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).

atlanta

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]

hospital-scene

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.

sanitary-commission

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

 

Note:

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

When Mexican Physicians Take to the Streets and to Villages

Today’s guest post is written by Dr. Gabriela Soto Laveaga, Professor of the History of Science at Harvard University. Her book Jungle Laboratories: Mexican Peasants, National Projects and the Making of the Pill (Duke University Press, 2009) won the 2010 Robert K. Merton Best Book prize in Science, Knowledge, and Technology Studies from the American Sociological Association. On Thursday, November 17th at 6pm, Soto Laveaga will give The Iago Galdston Lecture: “When Mexican Physicians Take to the Streets and to Villages.” There is no charge, but please register in advance here.

In late November of 1964 more than two hundred residents and interns from one of Mexico City’s leading public hospitals threatened to strike because they were denied a Christmas bonus. Their unexpected response revealed the financially precarious situation of junior doctors and the worrisome state of many of the nation’s public hospitals. The subsequent walk-out launched ten months of unprecedented actions in hospitals, clinics, and, surprisingly, Mexico City streets.

demonstration

Physician demonstration demanding “a solution to the medical problem in the country.”

As the movement gained momentum, physicians’ demands for living wages and better working conditions shifted to incorporate a call for social justice for peasants and blue-collar workers. The shift away from hospital-based labor demands alarmed an increasingly repressive regime that set out to discredit physicians through media manipulation, intimidation, and incarceration. By March 1965 many young physicians, once heralded as the future of the nation, were portrayed in the government-controlled media as traitors of the state.

codedmessage

Coded message requesting state governors send information about tension in hospitals. Source: National Archives, Mexico City.

Declassified material offers an extraordinary opportunity to learn —via decoded messages, transcribed wire-tapped conversations, and memos to the president— how the government sought to deal with unruly doctors. It is especially interesting to learn how the government used media – television and newspapers – to distort claims and dismiss doctors’ demands as the actions of a “greedy” profession. Especially revealing is, for example, how secret service agents infiltrated hospitals to gain first-hand knowledge of a movement that quickly became national in scope.

Throughout the multiple walk-outs, hospital emergency rooms remained opened but newspapers created a sense of growing dread among the population. In news stories doctors were often labeled “lazy,” “traitorous,” “murderous,” and, most often, as elites disconnected from the rest of society.

secretservicepicture

Secret Service picture of physicians protesting in May 1965. Source: National Archives, Mexico City.

Days before the 1965 State of the Union address, President Gustavo Diaz Ordaz sent military personnel to oust doctors from key hospitals. In his address the president spent more than thirty minutes speaking about the irresponsible “homicidal actions” of striking physicians. In the aftermath of the movement, more than five hundred physicians lost their license to practice medicine (most were able to practice again in the next presidential administration) and for the following fifty years, until summer 2015, there were no national, doctor-led movements in Mexico.

silentprotest

Doctors taking over downtown streets in silent protest, May 1965. Source: Página 24.

Of note is that after the social movement was unceremoniously truncated a handful of striking doctors joined an urban guerrilla Movimiento Revolucionario del Pueblo (People’s Revolutionary Movement) intent on destroying the government through violence. These doctors were, in turn, captured and together with other members of the guerrilla spent nearly a decade in Lecumberri prison for acts of treason.

The “medical” movement, as it came to be known, was really about two (often at odds) issues: the role of physicians in a rapidly changing society and the country’s need to provide proper healthcare to all working Mexicans, a right established in the 1917 Constitution. In fact young doctors’ reactions may be rooted not in 1960s urban discontent but, curiously, in experiences of city doctors in rural Mexico.

nurses

Nurses forming a  human barrier to protect striking physicians, 1965.

Starting in 1936, all Mexican medical students were required to spend time in remote, poor, and/or indigenous areas provided much-needed primary care. This mandatory social service was later written into the Mexican Constitution. For many city physicians their social service time was a transformative experience. For example, treating patients in extreme poverty while living with them as neighbors and facing similar hardships (such as lack of electricity or running water) sensitized many physicians to the complexity of providing care in Mexico. In addition, these doctors experienced, often for the first time, the deep socio-economic divisions in the country. It was young doctors most moved by their social service year who, oral histories reveal, were more likely to join a social movement.

Currently Mexico’s public healthcare system is going through dramatic shifts, and the 1965 movement is a reminder of the powerful and evolving role that physicians have played in transforming care in the country.

A Visit to the Drs. Barry and Bobbi Coller Rare Book Reading Room

Dr. Patrick Brunner, the author of today’s guest post, is Instructor in Clinical Investigation at The Rockefeller University.

On July 26 2016, a group of young physician-scientists from The Rockefeller University visited the Drs. Barry and Bobbi Coller Rare Book Reading Room at the New York Academy of Medicine. As part of the Clinical Scholars curriculum, led by Dr. Barry Coller and Dr. Sarah Schlesinger, these researchers regularly meet for educational tutorials, and the excursion to the Rare Book Room has clearly been one of the highlights of this past semester.

Arlene Shaner, the curator of this exceptional collection, presented seminal works to the group, and her deep insight and passion for the history of medicine made the excursion a unique experience. Ms. Shaner started the tour with the presentation of one of the most outstanding works of Western medicine – Andreas Vesalius’ opus magnum “De humani corporis fabrica libri septem” (On the fabric of the human body in seven books) from 1543. Ms. Shaner comprehensively and clearly outlined the historical context in which this book had been published, and fascinated her audience with a display of the book’s iconic woodprints. This artwork, which everyone in the room had seen in numerous reproductions, now laid open in its original form – showing the famous muscle man posing in front of an Italian landscape, and the skeleton, leaning on a spade, gazing towards the sky.

vesaliusgravedigger_watermark

Skeleton from the 1543 Fabrica. Click to enlarge.

A letter, sent from Oxford, dated July 7th, 1909, had been incorporated into the book as an inscription. From this letter one can learn that Sir William Osler himself donated the book to the New York Academy of Medicine. Ms. Shaner clearly knows each and every inch of this version of Vesalius work, one of three copies that the New York Academy of Medicine holds.

osler_detail_watermark Inscription by Sir William Osler found in our 1543 Fabrica. Click to enlarge.

Vesalius’ Fabrica has undoubtedly been one of the most influential books on human anatomy, overthrowing the observations and influences of the Greek physician Galen, which had been uncontested by Western medical science for more than 1300 years. And it was not until 1628 that another seminal work, which had also been put on display for the evening, William Harvey’s treatise “Exercitatio anatomica de motu cordis et sanguinis in animalibus” (On the motion of the heart and blood in animals), established that blood circulates in a closed system, and that the heart acts as a pump – a manuscript considered by many scholars to be the single most important publication in the history of physiology.

The visitors from The Rockefeller University were greatly impressed by the richness of this library – especially as they learned that all the books are available for review through the library’s archives, be it the “Anatomia hepatis” (The anatomy of the liver) by Francis Glisson, or the first atlas of skin diseases by the dermatological founding father Ferdinand von Hebra.

Arlene Shaner also presented Bernhard Siegfried Albinus’ “Tabulae sceleti et musculorum corporis humani” (Tables of the skeleton and muscles of the human body), first published in Leiden in 1747, which not only depicts anatomical studies in a monumental fashion, but presents the models within elaborate and artful surroundings – overall, an impressive testimonial of its time.

The climax of the visit was the display of a very special gift donated to the New York Academy by Sir Alexander Fleming – a capsule containing a colony of Penicillium, taken from the original culture that produced one of the world’s first antibiotics for medical use. And it has only been about 70 years since this medication became available!

fleminggrayobverse_watermarkCapsule containing a colony of Penicillium, donated by Sir Alexander Fleming. Click to enlarge.

Seeing all these treasures that irreversibly changed the world, and learning about the stories behind them in the context of both medical and art history, was a unique, and almost sensual, learning experience for the visitors, and Ms. Shaner’s never-ending expertise helped everyone in the room to deeply dive into history.

Aldous Huxley once said: “The charm of history and its enigmatic lesson consist in the fact that, from age to age, nothing changes and yet everything is completely different.”  Understanding the challenges that these authors face during their life times, which may not have been quite so different from the ones that we face today, while, at the same time witnessing the dramatic changes that have been instigated by their works, was a true inspiration. The afternoon passed quickly, and everyone agreed that they wanted to come back and further explore this treasury in the middle of New York City.

Deafness as a Public Health Issue in the 1920s & 1930s (Part 2 of 2)

Today we have part two of a guest post written by Dr. Jaipreet Virdi-Dhesi, the 2016 Klemperer Fellow in the History of Medicine at the New York Academy of Medicine and a SSHRC Postdoctoral Fellow in the Department of History at Brock University in St. Catharines, Ontario. She is working on her first book, Hearing Happiness: Fakes, Fads, and Frauds in Deafness Cures, which examines the medical history of hearing loss and “quack cures” for deafness. Some of these cures are explored on her blog, From the Hands of Quacks. You can find her on twitter as @jaivirdi.

Promotional photo by the New York League for the Hard of Hearing and its hearing clinic for testing and examination (The Bulletin, Dec. 1935)

Promotional photo by the New York League for the Hard of Hearing and its hearing clinic for testing and examination (The Bulletin, Dec. 1935)

The New York League for the Hard of Hearing launched several campaigns during the 1930s addressing the “psychological aspect” of acquired deafness mentioned by Wendell C. Phillips. Since deafness is an invisible affliction, Phillips emphasized the deafened person often feels isolated and unable to adjust to the sensory change, especially if the hearing loss occurred suddenly. Other otologists agreed as many patients narrated similar stories: their hearing was perfectly fine and normal, then one day something happened and they became deaf, and the process of coming to terms to the newfound deafened state was a difficult one. Illness such as influenza, pneumonia, meningitis, diphtheria, scarlet fever, measles, or ear abscesses were usually the culprit. So too were heard injuries, age-onset deafness in the elderly, misuse of drugs such as quinine, a poor diet (including too much sugar), and other ordinary factors:

“It is well to bear in mind the effects of hair-dyes, excessive smoking or drinking, and indeed, improper underwater swimming and diving. Vigorous blowing of the nose is also frequent causes of hearing impairment.”[1] 

Otologists claimed individuals needed to take responsibility for their hearing—to conserve what hearing one had, through proper diet, lifestyle, and hygiene, before it disintegrated. This was a remarkable shift from the 1920s “prevention of deafness” campaigns that concentrated on a screening program of early detection and medical care. While constant surveillance was still promoted, the late-1930s campaigns transformed hearing loss into an affliction that could easily be treated or managed by good habits.

Pamphlets reveal how parents were encouraged to become more “ear-minded” toward their children, that is, to pay attention if their child exhibits any signs of hearing loss, to avoid a circumstance in which a neglected hearing issue ends up turning a deafened child into a problem.

Advertisement for the New York League Hard of Hearing (The Bulletin, 1934).

Advertisement for the New York League Hard of Hearing (The Bulletin, 1934).

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Advertisement for the New York League for the Hard of Hearing (The [Hearing] News, October 1935)

 

 

 

 

 

 

 

 

 

 

In other words, the “problem of deafness” became less about the triumphs of medical cures for hearing loss or social organizations providing communication services, but more about conserving one’s hearing before it was gradually diminished. Themes for “Better Hearing Week” especially reflect this: the 1937 theme was “It’s Sound Sense to Conserve Hearing,” while the 1938 was “Help Conserve Hearing.”

Front page of the October 1937 issue of The Bulletin magazine, promoting the National Hearing Week, with reprints of letters from FDR.

Front page of the October 1937 issue of The Bulletin magazine, promoting the National Hearing Week, with reprints of letters from FDR

The American Society for the Hard of Hearing also launched their own campaigns. In 1937, the organization listed a four-point program publicizing their mandates: the prevention of deafness, the conservation of hearing, the alleviation of social conditions affecting the hard of hearing, and rehabilitation. In addition to popular radio broadcasts on the National Broadcasting System, 327 feature articles and 189 editorials were released in over 1600 newspapers.

“Hearing through Life,” a national campaign launched by the ASHH (Hygeia, October 1937).

“Hearing through Life,” a national campaign launched by the ASHH (Hygeia, October 1937).

The publicity campaigns of the 1920s and 1930s were really about transforming public perceptions of the hard of hearing and deafened as handicapped persons, rather than as “defectives”—an important observation in light of the eugenicist concerns of the period. But they were also about addressing hearing impairment not as a social or educational issue, but as a public health issue, one that required cooperation between different levels of civic infrastructures. As otologist Edmund Prince Fowler noted in 1940, the hearing impaired “should never be dismissed with the thought, “Nothing can be done.”[2]

Promotional photo for the League’s “Children’s Auditory Training Project” campaign of the 1940s (The Bulletin, Nov-Dec, 1949)

Promotional photo for the League’s “Children’s Auditory Training Project” campaign of the 1940s (The Bulletin, Nov-Dec, 1949)

Special thanks are owed to Arlene Shaner at the NYAM Library for her generous research assistance and lively conversations.

References

[1] Samuel Zwerling, “Problems of the Hard of Hearing,” Hearing News (January 1938).

[2] Bulletin of the New York League for the Hard of Hearing, 18.7 (November 1940).

Deafness as a Public Health Issue in the 1920s & 1930s (Part 1 of 2)

Today we have part one of a guest post written by Dr. Jaipreet Virdi-Dhesi, the 2016 Klemperer Fellow in the History of Medicine at the New York Academy of Medicine and a SSHRC Postdoctoral Fellow in the Department of History at Brock University in St. Catharines, Ontario. She is working on her first book, Hearing Happiness: Fakes, Fads, and Frauds in Deafness Cures, which examines the medical history of hearing loss and “quack cures” for deafness. Some of these cures are explored on her blog, From the Hands of Quacks. You can find her on twitter as @jaivirdi.

In 1935, physician Francis L. Rogers of Long Beach read a paper addressing the worrisome statistics of deafness. One study discovered nearly thirty-five thousand Americans were deaf. Another found that out of a million people tested for their hearing, 6% had significant hearing impairment. Yet another study reported three million people had some kind of hearing impairment. This “problem of deafness,” Rogers emphasized, “is primarily of public health and public welfare.” Not only were there too many people failing to adequately care for their hearing, but many cities, schools, and governments lacked the proper infrastructure to educate the public on the importance of hearing preservation. Indeed, as Rogers stressed: “Today the three great public health problems confronting the world are heart disease, cancer, and deafness.”[1]

Image 1

A window display in Detroit (Hearing News, June 1942)

The notion of deafness being statistically worrying as a public health issue actually dates to the late nineteenth century, especially to the work of otologist James Kerr Love of Glasgow. Love conducted several statistical studies of the ears of deaf schoolchildren, discovering that the majority of them were not completely deaf, but had some level of “residual” hearing. With proper medical treatment, the hearing could be intensified enough to warrant a “cure.” For other cases, children could be taught to make use of that residual hearing through invasive training using acoustic aids and other kinds of hearing technologies.

Love’s research concluded that many deafness cases could actually be relieved if the ears of children were examined early and frequently—that is, deafness could be prevented. His “prevention of deafness” concept was influential for the new generation of otologists in America, especially those who were members of the New York Academy of Medicine’s Section of Otology during the first three decades of the twentieth century.

To raise awareness on the necessity of proper medical examinations and frequent hearing tests, these otologists collaborated with social organizations such as the New York League for the Hard of Hearing, which was established in 1910. The League was a progressive group catering to the needs of hard of hearing or deafened persons who were raised in a hearing society rather than in a D/deaf community and communicated primarily with speech and lip-reading rather than sign language. Composed mostly of white, middle-class, and educated members who lost their hearing from illness, injury, or progressive deafness, the League strove to construct hearing impairment as a medical issue. They argued hearing impairment was not an issue of education or communication, but rather a handicap.

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An otologist examining a young patient’s ear (Hygeia, June 1923)

The collaboration between New York otologists and the League eventually created a national network of experts, social services, teachers, physicians, and volunteers who banded together to address the so-called “problem of deafness.” That is, the problem of how to best integrate the hard of hearing, the deafened, and to some extent, even the deaf-mutes, into society. One key achievement of the League was the establishment of hearing clinics to properly assess hearing impairment, especially in children, to ensure medical care could be provided before it was too late. This project was primarily spearheaded by Harold M. Hays (1880-1940), who was recruited as president of the League in 1913, becoming the first active otologist collaborating with the League. After the First World War, Hays set up a clinic for treating hearing loss in children at the Manhattan Eye, Ear, and Throat Hospital.

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Group hearing tests of schoolchildren, using an audiometer. Headphones are used first on the right ear, then the left. (Hygeia, February 1928)

Hays claimed that hearing impairment might be a handicap, but “the sad part of it is that 90 percent of all hearing troubles could be corrected if they were treated at the proper time.” With regular hearing tests, this was possible. Yet, as Hays argued, regular hearing tests were not considered on par with other hygienic measures under public health services:

We are saving the child’s eyes! We are saving the child’s teeth! Is it not worth while to save the child’s ears?”[2]

During the 1920s, Hays’ activism for regular hearing tests was so instrumental that in 1922, the League’s newsletter, The Chronicle, told its readers “we believe that the League would justify its existence if it did no other work than to prevent as much deafness as possible.”  To achieve this mandate, the League launched a large public campaign to raise awareness on the importance of medical care. Indeed, in one report for the League, Hays remarked that with the increased publicity, there were 10,000 calls to the League in 1918 alone inquiring about aural examinations. A steady increase in patients would follow: 17 clinic patients in 1924, 326 in 1926, and then 1,531 in 1934.

Another publicity campaign spearheaded by the League was the establishment of “Better Hearing Week” in 1926, a week-long awareness program (later renamed “National Hearing Week”). Held in October, the campaign included symposium discussions on the “Problems of the Hard of Hearing,” including topics on the relationship between the physician and his deafened patient, how the deafened could build their lives, and even on newest technological developments in hearing aids. October issues of The Bulletin (the renamed League newsletter) and the Hearing News, the newsletter of the American Society for the Hard of Hearing (ASHH) included reprints of letters from prominent leaders supporting the mandates of “Better Hearing Week,” including letters from President Roosevelt and New York Mayor LaGuardia.

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Advertisement for Western Electric Hearing Aid, the “Audiophone.” These before-and-after shots were powerful for demonstrating the effects of “normal” hearing, sending the message that outward signs of deafness, such as the “confused face,” could easily disappear once being fitted properly with a hearing aid. (Hearing News, December 1936)

The 1920s publicity campaigns were primarily focused on fostering ties between otologists and the League, in cooperation with hospitals and schools. In 1927, the League purchased audiometers and offered invitations to conduct hearing tests in schools across New York, so children with hearing impairment could be assessed accordingly. Two years later, the League worked with Bell Laboratories to further substantiate the conviction that deafness was a serious problem amongst schoolchildren and that something needed to be done.

At the same time otologists across America established joint ventures between organizations like the America Medical Association and the American Otological Society. They formed committees to write reports to the White House on the national importance of addressing the “prevention of deafness.” Wendell C. Phillips (1857-1934), another president of the League and the founder of ASHH, particularly emphasized the need to address the “psychologic conditions and mental reactions” of the deafened patient, for the tragedy of acquired deafness meant it is a “disability without outward signs, for the deafened person uses no crutch, no black goggles, no tapping staff.”[3] It was an invisible handicap that needed to be made visible if it was to be prevented, if not cured.

References

[1] The Federation News, August 1935.

[2] Harold M. Hays, “Do Your Ears Hear?” Hygeia (April 1925).

[3] Wendell C. Phillips, “Reminiscences of an Otologist,” Hygeia (October 1930).

Many Anatomy Lessons at the New York Academy of Medicine

Kriota Willberg, the author of today’s guest post, explores the intersection of body sciences with creative practice through drawing, writing, performance, and needlework. She is offering the workshop “Visualizing and Drawing Anatomy” beginning June 6 at the Academy. Register online.

Cheselden's Osteographia, 1733, opened to the title page and frontispiece.

Cheselden’s Osteographia, 1733, opened to the title page and frontispiece.

Different Disciplines, Same Body

I teach musculoskeletal anatomy to artists, dancers, and massage therapists. In my classes the students study the same raw material, and the set of skills each group acquires can be roughly organized around three distinct areas: representation of the body, kinesiology (the study of movement), and palpation (feeling the body).

As an anatomy teacher I am constantly on the prowl for images of the body that visually reinforce the information my students are learning. The Internet has become my most utilized source for visual teaching tools. It is full of anatomy virtual galleries, e-books, and apps. 3D media make it ever easier to understand muscle layering, attachment sites, fiber direction, and more.

In spite of the overwhelming volume of quality online cutting-edge anatomical imagery, I find myself drawn to historical 2D printed representations of the body and its components, once the cutting-edge educational technology of their respective centuries. Their precision, character, size, and even smell enhance my engagement with anatomical study. Many of these images emphasize the same principles as the apps replacing them centuries later.

The Essential Structure Of The Body

Different artists prefer different methods of rendering bodies in sketches. One method is to organize the body by its masses, outlining its surface to depict its bulk. Another method is to draw a stick figure, organizing body volume around inner scaffolding.

Plate XXXIII in Cheselden, Osteographia, 1733.

Plate XXXIII in Cheselden, Osteographia, 1733.

And what is a skeleton but an elaborate stick figure? William Cheselden’s Osteographia (1733) presents elegant representations of human and animal skeletons in action. These images remind us that bones are rigid and their joints are shaped to perform very specific actions. The cumulative position of the bones and joints gives the figure motion. In Cheselden’s world of skeletons, dogs and cats fight, a bird eats a fish, a man kneels in prayer, and a child holds up an adult’s humerus (upper arm bone) to give us a sense of scale while creating a rather creepy theatrical moment.

Muscle Layering

3D apps and other imaging programs facilitate the exploration of the body’s depth. One of the challenges of artists and massage therapists studying anatomy is transitioning information from the 2D image of the page into the 3D body of a sculpture or patient.

Planche 11 in Salvage, Anatomie du gladiateur combattant, 1812.

Planche 11 in Salvage, Anatomie du gladiateur combattant, 1812.

Salvage’s Anatomie du gladiateur combattant: applicable aux beaux artes… (1812) is a 2D examination of the 3D Borghese Gladiator. Salvage, an artist and military doctor, dissected cadavers and positioned them to mimic the action depicted in the statue. His highly detailed images depict muscle layering of a body in motion. The viewer can examine many layers of the anatomized body in action from multiple directions, rendered in exquisite detail. Salvage retains the outline of the body in its pose to keep the viewer oriented as he works from superficial to deeper structures.

Tab. VIII in Albinus, Tabulae sceleti et musculorum corporis humani, 1749.

Tabula VIII in Albinus, Tabulae sceleti et musculorum corporis humani, 1749 edition.

Bernhard Siegried Albinus worked with artist Jan Wandelaar to publish Tabulae sceleti et musculorum corporis humani (1749). Over their 20-year collaboration, they devised new methods for rendering the dissected body more accurately.  The finely detailed illustrations and large size of the book invite the reader to scrutinize the dissected layers of the body in all their detail. Although there is no superficial body outline, the cadaver’s consistent position helps to keep the reader oriented. On the other hand, cherubs and a rhinoceros in the backgrounds are incredibly distracting!

Fiber Direction

Familiarity with a muscle’s fiber direction can make it easier to palpate and can indicate the muscle’s line of pull (direction of action).

Figure in Berengario, Anatomia Carpi Isagoge breves, 1535.

Figure in Berengario, Anatomia Carpi Isagoge breves, 1535.

The images of Jacopo Berengario da Carpi’s Anatomia Carpi Isagoge breves, perlucide ac uberime, in anatomiam humani corporis… (1535) powerfully emphasize the fiber direction of the muscles of the waist. This picture in particular radiates the significance of our “core muscles.” Here, the external oblique muscles have been peeled away to show the lines of the internal obliques running from low lateral to high medial attachments. The continuance of this line is indicated in the central area of the abdomen. It perfectly illustrates the muscle’s direction of pull on its flattened tendon inserting at the midline of the trunk.

The Internal Body Interacting with the External World

One of the most important lessons of anatomy is that it is always with us. Gluteus maximus and quadriceps muscles climb the stairs when the elevator is broken. Trapezius burns with the effort of carrying a heavy shoulder bag. Heck, that drumstick you had for lunch was a chicken’s gastrocnemius (calf) muscle.

Tab. XII in Speigel, De humani corporis fabrica libri decem, 1627.

Tab. XII in Speigel, De humani corporis fabrica libri decem, 1627.

Anatomists from Albinus to Vesalius depict the anatomized body in a non-clinical environment. One of my favorites is Adriaan van de Spiegel and Giulio Casseri’s De humani corporis fabrica libri decem (1627). In this book, dissected cadavers are depicted out of doors and clearly having a good time. They demurely hold their skin or superficial musculature aside to reveal deeper structures. Some of them are downright flirtatious, reminding us that these anatomized bodies are and were people.

Kriota Willberg's self portrait. Courtesy of the artist.

Kriota Willberg’s self portrait. Courtesy of the artist.

I am so enamored of van de Spiegel and Casseri that I recreated page 24 of their book as a self-portrait. After my abdominal surgery, the image of this cadaver revealing his trunk musculature resonated with me. In my portrait I assume the same pose, but if you look closely you will see stitch marks tracing up my midline. I situate myself in a “field” of women performing a Pilates exercise that challenges abdominal musculature. And of course, I drew it in Photoshop.

Have You Heard of the Lincoln Collective?

Today’s guest blogger, Merlin Chowkwanyun, is an assistant professor of sociomedical sciences at Columbia University’s Mailman School of Public Health. He will present “The Lincoln Collective: The World of New York City Health Activism in the 1970s” at the Academy on May 24. Learn more and register.

I’m really looking forward to visiting the New York Academy of Medicine next week, in no small part because the health activism I’m going to discuss took place in New York City itself. My talk will focus on a couple dozen physicians, fresh out of medical school, who decided to do their residencies at Lincoln Hospital in the South Bronx in the 1970s.

They arrived in the summer of 1970 and called themselves “the Lincoln Collective,” hoping to form a critical mass of politically conscious physicians who could effect change in one institution, and in the process, provide a model for other activists across the country to follow. In its recruitment pamphlet, the Collective’s founders wrote that they intended “to become part of the solution rather than part of the problem” and “affirm[ed] that we are in training to serve the community, and that we are committed to dealing with the problems of the urban ghetto community in a long-run way.” That commitment entailed not just ephemeral service projects that lasted a few weeks, but finding ways to facilitate more permanent community input into healthcare facilities’ operations.

Cover of a Lincoln Collective Recruitment pamphlet.

Cover of a Lincoln Collective Recruitment pamphlet.

Lincoln epitomized the overtaxed, under-resourced urban hospital. One official document described it as “a hopelessly inefficient and inadequate building” with “dirt and grime and general dilapidation [that] make it a completely improper place to care for the sick…” And locals had nicknamed it “The Butcher Shop.” By conventional standards, then, Lincoln was not exactly a desirable or prestigious choice for your typical medical graduate at this time. So what was it that set the Lincoln Collective’s members apart? Who were these people? And where did their values come from? What were they hoping to get by converging on one of the most dilapidated hospitals in one of the most resource-deprived areas of the United States? And most important of all, what did it all mean in the end, when the Lincoln Collective came to a close in the mid-1970s?

To answer these questions, I’ll place the Lincoln episode in a wider story about changes that wracked the healthcare sector during the 1960s and 1970s. Many Collective members had been involved in student organizing on medical campuses, not exactly known, then and now, as cauldrons of political foment. Others had come from community organizing. And some were not particularly political and simply looking for a place to serve the most indigent and medically deprived. They came to Lincoln when the health field was undergoing what I have called a “governance revolution”—multi-pronged efforts throughout the era to decrease hierarchy within medicine and increase the participation of professionals in healthcare governance.

Article on medical student unrest in Medical World News, Oct. 13, 1967, pp. 63–67.

Article on medical student unrest in Medical World News, Oct. 13, 1967, pp. 63–67.

The Collective arrived at a time of tumult around the hospital itself. Groups like the Black Panthers and the Young Lords had made healthcare equality a major tenet of their organizing. At times, the Collective’s relationship with these groups was cooperative and fruitful, at other times, tense and ambiguous. Much of that depended on Collective members’ individual ideological inclinations, which were hardly uniform throughout the group. Tensions undergirded the encounter between mostly white physicians and mostly non-white, non-professional activists, and I’ll explore these challenges throughout the talk.

Pamphlet of Health Revolutionary Unity Movement, a health-oriented adjunct of the Young Lords that also organized around Lincoln.

Pamphlet of Health Revolutionary Unity Movement, a health-oriented adjunct of the Young Lords that also organized around Lincoln.

I’ve been thinking about the Lincoln Collective for more than a decade now. The title of my talk is an utterance I heard repeatedly when I was a college student in New York City studying activist movements in public health and medicine. “Have you heard of the Lincoln Collective?” people would ask. Some who posed the question were in it (and some claimed to be but, I’d later discover, were not). When I went off to graduate school, I put the story aside for a long time. At the confused age of 22, I didn’t feel I had the political maturity to really write about some pretty politically fraught and emotional events. Now, with more distance, I’ve returned to it.

We’re now in an era when people in the health sector—in the wake of a wave of police brutality and the Flint disaster—are asking themselves serious questions about the role political activism should play in their work. Turning back the clock and looking at a group of health activists from 50 years ago is a way of moving that conversation forward.

From Cholera to Zika: What History’s Pandemics Tell Us about the Next Contagion

By Sonia Shah

Sonia Shah, today’s guest blogger, is a science journalist and author of Pandemic: Tracking Contagions from Cholera to Ebola, and Beyond (Sarah Crichton Books/Farrar, Straus & Giroux, February 2016), from which this piece, including illustrations, is adapted.

On February 23 at 6pm, Shah will moderate the panel “Where Will the Next Pandemic Come From?,” cosponsored by the Pulitzer Center on Crisis Reporting. Register to attend.

Over the past 50 years, more than 300 infectious diseases have either newly emerged or re-emerged into territory where they’ve never been seen before. The Zika virus, a once-obscure pathogen from the forests of Uganda now rampaging across the Americas, is just the latest example. It joins a legion of other diseases that have similarly broken out of earlier constraints, including Ebola in West Africa, Middle East Respiratory Syndrome (MERS) in the Middle East, and novel avian influenzas in Asia, one of which hit the U.S poultry industry last spring, causing the biggest animal disease epidemic in U.S history.

When such pathogens spread like a wave across continents and global populations, they cause pandemics, from the Greek pan (“all”) and demos (“people”). Given the number of pathogens in our midst with pandemic-causing biological capacities, pandemics themselves are relatively rare. In modern history, only a few pathogens have been able to cause them: Yersinia pestis, which causes bubonic plague; variola, which causes smallpox; influenza A; HIV; and cholera.

Cholera is one of the history’s most successful pandemic-causing pathogens. The first cholera pandemic began in the Sundarbans in present-day Bangladesh in 1817. Since then, it has ravaged the planet in no fewer than seven pandemics, the latest of which is currently smoldering just a few hundred miles off the coast of Florida, in Haiti.

Cholera first perfected the art of pandemics by exploiting the rapid changes in transportation, trade, and demography unleashed by the dawn of the factory age. New, fast-moving transatlantic clipper ships and sailing packets, which moved millions of Europeans into North America, brought cholera to the New World in 1832. Thanks to the opening of the Erie Canal in 1825, the bacterial pathogen easily spread throughout the country, including into the canal’s southern terminus, New York City, which suffered repeated cholera epidemics over the course of decades.

The spread of cholera after the opening of the Erie Canal.

Cholera was well-poised to exploit the filth of 19th-century cities. The pathogen spreads through contaminated human waste. And outhouses, privies, and cesspools covered about 1/12 of New York City, none of which were serviced by sewer systems and few of which were ever emptied. (Those that were had their untreated contents unceremoniously dumped into the Hudson or East Rivers.) The contents of countless privies and cesspools spilled out into the streets, leaked into the city’s shallow street-corner wells, and trickled into the groundwater.

Even those who enjoyed piped water were vulnerable to the contagion. The company chartered by New York State to deliver drinking water to the city’s residents—the Manhattan Company, which started a bank now known as JPMorgan Chase—dug their well among the tenements of the notoriously crowded Five Points slum, in what is today part of Chinatown. They delivered the slum’s undoubtedly contaminated groundwater to one third of the city’s residents.

The 1832 cholera outbreak in New York City. the Manhattan Company, now JP Morgan Chase, sank its well amidst the privies and cesspools of the Five Points slum, atop the site of the Collection Pond, which had been filled in with garbage. The water was distributed to 1/3 of the city of New York.

The 1832 cholera outbreak in New York City. The Manhattan Company, now JP Morgan Chase, sank its well amidst the privies and cesspools of the Five Points slum, atop the site of the Collection Pond, which had been filled in with garbage. The water was distributed to 1/3 of the city of New York.

Just as the Zika and MERS viruses confound modern-day medicine, so too did cholera confound 19th-century medicine. Under the 2,000-year-old spell of miasmatism—the medical theory that diseases spread through stinky airs, or miasmas—doctors couldn’t bring themselves to admit that cholera spread through water, despite convincing contemporary evidence that it did.

But that doesn’t mean there was nothing that could have been done to mitigate the cholera pandemics of the 19th century.

The Manhattan Company knew the water they distributed was dirty. As a former director of the company admitted in 1810, Manhattan Company water was rich with its users’ “own evacuations, as well as that of their Horses, Cows, Dogs, Cats, and other putrid liquids so plentifully dispensed.” New Yorkers decried its smell and taste, which they variously derided as “abominable” and “nauseating.”1 They suspected, too, that the company’s water made them sick. “I have no doubt,” one letter writer opined to a local paper in 1830, “that one cause of the numerous stomach affections so common in this city is the impure, I may say poisonous nature of the pernicious Manhattan water which thousands of us daily and constantly use.”2

And New York’s physicians knew that cholera was coming down the Erie Canal and the Hudson River, heading straight for the city. Dr Lewis Beck, who collected the data mapped above admitted that the pattern of disease did “favor the idea that cholera is contagious,”3 and travelling down the waterways into New York City. So many people feared the migrants coming down the waterways during cholera outbreaks that residents of towns lining the canal refused to let passengers on passing boats disembark. In 1893, in fear of a cholera outbreak, an armed mob surrounded the cholera-infected passengers of the Normannia, a vessel recently arrived from Hamburg, Germany, trapping hundreds aboard for days.

But despite the public’s fears of contagion and contaminated water, little was done to protect the city from either. The city’s leadership refused to enact quarantines along the canal or the Hudson for fear of disrupting the lucrative shipping trade that had transformed New York from a backwater to the Empire State. The Manhattan Company retained its charter, despite public outcry about the quality of their water. The political machinations of the infamous Aaron Burr, pursuing his murderous rivalry with the now-storied founding father Alexander Hamilton, assured that.

Instead, each wave of deadly contagion was met with minor adjustments to society’s defenses against pathogens. International conferences began in 1851 to organize cross-border quarantines against cholera and other diseases. New York City opened its first independent health department, staffed by physicians rather than political appointees, in 1865, as cholera loomed (thanks in large part to the efforts of the New York Academy of Medicine). These reactive, incremental measures couldn’t stave off nearly a century of deadly cholera pandemics, but as the decades passed, they formed the foundation for the global health system we enjoy today. Following New York City’s example, independent health departments were built across the country. The international conferences to tame cholera led to the formation of the World Health Organization, in 1946.

Today, we continue to fight contagions in a similarly reactive, incremental fashion. After Ebola infected tens of thousands in West Africa and elsewhere, hospitals in the United States and other countries beefed up their investments in infection control. After mosquito-borne Zika infected millions across the Americas, public health agencies focused anew on the problem of disease-carrying insects.

Whether these measures will be sufficient to defuse the next pandemic remains to be seen. But a more comprehensive, proactive approach to defanging pandemics is now possible, too. The history of pandemics reveals the role of human activity in the emergence and spread of new pathogens. Industrial developments that disrupt wildlife habitat; rapid, ad hoc urbanization; intensive livestock farming; sanitary crises; and accelerated trade and travel all play a critical role, just as they did in cholera’s heyday. In some places, we can diminish the pathogenic threat these activities pose. In others, we can step up surveillance for new pathogens, using new microbial sleuthing techniques. And when we find the next pandemic-worthy pathogen, we can work to contain it—before it starts to spread.

References

1. Pandemic, p 64. From Koeppel, Gerard T. Water for Gotham: A history. Princeton University Press, 2001, 121, 141.

2. Pandemic, p 63. from Blake, Nelson Manfred. Water for the cities: A history of the urban water supply problem in the United States. No. 3. Syracuse University Press, 1995, 126.

3. Pandemic, p 106. from Tuite, Ashleigh R., Christina H. Chan, and David N. Fisman. “Cholera, canals, and contagion: Rediscovering Dr Beck’s report.” Journal of public health policy 32.3 (2011): 320-333.

50 years ago: Building the Case Against Lead

This post is part of an exchange between “Books, Health, and History” at the New York Academy of Medicine and The Public’s Health, a blog of the Philadelphia Inquirer.

By Christian Warren, Associate Professor of History, Brooklyn College

Estimates of environmental lead's harms today would be far, far worse had it not been for Clair Patterson's groundbreaking research. U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION

Estimates of environmental lead’s harms today would be far, far worse had it not been for Clair Patterson’s groundbreaking research. U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION

The world is a lot less polluted with lead than it was a half-century ago, thanks in part to geochemist Clair Patterson. Fed up with lead contamination in his laboratory, he mounted a research campaign that overturned decades of misguided industry-sponsored science. In 1965 he published a game-changing article declaring: “the average resident of the United States is being subjected to severe chronic lead insult.” Patterson wanted to shock a nation in denial about the cost of its embrace of all things lead. Some saw his argument as darkly prophetic. Others saw it as patently absurd.

Lead’s proponents had 40 years of scientific studies to lean on—science bought and paid for by the very companies covering the earth with lead. In 1923 Standard Oil and General Motors had introduced leaded gasoline—a disastrous debut involving front page horror stories of workers driven to madness or agonizing death from lead exposure. But the lead industries minimized the fallout brilliantly. First, they finessed a federal investigation into the dangers; second, they founded a lead-friendly research institution at the University of Cincinnati. Under the direction of Robert Kehoe, the Kettering Laboratory quickly became the world’s authority on lead and health.

By the early 1960s, when the tobacco industry and others were ginning up the manufacture of doubt about their toxic products, Kehoe had a long career amassing a huge store of what passed for scientific certainty. Dozens of his studies “proved” that lead posed no public health threat. Lead, he explained, was a natural component of the environment, and humans had evolved in a leaded environment. And, Kehoe maintained, a little lead was harmless. It might pose a danger above a certain threshold, but below that level there was no need to worry. Our modern urban environment with lead spewing out of every automotive tailpipe in the country, did not, he concluded, push us above that threshold. Bottom line: the public faced no risk from lead exposure. Patterson’s 1965 research article, “Contaminated and Natural Lead Environments of Man” did not blast a mighty hole in the lead industry’s fortress of certitude but it struck a sharp blow with pinpoint accuracy. The small fissure it opened ultimately undermined the lead industry’s foundation. Initially the industry responded with dismissals and character assassination—the same playbook followed by other polluters under attack. Patterson would not surrender and kept the hard science coming. (He died in 1995 at age 73.)

Patterson’s battles with lead contamination began in the laboratory. Studying the composition of meteorites early in his career he was frustrated by laboratory lead contamination, leading him to develop new clean-room protocols. The payoff came in 1956, when Patterson calculated the age of the earth to be 4.5 billion years, a figure accepted by scientists to this day.

To understand the sources of environmental lead pollution Patterson went to sea to measure the extent of lead in the ocean’s depths. He voyaged to frigid mountaintops and then to the earth’s coldest regions following the lead trail. He proved that lead pollution had been rising since antiquity—and that it had spiked since the introduction of leaded gasoline in the middle of the 20th century. These findings drove Patterson into the thick of environmental politics, perhaps the most treacherous environment he ever braved.

Patterson’s article used the new standards of proof in medicine and public health that looked at large populations instead of individuals, finding relationships between behaviors and health outcomes. The Surgeon General’s first report on cigarette smoking, published one year earlier, used this approach.

Through a brilliant application of the kind of atomic bean counting that he’d employed in establishing the earth’s age, Patterson demonstrated that the average American’s body contained a hundred times more lead than was natural. In later publications he drove this point home with a powerful graphic: the outlines of three human torsos, each with dots representing the amount of lead in their bodies. The figure for primitive man had one dot; the second and third figures, representing the average modern American and a patient at Kehoe’s “threshold” for clinical lead poisoning, were both grey with dots, barely a shade apart. The stakes, Patterson insisted, went beyond the health of individuals. “[T]he course of history,” he asserted, “may have been and is now being altered by the effect of lead contamination upon the human mind.”

Thanks to Patterson’s scientific work and the regulations it ultimately inspired we all live in a much less heavily leaded world than the one Patterson explored. But we still have far to go. Most new uses of lead-containing products have been banned in America for a generation, but the lead left behind from centuries of relying on “the useful metal” still poisons our homes and lands. The tremendous progress since Patterson’s day revealed lingering, pervasive harms caused by the lead that remained—learning and behavior deficits as well as cardiovascular and immunological consequences. And in many parts of the world, lead pollution remains far worse than in the U.S., with even greater impact on public health. Concerned citizens must demand the regulations and clean up efforts that will eliminate every last “dot” of lead from every man, woman, and child on the earth.

Christian Warren, author of Brush With Death: A Social History of Lead Poisoning, is associate professor of history at Brooklyn College of the City University of New York, where he studies the history of health and the environment.

Physicians Discuss Aphrodisiacs

Ken Albala is Professor of History and Director of Food Studies at the University of the Pacific. He is the author or editor of 24 books on food. He conducted his dissertation research primarily at the New York Academy of Medicine. Dr. Albala will present Aphrodisiacs: The Intimate Connection Between Food and Sex in Renaissance Nutritional Theory and lead the workshop “Hands On” Early Modern Cooking at our Eating Through Time Festival on October 17.

As a scholar sometimes you have ideas that get orphaned that you come back to after many years, very randomly. Such was a paper I first delivered at a Northern California Renaissance conference in 1995 on aphrodisiacs in medical literature. In truth, I had intended to fit the topic into my dissertation and it never made it in. The paper was a way to make use of the pile of notes I had taken at the New York Academy of Medicine just a few years before. And when I say a pile of notes, I mean an entire filing cabinet full of handwritten notes taken in pencil and coded with colored crayons. There was no such thing as a laptop then.

A page of Ken Albala's notes.

A page of Ken Albala’s notes.

These notes cover about 100 books I read at the Academy between 1989 and 1993, practically every dietary text written in Europe between the mid-15th and the mid-17th century. I was a permanent fixture in what was then called the Malloch Room, now the Drs. Barry and Bobbi Coller Rare Book Reading Room. The notes became my dissertation at Columbia University and eventually morphed into my first book Eating Right in the Renaissance (UC Press, 2002). While I always kept an active interest in the history of medicine, my career since then has shifted far more toward culinary history and broader food history. Every now and then I deliver a paper or write an article involving food and medicine, and I still teach a history of medicine course, but I had completely forgotten about the topic of aphrodisiacs. In jest I have often said it would be a really interesting topic for experiential research. Alan Davidson, the late author of the Oxford Companion to food, encouraged me many times to write a serious book on aphrodisiacs, but it never came to pass.

What surprise then, when this past spring, two decades after first giving that paper, I was asked to speak in Miami on aphrodisiacs. I thought, OK, I will just go into my computer and find that paper. No evidence of it. I realized that when I wrote that paper I was still learning to type, had just sent my first email, and had still written out everything by hand. So I needed to dig through the filing cabinets to find the original paper. Then to revise and update it using my original trove of notes taken 25 years earlier. Happily the paper was a success. I also delivered it in Dublin a few weeks later, and then a publisher contacted me asking if I would like to write a book on aphrodisiacs. I think I probably will. Isn’t it funny how every stray idea eventually finds a good home?

The most remarkable thing about the whole experience is that I can still hear the voices of early modern authors after all these years. I can still quote them in half a dozen languages. From the French version of Platina printed in 1507 there is “L’heure que tu sentiras ta viande estre cuite, car…l’heure est bonne pour engendrer enfans…”  (The moment you feel that your meal is digested, the time is good to produce children.) Or Girolamo Manfredi from 1474 “Imperho dicono li philosophi che chi usa molto il cohito vive poco e tosto invechia.” (Therefore philosophers say whoever has a lot of sex lives a short life and ages too soon.) Or there’s Baldassare Pisanelli who tells us that 4 drams of cloves in milk “aumento mirabilmente le forze di Venere” (greatly increase the power of Venus.) There’s also the Fleming Hugo Fridaevallis who tells us that asparagus is great for timid newlyweds “primas coniugii difficultates, et si quid minis in uxore tunc placet, dulce et amabile futurum tandem uxoris contubernium” (whoever…has conjugal difficulties at first, and if you are unable to please your wife, later she will be a sweet and loving mate).

Baldassare Pisanelli's Trattato della natura de' cibi et del bere Nel quale non solo tutte le virtù, & i vitii di quelli minutamente si palesano, 1586. His discussion of the power of cloves in milk appears top right.

Baldassare Pisanelli’s Trattato della natura de’ cibi et del bere Nel quale non solo tutte le virtù, & i vitii di quelli minutamente si palesano, 1586. His discussion of the power of cloves in milk appears top right. Click to enlarge.

Their opinions are of course very amusing, but they also give us some remarkable insights into the kinds of problems Renaissance people would have taken to their physicians. These kind of frank open discussions of sex gradually become rarer in the 16th century, no doubt under the influence of the Reformations a kind of prudery pervades the later dietaries. It took another few centuries until they discuss the topic again, in the 19th century, but all this is the subject for a book. Stay tuned.