Livers and Freckles — 19th Century Humoral Theories about the Summer Sun

“Of all the results that exposure of the skin to the sun or air produces, the most disagreeable is that known by the name of tan, or freckles. The finest and fairest skin is most liable to this affection, and such is the consolation usually offered to females who suffer — the state is nevertheless a disease when numerous.” 1
–Dr. William Kittoe, 1845

Victorian Tradecard from the Dittrick Collections.

Fig. 1 Victorian trade card from the Dittrick Collections for Faricum Almandine.

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Contraception or Bust: Marketing Around the Comstock Laws

Blog by Diana Suciu, student at Case Western Reserve University
Essay winner, USNA 287Q Gothic Science, SAGES 2015
Instructor: Dr. Brandy Schillace

ComstockCaricature

Comic depicting Comstock: woman gave birth to a naked infant!

From the late 1800’s until the 1960’s, the distribution and acquisition of contraceptives was banned in many American States. It was a popular belief, upheld by the enactment of the Comstock Law, that contraception would lead to promiscuous behavior. Passed in 1873, the Comstock Law enforced a heavy ban on all paraphernalia or literature associated with the topics of pornography, erotica, and contraception (Sex in the City, 1840’s, Dittrick Museum). The law was named after Anthony Comstock, a man who crusaded against the ‘obscene’ and ‘immoral behaviors’ that were rampant in the streets of large American cities (People & Events: Anthony Comstock’s “Chastity). Comstock embraced Victorian ideals, believing that contraception would cause men and women to act indecently and would erode the standards of morality that prevailed during the turn of the 19th century (Sex in the City, 1840’s). He was instrumental in enforcing a law in which men and women were denied legal access to contraceptives. The United States of America became the only western nation in this time period to convict citizens for the advertisement, distribution, or use of birth control (People & Events: Anthony Comstock’s “Chastity” Laws).

In 1875 a woman named Lydia Pinkham made it possible to obtain abortive agents despite the ever-present contraceptives ban. Under very careful advertising, she marketed a vegetable compound for ‘the worst female complaints’ (Lydia Pinkham Vegetable Compound). Her home brewed herbal elixir was a nationwide success; women bought her product to prevent ‘uterine tumors’ or the ‘changes of life’ from causing pain to their spine or abdomen.’ Lydia Pinkham put her picture on every bottle of her product; her motherly face became a household emblem for women all across the country. She became a marketing pioneer who was widely successful in established her product, and made her name as recognizable as Coke or Heinz (Schulman, 24). Many women came to think of Lydia as a confidant who would answer their letters and would provide personal and sexual advice. Even after her death, staff members from her company would answer letters from her faithful customers (Lydia E. Pinkham: Life and Legacy).

Lydia Pinkham's Tablets

Lydia Pinkham’s Tablets

Her advertisements claimed “it will dissolve and expel tumors from the uterus in an early stage of development. The tendency to cancerous humors there is checked very speedily by its use. It removes faintness, flatulency, destroys all cravings for stimulants, and relieves weakness of the stomach” (Ad from 1881 for Lydia Pinkham’s Compound at the Museum of Menstruation and Women’s Health.). To a modern casual observer this type of advertisement seems to be directed towards women whom experienced menstrual discomforts and similar ailments. To the Victorian reader the advertisement reads differently: the vegetable compound would cure nausea, strange cravings, and flatulence plausibly caused by unwanted growths in the uterus, and it worked particularly well if the ‘growths’ were in the early stages of development (Ad from 1881 for Lydia Pinkham’s Compound at the Museum of Menstruation and Women’s Health.”). It was an open, but cryptic advertisement for contraceptives aimed directly at the user and was prescribed to be taken daily as a drink or a pill to give strength to a ‘woman’s system’.

Pinkham’s over the counter contraceptive made it possible for women to receive abortive agents without getting prosecuted by the Comstock Law. This made the vegetable compound a common item to be found on many women’s nightstand. Ambiguous advertising of contraceptive products became common place throughout the enforcement of the Comstock Law (Chesler, 70). Because she was hailed as a public icon, no product sold as well as Lydia Pinkham’s Vegetable Compound. The company still exists under a different ownership, still branded under “Lydia Pinkham” and the compound’s main ingredients have not been altered from the traditional formula. Currently, the vegetable compound is marketed towards post-menopausal women, and “Lydia Pinkham” does not acknowledge the historical usages of the herbal elixir (Dietary Supplements and Pharmaceutical Products for Birth Control, PMS and Menopause). The company advertises that Lydia Pinkham’s Vegetable Compound was formerly used for treatment of PMS and other hormone imbalances, which could be probable, considering the vague wording of the early advertisements, yet given the true historical comprehension of the advertisement, unlikely (Dietary Supplements and Pharmaceutical Products for Birth Control, PMS and Menopause). Looking at the historical usages of the herbs versus their modern medical uses, we understand why the formula is now being used for post-menopausal symptoms and not for treating PMS. There are five main ingredients of the vegetable compound that are still the active ingredients in the current formula: Pleurisy root, Life root, fenugreek, unicorn root, and black cohosh (Dietary Supplements and Pharmaceutical Products for Birth Control, PMS and Menopause).

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Another of the ‘female pills’ on display at Dittrick Museum–Dr. Bronson, for “obstruction”

Pleurisy root, also known as common milkweed, was historically used in the Americas as an oral contraceptive, as well as an anti-inflammatory agent. Modern medicine regards the herb as a mild anti-inflammatory, a reliever of coughs and mucus build up, and an estrogenic (Pleurisy Root – Herbal Encyclopedia). This root should not be consumed by pregnant women as it is dangerous for the health of a developing fetus and taken in high enough and repeated dosages can induce miscarriage. Still, the estrogenic and anti-inflammatory properties of the root make it appropriate for women going through the stresses of menopause (Pleurisy Root – Herbal Encyclopedia). Here we notice that while the compound’s main ingredients have been preserved, “Lydia Pinkham” is targeting a different market segment effectively avoiding direct competition with the latest contraceptive products. Life root, commonly known as yellow ragweed, has many medical uses. The roots have been used as an anti-inflammatory as well as a blood stimulant to help regulate the menstruation cycle and decrease menstrual pain in women. Life root root is known as an emmenagogues, a plant that stimulates blood flow to the uterus, which can stimulate menstruation or prevent pregnancy (Ragwort – Herbal Encyclopedia). Fenugreek, Unicorn Root, and Black cohosh are all forms of emmenagogues that are currently not recommended to be consumed by pregnant women, and have historically been used as abortive agents. Emmenagogues also have strong estrogenic properties and can be used as an alternative for women who cannot take hormone replacement therapy for menopause (Black Cohosh). Just like Coke & Heinz, Pinkham’s Vegetable Compound survived the passage of time and successfully redefined itself to a new consumer group without exposing its weakness by competing head-to-head with a modernly engineered contraceptive drug. The compound was the right medicine for the time when the Comstock Law blocked legal access to contraceptives.

Pinkham’s Vegetable Compound was sold by all druggists and apothecaries throughout the late 19th and early 20th centuries (Ad from 1881 for Lydia Pinkham’s Compound at the Museum of Menstruation and Women’s Health.”). Her product sold millions of bottles, and Mrs. Pinkham became a strong public figure. She was able to give advice to women on sexuality and personal care. Also, she drew attention to serious female medical issues that were being ignored by standard medical practice. Without the Comstock Law men would have had access to condoms and women to diaphragms, and her medicine may have not been so successful. In an ironic manor, what should have stopped her, created a need in the market. As much as a progressive woman like Lydia Pinkham had to despair at the Comstock Law, it also created new possibilities for women to find social progress despite political oppression.

Works Cited

“Ad from 1881 for Lydia Pinkham’s Compound at the Museum of Menstruation and Women’s Health.” Ad from 1881 for Lydia Pinkham’s Compound at the Museum of Menstruation and Women’s Health. Web. 4 Feb. 2015. <http://www.mum.org/mrspink3.htm&gt;.

“Black Cohosh.” University of Maryland Medical Center. Web. 7 Feb. 2015. <http://umm.edu/health/medical/altmed/herb/black-cohosh&gt;.

Chesler, Ellen. Woman of Valor: Margaret Sanger and the Birth Control Movement in America. New York: Simon & Schuster, 1992. 70-75. Print.

“Dietary Supplements and Pharmaceutical Products for Birth Control, PMS and Menopause.” LydiaPinkahm.org. Web. 3 Feb. 2015. <http://www.lydiapinkham.com/&gt;.

Dittrick Museum. “Lydia Pinkham Vegetable Compound”. Case Western Reserve university: Dittrick Museum,2015. Placard

Dittrick Museum. “Sex in the City, 1840’s”. Case Western Reserve university: Dittrick Museum,2015. Placard

“Lydia E. Pinkham: Life and Legacy.” Museum of Health Care Blog. 19 June 2014. Web. 2 Feb. 2015. <https://museumofhealthcare.wordpress.com/2014/06/19/lydia-e-pinkham-life-and-legacy/&gt;.

“People & Events: Anthony Comstock’s “Chastity” Laws.” PBS. PBS. Web. 1 Feb. 2015. <http://www.pbs.org/wgbh/amex/pill/peopleevents/e_comstock.html&gt;.

“Pleurisy Root – Herbal Encyclopedia.” Herbal Encyclopedia. 28 Dec. 2010. Web. 1 Feb. 2015. <http://www.cloverleaffarmherbs.com/pleurisy-root/&gt;.

“Ragwort – Herbal Encyclopedia.” Herbal Encyclopedia. 28 Dec. 2010. Web. 1 Feb. 2015. <http://www.cloverleaffarmherbs.com/ragwort/&gt;.

Schulman, Bruce J. Making the American Century: Essays on the Political Culture of Twentieth Century America. Oxford: Oxford UP, USA, 2014.20-24 Print.

Rediscovering the Birthing Chair: Delivering Life While Sitting Up

Blog by Anneliese Braunegg, student at Case Western Reserve University
Essay winner, USNA 287Q Gothic Science, SAGES 2015
Instructor: Dr. Brandy Schillace

Birth Chair, Dittrick Museum

Birth Chair, Dittrick Museum

Envision two women. Each is in labor, each is in pain, and each is accompanied by a professional caretaker who is assisting her in giving birth. Here the similarities end. The first woman lies on a hospital bed with her hair strewn across the pillows; she is accompanied by a doctor, and she is simultaneously pushing her baby into the world as he pulls on it with forceps. The second woman sits on a birthing chair that was brought to and assembled in her bedroom; her hair is strewn across the chair back, she is accompanied by a midwife, and she is pushing her baby into the world as the midwife guides her through the process (“Midwifery Chair, c. 1850”).

The first woman is giving birth in 2015. The second woman is giving birth in 1850 (“Midwifery Chair, c. 1850”). In the generations between the second woman’s labor and the labor of her great-great granddaughter in this hospital room in 2015, now the present day, many changes will take place in the medical world. In an “‘unexplained revolution,’” typical birthing practice will “shift from female to male midwifery practice,” and “the female midwife… castigated as a rustic or vilified as a witch,” will come to “serve,” at most, “at the pleasure of the [male] surgeon” (Schillace). Pregnancy and labor will come to be “treated [not] as a natural process [but as] a medical condition” requiring a doctor’s intervention. (“Birth Chairs, Midwives, and Medicine”).

Birth chair, Dittrick Museum

Birth chair, Dittrick Museum, circa 1920

The primary birthing method shifted from use of the birthing chair to use of the birthing bed, “not necessarily because [lying on the birthing bed] is the best position for birth but… [because] it is the most convenient position for [the] doctor,” as it allows him to view the baby more easily and use a device that midwives have not used, the forceps (“Effective Birthing Positions”). Thus modern birthing culture will be born, and while women would, over time, become doctors, and pregnancy would come, once again, to be viewed as a natural state, the main method of delivery remained the birthing bed–the birthing chair largely forgotten. This is the way the world is today; however, hospitals of the present should not dismiss the method of the birthing chair too quickly. Giving birth on a bed, though it is the modern norm, is neither the only viable birthing option nor always the best one, and the expansion of birthing options would benefit the large number of modern women who go to hospitals to give birth to their babies.

Today, when most people picture a woman giving birth, they picture the woman lying on the hospital bed; less often do people picture the woman sitting on the birthing chair. The birthing chair birthing method is still used, but is much less common. This imbalance seems to imply that giving birth on a bed is somehow safer or more efficient than giving birth on a chair; however, studies evaluating the effectiveness of birthing chairs have shown that the birthing chair is a satisfactory birthing method for most patients who use it (Liddell, H. S., and P. R. Fisher) and that the use of a birthing chair does not increase the health risk to either the mother or the baby and is therefore a safe alternative to the use of a birthing bed (Kafka, M., et al.). Additionally, studies contrasting the birthing chair and the birthing bed have found there to be “less transient cord compression in upright positions” (Cottrell, B. H., and M. K. Shannahan) such as that taken while seated in a birthing chair and have found that “patients who delivered in the [birthing] chair [have] significantly lower rates of episiotomy [surgical cutting below the vagina performed to aid delivery] and manual separation of the placenta” in comparison to patients who delivered in a birthing bed (Scholz, H. S., et al.).

Birth chair, Dittrick Museum

Birth chair, Dittrick Museum,

While the birthing chair presents “minor disadvantages such as increased soiling of the chair” and, depending on the chair’s structure, “impedes operative deliveries from the perineal floor,” the advantages were determined to outweigh the minor disadvantages, and the suggested solution to the operative delivery impediment was not the use of a bed instead of a chair but instead a combination of the two into a birthing bed that can be shifted to accommodate all positions from sitting to recumbent (Schurz, A. R., H. Concin, and M. Kobermann). The results of these five studies indicate that while the birthing chair can safely be used as an effective alternative birthing method the birthing bed. In addition, because the less conventional birthing chair birthing method has been found to be a viable, potentially advantageous alternative to the birthing bed method, it would be beneficial to explore further the advantages of other less conventional birthing methods that exist.

The most effective of these other less conventional birthing methods include the birthing bar that attaches to a bed, the birthing stool, the upright sitting position, the kneeling position, and the curled side position, and each of these methods and positions presents certain advantages for the woman in labor (“Effective Birthing Positions”). These advantages include expanding the size of the woman’s pelvis (birthing bar and birthing stool), taking advantage of gravity to help push the baby (bar, stool, and upright sitting position), providing physical support for relaxation between contractions (bar, upright sitting position, kneeling position, and curled side position), and protection from back pain and vaginal tearing (kneeling position for the former and curled side position for the latter) (“Effective Birthing Positions”). Evidently, a variety of valid birthing methods exist. However, even though these methods present certain advantages to a woman in labor and even though, in the case of the birthing chair, research was performed as many twenty years ago indicating that the method is a positive one, the bed birthing method remains the primary birthing method made available to and used by laboring women. It is time that these studies’ suggestions be effected and that hospitals make information about and access to birthing chairs available to pregnant women, and it is time that other alternative birthing methods be scientifically examined and, if also found to be valid, also be publicized and made available.

DoctorsOffice

Examination chair, circa 1875, Dittrick Museum

Some birthing centers do, in fact, offer some of these alternative birthing methods, and it is noteworthy that these methods are available not only at birthing centers specifically designated as alternative but also at some mainstream hospitals. A well-regarded example of such a hospital is MIT Medical, of the Massachusetts Institute of Technology in Cambridge, Massachusetts. In addition to offering the traditional option of giving birth on a bed, the hospital states on its website that it “alternative birth experiences are also available, including birthing chairs, birthing balls, hypnobirthing, doulas, and water births” (Patient Services: Obstetrics and Gynecology”). The fact that MIT Medical presents these options on its website is important; in order for effective birthing methods currently considered alternative to become accepted as mainstream, it is vital that established, well-respected hospitals embrace these methods and clearly state their availability. In doing so, hospitals make the labors of more women safer and easier, as they become better able to accommodate the needs of all the women who come to the hospital to deliver a child.

No two births are exactly alike. The uniqueness of each birth makes it vital that hospitals pay attention to the fact that giving birth in a bed, while the most common method of birthing, is not the only viable option and not always the best one. Hospitals like MIT Medical have taken a positive step toward addressing non-bed birthing methods, but even at MIT Medical, such methods are still presented as “alternative,” misleadingly implying that they may be less reliable than the bed birthing method (“Patient Services: Obstetrics and Gynecology”). Doctors and midwives should therefore continue to expand their knowledge and provision of different birthing practices and, just as importantly, make available to pregnant women and their partners information about the variety of safe, effective birthing options that exist. In doing so, they will ensure that both the woman in the bed and the woman in the chair will be in those places because they have chosen to give birth there and that they have chosen those places because they made the informed choice that those birthing methods are the best birthing methods for them.

Works Cited

“Birth Chairs, Midwives, and Medicine.” University Press of Mississippi. UP of Mississippi, n.d. Web. 6 Feb. 2015. <http://upress-test.hpc.msstate.edu/books/63&gt;.

Cottrell, B. H., and M. K. Shannahan. A Comparison of Fetal Outcome in Birth Chair and Delivery Table Births. N.p.: n.p., 1987. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/3140301&gt;.

“Effective Birthing Positions.” Taking Charge of Your Health & Wellbeing. U of Minnesota, Aug. 2009. Web. 6 Feb. 2015. <http://www.takingcharge.csh.umn.edu/activities/effective-birthing-positions&gt;.

Kafka, M., et al. The Birthing Stool–An Obstetrical Risk? N.p.: n.p., 1994. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/7988858&gt;.

Liddell, H. S., and P. R. Fisher. The Birthing Chair in the Second Stage of Labour. N.p.: n.p., 1985. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/3862405&gt;.

“Midwifery Chair, c. 1850.” Dittrick Medical History Center and Museum. Allen Memorial Medical Library. 11000 Euclid Ave, Cleveland, OH 44106-1714. 27 January 2015.

“Patient Services: Obstetrics and Gynecology.” MIT Medical. Massachusetts Institute of Technology, n.d. Web. 6 Feb. 2015. <https://medical.mit.edu/services/obstetrics-gynecology&gt;.

Schillace, Brandy. “On the Trail of the Machine: William Smellie’s ‘Celebrated Apparatus.'” Dittrick Museum Blog. Case Western Reserve University, 4 Apr. 2013. Web. 6 Feb. 2015. <http://dittrickmuseumblog.com/2013/04/04/on-the-trail-of-the-machine-william-smellies-celebrated-apparatus/&gt;.

Scholz, H. S., et al. Spontaneous Vaginal Delivery in the Birth-Chair versus in the Conventional Dorsal Position: A Matched Controlled Comparison. N.p.: n.p., 2001. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/11603105&gt;.

Schurz, A. R., H. Concin, and M. Kobermann. Experience with EK-Birthing Chair (Author’s Transl). N.p.: n.p., 1981. PubMed. Web. 6 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/6915863&gt;.

Check that Temperature! Rhythm Method, Thermometers, and the Gynodate

unnamedSex, contraception, and reproduction: if you think those are topics best avoided in a museum, think again! Next week, the Dittrick hosts its annual Percy Skuy Lecture on the History of Contraception, and this time, it’s all about temperature. Hot under the collar? It might be your cycle! Leo J. Latz, a Chicago doctor, first championed the Rhythm Method (based on work by Ogino-Knaus) in the United States. In 1932 Latz published The Rhythm of Sterility and Fertility in Women, which sold over 200,000 copies by 1942; he contended that the “findings of modern science disclose a rational, natural, and ethical means to space births and to regulate intelligently the number of children.” This coming Thursday, April 9th, come hear about the use of thermometers and the rhythm method to control fertility–lecture by Dianna Day, followed by a reception upstairs in the contraception gallery The event is FREE, but please do RSVP to ensure a seat: http://artsci.case.edu/dittrick/upcoming-events/ Want to learn more about contraception’s contested history? Here are some tidbits from our archive–and we hope to see you next week!

The-Rhythm-1934-coverRHYTHM METHOD
How did it work? Latz advised avoiding intercourse for eight days: for women with a regular menstrual cycle, this began five days before ovulation, with an extra three days tacked on for safety’s sake. As a devout Roman Catholic, Latz advanced this method of fertility control as more in line with Church teachings. He published pamphlets on rhythm for priests to distribute to couples, and parish bingo games gave out his book as a prize. Many shared Leo Latz’s faith in the science behind the Ogino-Knaus findings. But applying them to birth control proved not so simple, nor straightforward. Calculating the time of ovulation can still be tricky. It varies from woman to woman, and a woman can ovulate at a different time each month. Stress, illness, or interruptions in normal routine can also alter a woman’s cycle. Despite these uncertainties, the Ogino-Knaus method caught on, as evidenced by the proliferation of rhythm method calculators after 1930. Companies produced graphs, wheels, calendars, and slide rules, which cost from 10¢ to $5. In 1955 over 65% of Catholic women surveyed said they used Rhythm… And of course, given that is was a private means of controlling fertility, many more likely took advantage.

Ironically, Leo Latz felt biting backlash for all his efforts to bring an acceptable form of contraception to Catholics. Some felt he went too far. When Latz published The Rhythm in 1932 he served on the medical faculty of Loyola University. According to Leslie Tentler, writing in Catholics and Contraception: An American History (2004), Latz “was abruptly fired from that position in August of 1934,” and this action “was almost certainly a direct result of Latz’s prominent association with the cause of rhythm.” In 1935 Latz confessed to his friend Father Joseph Reiner, S.J., that no one “knew the anguish and dishonor I …suffered, when people said: ‘I heard you were thrown out of the University.” –Jim Edmonson (see original post here)

gynodate 2009-004-frontGYNODATE
A later variant of rhythm calculator was known as the “Gynodate.” Swiss clockmaker Jaquet introduced the “Gynodate” in 1958. It combined a regular alarm clock and a gauge to calculate the “safe period” as directed by Hermann Knaus. Jaquet claimed it “indispensable for every woman for natural birth control.” The Museum of contraception and abortion in Vienna, Austria, had the associated ephemera (pictured here). The thing that we like best about the “gynodate” is its stylish concealment of its function. Looks like a nice, if simple, alarm clock when the Gynodate 2 high resdecorative bezel is closed. But lift the hinged cover and you reveal adjustable dials to set for the onset and end of the monthly period, and hence gauge the days of fertility. It’s reminiscent of oral contraceptive dispensers in the form of lipstick containers or dialpak dispensers disguised as facial powder compacts…Certainly not the first, nor the last, time that designers strived to camouflage the purpose of a medical device. Sometimes this was done to conceal an object’s function from unwitting patients (as in the case of medical furniture in the 1880s), while at other times it was done to safeguard personal dignity, as in the concealment of contraceptive purpose of the object at hand, the “gynodate”. –Jim Edmonson (see original post here)

Nancy Talbot Clark and her sisters at Western Reserve in the 1850s: pioneers of medical education of American women

On Monday, March 8, Case Daily hosted a trivia quiz in honor of women’s history month. They asked this question: “In 1876, fifty years after it was established, the first woman graduated from Western Reserve College. Who was she?” While they sought the first female graduate of our undergraduate school, it brought to mind a similar question regarding our medical school and its early women graduates. So, I pose a variant of the question appropriate for women’s history month:“Who was the first female graduate of the medical department of Western Reserve College?” The answer is simple: Nancy Talbot Clark. Going beyond, we find that her experience reveals an intriguing, complex, and instructive story about women entering the ranks of the medical profession. Permit me to elaborate.

Nancy-Talbot-Clark-BinneyNancy Talbot Clark graduated in 1852, making her the first female medical graduate of Western Reserve College and the second woman graduate of a co-ed regular (non-sectarian or allopathic) medical college in the entire Unites States. This last point is significant, for the medical establishment of 19th century America discounted the value of medical degrees conferred by sectarian (homeopathic, eclectic, &c) or all female schools. Elizabeth Blackwell merits distinction as the first woman in this country to graduate from a regular (or allopathic) co-educational medical school, having graduated from Geneva Medical College in 1849. Clark came next when she matriculated at Western Reserve, and was in turn followed by five more women who graduated before 1856. In that year Dean Delamater, who championed women’s medical education, retired and his successor, and the rest of the all-male faculty, deemed it “inexpedient” to continue admitting women. Decades passed before women again matriculated at Western Reserve.

The rich narrative of Clark’s career shows clearly that the path for women entering medicine was fraught with challenge and frustration. Tragedy, misogyny, and purported moral and social propriety all conspired to thwart what might otherwise have been a promising professional life for Nancy Talbot woman dissectingClark. An early marriage in 1845 to dentist Champion Clark seemingly precluded a career at all, medical or otherwise, for society expected married women to remain at home, not enter the marketplace. At 22 she bore a daughter who died within a year, and then her husband succumbed to typhoid fever in March 1848, leaving her a young widow. How she found her way to Cleveland is unclear, but biographical notes indicate that the wife of Dean Delamater came from nearby Sharon, Massachusetts, Clark’s hometown. Whatever the route, Clark studied for two years, graduating in March 1852. The school took special notice, publishing in the local newspaper that “Among the graduates is Mrs. Nancy E, Clark of Sharon, Mass., a lady who has, during the past two sessions, commanded the respect of Instructors and members of classes by her lady-like deportment and faithful intelligent attention to her duties as a Medical Student.”

pulse-lo-resClark returned to Boston, Massachusetts, where she practiced medicine from April 1852 to August 1854, and tried unsuccessfully to gain admission to the Massachusetts Medical Society. Male members rejected her application, asserting that “their duty requires them to examine male candidates only for membership.” Like Elizabeth Blackwell before her, Clark departed for France with her physician brother. There, she studied and interned at La Maternité the premiere obstetric hospital in the French capital. On the journey over she met the recently-widowed Amos Binney of Boston, whom she later married. A family of six children ensued and predominated until 1874 when Clark opened a free dispensary for women in Boston.

By focusing this cohort of early women graduates of Western Reserve we gain a sense of the diversity of their career trajectories. No single career arc applies to these women. As noted, marriage comprised a career-ending event for Clark, despite her evident skill and talent. Emily Blackwell, younger sister of Elizabeth, followed and went on to found the New York Infirmary for Indigent Women and Children and ended her career at the London School of Medicine for Women. Marie Zakrzewska, trained as a midwife in Berlin, emigrated in hopes of becoming a physician. Prominent women of Cleveland sponsored her through the Female Medical Education Society of Ohio, and she went on to a distinguished career in women’s medical education. Cordelia Greene pursued a career in the so-called “water cure” or hydropathy movement, starting at a spa in Cleveland, and ending in a western New York water cure establishment. Sarah Chadwick’s career included a year of service as a surgeon to Civil War troops, but married afterward, and retired from medicine. Elizabeth Griselle rounded out the group, with perhaps the most conventional private medical practice in Salem, Ohio. So, we at CWRU can justly take pride in the early strides to promote women as medical professionals, but need to go beyond a cursory mention to more fully understand the challenges these pioneering women faced in their struggle to attain equality in the workplace and in society more generally.

ABOUT THE AUTHOR: James Edmonson, PhD, chief curator of Dittrick Medical History Center and Museum

For more on our pioneering medical women at Western Reserve, see

Linda Lehmann Goldstein. “Roses Bloomed in Winter: Women Medical Graduates of Western Reserve College, 1852-1856,” Case Western Reserve University, May 1989.

Linda Lehmann Goldstein, “ ‘Without compromising in any particular’: The success of medical coeducation in Cleveland, 1850-1856, Caduceus 10 (1994): 101-116.

A Look Back: 2014 Dittrick Events

Throughout 2014, the Dittrick Museum shared our enthusiasm for the history of medicine with a growing audience. Whether you’re from our home campus of Case Western Reserve University, the greater Cleveland area, or part of a larger digital community, we appreciate all of these opportunities to meet and learn with you.

Our growing public outreach led us to work with the wonderful Cleveland Bazaar, host a book talk for author Kate Manning, and hear a lecture on WWI medicine from scholar Beth Linker. We explored a cemetery, rare book archives, and museum galleries with diverse groups of visitors. What’s more, these events were beautifully captured by local photographer Frank Lanza.

We invite you to look back on the success of last year and join us for some of the great upcoming events planned for 2015.

Deadly Effects: Epidemics, Vaccines, and the Measles Outbreak

The recent outbreak  of measles at Disneyland has spurred a rash of competing newscast, blog posts, and social media responses. One question continues to be foremost–as quoted by CNN correspondent Mariano Castillo, “how bad is it?” Castillo reminds the reader: “to call the news surrounding vaccinations a “debate” is misleading. The scientific and medical consensus is clear: Vaccinations are safe, and they work.” [1] The question is not about efficacy but about consequences; parents may have a variety of reasons for not vaccinating their children, sometimes on the grounds of safety or mistrust of the vaccine. However, as pointed out by members of the CDC and others, those who do not vaccinate live in the same communities as those who do; what happens if measles once more establishes a foothold? What might be at stake? History can provide useful parallels–especially the history of how vaccines were first administered and why.

Deadly Childhood Diseases

IDiphtheria throatn 1875, the 243-person death toll from diphtheria comprised 8.2% of all reported deaths. As was typical of the disease, children comprised most of the mortalities. In the 1880s Dr. Joseph O’Dwyer, a Cleveland Ohio native, developed a method of intubating patients (inserting a tube to keep the airway open) to survive the life-threatening phase of diphtheria. Otherwise, the diphtheria infection slowly closed the throat, and children suffocated to death. [Dittrick Museum, hall exhibit. Read more.]

In 1898, Cleveland witnessed a minor outbreak of of the worlds most dreaded diseases: smallpox. Only a year later, the cases jump from 70 to 475, six times the rate of outbreak. In 1900, the numbers double again to 993–and then, in the plaSmallpox_hartzell4gue years of 1901 and 1902, more than 1200 people become ill, with over 200 dying at the height of the disaster. Many of these were children. Those who survived the epidemic were left with horrendous scarring, the “pocks” that welted on the skin left their mark for a lifetime. [Dittrick museum, hall exhibit. Read more.]

In the 20th century, one of the most feared childhood disorders not only killed, but crippled. Poliomyelitis killed more than 6000 people in the US in 1916 [2]; most were under the age of 14. Parents lived in fear; no one–not even President FDR–was safe. An early attempt at vaccine creation proved unsuccessful, and the disease continued. By 1952, 57,628 polio cases were reported in the United States, 21,000 of them paralytic cases.[2]

In each oR.W.Lovett, Treatment of Infantile Paralysisf these epidemics, the victims were largely children–but also those with weakened immune systems, the elderly, the ill. The diseases attacked the powerless, who expired or were crippled under the horrifies gaze of their loved ones. And for much of history, no cure availed itself. But cures did come, in the form of vaccines. And strangely, the key to polio had been found be a man searching in desperation for a cure for measles.

Measles and Milestones

Measles does not, perhaps, sound as terrifying as small pox and polio. However, this highly contagious disease had a much higher mortality rate. Affected children were contagious both before and after the appearance of measles, and worse–it could survive in the air for over an hour just waiting for the next victim. [3] Children got diarrhea and vomited, had a vivid red rash and watery eyes. It hospitalized an average of 48,000 Americans each year through the 1960s, leaving the survivors compromised sometimes with brain damage or deafness. With over 4000 cases of encephalitis, many children became wards of the state. [2] In other, poorer, countries, millions died every year. Alexander Langmuir, chief CDC epidemiologist in 1961, stated emphatically: “Any parent who has seen his small child suffer even for a few days with a persistent fever of 105, hacking cough and delirium, wants to see this disease prevented.” [3]

Smallpox_vaccinephoto

smallpox vaccine

At the same time, it was important for Langmuir that the vaccines be safe. In 1935, Maurice Brodie and John Kolmer tested a polio vaccine that proved disastrous and even deadly. It would be 1952 before the next serious trial, the successful Salk and Sabine vaccines. John Enders, who found the key to polio while looking for a measles cure, created a vaccine of mild measles that was added to other boosters children received for the diseases mentioned above. At last, children could be better protected and parents need not fear the daycare centers or play dates, school yards or other common grounds that had harbored these diseases. [3]

That does not mean, of course, that vaccines were unproblematic. The first disease to yield a vaccine was, in fact, smallpox. Edward Jenner injected a milder version, that of cowpox, into a healthy child. The act of risk and daring would be considered highly unethical today–but again, small pox killed and maimed many in the 18th century. The treatment worked. For polio, the earlier trial had resulted in illness and death. A later version, by Albert Sabin, introduced a weakened but still living virus. Jonas Salk’s vaccine worked by stimulating the immune system against polio without giving a live virus. Complications still arose, such as the contamination of both vaccines with SV40 virus at a facility of American Home Products. Even so, the US was polio free by 1979, and the crippling, painful, deadly disease no longer threatened American children. Measles, mumps, rubella, smallpox, polio, and diphtheria–despite setbacks, US parents, spurred by public action and social responsibility as well as the need to protect their own children, flocked to immunization centers. The understanding: we aren’t protected until we are *all* protected.

But the truth is, these diseases have not vanished. They rage in other countries and among the poor and disenfranchised. Viruses are no respecter of persons or of borders, and in this global world, they come unbidden. The World Health Organization recently published some facts about measles, alone:

  • Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
  • In 2013, there were 145 700 measles deaths globally – about 400 deaths every day or 16 deaths every hour.
  • Measles vaccination resulted in a 75% drop in measles deaths between 2000 and 2013 worldwide.
  • In 2013, about 84% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 73% in 2000.
  • During 2000-2013, measles vaccination prevented an estimated 15.6 million deaths making measles vaccine one of the best buys in public health.[4]smallpox_hartzell2

The outbreak in Disneyland does not represent a strange isolated event, but a reintroduction of a dangerous virus onto American soil. The history of vaccination does not suggest that the process or practice was easier then than now; quite the reverse. But the impetus to immunize was driven far less by an understanding of choice and far more by a unified desire to eradicate disease…and by the still-painful and still-present memories of its horrors.

References

[1] Mariano Castillo. “Measles Outbreak: How bad is it?” CNN Feb 2, 2015 http://www.cnn.com/2015/02/02/health/measles-how-bad-can-it-be/

[2] Polio Timeline, History of Vaccines http://www.historyofvaccines.org/content/timelines/polio

[3] Arthur Allen. Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver. London, Norton 2007 (216-217)

[4] Measles. World Health Organization. Nov 2104. http://www.who.int/mediacentre/factsheets/fs286/en/

Additional reading:

Lucas, William Palmer, 1880-1961. Experiments as to the protective value of certain specific sera and vaccines against the virus of poliomyelitis / by William P. Lucas and Robert B. Osgood. Boston, Mass. : Wright & Potter Printing Co., State Printers … , 1912

Horder, Thomas J. (Thomas Jeeves), 1871-1955. Clinical pathology in practice, with a short account of vaccine-therapy, by Thomas J. Horder ..London, H. Frowde; Hodder & Stoughton, 1910

Kirkpatrick, J. (James), approximately 1696-1770. The analysis of inoculation: comprising the history, theory, and practice of it: with an occasional consideration of the most remarkable appearances in the small pocks. London, J. Buckland [etc.] 1761

Author: Brandy L Schillace, PhD, Research Associate/Guest Curator, Dittrick Medical History Center