No Spice More Superior: Pepper

By Emily Miranker, Events & Projects Manager

The marvelous thing about libraries (well, one on an infinite list of marvels…) are the remarkable rabbit holes of investigation and imagination you fall into. Recently, I spent a lot of time with materials related to infection getting ready for our exhibition Germ City. I did not expect to run into a kitchen staple while reading up on cholera, and yet:

Black Pepper is a remedy I value very highly. As a gastric stimulant it certainly has no superior, and for this purpose we use it in congestive chills, in cholera morbus, and other cases of a similar character.

Black pepper as a cure for anything, let alone something as virulent as cholera was news to me. The above passage comes from 19th century physician John Milton Scudder’s 1870 book Specific medication and specific medicines. In the 19th century “specific medicine” referred to a branch of American medicine, eclectic medicine, that relied on noninvasive practices such as botanical remedies or physical therapy.[i] As an eclectic practitioner, Scudder’s work was not mainstream, regular medicine, so I wondered if perhaps that was why pepper should come up as a remedy. Surely, pepper only belongs in the kitchen not the medicine cabinet. But doing more research, it turns out that black pepper, Piper nigrum, originally from India, has been used for medicinal purposes for centuries.

Black Pepper_Bentley_1880

A member of the Piperaceae family of plants, black pepper is a tropical vine. Its berries (the dried berries are the peppercorns we’re familiar with from the kitchen), were known to the Egyptians, Greeks, and Romans long before it became one of the most sought-after spices in Europe during the Age of Exploration, the 15th-18th centuries. Depending on when it’s harvested, a vine produces four kinds of peppercorn. Green peppercorns are unripe berries that are freeze-dried. White pepper is almost ripened, the berries are harvested and soaked in water which washes off the husk leaving the gray-white seed. Red peppercorns are fresh, ripe berries. Black peppercorns are harvested when the spike of berries is midway ripe; these unripe berries are actually more flavorful than a fully ripe berry. The black peppercorns are blanched or left to ferment a few days and then dried in the sun. The drying process turns the husk black.[ii]

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A detail of a page of recipes calling for pepper by the Roman gourmand Apicius, the oldest cookbook in West. Author’s favorite: #31 Oenogarum in Tubera, a wine sauce for truffle mushrooms calling for pepper, lovage, coriander, rue, broth, honey and oil.

Pepper came to the tables and pharmacies of Europe via trade from the west coast of India. It was coveted enough to be part of the ransom demand Alaric the Goth made of Rome when he invaded in 408 C.E.[iii] With its strategic location on the Adriatic, Venice dominated the spice trade in Europe in the Middle Ages. The Portuguese were the first to break the Venetian hold by finding an all-ocean route to India. By the 17th century the Dutch and English were players in the spice trade. Innocuous-seeming dark grains in shakers on tabletops now, pepper was once more valuable than silver and gold. Sailors were paid in pepper. The spice was also used for paying taxes, custom duties, and dowries.[iv] In their quest for pepper, among other spices such as cinnamon, cloves, and nutmeg, the Europeans brutally pursued spice monopolies regardless of the upheaval and violence they wrecked on the peoples of India, Sumatra and Java.

Dating back to 6,000 B.C.E. the Materia medica of Ayurveda advocates using pepper for a number of different maladies, especially those of the gastrointestinal tract.[v] To this day in India, a mixture of black pepper, long pepper, and ginger, known as trikatu, is a common Ayurvedic medicinal prescription. Trikatu is a Sanskrit word meaning “three acrids.” In the Ayurvedic tradition “the three acrids collectively act as ‘kapha-vatta-pitta-haratwam’ which means ‘correctors of the three doshas of the human.’”[vi] Doshas are energy centers in the body in the Ayurvedic tradition.

Pepper figured in Western medicine from antiquity onwards as well. Writing in the 7th century, Byzantine Greek physician Paul of Aegina quotes the 2nd-century Greek Galen on pepper’s’ medical properties, “it is strongly calefacient and desiccative.”[vii] Warming and drying, thus very good for stomach problems in his estimation. Side note: Galen’s office was in the spice quarter of Rome, underscoring the connections between health, spices, and food. Peppers’ use as a “gastric stimulant” persisted through the centuries. In our collection’s The elements of materia medica and therapeutics (1872), Jonathan Pereira states pepper “is a useful addition to difficult-to-digest foods, as fatty and mucilaginous matters, especially in persons subject to stomach complaints.” The illustrations of pepper plants in this post come from Robert Bentley’s Medicinal Plants (1880) which includes their medical properties and uses along with descriptions of habitats and composition.

Black pepper medicinal properties_Bentley_watermarked

Scientific studies on pepper coalesce around its compound piperine. The stronger—more pungent—the pepper, the more piperine it contains. The argument of studies on pepper’s properties is that adding pepper to a concoction increases its efficacy and digestibility. Research suggests “this bioavailability enhancing property of pepper to its main alkaloid, piperine…. The proposed mechanism for the increased bioavailability of drugs co-administered with piperine is attributed to the interaction of piperine with enzymes that participate in drug metabolism.”[viii]

I hadn’t looked to black pepper for any health benefits; finding it mentioned in my reading up on cholera was a fascinating surprise. I look to it for that delicious heat and spicy pungency it brings to my meals. But that’s the great thing about researching in our library; you always find delights beyond what you’re looking for.

References
[i] Eclectic Medicine. https://lloydlibrary.org/research/archives/eclectic-medicine/ Copyright 2008. Accessed August 30, 2018.
[ii] Sarah Lohman. Eight Flavors: The Untold Story of American Cuisine. New York: Simon & Schuster, 2016.
[iii] Majorie Schaffer. Pepper: A History of the World’s Most Influential Spice. New York: St. Martin’s Press, 2013.
[iv] Schaffer. Pepper. 2013.
[v] Muhammed Majeed and L. Prakash. “The Medicinal Uses of Pepper.” International Pepper News. 2000. Vol. 25, pp. 23-31.
[vi] Majeed & Prakash. 26.
[vii] Paulus Aegineta. La Chirurgie. Lyons: 1542.
[viii] Majeed & Prakash. 28.

 

The Red Cross Institute for Crippled and Disabled Men and the “Gospel of Rehabilitation”

Today we have a guest post written by Ms. Julie M. Powell, 2018 recipient of the Audrey and William H. Helfand Fellowship in the History of Medicine and Public Health. Ms. Powell is a PhD candidate at The Ohio State University, her dissertation topic explores the growth of wartime rehabilitation initiatives for disabled soldiers and the rhetoric that accompanied and facilitated this expansion. 

In May 1917, one month after the United States joined the First World War, the American Red Cross created the Institute for Crippled and Disabled Men to “build up re-educational facilities which might be of value to the crippled soldiers and sailors of the American forces.”[1] To this end, Director Douglas McMurtrie (1888–1944) collected approximately 3,500 separate books, pamphlets, reports, and articles from the European continent, North America, and the United Kingdom and its Dominions. He and his research staff pored over the documents, authoring reports, news articles, and lectures that were subsequently fed back into circulation both in the United States and abroad. A look at the collection and the work of the Institute provides a window into the development of rehabilitative care in the early twentieth century, demonstrating that transnational medical networks operated and expanded throughout the war and that the transmission of information and ideology often went hand in hand.

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The Red Cross Institute for Crippled and Disabled Men, 1918.

The proliferation of literature on rehabilitation (including surgical amputation, orthopaedics, prosthetic design, physical therapy, and vocational re-education) can be attributed both to a sense of urgency—20 million men were wounded in the war—and to the relative newness of the field. The first orthopaedic institute was created in Munich in 1832 and the next in Copenhagen in 1872 but these, and others that followed, focused exclusively on care for disabled children. The first significant moves toward the retraining of adults were taken up in the two decades before the war. In 1897, in Saint Petersburg, disabled men began to be trained in the manufacture of orthopaedic devices and in 1908, with the founding of a school in Charleroi, Belgium, the industrially maimed were taught bookbinding, shoe repair, basket making, and more. The first retraining school for invalided soldiers was created in December 1914 in Lyon, France, four months after the outbreak of hostilities. The school provided the inspiration for over 100 similar schools throughout France. The period 1915–1917 saw a proliferation of orthopaedic and re-education institutions throughout Europe and the western world. It was on these models that the Red Cross Institute was founded.

The first institution of its kind in the United States, the Red Cross Institute for Crippled and Disabled Men resided at 311 Fourth Avenue (now Park Avenue South) in New York. Disabled men, either funded by the U.S. Army or attending through no-interest loans, trained in four trades: welding, mechanical drafting, printing, and the manufacture of artificial limbs. McMurtrie and his staff hosted meetings of disabled men—punctuated by cake and ice cream—wherein testimonials from the recently rehabilitated served as recruitment tools for the Institute.

But the broadest impact of the Institute came from its crusade to spread what McMurtrie referred to as the “gospel of rehabilitation”—an insistence on returning the disabled man to independence and self-sufficiency that he might eschew charity and compete fairly in the labor marketplace. Such notions were deeply rooted in classical liberalism, a foil to large-scale social welfare programs that would only emerge in the wake of the Second World War. In The Disabled Soldier, McMurtrie wrote plainly:

When the crippled soldier returns from the front, the government will provide for him, in addition to medical care, special training for self-support. But whether this will really put him back on his feet depends on what the public does to help or hinder, on whether the community morally backs up the national program to put the disabled soldier beyond the need of charity… In light of results already obtained abroad in the training of disabled soldiers, the complete elimination of the dependent cripple has become a constructive and inspiring possibility. Idleness is the great calamity. Your service to the crippled man, therefore, is to find for him a good busy job, and encourage him to tackle it. Demand of the cripple that he get back in the work of the world, and you will find him only too ready to do so.[2]

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A reproduction (right) of part of McMurtrie’s poster exhibit for the Institute featuring the liberal “gospel of rehabilitation”: self-sufficiency, competition, and independence from charity.

McMurtrie’s gospel sounded the same notes as the works of U.S. Allies across the pond, whose material he’d spent years collecting. In 1918, famed novelist, advocate of the war wounded, and editor for the rehabilitation journal Reveille, John Galsworthy warned against the perils of charity, of “drown[ing] the disabled in tea and lip gratitude” and thereby “unsteel[ing] his soul.” Rather, he wrote:

We shall so re-create and fortify…[the disabled soldier] that he shall leave hospital ready for a new career. Then we shall teach him how to tread the road of it, so that he fits again into the national life, becomes once more a workman with pride in his work, a stake in the country, and the consciousness that, handicapped though he be, he runs the race level with his fellows, and is by that so much the better man than they.[3]

Such rhetoric was of a piece with appeals from British Minister of Pensions, John Hodge, for the restoration of men to “industrial independence,” that they might “hold their own in the industrial race.”[4]

When McMurtrie invited the world’s newly-minted experts in rehabilitation to New York in 1919, they shared—as they had through pamphlets, pictures, and films—not just information but ideology. Discussions on war surgery and the organization of rehabilitation schemes unfolded side-by-side with talks on public education and encouragement of the disabled to train.

Such propaganda efforts were critical. According to McMurtrie: “The self-respect of self-support or the ignominy of dependence—which shall the future hold for our disabled soldiers?” The credit or blame, he held, would rest with a public that either demanded self-sufficiency or patronized its men with charity.

References:
[1] Douglas C. McMurtrie, The Organization, Work and Method of the Red Cross Institute for Crippled and Disabled Men (New York: The Red Cross Institute for Crippled and Disabled Men, 1918).
[2] Douglas McMurtrie, The Disabled Soldier (New York: The Macmillan Company, 1919), 37.
[3] John Galsworthy, “Foreword,” The Inter-allied Conference on the After-Care of Disabled Men: Reports Presented to the Conference (London: His Majesty’s Stationary Office, 1918): 13–17. Reprinted in his book of essays Another Sheaf (New York: Charles Scribner’s Sons, 1919).
[4] John Hodge, “The Training of Disabled Men: How We Are Restoring Them to Industrial Independence,” Windsor Magazine no. 281 (1918): 569–571.
[5] McMurtrie, The Disabled Soldier, 75.

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Side Effects May Include

By Emily Miranker, Events & Projects Manager

You’re curled up on your couch watching the latest episode of a favorite show when a commercial break comes along. An actor with amazingly white teeth goes from an unhappy to a happy face suddenly able to go about their regular life without discomfort, all thanks to Some Medication. As the ad spot wraps up, a soothing and fast-talking voice rattles off a litany of side effects: dizziness, loss of appetite, dry mouth, nausea, indigestion, insomnia, and so on.

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Finding and Learning About Side Effects, FDA.gov.

I grew up used to the recitation of possible side effects and long lists of them stapled to prescriptions from the pharmacy. “Yeah, yeah; might get a headache…” But there is huge importance in a regular headache and a headache that presages something medically serious. Mrs. Anne St. C. of Buffalo, NY was not used to these warnings in the 1960s. Because they didn’t exist.

The inclusion of side effects, also called adverse events by the Food and Drug Administration, was an incredibly important milestone for patients and informed consumer choice. We owe these warning labels to another milestone event in public health; the oral contraceptive, the first of which was Enovid, approved for prevention of pregnancy in the United States in 1960.[1] This was a game changer for American women, and within two years 1.2 million women were taking the pill.[2]

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Advertisement for Enovid. American Journal of Obstetrics and Gynecology, Vol. 83 No. 3, February 1, 1962.

One of those women was Anne St. C.

Wife of a professor at a local [Buffalo, NY] university, mother of three and a user of the pill, [she] called her gynecologist and asked, “Is the pill safe? Should I be taking it?” Dr. K. snapped, “Of course, it’s all right for you to take the pill. If it weren’t, I’d never have prescribed it.” Anne did not tell the doctor the real reason why was she calling. In the preceding two weeks she had experienced several attacks of dizziness and double vision. She had also suffered from stiffness in the neck. If she had not been cowed by her doctor’s brusqueness, she might have detailed her symptoms. In that case, the doctor’s reaction might have been quite different. As it was, Anne had a stroke exactly eight days later.[3]

In that Anne survived her stroke, she was lucky. For other women, the side effects were fatal.

Two points about the world in which the oral contraceptives came to market. First, in assessing the safety of the pill, regulators focused on its “ability to prevent pregnancy because pregnancy and delivery were inherently medically risky”[4] and since the pill was effective in that objective, it met the law’s safety requirement. Second, the pill was approved before the dangers of thalidomide‑ discovered to cause birth defects in children whose mothers took it for morning sickness‑ were known and the consequent Kefauver Harris Amendment (“Drug Efficacy Amendment”) of 1962 passed.[5]

When Anne St. C. was taking the pill, doctor-patient relationships existed in the context of the 1938 Federal Food, Drug, and Cosmetic Act. That act required pharmaceutical companies to make information about drug safety available to physicians. When patients got information it was “through the filters of the prescribing physicians and the dispensing pharmacist.”[6] The balance of power rested with the medical practitioner. Come the late 1960s, the burgeoning feminist and consumer rights movements challenged the status quo of the doctor-patient relationship. The balance of power was  questioned and began to shift.

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Barbara Seaman, Alliance for Human Research Protection.

Journalist Barbara Seaman, exposed the dangers of the pill in her 1969 book The Doctors’ Case Against the Pill. She wrote that “a typical package insert that is supplied with one of the most popular oral contraceptives…lists more than 50 side effects of the pill, including a number that can be fatal…Relatively few women ever see these warnings because they are written for physicians; doctors or pharmacists usually remove them from the pill packages,” advocating that it was the patient’s privilege to decide. A woman was “entitled to know the risks and give her informed consent.”[7]

Seaman’s book brought the issue to the attention of Wisconsin Senator Gaylord Nelson (organizer of the first Earth Day). In January 1970 Nelson instigated Congressional hearings on the safety of the pill and the sufficiency of information about its side effects.[8] Attending the hearings, Seaman and fellow activist Alice Wolfson (both future founders of the National Women’s Health Network) were struck by “the fact that there were no women testifying and that there are no women on panel.”[9] Wolfson’s collective, D.C. Women’s Liberation, organized women to position themselves in the hearings’ audiences and outside the Capitol to voice their twofold concerns; the dangers of the pill and the exclusionary structure of the hearings. The feminist activists’ strategic interruptions at the hearings and protests outside the Capitol captured media attention.

Policeman Approaching Young Feminists

D.C. Women’s Liberation demonstrators at the Nelson Hearings, 1970

Amid the media coverage the feminists brought, FDA Commissioner Dr. Charles Edwards announced on the final day of the hearings “that his agency planned to require a … package insert in every package of birth control pills … written by the FDA in lay language and directed to the patient.”[10] While compromise about the writing and scope of the inserts continued, the activists’ efforts laid the groundwork for the warnings that come with all prescription packages today. And today’s pills contain lower doses of hormones than the first Enovid pill.[11]

We continue this important work in increasing the public health literacy and access at the Academy with our Language Access in Chain Pharmacies project, which supports multilingual medication labels. Being able to understand firsthand how to use and any risks or side effect is immensely empowering for a patient and goes a long way to fostering trust in the healthcare system.

Special thanks to Allison Piazza for research assistance with this post.
References:
[1] Suzanne White Junod. FDA’s Approval of the First Oral Contraceptive, Enovid. Update. 1998, July-August. https://www.fda.gov/downloads/AboutFDA/WhatWeDo/History/ProductRegulation/UCM593499.pdf Accessed July 9, 2018.
[2] Alexandra Nikolchev. A brief history of the birth control pill. Need to Know on PBS. http://www.pbs.org/wnet/need-to-know/health/a-brief-history-of-the-birth-control-pill/480/ Published May 7, 2010. Accessed July 10, 2018.
[3] Barbara Seaman. The Doctors’ Case Against the Pill. New York: Peter H. Wyden, Inc., 1969: 109.
[4] Junod. https://www.fda.gov/downloads/AboutFDA/WhatWeDo/History/ProductRegulation/UCM593499.pdf Accessed July 12, 2018.
[5] Sam Peltzman. An Evaluation of Consumer Protection Legislation: The 1962 Drug Amendments. The Journal of Political Economy, Vol. 81, No. 5. 1973 Sept-Oct.
[6] Elizabeth Siegel Watkins. Expanding Consumer Information: The Origin of the Patient Package Insert. Advancing Consumer Interest, Vol. 10, 1. 1998.
[7] Seaman, 9 & 15.
[8] Nikolchev. A brief history of the birth control pill. http://www.pbs.org/wnet/need-to-know/health/a-brief-history-of-the-birth-control-pill/480/ Accessed July 10, 2018.
[9] National Women’s Health Network. https://nwhn.org/pill-hearings/ Accessed July 12, 2018.
[10] Watkins. Expanding Consumer Information. 1998.
[11] Pamela Verma Liao. Half a century of the oral contraceptive pill. Can Fam Physician, Vol. 58, No. 12. 2012 December. Accessed August 24, 2018.

 

Summer Reading Suggestions – Part II

By Emily Miranker, Events & Projects Manager

Our last post suggested foundation and fictional summer reading along the theme of contagion, especially the infectious influenza epidemic of 1918, to whet your appetite for our forthcoming exhibition Germ City: Microbes and the Metropolis (opening September 14, 2018). Read on for more not-your-usual summer reading ideas.

Cities are concentrated hubs of peoples’ movements and interactions; for better or worse, the perfect location for populations and infections to collide. And, perhaps more than any other modern metropolis, the fabric of New York City has been shaped by responses to epidemic disease.

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Cities and Sickness

  • Hives of Sickness: Public Health and Epidemics in New York City, edited by David Rosner
  • Epidemic City: The Politics of Public Health in New York, James Colgrove
  • Smell Detectives: An Olfactory History of Nineteenth-Century Urban America, Melanie A. Kiechle
  • The Ghost Map: The Story of London’s Most Terrifying Epidemic and How It Changed Science, Cities, and the Modern World, Steven Johnson

Rosner’s Hives of Sickness is a great work to start with for looking at disease through the lens of urbanism; it’s a collection of nine essay the reader can dip and in out of. It’s fascinating to see how many of NYC’s public health initiatives were assigned to government agencies besides or along with the Dept. of Health, demonstrating how creating a health city is not an issue to be siloed. Follow that theme of health’s importance across civic agencies to James Colgrove’s Epidemic City, an analysis of the perspectives and initiatives of the people responsible for the city’s health since the 1960s.

Illustrated Newspaper August 1881_cholera_watermark

Another thing that cities mean is lots of people crowded together; which can smell bad. Bad smells and foul air (malaria, anyone?) were believed to be a cause of disease in the 19th century. Smell Detectives shows how hard it proved to find the sources of those dangerous odors and explores the larger tension between evolving scientific knowledge and people’s common, olfactory senses.

 

From across the pond in London is the story of the 1854 cholera epidemic; Dr. John Snow and Rev. Henry Whitehead’s use of interviews and mapping to identify the source as a contaminated water pump—not foul air—and with this the birth of the field of epidemiology and the power of visualizing data. The Ghost Map is a riveting, multidisciplinary tale.

 

Don’t be so Literal:

  • Illness as Metaphor and AIDS and Its Metaphors, Susan Sontag
  • In Sickness and in Health: Disease as Metaphor in Art and Popular Wisdom, by Laurinda S. Dixon
  • Contagious: Cultures, Carriers, and the Outbreak Narrative, Priscilla Wald
  • Punishing Disease: HIV and the Criminalization of Sickness, Trevor Hoppe

Disease is more than a clinical fact. It’s a concept. Trends go viral. Something cool is sick. There are cancers in the body politic. A cancer survivor herself, author Susan Sontag challenges victim-blaming in her seminal and intense work Illness as Metaphor and its follow-up AIDS and its Metaphors. In Sickness and in Health is a good counterpart, its concentration being on figurative illness through the visual arts and imagery. Many people with AIDs belonged to stigmatized minorities which led to society to link sickness to ‘badness,’ and the criminalizing of illness is not specific to AIDS alone as Trevor Hoppe’s Punishing Disease reveals. In Contagious, Priscilla Wald uses history, journalism, literary and cinematic depictions of disease to describe the “outbreak narrative,” and how getting stuck in this particular storyline and mode of thinking might limit our approach to the next big pandemic.

Bonus book

The Plague, Albert Camus

It’s on every other high school required reading list for a reason; Camus’ masterfully written tale of the town of Oran beset by plague is about death by disease but it’s also a powerful allegory about how we choose to live.

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Summer Reading Suggestions – Part I

“There is a narrative power to epidemics … these events typically unfold dramatically and contain elements of discovery, reaction, suspense, conflict, illness, perhaps death, and one hopes, resolution.” -Howard Markel, When Germs Travel

 

This September we open an exhibition with our partners (and next door neighbor) The Museum of the City of New York; Germ City: Microbes and the Metropolis. This year marks the 100th anniversary of the influenza pandemic of 1918 which infected an estimated quarter of the world’s population and caused the death of more people than the First World War.

Germ City exhibit graphic_ltblue

Prompted by this centenary, the exhibition and its related programs are the New York City site of the exploration of germs living in people the way people live in cities, along with sister sites in Hong Kong and Geneva. This international collaboration, Contagious Cities, was developed by the Wellcome Trust. Inspired by the Reading Room at the Wellcome Trust’s home in London, our exhibition will include a reading room of books and articles visitors can read.

If you just can’t wait till September to dig deeper into tales of cities’ roles in causing and controlling disease or the stories of human ingenuity, fear, and compassion in the face of sickness; pick among these titles for not-your-usual summer reading. Please bear in mind titles suggested below may not be in the exhibition’s reading room, but that’s where your local library steps in: find yours here.

Hear them Here: Authors Speaking at our Programs

  • The Great Influenza: The Story of the Deadliest Pandemic in History, John M. Barry
  • Silent Travelers: Germs, Genes, and the Immigrant Menace, Alan M. Kraut
  • Infectious Fear: Politics, Disease, and the Health Effects of Segregation, Samuel Kelton Roberts
  • After Silence: A History of AIDS Through its Images, Avram Finkelstein
  • Pandemic: Tracking Contagions, from Cholera to Ebola and Beyond, Sonia Shah

Many people aren’t aware of the 1918 influenza pandemic or how widespread and deadly it was in New York, the United States, and globally; so John Barry’s account of the pandemic’s history in The Great Influenza and connecting it to current day challenges like avian flu is a good foundation read. Readers can attend on Sept. 27th [coming soon to our events page] to hear Barry in panel discussion on the legacy of the 1918 flu and how surviving future pandemics may be as much a political issue as a medical one. Moderating that conversation will be Alan Kraut, author of Silent Travelers, a look at the medicalized prejudice that so often targets immigrants.

Infectious Fear Cover_RobertsGerms themselves may be blind when it comes to who infect; but outbreaks don’t strike populations with equity. We tackle the fraught intersection of disease and disparity in a discussion on Nov. 28th  [coming soon to our events page] and give the thumbs-up to our moderator Professor Samuel Roberts’ thought-provoking book Infectious Fear. For a closer look at the lived experiences of disease and how those infected are remembered or all too often forgotten join us in February 2019  [coming soon to our events page] for Remembering the Dead; you’ll have plenty of time to check out panelist Avram Finkelstein’s unflinching look at the AIDS crisis and the responses of artist-activists; After Silence. We face our future with infectious diseases in a discussion in April 2019 lead by journalist Sonia Shah. She weaves an amazing story with history, reportage and personal narrative in Pandemic: Tracking Contagions about how we are making predictions about the next major pandemic.

If you’d like a nonfiction read for a younger audience pick up Jim Murphy’s An American Plague. This is a dramatic retelling of the yellow fever epidemic in 1793 Philadelphia, a survival challenge to the city’s inhabitants as well as the young nation itself with a good spotlight on the incredible role of the Free African Society in caring for the sick. An American Plague pairs nicely with Laurie Halse Anderson’s fictional Fever 1793, also intended for the middle-school reader but from the point of view of its 15-year old heroine Mattie.

Which brings us to works of fiction more generally …

Fiction: Disease as a way to Explore the Body and Self; the Individual and Society

  • Fever: A Novel, Mary Beth Keane
  • The Last Man, Mary Shelley
  • Blue Pills a Postive Love Story, Frederik Peeters
  • The Andromeda Strain, Michael Crichton

For a change of pace from incisive facts and socio-scientific trends, delve into the highly personal story of Mary Mallon, an Irish immigrant to the United States better known as ‘Typhoid Mary,’ in Mary Beth Keane’s Fever. From Mary Shelley of Frankenstein fame, there’s an apocalyptic story of humankind brought face to face with its own destruction due to plague in The Last Man complete with thinly veiled versions of Lord Byron, Percy Shelley, and herself. Most of the English Romantics were deceased by the time Shelley wrote this, so an undercurrent of eulogizing comes through in her tone as she explores the failure of imagination to save society.

Translated from the French by Anjali Singh is Frederik Peeters’ graphic novel, Blue Pills – A Positive Love Story, the story of a man’s relationship with his girlfriend and her son who are both HIV+. The black and white artwork allows for an arresting depiction of what is literally happening to the protagonist and simultaneously what he is perceiving and coping with in the moment.

You didn’t think there wouldn’t be a Michael Crichton, did you? The Andromeda Strain is the kick-off novel of bio-tech thrillers with its deadly microbe brought back from space on a military satellite.

Bonus book:

Eleven Blue Men and Other Narratives of Medical Detection, Berton Roueché

One of the best writers from The New Yorker, Roueché’s short stories are superbly written vignettes of medical mystery solving.

Through The Grapevine: writing for Alcoholics Anonymous

By Anne Garner, Curator of Rare Books and Manuscripts

Alcoholics Anonymous first issued The Grapevine in June of 1944, seventy-four years ago this month.  In the journal’s inaugural issue, an uncredited author recounts the founding of the publication “in a big, smoke-filled room” where “six ink-stained wretches sipped at their Cokes … a cashier, a radio script writer: an author: a bookseller: an art director: a wife and mother of two.”  When questioned on the journal’s purpose, the mother of two explains.  It’s about “A.A.’s whole design of living.  There’s going to be a big, full-page on local group doings … and we’re planning to get all the big general stuff on alcoholism into the paper.  Best of all, we think, is the Servicemen’s Letter page…”[1]

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While managed by senior advisor and Alcoholics Anonymous founder Bill W., The Grapevine was conceived and established by a handful of New York “A.A.” women. In “–the story of your magazine – – ” published in the December 1948 issue, the initial idea for the serial publication was credited to “Lois K., a New York member,” who suggested a trial run. A preliminary meeting between Lois K. and three other women in the program, Priscilla P., Grace O. and Marty M. (the latter was the founder of the National Committee for Education on Alcoholism) solved initial questions about content and funding.  They also decided that male representation was needed, and added two men to their staff, Chase H. and Abbott T. Alcoholics Anonymous founder Bill W. gave the plan his blessing, and in his first editorial for the publication, called The Grapevine, “a lighted lamp.”[2]

The initial print run was 1,200 copies, and demand was steady. Members voted on October 3, 1945 to designate The Grapevine as the initial periodical of A.A.  In 1944 and 1945, the journal was produced entirely by non-paid volunteers; by 1948, The Grapevine was supported by four paid staff.  In September of 1948, a smaller, pocket format was conceived (the earliest editions bear a fruit-heavy vine on the cover with the issue information but no title, in an instance of design safeguarding anonymity.)

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The first edition of “Alcoholics Anonymous,” or “the Big Book,” (1939) included only one essay about a female in recovery.  But from the beginning, The Grapevine was more inclusive of women’s stories.  An early article by founding member Grace O. focused on female membership and the perceived challenges by men of women at meetings.  Here, she ticks out some of the complaints expressed by male members, who believed “women talk too much,” “many women form attachments that are too intense,” “women’s feelings get hurt too often,” and that they frequently “are attention demanders;” she concludes that the way forward is with patience and acknowledgement of common purpose.[3]  As Leslie Jamison writes in her 2018 book, The Recovering, “Describing the ‘traditional beliefs’ that inflect how male and female drinking have been understood differently, one clinical textbook puts it like this. ‘Intoxication in a woman was thought to signal a failure of control over her family relationships.’”[4]

3Grapevines_1948-1949

A selection of The Grapevine from 1948-1949.

4Grapevine_t_May1949_v5n2_WatermarkedPnina Levy demonstrates that in the earliest years of the organization men and women shared editorial and writing responsibilities for the serial, though the organization wasn’t always able to shake the entrenched cultural and social gender stereotypes of the early post-War period.[5] A May 1949 article, “Lady A.A.s Get Their Heads Together” acknowledged the challenges of “scurrying to fix dinner, wash dishes, prepare kids for bed, dress yourself and make the meeting across town by 8 o’clock.”[6]  In a “Vino Vignette” published in a 1946 issue, Esther E. tells of the difficulties of moving to her new town of San Antonio to kindle a regular meeting because she’s a woman. She’s successful assembling a group of three females and one male; eventually, as she says, “‘evah-thing’ caught fire.”  The December 1955 issue has no less than five articles by women, including articles about co-ed sponsorship, a narrative of a former female prisoner in recovery, and “My Son and I and AA,” written by a New York program mother.[7]

Today, The Grapevine is still in print, along with La Vina, for Spanish audiences.  Current information about subscriptions and excerpts from past issues can be found here.

References
[1] Anonymous. “Grapevine’ in Bow.” The Grapevine.  June 1944. Vol 1, No. 1.
[2] Anonymous.  “—the story of your magazine—“ The Grapevine. December 1948. Vol 5, No. 7; Bill W., “The Shape of Things to Come,” The Grapevine. June 1944. Vol. 1, No. 1.
[3] Grace O. “Women in A.A. Face Special Problems.” The Grapevine. October 1946. Vol. 3, No. 5, P. 1, pp 6 – 7, 10.
[4] Leslie Jamison. The Recovering.  New York: Little Brown, 2018.
[5] Pnina Levi. “Gender and Alcoholism: Pioneering alcoholic women’s contribution to Alcoholics Anonymous, 1937 – 60.”  Social History of Alcohol and Drugs. 2015. Vol. 29, pp. 112-35.
[6] Anonymous. “Lady A.A.’s Get Their Heads Together.” The Grapevine.  May 1949. Vol. 5, No. 12, p. 11.
[7]  See, “I’ve Changed My Tune,” “My Son and I and AA,” “Adding Up the Score,” “A Lady’s Gripe,” “I’ve Got What I Want for Christmas,” all from The Grapevine. December 1955.  Vol. 12, No. 7.Shop ad_book arts

Facendo Il Libro: The Making of the Book (and a digital collection and exhibit)

By Anne Garner, Curator, Rare Books and Manuscripts, and Robin Naughton, Head of Digital

The Academy Library is thrilled to announce “Facendo Il Libro: The Making of Fasciculus Medicinae, an Early Printed Anatomy.”  This online exhibit, focused on an astonishing and influential medical book first published in Italy in 1491, was made possible through the generous support of the Gladys Krieble Delmas Foundation.

Originally collected in manuscript form, the Fasciculus Medicinae (the “little bundle of medicine”) is a richly illustrated collection of medical treatises on uroscopy, phlebotomy, anatomy, surgery, and gynecology.  The Fasciculus Medicinae was first published in 1491, but demand for it made it a favorite text for printers. By 1522, it had been issued more than twenty times.  Variations in the text and the illustrations through time show the early modern tension between medieval medical ideas and advances in medical understanding forged at the beginning of the 16th century.  The exhibit allows visitors to browse full-text scans of all five editions (1495–1522) in The New York Academy of Medicine’s collections; to investigate each edition’s exquisitely illustrated woodcuts and to explore their cultural and medical meanings; and to compare the books’ illustrations in different editions over time.  The site includes contributed essays from Dr. Taylor McCall, art historian of material culture and medieval medicine at the Walters Art Gallery, Baltimore, and from Dr. Natalie Lussey Seale of the University of Edinburgh, whose work focuses on early modern Venetian print culture.  Dr. McCall’s essay looks at the creation of the text and its accompanying illustrations, while Dr. Seale’s essay offers a window into Venetian printing processes in the 16th century and describes the making of a book in early modern Italy.

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Frontispiece, 1495.

The illustrations of the Fasciculus Medicinae offer an intriguing glimpse of medical practice in the 16th century.  The book’s woodcuts include narrative scenes depicting the earliest Western depiction of dissection in print, an early illustration of a diagnostic consultation showing a professor analyzing a urine flask, and a physician, holding an aromatic sponge to his nose to avoid infection, attending a sick plague patient confined to his bed.  Other woodcuts help us to understand early modern conceptions of health and illness.  The Fasciculus Medicinae’s female anatomical figure captures late medieval ideas about women’s bodies, reproduction, and pregnancy.  A “Wound Figure” graphically depicts the various threats to the body, from blows to the head down to the prick of a thorn on the feet.  Perhaps most surprising of all, the Fasciculus Medicinae’s “Zodiac Figure,” who balances all twelve zodiac signs on his body, conveys the powerful role the stars and planets played in health in the medieval imagination.  This figure, who dates to earlier manuscripts from the medieval period, survives well into the twentieth century, appearing alongside horoscopes in a modified form in print in American almanacs produced by pharmaceutical companies.

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Delmas Homepage imageThe Facendo Il Libro website has a simple design, but a complex structure.  It is both a standalone digital collection and an online exhibit built using Islandora, an open-source digital repository framework.  Representing the first full-text internal digitization project for the Academy Library, the five editions of the Fasciculus Medicinae were digitized in the Library’s Digital Lab. The online exhibit was built using an Islandora multi-site to leverage the digital collection repository (Fedora), Drupal Book module, and the current Library branding theme.

The ability to draw from the common repository made it possible to store content once and use it in multiple ways.  Thus, the five digitized editions are available in two different places using a single source.  The built-in navigational structure for the exhibit makes it easy for users to explore the collection in a linear fashion or by sections.

First images of the 1500 edition

Replicating the physical experience of touching the text is still a challenge for digital projects.  Thus, it was important to create a digital experience that provides the user with some sense of the materiality of the object. For example, the 1500 edition was bound with another text (Savonarola’s Practica medicinae), which is evident from the first digital image of the book. The image shows the thickness of the text and the fact that the 1500 edition begins in middle of the physical object. It shows the user exactly what will be encountered when using the physical item.  It also highlights a significant piece of information that could have been lost due to cropping.

Another important aspect of the online exhibit is the illustrations page, where users can see all the illustrations from all editions in one place.  When a user clicks on an illustration, the user is immediately taken to a page with descriptions of each illustration as it appears in each edition.  To explore the images, users can click on an image and zoom in to see the intricate details.

Facendo Il Libro: The Making of Fasciculus Medicinae, an Early Printed Anatomy” offers a great opportunity for users to learn and explore the Library’s five editions of Fasciculus Medicinae in context.

Explore Facendo Il Libro Online Exhibit.

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The British National Health Service and the Fight for Universal Health Insurance in the United States

Today’s guest post is by Andrew Seaton, the 2018 Paul Klemperer Fellow in the History of Medicine. Andrew is a History PhD candidate at New York University. His dissertation explains the survival of the British National Health Service since 1948, and its significance at home and abroad. Andrew will be presenting his Fellowship research on Wednesday, April 18, at 4 p.m. in the Hartwell Room. Please email history@nyam.org if you would like to attend. Space is limited.

Americans have often looked to other countries in their debates about extending health insurance. Health reformers in the Progressive Era held up Germany’s sickness insurance as a model to work toward, only to have this turned against them during the First World War.[1] In the postwar period, the British National Health Service (NHS) became a focal point of discussion. President Truman’s attempts to include “national health insurance” within existing Social Security legislation coincided with the establishment of the NHS in 1948. When Truman’s opponents – foremost among them the American Medical Association (AMA) – depicted the NHS as emblematic of the problems with “socialized medicine,” (see image below) progressives rushed to its defense.

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Typical representation of the British National Health Service by the American Medical Association. “The Rebellion of British Doctors,” Editor and Publisher, March 6 1948.

The left-wing health economist, Michael M. Davis – whose papers are housed in the New York Academy of Medicine historical collections – stood as a central advocate for the British model. Davis was one of the most important American health campaigners of the mid-twentieth century. He founded organizations such as the Committee for the Nation’s Health (CNH) in 1946 to promote national health insurance, and worked closely with Truman to achieve legislative reform.[2] Cognizant of attacks in the Progressive Era on the German model, the CNH realized that AMA “misinformation” about the British scheme would seriously harm their chances of securing their goal of comprehensive health coverage for all. Responding to this threat, the CNH rebutted AMA communications on the NHS in their own pamphlets (see image below), provided statistics and details about the British health service to newspaper editors, and reprinted favorable media coverage from the U.K.

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Committee for the Nation’s Health, “The Truth About Britain’s Medical Program” (March, 1949).[3]

Trans-Atlantic trips undergirded American battles over the NHS. Dozens of opponents and supporters of extending health insurance in the U.S. undertook field studies in Britain to aid in the battle back home. Davis – by this point nearly eighty years old – undertook such a trip in 1959 with his wife, Alice. They not only met with their extensive contacts in the medical profession and British civil service, but also spoke to ordinary people in public parks across the country to find out how they felt about the NHS. The Britons that Michael and Alice Davis met – from hotel maids to university professors – were “practically unanimous” in saying they “wanted the Health Service,” pointing to the end of anxieties about doctors’ bills as the main cause of satisfaction.[4] The following year, Davis presented these findings as a talk to various American community and labor organizations in an attempt to stimulate interest in national health insurance.

Despite these efforts, Davis and other progressives lost their battle with the AMA. Congress struck down Truman-era health bills, the CNH ended its activities in 1956, and trade unions turned towards securing the best deals for their members through private health insurance rather than advancing a federal health program. The reputation of the NHS played an important part in these events; the AMA’s negative vision of the NHS triumphed over that presented by figures like Davis. This underlines the importance of transnational perspectives when thinking about the history of health care in America – and indeed in Britain – alongside the significance of convincing a wider public when attempting to enact structural change. If Davis’s dream of universal medical coverage in the U.S. is ever to be realized, it will rest in part on shaping popular opinion about America’s place in the wider world of health systems.

References:
[1] Beatrix Hoffman, The Wages of Sickness: The Politics of Health Insurance in Progressive America (Chapel Hill: The University of North Carolina Press, 2001), 54-74.
[2] For a biography of Davis, see Alice Taylor Davis, Michael M. Davis: A Tribute (Chicago: Center for Health Administration Studies, 1972).
[3] New York Academy of Medicine, Library of Social and Economic Aspects of Medicine of Michael M. Davis, Box 64, CNH Releases on British N.H.S., “The Truth About Britain’s Medical Program” (March, 1949).
[4] New York Academy of Medicine, Library of Social and Economic Aspects of Medicine of Michael M. Davis, Box 62, Bibliography: England: 2, Michael M. Davis, “My Observations Last Summer of the British National Health Service” (1960).

Diagnosing Love:  A Look at Classical Sources

By Anne Garner, Curator, Rare Books and Manuscripts

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Frontispiece from Galeni librorum (1525)

In lyric from the 7th Century BCE, Sappho offers the famous description of the symptoms of lovesickness:

My heart beats (but my blood is gone)
At the sound of your sweet laugh.
I cannot look at you for long,
I cannot speak.

My tongue is wounded, and a light
Flame runs beneath my skin.
In my eyes there is no sight,
But my ears roar.

Dank sweat and trembling pass
Where my body was before.
I am greener than grass,
I am almost dying.

(Sappho fragment 2, translation by Willis Barnstone).[1]

For Sappho, love is an affliction, with all the attendant symptoms of a bad fever: Beset by cold sweat, drumming ears, and shaking, the speaker of Sappho’s poem has also gone green.  Her lines also allude to another physical response to falling  in love, one taken up by Galen, Hippocrates, and other classical writers interested in clinical observation and diagnosis. Sappho’s description of the heart, with fire pulsing under the skin, suggests that love may also cause a spike in pulse rate.

Texts from Greek and Roman medical authorities support the idea that an increase in pulse rate might signal an unrequited love.  Both men and women were susceptible to physical illness as a consequence of desire in stories told by Appian, Plutarch, Valerius Maximus, Galen, and others; later sources in the early modern period, especially Dutch genre paintings like those of Jan Steen (see below), often argue that the malady is largely a female ailment.

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Jan Steen’s The Doctor’s Visit (c.1663). Taft Museum of Art (Cincinnati, Ohio).

Many of the earliest Greek prose accounts in classical writing date much later than Sappho.  Lovesickness is not mentioned at all in the core Hippocratic corpus, comprised of approximately seventy collected works by multiple authors in Ionic Greek.  And yet, the Greek physician and writer Soranus (fl. 1st / 2nd century CE) tells a story about the physician Hippocrates of Kos, born around 460 BCE. When Hippocrates visits the sick and lethargic king Perdiccas of Macedonia, he notices that his pulse increases each time Phyle, the wife of Perdicca’s deceased father, is near.  His health improves remarkably once Phyle establishes herself at his bedside (and, we are to infer, in his bed).[2]

The Roman physician Galen (130–210) relates the case of the wife of one Justus, kept awake at night by an ailment that she is reluctant to discuss.  After examining and questioning her, Galen suspects her to suffer from melancholy.  But when a visitor to the woman’s sick bed mentions he’s just seen a performance by the dancer Pylades, Galen writes that the woman’s “facial expression changed, and observing this and putting my hand on her wrist, I found that her pulse had suddenly become irregular in several ways, which indicates that the mind is disturbed.” Galen recounts that when other dancers are mentioned the woman’s pulse remained unchanged.  Pylades, Galen concludes, and her love for him, are at the heart of her illness.[3]

Galen also discusses the case of one Prince Antiochos, the son of the king of Syria (ca. 294 BCE).  Antiochos’ story appears in Appian’s Syrian Wars. King Seleucus the Conqueror, sick with worry over Antiochos’ sudden illness, brings the great physician Erasistratus to his son’s bedside. Erasistratus examines him, but can’t find any signs of disease.  When he questions him, Antiochos is close-lipped.  Erasistratus stations himself near the young man’s bed, and watches his physical symptoms when people enter and leave the room.  As Appian describes it:

He found that when others came the patient was all the time weakening and wasting away at a uniform pace, but when Stratonice [his stepmother] came to visit him his mind was greatly agitated by the struggles of modesty and conscience, and he remained silent. But his body in spite of himself became more vigorous and lively, and when she went away he became weaker again.

Erasistratus persuades the king to give Stratonice to Antiochus to marry, the only possible solution for his incurable disease.[4]

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Frontispiece of Ovid’s The Art of Love (1931).

All of these fallen hearts in the writings of Galen and others beg the question: how to treat a lovesick patient? The answer varied, depending on the source. The physicians in stories by Soranus and Galen conclude that relief could be found only in consummation of the relationship.  For others, the answer was more complicated. Ovid, who wrote more than a hundred years before Galen, is emphatic about the necessity of ridding oneself of desire. In his Remedia Amoris (“Remedy of Love”), a poem enumerating the cures for lovesickness, he writes:

I believe in drastic treatments only, for there can be no cure without pain. When you are ill, they deny you all the good things you crave and feed you nothing but bitter physic, and yet you suffer it willingly enough to save the health of your body. You must submit to the same treatment to save your mind, for it certainly is as precious.[5]

So what course does Ovid prescribe?  Ovid seconds Galen’s conclusion that sex with the desired person is a good idea, but makes the suggestion that the desired should be positioned in the most unflattering light possible.  If that doesn’t work, he advises the sufferer to avoid poetry (except presumably, his own), and move to the country.

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Philip Ayre’s Emblemata amatoria (c.1690)

References:
[1] Sappho & Barnstone, W. Poems. Los Angeles: Green Integer, 1999.
[2] Jody Rubin Pinault. Hippocratic Lives and Legends. Leiden: E.J. Brill, 1992; Michael Stolberg. Uroscopy in Early Modern Europe. Surrey: Ashgate, 2015.
[3] Corpus Medicorum Graecorum, V, 8, 1.  Accessed online February 7, 2018. pp.101-103.
[4] Horace White and Appian, Syrian Wars. New York: Macmillan, 1899.
[5] Ovid and Charles D. Young.  “Remedy of Love.” In The Art of Love. New York: Horace Liveright, c 1931.

Expanding Access to Biodiversity Literature: Medical Botany

By Robin Naughton, Head of Digital and Arlene Shaner, Historical Collections Librarian
Cross-posted at The Biodiversity Heritage Library blog.

The New York Academy of Medicine Library has contributed nine digitized titles (11 volumes) on medical botany to the Biodiversity Heritage Library (BHL) as part of the Expanding Access to Biodiversity Literature project.   It is very exciting to share some of the Academy Library’s botanical resources with the wider public.

While the Library’s collections include a large number of printed botanical books dating back to the beginning of the sixteenth century, for this project we were interested in identifying resources that could be sent to the Internet Archive for external digitization, which meant that we concentrated on our holdings from the second half of the 19th century forward through 1922.  After generating lists from our online catalog, we checked to see if any of these resources had already been digitized by the BHL, Internet Archive, or HathiTrust.  For this process, we developed a set of simple guidelines.

  • Resources not available via BHL, Internet Archive or HathiTrust remained on the list.
  • Resources already available via the BHL were eliminated from the list.
  • Resources already available via the Internet Archive were eliminated from the list because BHL harvests content from the Internet Archive, so there would be no need for us to digitize that content.
  • Resources already available via HathiTrust could still potentially be digitized for access via the BHL based on whether our copy provides additional information for the public once digitized. For example, the Indian Medicinal Plants (Kīrtikara & Basu, 1918) has been partially digitized by HathiTrust, but the volume with the images was missing. As such, it became important for us to digitize so that it would be fully available.

We went through multiple lists and rounds of de-duplication to narrow down our potential submission.  Once we finalized the list, Scott Devine, Head of Preservation, conducted a conservation assessment to determine which resources could be sent out for digitization and which were so fragile that they could only be digitized in house.  We separated these into two lists.  The first list was sent to the Internet Archive for digitization and is our contribution to BHL.   The second list will be a project for our new digital lab and we hope to make them available at a future date.

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Indian Medicinal Plants (1918), plate #256 showing Leea Sambucina.

The Indian medicinal plants (Kīrtikara & Basu, 1918) stood out as a resource to digitize and share widely.  It documents the medicinal plants found in India.  The authors describe a need to provide a text that reproduces illustrations of Indian medicinal plants from other works since there were few prior to this publication.  Dr. W. Roxburgh’s text, reprinted in 1874, was used as a reference throughout.

Although Indian medicinal plants did not focus on the use of plants in the development of drugs, this theme can be seen throughout the resources submitted to the BHL. Each author grapples with the role of plants in the creation and production of drugs.

Fig3

A course in botany and pharmacognosy (1902), plate #1 showing organized cell-contents.

In A course in botany and pharmacognosy (1902), Henry Kraemer, Professor of Botany and Pharmacognosy, defines pharmacognosy as the “study of drugs of vegetable origins.” Kraemer devotes the first part of his text to plant morphology and the second part to pharmacognosy.  In addition, he provides illustrations to aid in the study of both parts so that students can connect the descriptions throughout the text to the visual representations.

Fig4

Pharmaceutical Botany (1918), fig 57 showing leaf bases, species and compound leaves.

Youngken’s Pharmaceutical botany, 2nd edition (1918) was expanded to take advantage of the growing area of botany, including a section on drug-yielding plants.  The text focuses on the morphology and taxonomy of plants used in drug development.

In Pharmacal plants and their culture (1912), Schneider argues that the majority of imported plants used in medicine could already be available in the United States.  He focuses on California and outlines what can be cultivated and grown in the state.  Schneider provides a list of uses and common names.

The medicinal plants of Tennnessee (1894) is an observational inventory of Tennessee’s plants and their descriptions based on a similar project conducted by North Carolina.  Published by the Tennessee Department of Agriculture, the report emphasizes the importance of documenting and understanding the native plants of Tennessee and how they can help increase usage and revenue.

Overall, readers of this collection can begin to understand the role of plants in the creation, development and economic viability of drugs.  Many of the resources provide some form of inventory, index or list that documents the plants and associated drugs.

All titles submitted by the Academy Library to BHL:

The BHL Expanding Access project is funded by the Institute of Museum and Library Services (IMLS).