Red Medicine: The West Looks at the Soviet Experiment in the 1930s

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

Last month marked the 100th anniversary of the Great October Revolution, whereby the Bolsheviks in Petrograd overthrew the Russian government and took power.[1] Immediately after, the Revolution’s leader, Vladimir Lenin, consolidated his rule by suppressing competing political parties; withdrawing Russia from World War I; and fighting a bitter Civil War. By the early 1920s, the country had obtained a modicum of peace, albeit isolated from the rest of the world. Through wars and purges, technological advance and political suppression, the Bolsheviks, renamed the Communist Party, held control in Russia for almost 75 years.

In a Hospital Waiting Room, Moscow

Margaret Bourke White, “In a Hospital Waiting Room, Moscow,” 1932. Red Medicine, endpaper.

Lenin was aware of Russia’s backwardness compared with the West. He saw Communist rule as a way to make up for that deficiency. His oft-cited definition of communism made this belief explicit: “Communism is Soviet power plus the electrification of the whole country.” Soviet power meant political rule that flowed from ostensibly democratic workers’ councils (the Russian word for “council” is “soviet”), with the aim of basing governance in the working class; electrification meant providing the latest means of technological development. Soviet rule and technological development, together, would enable the country to leap-frog its capitalist neighbors and become the vanguard for humanity’s future development, both social and economic.

The socialist left hoped this vision would be realized. Early accounts were enthusiastic—sympathetic American journalist Lincoln Steffens gushed in 1919: “I have seen the future, and it works!”

By the 1930s, as the United States and Europe slid into the Great Depression, Soviet Russia was held out as a more workable and more equitable society than those in the West. In the field of medicine and public health, two observers set out to see if that were true. Sir Arthur Newsholme (1857–1943), and John Adams Kingsbury (1876–1956), a Briton and an American, traveled through the Soviet Union in August and September 1932.[2] Their account was published the following year as Red Medicine: Socialized Health in Soviet Russia.[3]

Itinerary of the authors

“Itinerary of the authors, who traveled 9,000 miles within Soviet Russia.” Red Medicine, p. 19.

Newsholme and Kingsbury travelled over 9,000 miles throughout the Soviet Union. Entering Russia from Poland, the two traveled to Moscow, took a trip up to Leningrad and back, and then headed east to Kazan, south to Samara and Stalingrad, and jogged back to Rostov-on-Don before journeying to Tiflis (Tbilisi) in Soviet Georgia. They traveled back to Moscow by way of Sochi, Sevastopol (in Crimea), and Kharkov in Ukraine, and from Moscow, they returned to Poland. Their book chronicled their trip with an overlay of commentary. It was in part a look at Soviet institutions, such as residential and non-residential treatment, physician training, maternity care, and tuberculosis sanitaria. Beyond this, the authors provided social and political observations on life in the Soviet Union, with chapters on “The Background of Russian Life,” “Stages in the Introduction of Communism,” “Women in Soviet Russia,” and “Religious and Civil Liberty and Law.”

Though clear-eyed about the authoritarian nature of the Soviet government, Newsholme (the acknowledged author of most of the work) nonetheless focused on one question:

Does the Soviet organization—including all that is implied in the unification of financial responsibilities and control of the entire resources of the country—assist to an exceptional extent a complete medical and hygienic service for the entire community? To this question we can at once give a definitely affirmative answer. [4]

Though the “civilized countries” had variously tended toward socialized medicine, he thought that the U.S.S.R. had surpassed them all, both in delivery of health care and in prevention, in social services as well as medicine more narrowly defined. As one reviewer of Red Medicine understood Newsholme’s claim:

“[In the] organization and practice of medicine . . . the present government has made truly great progress, and seems to have only fairly gotten under way. The authors clearly perceive that Russia has laid a more adequate basis for up-to-date public health than any western nation; also, that we have arrived at a stage of cultural development when medical services must be provided on a sound basis for all, regardless of ability to pay.”[5]

Traveling dental station

Soviet Photo Agency, “Traveling dental station in rural district near Moscow,” [1932]. Red Medicine, p. 223.

This level of public support was seen as the inevitable goal of social development, so much so that, as Newsholme put it, “Even if the Communist experiment fails, Russian government cannot be expected to revert entirely to capitalist conditions.”

Did the Soviet experiment work? The new system of medicine and public health was initially very successful in dealing with infectious disease and extending care more widely through the country. Nonetheless, as Newsholme had envisioned, the initial impetus could not be sustained. Fifty years after Red Medicine, the system was broken; while citizens could usually get access to health care, quality lagged. After the collapse of the Soviet system in 1989–91, the new Russian government attempted reform and adopted a mixed public-private economic model, mandating compulsory health insurance while continuing a guaranteed right to free care. Fifteen years on, though, an OECD report concluded that “Russia continues to struggle with a health and mortality crisis.”[6] One could fairly state that our country faces such as crisis today as well, and in both cases, the resolution is yet to come.

A note: Red Medicine includes several photographs by noted photojournalist Margaret Bourke-White, taken during her own 1932 trip to the Soviet Union, and provided freely to the authors for their use.[7]

Endnotes:
[1] Yes, it took place in November! In 1917, Russia still used the Julian calendar, according to which the day of the Bolshevik coup was October 25. The rest of the West, using the Gregorian calendar, called that day November 7. Most of Catholic Europe had switched to the Gregorian calendar in 1582, with the Protestant countries adopting it in the 17th century and the British domains in 1752. Russia made the change in early 1918, one of the last countries in Europe to do so.

[2] Newsholme was an eminent British public servant and advocate of state intervention in public health, while Kingsbury, a Fellow of The New York Academy of Medicine, was formerly Commissioner of Public Charities for New York City, and at that time, Executive Director of the Milbank Fund, a foundation supporting research in health policy.

See “Sir Arthur Newsholme, K.C.B., M.D. (LOND.), F.R.C.P.,” American Journal of Public Health 33(8) (August 1943): 992–94; John M. Eyler, Sir Arthur Newsholme and State Medicine, 1885–1935, Cambridge History of Medicine (Cambridge: Cambridge University Press, 1997); Arnold S. Rosenberg, “The Rise of John Adams Kingsbury,” The Pacific Northwest Quarterly 63(2) (April 1972): 55–62; “Biographical Note,” The John Adams Kingsbury Papers, Manuscript Division, Library of Congress, accessed November 7, 2017.

[3] Sir Arthur Newsholme and John Adams Kingsbury, Red Medicine: Socialized Health in Soviet Russia (Garden City, NY: Doubleday, Doran, 1933). Note that, despite the title, the work was about more than Soviet Russia. The two men’s travels took them to the Georgian and Ukrainian Soviet Republics as well.

This work was conceived as in some ways completing Newsholme’s previous three-volume survey of medical practice in Europe, which he undertook with the support of the Milbank Foundation: Medicine and the State: The Relation between the Private and Official Practice of Medicine, with Special Reference to Public Health. London, Baltimore: George Allen and Unwin, Williams and Wilkins; 1932. The Academy Library holds the third volume.

[4] Newsholme and Kingsbury, Red Medicine, “Concluding Observations” (for this and subsequent statements).

[5] Frank H. Hankins, “[Review of] Red Medicine: Socialized Health in Soviet Russia. By Sir Arthur Newsholme and John Adams Kingsbury,” Social Forces 14 (1) (1 October 1935), 155–56, accessed November 7, 2017. Hankins (1877–1970) was a prominent American sociologist.

[6] William Tompson, “Healthcare Reform in Russia: Problems and Prospects,” Organisation for Economic Co-operation and Development, Economics Department Working Papers, No. 538 (Paris, January 15, 2007), 5.

[7] Gary D. Saretzky, catalog for “Margaret Bourke-White in Print: An Exhibition at Archibald S. Alexander Library, Rutgers University, New Brunswick, New Jersey, January–June 2006,” item 23, Red Medicine, accessed November 7, 2017.

“The Politics of Infrastructure” Class Review

By Audrey Sage Lorberfeld, Digital Technical Specialist

As part of the ongoing collaboration between the Brooklyn Institute for Social Research (BISR) and The New York Academy of Medicine Library, I was able to spend the beginning of summer contemplating how material and immaterial infrastructures affect peoples’ daily lives.

Throughout the BISR course titled “The Politics of Infrastructure,” taught by one of my favorite professors, Danya Glabau, we covered everything from why park benches are a certain length (so that people don’t sleep on them), to the United States’ unique economy of technological obsolescence. We took some deep dives into theoretical texts, such as Michelle Murphy’s Sick Building Syndrome and the Problem of Uncertainty and Bruno Latour’s Science in Action: How to Follow Scientists and Engineers Through Society. We were also encouraged to apply what we read to our daily lives. During my morning commutes, I suddenly found myself wondering if an umbrella or a subway car were inherently political objects (and what this might mean for their construction and use).

As always, there were beautiful treasures from the Academy Library that we were able to view during class, thanks to our Rare Books and Manuscripts Curator Anne Garner’s expansive knowledge of our holdings. One item she found for the class that was particularly striking was Stephen Smith’s The City That Was (1911).[1] We used this item as a complement to our unit titled “Infrastructure and Public Health,” where we read critical texts such as Paul Farmer’s “An Anthropology of Structural Violence” and Manjari Mahajan’s “Designing Epidemics: Models, Policy-Making, and Global Foreknowledge in India’s AIDS Epidemic.”

HyperFocal: 0

Image from Smith’s The City That Was (1911) showing the “Region of Bone-Boiling and Swill-Milk Nuisances.”

Smith was a New Yorker who many now regard as the father of public health. He founded the American Public Health Association and was the first to attribute the spread of typhus and cholera to environmental conditions around New York City.[2] Without him, New York would likely not have advanced into the public health-conscious city it is today (at least not as quickly). In The City That Was, Smith outlines through detailed illustrations various areas of the city that were public health concerns. I hate to imagine what Nolita’s trendy residents would think of their apartments if they knew they were once next to noxious hide-curing and fat-gathering houses.

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Image from Smith’s The City That Was (1911) showing the “Region of Hide-Curing, Fat-Gathering, Fat and Soap Boiling, and Slaughter-Pens, Behind the Bowery Shopping Houses.”

While examining physical infrastructures, past and present, provided us with the tools to critique New York’s metropolitan landscape responsibly, we also learned about more cerebral types of infrastructure. One author whose work particularly struck me was Susan Leigh Star. In her article titled “Power, Technology and the Phenomenology of Conventions: On Being Allergic to Onions,” she examines the power of living in between worlds, and challenges her readers to question the idea of standardization. Of the latter, she brings attention to stoplights, writing: “The initial choice of red as a colour of traffic lights that means, ‘stop’, for example, is now a widespread convention that would be functionally impossible to change, yet it was initially arbitrary.” And it’s true — who decided that red meant stop? Why does red mean stop everywhere now, from stop signs to walk signals?

Star_DimensionsOfPower_1991

Diagram showing Star’s theory of the dimensions of power, from “Power, Technology and the Phenomenology of Conventions: On Being Allergic to Onions,” 1991.

For me, the power of Star’s scholarship really became solidified throughout her discussion of marginality, though. She writes:

“We are at once heterogeneous, split apart, multiple — and through living in multiple worlds without delegation, we have experience of a self unified only through action, work and the patchwork of collection biography . . . That is, in the case of Pasteur or any executive, much of the work is attributed back to the central figure, erasing the work of secretaries, wives, laboratory technicians, and all sorts of associates. When this invisible work . . . is recovered, a very different network is discovered as well . . . All of these ways of gaining access imply listening, rather than talking on behalf of. This often means refusing translation — resting uncomfortably but content with that which is wild to us.”[3]

As someone who works in the intersection of medicine and the social sciences, the ideas in the above quote seem especially relevant. Biological scientists hate lingering in the unknown, while social scientists get tenure by writing about it. The idea of a library whose collections reflect the chameleonic history of medicine likely exists in a space much like Star’s “multiple worlds.” And, similar to those lab technicians whose names you never read about when a team of scientists win the Nobel Prize, libraries function largely on invisible labor. Thanks to Star, I am getting more comfortable with my own brand of marginality, too.

Glabau lead us expertly down these paths and many more during my time as a BISR student in “The Politics of Infrastructure.” We are currently hosting another one of her classes (“Science, Race, and Colonialism“), so stay tuned for more synopses from the field.

References:
[1] Smith S, The City That Was. New York, NY: F. Allaben; 1911.
[2] A Short Narrative of Dr. Stephen Smith. Medph.org. Published 2016. Accessed July 10, 2017.
[3] Star S. Power, Technology and the Phenomenology of Conventions: On Being Allergic to Onions. The Sociological Review. 1991; 38(S1):26-55, p29-30.

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).

Image 6b

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.

Image 2

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.

Image 3

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.

Image 4

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).

Presenting Grey Literature at the 13th International Conference on Urban Health

By Danielle Aloia, Special Projects Librarian, and Robin Naughton, Digital Systems Manager

Danielle Aloia, Special Projects Librarian, and Robin Naughton, Digital Systems Manager, presented Hidden Urban Health: Exploring the Possibilities of Grey Literature on the Academy’s Grey Literature Report (GreyLit Report) in two sessions at the recent International Conference on Urban Health in San Francisco, April 1-4, 2016. The conference focused on Place and Health and included a joint program with the American Association of Geographers. Combining data from geography with health data is one way to develop better models for urban and population health, and those involved in fields as diverse as urban planning, transportation, housing, and education all need to be at the table.

Themes of the ICUH 2016 opening ceremony. Photo by Danielle Aloia.

Themes of the ICUH 2016 opening ceremony. Photo by Danielle Aloia.

During the conference, two themes particularly relevant to the GreyLit Report emerged: the need for a better definition of urban health and the importance of interdisciplinary research. These are important concepts for the GreyLit Report when collecting and providing access to urban health resources, helping us to identify and understand topics that cross disciplines.

We had an opportunity to appeal to the cross-disciplinary audience of researchers during two conference sessions, providing a brief explanation of what grey literature is and ways to search for it beyond traditional databases. In brief, grey literature is produced by think tanks, university centers, government agencies, and other organizations. It can be published as reports, fact sheets, data sets, white papers, and more. It provides current research on trending topics and is used to communicate findings to stakeholders and policy-makers.

Robin Naughton and Danielle Aloia before the Hidden Urban Health: Exploring the Possibilities of Grey Literature session. Photo courtesy of ICUH.

Robin Naughton and Danielle Aloia before a Hidden Urban Health: Exploring the Possibilities of Grey Literature session. Photo courtesy of ICUH.

Some forms of grey literature can be found in traditional databases, such as PubMed or Web of Science, but the majority is not indexed or organized in systematic ways. To help solve this problem, the Academy Library developed the GreyLit Report in 1999 to collect these reports and make them accessible. During the presentations, we emphasized the importance the GreyLit Report places on interdisciplinary research. We collect reports related to public health in all sectors, to truly make a one-stop-shop for urban health.

During the presentation, participants learned about Google Custom Search (using Google to search specific websites and document types), Twitter, and the GreyLit Report as three resources relevant to finding grey literature. Still, depending on the resource used for search, altering keywords may be necessary to get relevant results. What terms one discipline uses may be defined differently in another. For example, the word mobility can have multiple meanings. In urban health, it usually means how people get from place to place, but when searching Google or Twitter one can get results for mobile technologies and physical disabilities. We clarified that the terms used in searching are very important to the relevance of the results. Often, searches in Google and Twitter need to be weeded through to find relevant results. We also presented some criteria for evaluating such results: authority, credibility, affiliation, purpose, and conflict of interest.

Danielle Aloia presenting at ICUH. Photo by Robin Naughton.

Danielle Aloia presenting at ICUH. Photo by Robin Naughton.

The GreyLit Report is much easier to search than Google or Twitter. Because we collect, archive, and index reports from all sectors, its focus limits irrelevant results. Users do not have to wade through millions of results, but have a credible, authoritative selection from which to choose.

At the end of each session, we opened up a conversation with participants to see what their concerns were in regard to grey literature and how the GreyLit Report may help them in their research. This produced an intimate, lively discussion. Participant concerns about grey literature included how to promote their own grey literature and ideas to enhance the Report. One idea is to add canned (one-click) searches on specific urban health topics.  Another idea is to add the United Nations’ 17 Sustainable Development Goals with links to reports in those areas so that users can easily find grey literature for specific sustainable development goals in urban health. We will work on enhancing the GreyLit Report website, and more importantly, we will think about ways to help promote this growing body of research for users.

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.

What a Boy Scout Merit Badge Tells Us About the History of Public Health

By Johanna Goldberg, Information Services Librarian

This month, the Boy Scouts of America celebrated its 106th birthday. To mark the occasion, we are featuring at a pamphlet from our collection, called simply Public Health.

In 1922, the Boy Scouts published the pamphlet as one of a series designed for scouts to study in order to receive merit badges. Though as the pamphlet states:

“It would defeat one of the purposes of these merit badge tests if any attempt were made in a pamphlet of this character to so completely cover the requirements as to remove the necessity for the boy to use his own initiative and show his resourcefulness in seeking sufficiently complete information and practical experience to enable him to successfully pass the test.”1

What was on the test? The cover explains:

The cover and inside cover of Public Health, 1922.

The cover and inside cover of Public Health, 1922. Click to enlarge.

We can’t resist a close up of the cartoon at the bottom of the cover, showing how boy scouts with knowledge of public health best practices chase away causes of disease, from bad sanitation and drainage to flies and mosquitoes to “general disorder and filth.”1

A close-up of the cartoon on the cover of Public Health, 1922.

A close-up of the cartoon on the cover of Public Health, 1922.

The Boy Scouts of America still offer a merit badge in public health. Interestingly, many of the requirements are strikingly similar to their 1922 counterparts. Today’s scouts must explain disease transmission (though diseases have changed from tuberculosis, typhoid, and malaria to E. coli, tetanus, AIDS, encephalitis, salmonellosis, and Lyme disease). Instead of drawing a house-fly and showing how it carries disease, boy scouts today have to discuss how to control insects and rodents to prevent them from introducing pathogens.2

The major difference between today’s test and that of 1922 is the addition of a question about immunization. Today’s scouts must define the term and discuss diseases that can and cannot be prevented through immunization. In 1920, 7,575 Americans died of measles, 13,170 died of diphtheria, and 5,099 died of pertussis.3 In 1922, the only vaccine recommended for universal use in children was smallpox. By the end of the 1920s, diphtheria, pertussis, and tetanus joined that list, followed by polio, measles, mumps, and rubella in the 1960s and 70s.3 Today, there are 15 vaccine-preventable childhood diseases.4

While many of the same public health issues have remained at the forefront since 1922, our means of responding to them have progressed. If there is still a test for a public health merit badge in another 94 years, one hopes that the questions will reflect even more advances in prevention and control of disease.

References

1. Public Health. Boy Scouts of America; 1922.

2. Public Health. Available at: http://www.scouting.org/Home/BoyScouts/AdvancementandAwards/MeritBadges/mb-PUBH.aspx. Accessed February 10, 2016.

3. Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children — United States, 1990-1998. MMWR Wkly. 1999;48(12):243–248. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00056803.htm#00003752.htm. Accessed February 10, 2016.

4. Vaccines: VPD-VAC/Childhood VPD. Available at: http://www.cdc.gov/vaccines/vpd-vac/child-vpd.htm. Accessed February 10, 2016.

The Right to Health (Item of the Month)

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

Does one have a “right to health”? And if so, what does that right entail? Access to healthcare? Access to all healthcare? Equality of health outcomes?

The debate in this country over passage of the Affordable Care Act brought to the fore the differing assumptions over a “right to health.” Yet since at least 1946, members of the United Nations have asserted the right to health as a fundamental global human right. The constitution of the World Health Organization “enshrines the highest attainable standard of health as a fundamental right of every human being.”1 This right was further stated in the Universal Declaration of Human Rights of 1948—framed as the right to a standard of living “adequate for health and well-being.”2 The right to health remains a formative principle in global health. For example, three of the UN’s eight Millennium Development Goals are explicitly health related, and all have a health component.3

Though this right to health reached its full flower in the mid-20th century, it originated some 50 years earlier. In the late 19th century, urban and industrial ills had pushed their way onto the political agenda across the western world. Many reformers thought that supporting political rights was not enough: social and economic rights needed to be affirmed as well. One of these thinkers was the New York City-based urban researcher William Harvey Allen. In a series of books, and most notably Civics and Health (1909), Allen laid out the reasons why health was a human right.4

“Necessary to Efficient Democracy,” the way that experience in schools and other institution is brought to the public, in William Harvey Allen, Civics and Health, 1909), p. 310.

“Necessary to Efficient Democracy,” the way that experience in schools and other institutions is brought to the public, in Allen, Civics and Health, 1909, p. 310.

Allen made granting the right to health the apex of moral development, both in the individual and the society. He placed “rights” as the last and best of the seven motivations for public health action, starting with instinct and ranging through commerce to humanitarianism.5 Indeed, to promote health Allen said one could not rely on the love of money or the joy of human sympathy: “So long as those who suffer have no other protection than the self-interest or the benevolence of those better situated, disease and hardship inevitably persist.”6 By society’s affirming the right to health, it acknowledged that the citizenry’s well being had a claim on its attention and resources, and it made itself accountable to provide it. “Health administration is incomplete until its blessings are given to men, women, and children as rights that can be enforced through courts, as can the right to free speech, the freedom of the press, and trial by jury,” wrote Allen. The political rights claimed in the eighteenth century meant little if one did not have the physical means to exercise them in the twentieth. Those “permanently incapacitated . . . cannot appreciate the privilege of pursuing happiness.”7

According to Allen, it was not that people did not know what to do to secure public health—for the most part they did. It was rather that the means were often shunted aside, a problem of enforcement—and hence his argument for health as a right! Allen looked to find the most practical way to correct health deficiencies, and as co-director of the city’s newly established Bureau of Municipal Research, he looked upon all of New York as a test site.8 Here, he turned his attention to the health of school children, “the best index to community health.”9 Determining the status of children’s health was a comprehensive way of judging the health of the whole community, as children from all ranks of the community were available to reformers, and the mechanisms were already in place to examine and collect data. Allen saw children’s health as the indicator, not just to the health of the city, but to the right to health. Much of his book was devoted to measuring as well as intervening in children’s health, in such ways as enforcing milk purity laws, quarantines for communicable diseases, and vaccination for smallpox. He was concerned with controlling germs, paying attention to eye and ear health, and promoting school play and physical education. He saw the health of teachers as crucial to that of their charges. And, as detailed in our earlier blog post, he supported removal of tonsils and adenoids.

Sample record card for school physical examination, as found in Allen, Civics and Health, 1909, p. 34. As Allen noted: “Weight, height, and measurements are needed to tell the whole story.”

Sample record card for school physical examination, as found in Allen, Civics and Health, 1909, p. 34. As Allen noted: “Weight, height, and measurements are needed to tell the whole story.”

Yet, Allen did not think that the solution lay only in better school health. Society as a whole needed to address the health of its members throughout their lives. He suggested measures such as coordinating school health with other social agencies, requiring work physicals and promoting industrial hygiene, waging war on the “white plague” of tuberculosis, providing physicians with training not just in restorative medicine but also in preventive medicine, discouraging tobacco and alcohol use, and setting up institutions for large-scale information gathering and coordination through a national bureau of health.10

Many of Allen’s practical ideas today seem commonplace in the wake of the great shifts in public health that took place in the 20th century. But one thing stands out: seeing health as a right brought it out of the realm of enlightened self-interest and humanitarian relief. Health became social, health became enforceable, health became a right. That legacy, contested though it now is in American society, remains present today.

References

1. World Health Organization, Fact Sheet No. 323, “The Right to Health,” reviewed November 2013, http://www.who.int/mediacentre/factsheets/fs323/en/#, accessed September 23, 2015.

2. United Nations, “Universal Declaration of Human Rights,” Article 25, http://www.un.org/en/documents/udhr/, accessed September 23, 2015.

3. For the UN Millennium Development Goals, see http://www.un.org/millenniumgoals/, accessed September 23, 2015; for a summary of international conventions, see Mervyn Susser, “Health as a Human Right: An Epidemiologist’s Perspective on the Public Health,” American Journal of Public Health 1993 March; 83 (3): 418–26.

4. William Harvey Allen, Civics and Health, with an introduction by William T. Sedgwick (Boston, New York, Chicago, and London: Ginn and Company, 1909). For information on Allen (1874–1963), see in addition to the Recchiuti book below: “Reminiscences of William Harvey Allen: oral history, 1950,” Columbia Center for Oral History, http://oralhistoryportal.cul.columbia.edu/document.php?id=ldpd_4072329.

5. Allen, Civics and Health, pp 11–22. The seven motivations are Instinct, Display, Commerce, Anti-Nuisance, Anti-Slum, Pro-Slum [Abatement], and Rights.

6. Allen, Civics and Health, 20.

7. Allen, Civics and Health, 20.

8. For Allen and the Bureau of Municipal Research, see John Louis Recchiuti, Civic Engagement: Social Science and Progressive-Era Reform in New York City (Philadelphia: University of Pennsylvania Press, 2006), Chapter 4, pp. 98–124.

9. The phrase comes from the title of Chapter 4, “The Best Index to Community Health is the Physical Welfare of School Children,” page 33.

10. Allen, Civics and Health, Part III, “Coöperation in Meeting Health Obligations,” and Part IV, “Official Machinery for Enforcing Health Rights.” For an earlier attempt at a national bureau of health, see Jerrold M. Michael, “The National Board of Health: 1879–1883,” Public Health Reports 2011 Jan-Feb; 126(1): 123–29.

Adenoids and American School Hygiene in the Early 20th Century

Kate Mazza, today’s guest blogger, received her doctorate in US history from the Graduate Center, CUNY. Her dissertation, “The Biological Engineers: Health Creation and Promotion in the United States, 1880-1920” examines the ideas and progress of the interrelated health reforms of physical education and school hygiene. She has published an article, “Distracted At School: Aprosexia, ADHD and Adenoids in American Culture” in the Journal of American Culture.

NYTimesHeadlines_AdenoidsAs the school year came to a close in June 1906, a panic swept through New York’s Lower East Side. According to newspaper reports, hundreds of parents, mostly Eastern European immigrants, ran to about a dozen local schools believing that their children were going to be harmed or murdered by doctors. Some people broke windows, some hit school workers, many yelled and cried and all demanded to see their children. At each school, children were eventually dismissed early, and, to the great relief of the frightened parents, were unharmed. A similar course of events took place in Brownsville, Brooklyn the next day.1 These events came to be known as the “adenoid riots” because they occurred a week after students had undergone surgeries, apparently without incident, to remove enlarged adenoids at Public School 110 in the Lower East Side.

What caused the riots? Most accounts of the time blamed the immigrant population, stating that they were subject to panics, suspicious and ignorant of modern medical practice, and incensed and saddened by recent news of the Bialystok pogroms. Reporters also commented that local doctors intentionally spread rumors that children were being harmed because they saw free school and city services as a threat to their business.

Modern scholars, sympathetic to the immigrant’s perspective, have analyzed the events as a reaction against coercive means of assimilation.2 Yet while “Americanization” certainly played a role in this health initiative, school medical inspection affected children of all classes and ethnic groups in the United States and abroad. The confusion, fear, and misunderstanding of the adenoid riots was caused, in part, by erroneous beliefs about the implications of enlarged adenoids (masses in the back of the nasal cavity that can help fight infection), the methods used in NYC, and the zealousness of the hygienists to find and root out adenoids.

In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), page 4.

“Mouth breathing means adenoids; adenoids mean deadened intellects.” In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 4.

In 1887, Amsterdam physician A.A. Guye connected enlarged adenoids to aprosexia, or the inability to pay attention, along with poor memory and headaches.3 This idea laid the foundation for associating adenoids with academic failure, disobedience, and truancy. Over the years, physicians also linked enlarged adenoids to deafness, poor voices, trouble sleeping, colds, weight loss, restlessness, chest and mouth deformity, mouth breathing, ear disease, and even tuberculosis.4

By the early 1900s, many involved in the growing school hygiene movement in the United States were convinced that enlarged adenoids were a common impediment to learning. In 1905 New York City became one of the first cities to inspect students for enlarged adenoids along with ear, nose, and throat problems. This more thorough physical examination was added to examinations for contagious diseases that had taken place since the 1890s in a number of cities.

"Mouth breathers before adenoid party." In Allen, Civics and Health, 1909, p. 55.

“Mouth breathers before ‘adenoid party.'” In Allen, Civics and health, 1909, p. 55.

Chief Medical Inspector of the New York City Department of Health, Dr. John C. Cronin, spearheaded the expanded medical inspection. He claimed that at PS 110, 137 children out of 150 in a specialized class of so-called “backward,” “incorrigible,” and “truant” children had enlarged adenoids.5 As the end of the school year approached, 56 children had had them removed, with 81 remaining. Cronin arranged to have the students convalesce in the countryside with the Society of Improving the Condition of the Poor at the end of the school year. Yet Cronin also wrote later that “it was then thought justifiable to get information as to what scholastic results would be obtained if these children were operated on collectively.”6 Seemingly frustrated, he brought in three doctors from Mount Sinai hospital to perform the operations at the school, after obtaining permission slips from parents. Cronin stated that doctors performed operations on 81 children in 84 minutes.7 While it was typical to do these surgeries quickly and without anesthesia or after care, these operations were done at an exceedingly rapid pace. From various accounts, children left the schools bleeding profusely. The riots occurred a week later.

"Mouth breathers immediately after 'adenoid party.'" In Allen, Civics and Health, 1909, p. 46.

“Mouth breathers immediately after ‘adenoid party.'” In Allen, Civics and health, 1909, p. 46.

Despite the rioting, Cronin publicized the efforts at PS 110 as an outright success. He held that all but four of the students had significant mental and physical improvement. He wrote: “From dullards, many of them have become the brightest among their fellows, after the operation.”8 A New Jersey doctor commented that removal of adenoids “has been followed by such wonderful improvement of the body and mind as to make recital sound like romance. The story of public school No. 110 in New York City, is almost beyond belief except to those who are familiar to it.”9 Medical and educational journals were filled with accounts of transformation through adenoid surgeries, many referencing PS 110.

As they preached their belief in transformation through surgery, these doctors and hygienists continually bolstered the idea that presence of enlarged adenoids caused poor scholarship and deviance. This association is clear when looking at hygiene statistics. When medical inspections took place in Northeastern urban centers, adenoids were found in roughly 30% of students. However, when the students were in a reformatory or a specialized class, like the students at PS 110, numbers climbed to 90%.

"Throat inspection in the Orange, N. J. schools." In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 148.

“Throat inspection in the Orange, N. J. schools.” In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 148.

Even while the “adenoid craze” was in full swing, many parents did not abide by the prescriptions of medical inspectors to have their children undergo various treatments and adenoidectomy. When “defects” were found in school medical examinations, the rate of compliance was usually less than a third, as inspectors in various cities including Cleveland, Chicago, and Bridgeport, Connecticut remarked in the 1900s and 1910s.10

During the 1910s, the faith that experts had in the radical transformation of students through adenoidectomy began to wane. Walter Cornell, a leading advocate of the surgeries, found that his study group did not succeed academically after the surgeries as was expected, and wrote in 1912 that this case “certainly explodes the theory that the removal of adenoids is the panacea for all juvenile delinquencies.”11 Others began to see similar results.

"Typical adenoid faces showing mouth breathing, flattened noses, and protruding eyes." In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 170.

“Typical adenoid faces showing mouth breathing, flattened noses, and protruding eyes.” In Gulick and Ayres, Medical inspection of schools, 1917 (2nd ed.), p. 170.

Medical inspection, particularly in New York City, came under fire, as many complained that examinations were too superficial and inaccurate and that enlarged adenoids were overdiagnosed. In one investigation, for example, the same group of children was examined by two different inspectors. The first inspector found that 70 students needed adenoidectomy, the second found that 96 did, with only 49 students in common.12

For school and city authorities, adenoid surgeries were an appealing, cheap, convenient way to reform education by changing the child, rather than overhauling the educational system. It is not surprising that they were overdiagnosed or misdiagnosed. While the adenoid riots took place at the beginning of the “adenoid craze,” they illustrate a general suspicion of these new hygiene practices and of the school’s new role in public health.

References

1. “East Side Parents Storm the Schools,” New York Times, 28 June 1906, pg. 4; “Throat-Cutting Rumors Revive School Rioting,” New York Times, 29 June 1906, pg.9.

2. For an interesting view of the adenoid riots, see Alan Kraut, Silent Travelers: Germs, Genes and the Immigrant Menace (Baltimore: Johns Hopkins University Press, 1994).

3. A.A. Guye, “On Aprosexia, Being the Inability to Fix the Attention and other Allied Alterations of the Cerebral Functions caused by Nasal Disorders,” Journal of Laryngology and Rhinology 3 no.11 (December, 1889):499-506.

4. For example, see Macleod Yearsley, Adenoids (London: The Medical Times, 1901); 39-74; W.E. Casselberry, “Facial and Thoraic Deformities Incident to Obstruction by Adenoid Hypertrophy in the Naso-Pharynx,” Journal of the American Medical Association 15 no. 12(September 20, 1890): 417-420; W.L. Grant, “Some Common Conditions of the Nose and Naso-Pharynx Demanding Operative Interference,” Philadelphia Medical Journal 2 no.16(October 15, 1898):798-799; Allen T. Haight, “Naso-Pharyngeal Adenoids as a Causative Factor in Ear Diseases,” Journal of the American Medical Association 33 no. 26 (December 23, 1899): 1577-1578.

5. John J. Cronin, “The Physical Defects of School Children,” The Journal of the New York Institute of Stomatology 2 no. 4(December, 1907):280.

6. Ibid., 280.

7. “Medical Attention in Public Schools,” American Gymnasia and Athletic Record 3 no. 6(February, 1907):125.

8. John J. Cronin, “The Doctor in the Public School” The American Monthly Review of Reviews 35 no. 4 (April, 1907): 438.

9. F.C. Jackson, “The Medical Supervision of Schools” The New Jersey Review of Charities and Corrections 7 no. 3 (March, 1908): 84.

10. Luther Gulick and Leonard Ayres, Medical Inspection of Schools (New York: Russell Sage, 1909, ed.), 102; Florence A. Sherman, “Medical Inspection in Bridgeport (Conn.) Public Schools,” Fourth International Congress on School Hygiene 4(August, 1913):394; Mrs. Edward W. Hooke, “To Save All Babies,” The American Club Woman 10 no. 6(December, 1915):117.

11. Walter Cornell, Health and Medical Inspection of School Children (Philadelphia: F.A. Davis Company, 1912), 278.

12. A Bureau of Child Hygiene: Co-operative Studies and Experiments by the Department of Health of the City of New York and the Bureau of Municipal Research (Bureau of Municipal Research, 261 Broadway: September, 1908): 13.

Presentations Announced for the Fifth Annual History of Medicine Night: Insights from the Early Modern Period

The New York Academy of Medicine’s Section on History of Medicine will hold the “Fifth Annual History of Medicine Night: Insights from the Early Modern Period” on March 11 from 6:00 pm–7:30 pm at NYAM, 1216 Fifth Avenue at the corner of 103rd Street. Register to attend here.
RBR shelfPresenters will address historical topics relating to medicine with a focus on the Early Modern period.  This year’s presenters are:

Barbara Chubak, MD
Urology Resident (PGY-5), Montefiore Medical Center
“Imagining Sex Change in Early Modern Europe”

Jeffrey M. Levine, MD
Assistant Clinical Professor of Medicine and Palliative Care
Icahn School of Medicine at Mount Sinai
“A Fresh Look at the Historiated Initials in the De Humani Corporis Fabrica”

John E. Jacoby, MD, MPH
Assistant Clinical Professor of Medicine and Pediatrics
Icahn School of Medicine at Mount Sinai
“On the Life of Dr. Robert Levett: The Philosophy of Primary Care”

Nina Samuel, PhD
Center for Literary and Cultural Research
University of Berlin
“The Art of Hand Surgery”

Michelle Laughran, PhD
Associate Professor of History
Saint Joseph’s College of Maine
“The Medical Renaissance among Three Plagues: Epidemic Disease, Heresy and Calumny in Sixteenth-Century Venice”

Sharon Packer, MD
Assistant Clinical Professor of Psychiatry and Behavioral Sciences
Icahn School of Medicine at Mount Sinai
“Epidemic Ergotism, Medieval Mysticism & Future Trends in Palliative Care”

Part two of this lecture series, “History of Medicine Night: 19th– and 20th-Century Stories,” will take place on May 6, 2015.