogenous Inflammations of the Uveal Tract (1961), although in both of those volumes her paintings were reproduced using photographic processes rather than lithography, and reduced in size.  While still extraordinarily beautiful, the texture found in the earlier lithographs disappears in the reproductions in these later publications.

Plates XXVII and XXVIII (left) and plates XXIX and XXX (right), from Endogenous Uveitis (1956).[4]

For decades after her death, the Department of Art as Applied to Medicine at Hopkins continued to celebrate Annette Burgess’s legacy with an award to honor excellence in ophthalmological illustration.

References:
[1] Davis RW. Annette Smith Burgess (1899-1962).  Journal of the Association of Medical Illustrators. 1963; 14:25-28.
[2] Wilmer WH. Atlas Fundus Oculi. New York: MacMillan; 1934, p. 7.
[3] Woods AC.  Obituary in “News and Comment.” Archives of Ophthalmology. 1962; 68(6): 880.
[4] Woods AC. Endogenous Uveitis. Baltimore: Wiliams & Wilkins, 1956.

The “Best” Tonic: Pabst Malt Extract Pamphlets in the Academy Library

By Anne Garner, Curator, Rare Books and Manuscripts

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Girl in yellow embracing a Pabst Malt Extract bottle. Click to Enlarge.

Guinness enthusiasts are well familiar with the brewery’s famous tagline “Guinness Is Good for You.”  But did you know that the American company Pabst staged a successful marketing campaign in the late nineteenth and early twentieth centuries built on the idea that their own Milwaukee-based malt extract could cure a range of ailments?  A series of pamphlets produced by the Pabst Brewing Company tells the story.

Pabst has its origins in Milwaukee, Wisconsin, a city well-situated for a brewery with its harbor, its caves (nature’s coolers, before refrigeration), and its large population of German immigrants.[1]

An 1897 edition of Henriette Davidis’ Praktisches Kochbuch, published in Milwaukee in both German and English for an audience of German-Americans, includes some fourteen recipes using the beverage, including beer soup, beer with raisins, and beer eggs.

Pabst was first established as the Empire Brewery in Milwaukee in 1844 by German immigrant Jacob Best.  In 1872, Frederick Pabst, married to Best’s granddaughter, became president of the company.  It was renamed after Pabst in 1889.

Henriette Davidis’ Praktisches Kochbuch (1897). Click to Enlarge.

Milwaukee from “Wedding Secrets,” Page 33. Click to Enlarge.

Beginning in 1876, Pabst won awards for its formula.  The company began to tie blue ribbons around the necks of their bottles to mark its first place status. The name stuck, and was later incorporated into their brand in 1895).[2]

By the 1890’s, many American breweries were manufacturing malt extract for medicinal purposes.  This thick, syrupy liquid derived from barley and grains certainly contained sugar and may have contained some nutrients.  Malt Extracts were widely used as a digestive aid, and for the recovery of convalescents.

Convalescent double-page spread from “Heart Darts” (ca.1908). Click to Enlarge.

But they also contained alcohol.  In 1896 at a meeting of the Boston Society of Medical Sciences, Dr. Charles Harrington shared his findings after a study of the ingredients of these preparations:

“Twenty-one different brands of liquid malt extract were obtained and analyzed. That they were not true malt extracts is shown by the fact that in no one was there the slightest diastatic power; all were alcoholic, some being stronger than beer, ale, or even porter. In a number of specimens a large amount of salicylic acid was detected.”[3]

Pabst promotes their Malt extract in a series of pamphlets in our collection.  In the earliest of those here at the library, “More Secrets,” (1889), the text asserts that their tonic is:

“a simple extract of Malt and Hops, precisely similar in nutrition and medicinal value to those hitherto so extensively prescribed by the entire medical profession.  It is not a patent medicine.”

Two years earlier, a paper given by author and researcher S.P. Sharples, showed that Pabst’s malt extract contained 5.16 cubic centimeters of alcohol in a 100 cubic centimeters of the liquid.[4]  Like many patent medicines, a full list of the formula’s ingredients is not given in the advertising material.

The pamphlets also suggest use for ailments similar to those treated by patent medicines.  A pamphlet called “Heart Darts” (ca. 1908) recommends Pabst Extract for the overworked, the nervous, the dyspepsic and the old aged, and includes charming illustrations of the afflicted:

Dyspepsia, insomnia, nervousness and overworked, all from “Health Darts” (1908).

Pabst also claimed to cure insomnia.  “100 Points of Perfection” (ca. 1894) argues against taking drugs for sleep, but recognizes the necessity of sleep to produce calm nerves. How to sleep?  According to “100 Points,” choose Pabst, and “Take a bottle a day, for two weeks.”  Zzzzzzzzzzzzzzzzzzzz.

Ghosts and sleep from “100 Points of Perfection” (ca. 1894). Click to Enlarge.

During the 1890’s, Pabst ran a series of ads in women’s medical journals to target nursing mothers.

Ad from Women’s Medical Journal (1895). Click to Enlarge.

As their pamphlet “Baby Secrets” explains, the extract is “an ideal preparation for nursing mothers, giving them abundant nourishment to resist the extra drain upon the system” and aids in sleep. Harried mothers are also promised that a bottle a day for 24 days will restore beauty.

The back cover of “Baby Secrets” (1897) features a conspiring Cupid whispering into a stork’s ear. Click to Enlarge.

“Baby Secrets” is one in a series of “Secrets” pamphlets produced in the 1890’s, available by mail order for free.  The Academy Library has eight in total. Click on images to enlarge.

“More Secrets” (ca. 1889) opens with the assertion that Pabst malt liquor is not a patent medicine, but “a simple extract of Malt and Hops, precisely similar in nutrition and medicinal value to those hitherto so extensively prescribed by the entire medical profession.”

“Still More Secrets” (1890) offers guidance for nursing mothers: Do nurse him, do help him,/ Throw bottles away;/ You take the “Best” Tonic,” / He’ll come here to stay.”

“Untold Secrets” (ca. 1892) emphasizes the importance of sleep.

“Ominous Secrets” (1894) which contains stories of mysteries and omens, journeys and old world luxuries, shows an old man kneeling in front of the Sphinx.

“Wedding Secrets” (1895) features a sheepish Cupid, next to the discarded flowers and shoes belonging to the bride and groom.

“Home Secrets” (1898) features a smiling woman with her head resting languidly on her hand, waving an empty teacup.

“Open Secrets,” (ca. 1895) recommends Pabst malt extract as a meal and as a remedy to young mothers, whose children have “almost drained their young lives away.” It closes with a plug for their beer– “we will see that you get [it] without difficulty.”

Malt Tonic from “100 Points” back cover (ca. 1894).

When Prohibition went into effect in 1920, Pabst had the manufacture of malt extract to fall back on (as well as another Wisconsin no-brainer of a product: cheese).  That same year, Pabst began to market it for its cooking properties, as a sugar substitute and to leaven bread.  But it really came in handy for bootleg home-brews.  The newspaper of Lima, Ohio reported in 1929 that the weekly sales of malt there could produce the equivalent of 400,000 pints of beer.[5] 

McGuiness menu cover and beer list.

When the Volstead Act was repealed, Pabst reprises their production of their Blue Ribbon brand with a vengeance.  This New York menu, probably from the 1940’s from the midtown New York Irish bar McGinnis shows a range of beers available, including both Guinness and Pabst.  We’re wondering if the 5 cents price difference implies that while Guinness might be good for you, Pabst was banking on an audience that thought it might be even better.

References:
[1] Smith, Gregg.  Beer in America:  The Early Years – 1587-1840.  Boulder:  Brewer’s Publications, 1998.
[2] From “The Whole Story.”  Accessed March 2, 2017 at http://pabstblueribbon.com/pbr-history/.
[3] See Martha Meir Allen’s Alcohol:  A Dangerous and Unnecessary Medicine.  Marcellus, N.Y. : National Woman’s Christian Temperance Union, c1900. P. 316.
[4] Allen, p. 317.
[5] Lima News, March 31, 1929.

Infectious Madness, the Well Curve and the Microbial Roots of Mental Disturbance

3cfce0fe054a12627f41292ec26e6b22Today’s guest post is written by Harriet Washington, a science writer, editor and ethicist. She is  the author of several books, including Medical Apartheid: The Dark History of Experimentation from Colonial Times to the Present. On Wednesday, March 15 at 6pm, Washington will discuss: “Infectious Madness, the Well Curve and the Microbial Roots of Mental Disturbance.” In this talk, based on her book Infectious Madness: The Surprising Science of How We “Catch” Mental Illness, Washington traces the history, culture and some disturbing contemporary manifestations of this ‘infection connection.” To read more about this lecture and to register, go HERE.

“Mind, independent of experience, is inconceivable.” —Franz Boas

Psychological trauma, stress, genetic anomalies and other experiences that limit the healthy functioning of the mind and brain are widely recognized as key factors in the development of schizophrenia, major depression, and bipolar disorder.  However, despite a plethora of examples and evidence of microbial disorders from rabies to paresis, infection has been slow to join the pantheon.  This aversion persists largely because the perceived causes of mental disorders have evolved not only with our scientific knowledge of medicine but also with our tenacious cultural beliefs and biases.  Instead, we have long clung to what  Robert Sapolsky calls a “primordial muck” of attribution that includes broken taboos, sin—one’s own or one’s forbears’— and even bad mothering.

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Representation of the dancing mania by Flemish painter Pieter Brueghel the Younger.Source.

Flemish painter Pieter Brueghel the Younger (1564–1636) painted the above representation of the dancing mania known as choreomania or St. Anthony’s Fire, which has seized a pilgrimage of epileptics en route to the church at Molenbeek. Such compulsive dancing was originally ascribed to satanic influence such as bewitchment, and later to a collective hysterical disorder, but is now ascribed to ergotism— the  infection of rye and other grains by the fungus Claviceps purpurea.  When people ate the tainted bread, their symptoms included compulsive dancing. Some have ascribed the mass hysteria of the Salem witch trials to ergotism.  Streptoccocal infections have also produced cases called Sydenham’s chorea.

Not all traditional “causes” of mental illness are confined to the past.  As late as the 1980s, the alternating rage, coldness and oppressive affection of domineering “schizophrenogenic mothers” was taught in psychology classes as the root of schizophrenia, just as Tourette’s syndrome initially was laid to poor parenting.

For Infectious Madness: The Surprising Science of How We “Catch” Mental Illness, I interviewed scientists working on the effects of infections on mental health such as Susan Swedo, chief of the pediatrics and developmental neuroscience branch at the National Institute of Mental Health, who studies the role of Group A strep (GAS) infections in children in rapid-onset cases of obsessive compulsive disorder, anorexia, and Tourette syndrome. Other visionary researchers, such as E. Fuller Torrey, executive director of Maryland’s Stanley Medical Research Institute, and Robert Yolken, director of developmental neurovirology at Johns Hopkins University, have for decades investigated the role of microbes in mental illness and have traced the path of viruses such as influenza, herpes simplex and Toxoplasma  gondii, among other microbes, in schizophrenia and bipolar disorder.

There are a myriad of ways in which infections cause or encourage mental disease. In order to suit its own need to reproduce within the stomach of a cat, the unicellular parasite Toxoplasma gondii changes the behavior of rodents — and incidentally, use it to gain entry. This seems strange, but changing the behavior of a host to suit its own needs is a common stratagem of parasites. The Cordyceps fungus, for example, manipulates an ant in the Amazon into climbing a tree where the fungal spores can be more widely disseminated. The spore- bearing branches extend from the corpse of the ant pictured below.

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The Cordyceps fungus manipulates an ant in the Amazon into climbing a tree where the fungal spores can be more widely disseminated. The spore-bearing branches extend from the corpse of the ant.Photograph © Gregory Dimijian, MD.

Infection, redux

“Everything has been thought of before, but the problem is to think of it again.” —Goethe

There is a long, all but forgotten history of infectious theories of mental illness. In his 1812 psychiatry text Medical Inquiries and Observations upon the Diseases of the Mind, for example, Benjamin Rush, MD, included a first detailed taxonomy of mental disorders, each with its own physical cause. He cited disruptions of blood circulation and  sensory overload as the basis of mental illness, and he treated his patients with devices meant to improve circulation to the brain, including such Rube Goldberg designs as a centrifugal spinning board, or to decrease sensory perceptions, such as a restraining chair with a head enclosure.

Restraining Chair

Pictured here is the “tranquilizing chair” in which patients were confined. The chair was supposed to control the flow of blood toward the brain and, by lessening muscular action or reducing motor activity, reduce the force and frequency of the pulse.Photograph © 2008 Hoag Levins.

Paresis, an infectious mental disorder

In 1857, Drs. Johannes Friedrich Esmark and W. Jessen suggested a biological cause for paresis: syphilis. Many researchers started to view paresis as the tertiary stage of syphilis, which often attacked the brain indiscriminately, and they began referring to it as neurosyphilis. This theory held out hope that if syphilis was ever cured, paresis could be too.

Nineteenth-century asylum keepers, however, persisted in viewing paresis as wholly mental in character. The long-standing insistence on divorcing physical illnesses from mental ones had to do with religious philosophy and culture but also with the politics of the asylum, which remained a battleground between physicians and religious and philosophical healers.

Matters were complicated by the fact that most physicians, despite the evidence that paresis was the mental manifestation of a physical disease, continued to treat paretics with the same ineffectual therapeutics given other mentally ill patients. Traditional treatments such as “douches, cold packs, mercury, blistering of the scalp, venesection, leeching, sexual abstinence, and holes drilled into the skull [trephination]” continued—without positive results. Even when toxic mercury-based treatments for syphilis were replaced by Paul Ehrlich’s safer, more effective arsenic-based Salvarsan (also called arsphenamine and compound 606), it was not used against paresis.

But in June 1917, Professor Julius Wagner-Jauregg of the University of Vienna Hospital for Nervous and Mental Diseases undertook a radical approach. He had noticed that some paretic patients improved markedly after contracting an infectious illness that gave them fevers. He decided to fight fire with fire by turning one disease against another: he sought to suppress the symptoms of paresis by infecting its sufferers with malaria.

Before Wagner-Jauregg won the Nobel and Freud forged the future of psychiatry, a paradigm shift had already taken place that transformed science’s approach to the nature of disease. It is the very framework that supports the role of infection in mental illness—germ theory. Developed by Louis Pasteur and Robert Koch, germ theory posits that specific microbes such as bacteria, viruses, and prions (infectious proteins) cause illness.

For more on this fascinating topic, join Harriet Washington on Wednesday, March 15 at 6pm.  More information can be found here

Charles Bell: Artistry and Anatomy

By Anne Garner, Curator, Rare Books and Manuscripts

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Close-up of plate 1 showing the heart, from Charles Bell’s Engravings of the Arteries, 1801.

Imagine you’re a medical student, and inside your go-to study text is this astonishing, hand-colored image of the heart (above). Twenty-first century medical students should be so lucky!

Engravings of the Arteries by the Scottish anatomist, Charles Bell (1774-1842), was first published in 1801, some 57 years before the first edition of Henry Gray’s Anatomy. Devised for medical students, it aimed to offer accurate and simply-rendered illustrations of the arteries to “present to the student at one glance the general distribution of the vessels and to fix them in his memory.”  The book was used by students as a preparatory text for surgical study and practice.

The ten beautifully-rendered engravings in this volume were delicately colored by hand, and labelled with letters corresponding to explanatory descriptions of the arteries on the opposite page.  In the preface to this work, Bell is explicit in his instructions on how the book was to be used:

In studying the arteries, or any part of anatomy, we should, in the first place, run the eye over the corresponding plate, then read the general description in the text; and lastly, proceed to study more closely, step by step.

For Bell, true anatomical understanding was aided in pairing accurate drawing with thorough description.  Bell also believed that a variety of bodies should be used as subjects, and that the artist must choose the most typical anatomical examples to copy accurately. Any deviation from usual forms would be preserved in the illustration, but noted and explained in the description.

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Plate 3, showing the carotid artery, the lower thyroid artery and the upper thyroid artery in Charles Bell’s Engravings of the Arteries, 1801.

Engravings of the Arteries was the second volume of two; Charles’ brother, John Bell, an eminent surgeon, had written the first volume of this companion set, Engravings, Explaining the Anatomy of the Bones, Muscles, and Joints, in 1794. The elder brother mentored the younger in medicine, though Charles’s formal training occurred at Edinburgh University (he earned his medical degree there in 1798.)  Both Charles and John taught anatomy at the Royal College of Surgeons, until 1804, when the brothers were banned from practicing medicine in Edinburgh by the faculty there, jealous of the success of their anatomy classes.  They moved to London that year and established a new anatomy school, as well as a thriving surgical practice.

On the left: Plate 6, showing the arteries of the arm, and on the right, plate 9, showing the arteries of the lower extremity, both from Charles Bell’s Engravings of the Arteries, 1801.

Trained as an artist, Charles Bell’s skill in this respect is a landmark of his considerable body of anatomical work.  In 1806, Bell wrote an important book, Essays on the Anatomy of Expression in Painting, combining his interest in art and medicine in a book rich in information.  This new book, for an audience of visual artists, advanced ideas he’d first voiced in Engravings, arguing for great attention to anatomy to render the human body accurately (this time, for art’s sake.)

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Bell argued in Essays on the Anatomy of Expression in Painting (1806) that the ancient models often imitated by painters did not accurately reflect anatomical realities.

During his career, Bell also made important inroads in determining the sensory functions of the nervous system.  He was an early advocate of the idea that different parts of the brain controlled different functions; his pioneering work on the brain and cranial nerves influenced the work of other important brain researchers for decades[1].  Bell’s palsy, or facial paralysis caused by nerve dysfunction, is named after him.

For art lovers–and heart lovers too, on our minds this National Heart Month of February–Bell’s gossamer drawings have a special place in the history of anatomical illustration.  Bell understood that image and text could work in concert to save laborious use of words to convey anatomy.  But he also understood the added value of drawing the body with attention, skill, and reverence.  Bell knew that accurate and clear drawings could dramatize with nuance the systems of the body, in all their astonishing perfection. That idea is very much on display in this beautiful book.

Reference:

[1] Bell C. On the nerves; giving an account of some experiments on their structure and functions, which lead to a new arrangement of the system. Philosophical Transactions of the Royal Society of London. 1821 Jan 1;111:398-424.

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The Marrow of Tragedy: Disease and Diversity in Civil War Medicine

Today’s guest post is written by Dr. Margaret Humphreys, Josiah Charles Trent Professor in the History of Medicine at Duke University. She is the author of Yellow Fever and the South (Rutgers, 1992) and Malaria: Poverty, Race and Public Health in the United States (Johns Hopkins, 2001), Intensely Human: The Health of the Black Soldier in American Civil War (2008) and Marrow of Tragedy: The Health Crisis of the American Civil War (2013). On Tuesday, February 21 at 6pm, Humphreys will give The John K. Lattimer Lecture: “The Marrow of Tragedy: Disease and Diversity in Civil War Medicine.” To read more about this lecture and to register, go HERE.

In a memorable scene from the movie Gone with the Wind, Southern belle, Scarlett O’Hara, picks her way through the battle-wounded men lying on the ground near the train station in Atlanta, frantically seeking Dr. Meade to help her with her sister-in-law Melanie’s imminent delivery.  Meade brushes her off and turns to a screaming soldier, telling him that his leg would have to come off, and without anesthesia.  The man’s screams echo as Scarlett heads back to Melanie’s bedside.  This cinematic portrayal of Civil War medicine reflects a wide belief that there was no anesthesia at that time.  Indeed, it was said that the war occurred “at the end of the medical middle ages.”  (This quotation is widely attributed to Union Surgeon General William Hammond, but without citation).

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Scene from Gone with the Wind (1939).

In my book, Marrow of Tragedy: The Health Crisis of the American Civil War, I begin from a different perspective, recognizing that there was such a thing as “good medicine” and “bad medicine” during the War.  Medical care could be effective, and it could make a difference in disease and injury outcomes.  For example, chloroform and ether anesthesia meant most surgery occurred with the patient unconscious (although Confederate surgeons did run out of these supplies in desperate circumstances, such as the siege of Atlanta near the end of the war).

Alarming as the notion of amputation completely without anesthesia, are the revealing mortality rates from disease at this point in the war. Put simply, for every one white Union soldier who died of disease during the War, a little over two black Union soldiers died, and almost three Confederates succumbed.[i]

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Image source: Getty Images.

How can we account for these differences?  A major factor was the quality and quantity of food, a core ingredient of the modern concept of “social determinants of health.”  White Union troops also received better hospital care, calling on part of the strong social networks of the folks back home and their political impact.  The Union hospital system was much better funded, with full access to important medicines, such as quinine, opiates, and anesthetics; and the technology of cleanliness, which included clothing, soap, and disinfectants.  Nursing care was key, as well, with northern hospitals staffed by volunteer nurses, while those in the south were often civilians or slaves challenged by lack of formal training as well as lack of resources.

To learn more about Civil War medicine, join us on Tuesday, February 21 at 6pm. Register HERE.

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Image source: Harper’s Weekly, April 9, 1864.

 

Note:

[i] Actual numbers, per 1000, were 63, 143, and 167, respectively.

Celebrate Valentine’s Day with 19th-century Medical Trade Cards

By Becky Filner, Head of Cataloging

During the last two decades of the 19th century, the United States witnessed an explosion of mass-market advertising in the form of trade cards. A combination of factors contributed. Lithography, first invented in the late 1700s, made it practical to print large runs of images relatively inexpensively. Heavy paper became less expensive because it was being made from bleached wood pulp instead of cloth. The invention of the camera supplied endless images for reproduction. Advances in high-speed steam presses made it practical to mass produce trade cards, and new modes of transportation made it possible to distribute them throughout the country.[1]

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This medical trade card for Pond’s Bitters (“cures constipation, headache, indigestion, biliousness, malaria, dyspepsia”) encourages the couple depicted to focus on each other and “let the dog have the lunch!”[2]

The cards pictured here are all from an extraordinary new collection. Late last year, the Academy library received The Bingham Patent Medicine Collection as a bequest. This rich collection – a complement to our William Helfand Collection of trade cards – contains approximately 4,900 trade cards produced by pharmaceutical manufacturers in the 19th century.

These cards advertising “El Tricofero de Barry” and “Pildoritas de Reuter” were printed in New York by Barclay & Co., but the text is in Spanish. Click to enlarge.

The late Walker Bingham was a completist, and his carefully assembled collection reflects years of assiduous collecting and research. An announcement will be made when the collection is available to the public. Meanwhile, have a look at Bingham’s book, The Snake-Oil Syndrome: Patent Medicine Advertising, for more of his cards and an excellent overview of pharmaceutical advertising. Here he writes of patent medicine:

It is probable that most of the nineteenth century patent medicines had no effect at all on the diseases that they were sold to cure. They were not even palliatives. Some sufferers may have been misled into taking patent medicines instead of more effective (and possibly more expensive) drugs prescribed by a doctor, but generally speaking, at that stage of medical learning there was often little that any doctor could do for a patient with a serious disease except give emotional support.[3]

The medicines that did have more than a placebo effect often relied on ingredients like morphine, cocaine, heroin, opium, chloroform, and alcohol. These drugs were especially dangerous when given to children or self-administered in large doses. The patent medicine business was booming in the late 19th century, and it relied heavily on advertising to attract customers since the medicines were ineffectual at best. In addition to trade cards, patent medicine companies produced millions of newspaper ads, almanacs, show cards, and other mailing pieces.

Most trade cards were designed to appeal to women and children, with sentimental images of animals, flowers, babies, families, and scenery.[4] The Valentine’s Day images below fall into this category, with roses, doves, and cherubs promoting Brown’s Iron Bitters (“Cures Malaria, Dyspepsia, Weakness, &c.”), Burdock Blood Bitters (“It makes pure, healthy blood, and regulates all the organs to a proper action, cures constipation, liver and kidney complaint, female weakness, nervous and general debility, and all the distressing miseries from which two-thirds of the women in American are suffering”), Boschee’s German Syrup (“No person suffering with consumption, coughs, colds, croup, bronchitis, asthma, or any disease of the throat, lungs or chest can take it without getting immediate relief”), and Wilson’s Popular Corn Salve (we are not told what this product does, but “every box [is] guaranteed or money refunded.”)

Most trade cards were designed to appeal to women and children, with sentimental images of animals, flowers, babies, families, and scenery. Click to enlarge.

Sentimental images of couples also sell products, including a trio of kissing couples selling Smith’s Bile Beans (they “cure biliousness”), two different images of couples with umbrellas, one selling Dr. P.O. Baldo’s Blood and Liver Pills and the other selling Wilbor’s Compound of Cod Liver Oil and Phosphates, and a trade card that recommends buying a bottle of Race’s Indian Blood Renovator for your new wife “to prove to her [your] fervent love.”

Sentimental images of couples also sell products. Click to enlarge.

Other more satiric and risqué trade cards are clearly aimed at an adult audience. The card below, “The Five Senses,” is one of the racier examples in the Library’s trade card collection. The back advertises Lash’s Kidney & Liver Bitters, described as “a mild cathartic and sure cure for constipation, indigestion, biliousness, dyspepsia, malaria, chills and fever, nervous or sick headache.” The front of the card shows a series of five images of a woman “seeing” a man, “hearing” him approaching, “smelling” a flower he has given her, and sitting in his lap while he is “feeling” her bottom. The final image, “Tasting,” shows the edge of a bed and the woman’s dress, undergarments, and stockings thrown across a chair. Apparently taking Lash’s Kidney & Liver Bitters will ensure a happy Valentine’s Day!

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“The Five Senses” (above) is one of the racier examples in the Library’s trade card collection.

References:

[1] Summarized from A. Walker Bingham’s account of trade cards in The Snake-Oil Syndrome: Patent Medicine Advertising (Hanover, Massachusetts: The Christopher Publishing House, 1994), p. 117-119.
[2] All trade cards in this post are from The Bingham Patent Medicine Collection in the Library of the New York Academy of Medicine.
[3] Bingham, p. 7.
[4] According to Bingham, mothers used to paste trade cards into albums as birthday or Christmas presents for their children (p. 117.)

Hebra’s Atlas of Skin Diseases, and #ColorOurCollections: Day 3

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It’s the third day of #ColorOurCollections, a week-long special collections coloring fest organized on social media. Every day on our blog, we will feature #ColorOurCollections coloring sheets from our library, along with content from participants worldwide.

Today’s Academy coloring sheets come from the works of Ferdinand von Hebra  (1816- 1880), a significant figure in the influential Vienna school of dermatology. Dermatology emerged as a clinical specialty in the early to mid-19th century, and in 1849, Hebra was appointed the first German language professor in the subject, at Vienna General Hospital.[i]

Hebra’s Atlas of Skin Diseases (1856 – 76) was a monumental work printed in 10 installments, with mostly life-sized illustrations, using the new technique of chromolithography, which allowed the artist to draw directly onto the lithographic stone and print in color. The illustrations were created by two Viennese painter physicians, Anton Elfinger and Carl Heitzmann. Each issue of the Atlas was dedicated to a group of disorders which affected the skin.

The “tattooed man” is an unusual addition to the Atlas, being presented as of cultural rather than the clinical interest. Unusually, the tattooed man is also identified by name, as Georg Constantin, a circus performer from Albania. Constantin was a well-known circus performer, who traveled extensively in Europe and North America. He spent time with Barnum’s Circus as “Prince Constantine,” where he also sold pamphlets describing his tattoos (which are variously described as Chinese and Burmese in origin).[ii] Constantin’s body was covered with 388 tattoos of animals and symbols in red and blue. As was Hebra’s habit, Constantin was depicted twice in the Atlas, once in full color and once as the outline drawing presented here.[iii]

Itching to color the tattooed man? Some of these intricate patterns from participating institutions may also be your groove.

From University of North Carolina at Chapel Hill’s Health Science Library: Adam Lonicer, Naturalis historiae opus novum (1551).
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From Amguedddfa Cymru – National Museum Wales: Benjamin Wilkes, Twelve new designs of English Butterflies (1742).

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We’re also loving Muhlenberg College Trexler Library‘s maps coloring book.  Check out this detailed world map of Johann Baptist Hormann’s Planiglobii terrestris cum utroq hemisphærio cælesti generalis repræsentatio (1720).muhlenbergcollege_colorourcollections_maps

References:

[i] Holubar, K. (1981), Ferdinand von Hebra 1816–1880: On the Occasion of the Centenary of His Death. International Journal of Dermatology, 20: 291–295. doi:10.1111/j.1365-4362.1981.tb04341.x

[ii] Margo DeMello, Bodies of Inscription: A Cultural History of the Modern Tattoo Community (Duke University press, 2000), p56. DeMello states that Constantin sold pamphlets describing the “Chinese cannibal natives” who had forced his tattooing on him. In Hebra’s Atlas the tattoos are identified as being Burmese. There is also a suggestion that Constantin had himself tattooed with an eye to displaying himself as a circus attraction.

[iii] Mechthild Fend, “Skin portraiture ‘painted from nature’: Ferdinand Hebra’s Atlas of Skin Diseases (1856-76)”, in Hidden Treasure, Michael Sappol (ed), New York: Blast Books, 2012, pp. 122-26.