Don’t Lose This Ticket! The Train to No-Diphtheria-Town

photo 2In April, we posted about “Deadly Diphtheria,” an acute bacterial infection spread by personal contact, was the most feared of all childhood diseases. One in ten died from the disease, which suffocated its victims via a membrane that grew over the larynx. One of it’s greatest horrors? It struck children under the age of five.

Diphtheria vaccination first appeared in the 1890s, but only became widely used in the 1920s. Tracheotomy (opening the throat) and the intubation technique developed by Cleveland native Dr. Joseph O’Dwyer in the 1880s, which kept the airway open with a tube, provided last-resort means of saving a life. Even so, vaccine remained the only means of protecting children from suffering. The difficulty lie not in whether the vaccine would work, but whether parents would be diligent enough to bring their children in for the full number of vaccinations through the course of four treatments. The solution? Oddly enough, a train ticket.photo 3

In the present-day US, few trains still run, but the iconic imagery remains. Consider the buzz among children of all ages after the Harry Potter series introduced Platform 9 (and three-quarters)–or the magic ticket of Polar Express. What child doesn’t love a train set? Who doesn’t want a magic ticket? In the 1930s in Maryland, Metropolitan Life Insurance and the County Health Department of Elkton conspired to take advantage of this long-time love of locomotion.

Train Ticket to No-Diphtheria Town

Welcome to the “Health Road,” and do not lose this ticket. Curator Jim Edmonson came across this piece of history on an auction site while traveling in Philadelphia. This little ticket book refers to the physician as the little traveler’s friendly Conductor, and four stations unfold, ready to be stamped with the date of arrival.

photo 1On this journey, we find two-year-old Jane Elizabeth from Elkton, MD. Jim was surprised to find her picture included with the ticket; together these items tell a story of medical success.  Little Jane (here in the buggy) began her travels on April 11, 1930, and concluded them with the Schick test on Feb 21, 1931 proving that she was safe once and for all! (Hip! Hip! I’m in No-Diphtheria Town!)photo 2

Little Jane grew up safe and healthy–here is a picture of her on her High School Graduation. Thank heavens for the Health Road!

Arguing Insanity: The Trial of President Garfield’s Assassin

Who Assassinated the President?

When Charles Guiteau bought an ivory-handled British Bull Dog Revolver, he was thinking of which weapon was going to look best in a museum. Because his was a mission inspired by God; he was to kill the president.

Guiteau_Gun

On July 2nd, 1881, after weeks of stalking him, Guiteau shot President Garfield at a public train station. The bullet from his revolver entered the president’s back, leaving shattered vertebra in its wake before becoming lodged somewhere behind his pancreas [1].

Medical historians have since determined it was the probing of his wound with dirty hands and unclean instruments by Garfield’s many physicians which lead to his septicemia and inevitable death on September 19th [2]. In fact, at his trial, Guiteau mentioned that while he acted as shooter, it was “the doctors [who] finished the work” [3, p. 138]. The aftermath of President Garfield’s passing made better antiseptic techniques a surgical necessity.

Changing_Garfield's_Bedclothes

However, medical history was made on both sides of the assassin’s gun.

The trial of Guiteau, which began November 7th, 1881, was the first high profile case in the United States where a plea of not guilty by reason of insanity was ever considered. At this point in history, the physicians called upon to define insanity did so from a variety of perspectives [4].

Insanity: Evidence or Opinion?

For the defense, expert witnesses pointed to Guiteau’s “lopsided smile” and “congenital evidence of insanity” such as the abnormal shape of his skull and a “defect in his speech” [3, p. 203]. While some of the physicians working with the prosecution agreed that skull shape could indicate insanity, they found no such evidence in the defendant. Other physicians considered insanity to be a disease caused by “cerebral lesions”—but denied that Guiteau could have been experiencing such lesions as he had displayed far too much rationality.

L0016100 Six pictures of crania and heads of the insane.While the prosecution’s witnesses believed that Guiteau was likely a “depraved” or “eccentric” man, they claimed he had been in possession of his faculties on July 2nd, and thus was guilty of murder [3]. They also determined that his erratic behavior in court was an act meant to support his insanity plea.

While the doctors argued whether insanity was an inborn or contracted condition, and what the role of delusion was, the determination of guilt remained the jury’s. For months they watched the man who had killed their president compare himself to St. Paul and sign autographs in the courtroom [5].

Thus, despite Guiteau’s continued planning of a lecture tour and a run for the presidency in 1884, he was found guilty of murder and sentenced to death by hanging [3]. Dr. Walter Channing summed up the public’s general opinion: Guiteau was “crazy, perhaps, but not so crazy that he should not be hung.” For, while the depths of sympathy were great for the president and his family, there was “little feeling for the doer of the foul deed.” [4, p. 3]

Guiteau_Verdict

In such a scenario, is medical evidence truly considered or simply used to alleviate a nation’s need for retribution? I leave you with the words of Channing on the subject:

The verdict shows how uncertain the boundaries are to the disease called insanity. In a case where the symptoms are at all obscure, we can almost make ourselves believe anything that we choose to. [4, p. 4]

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Flipping through Anatomical Fugitive Sheets

Anatomical Fugitive Sheet of Female Figure, c. 1560Bodies move and have layers. Yes, this is hopefully an obvious statement. But imagine you lived in the 16th century and were attempting to demonstrate this point. In print.

When illustrations served as a primary means of study for students of anatomy and medicine, could a piece of paper adequately represent the complexity of the human body?

How about multiple pieces of paper?

Anatomical “fugitive” sheets, so named because of their unfortunate tendency of being torn or misplaced over time, allowed readers to visualize the layers of organs lying beneath an illustrated subject’s flesh [1]. Any observer could see the interior of the body through stages of dissection without the limitations set by a decaying corpse.

The earliest uses of moveable, superimposed flaps are from 1538 by Heinrich Vogtherr in Strasbourg, Germany [2]. Vogtherr created multiple delicate layers of pressed linen to show the positions of organs in both male and female subjects. Although few examples remain, conservators at the Harvard University Library are working to preserve these rare anatomical texts.

In his 1543 de Human corporis fabrica libri septum, Vesalius also provided readers the option of creating their own anatomical flaps by including instructions as to how to cut out and attach additional illustrations onto other plates. Although the idea of cutting and pasting into a first edition Vesalius text might strike terror into the hearts of medical historians today, it seems such alterations were the author’s original intention [3].

The use of such flaps extends throughout the 19th century, including G. Spratt’s 1848 edition of Obstetric Tables: Comprising Graphic Illustrations with Descriptions and Practical Remarks; Exhibiting on Dissected Plates Many Important Subjects in Midwifery [4]. Despite the verbosity of the title, this work teaches through illustration rather than words. Included among the “dissected plates,” is a blushing female with downturned eyes, lifting her skirt to expose her naked body to the reader. As one thumbs through the fugitive pages, the woman’s belly swells, her breasts change in shape, and the outlined womb also tilts and grows. When one reaches the final flap, a child, in utero, is exposed. Thus, Spratt is able to demonstrate with anatomical fugitive sheets not only the anatomy of a body, but the way it changes over time.

 

Newer technologies from plastic transparent sheets to computer animation have made anatomical fugitive pages a thing of the past. However, these simple paper flaps remain an example of the early ingenuity and workmanship that used humble materials to explain the wonders of anatomy.

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Morbid Matter: Public Health and Public Opinion

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John Snow in Anesthesia and Epidemiology
Today, June 16th, we remember the work of Dr. John Snow who died on this day in 1858.  During his lifetime, Snow’s innovative work in the fields of anesthesia and epidemiology was met either with public rejoicing or skepticism [1]. As public opinion has shifted with new available information, technologies, and social expectations, so has the response to Snow’s endeavors. When the control and protection of bodies become subjects of public discourse, the morbid matters of health are determined not only by research, but by convention.

Chloroform: The Popular Poison
John Snow popularized the use of chloroform as an anesthetic during childbirth when he successfully administered the drug to Queen Victoria during her last two deliveries in the 1850s [2]. This royal promotion was concurrent with shifts in obstetrics, including increases in both aggressive surgical methods and physician-led deliveries [3]. The pain caused by invasive practices like the routine use of forceps or episiotomies prompted obstetricians to use ether and chloroform, the only available anesthetics in the 19th century.

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Furthermore, early feminists advocated for these drugs in order to improve obstetric care and eliminate pain during childbirth [4]. Because pain was then thought to do permanent damage to one’s health, Snow’s use of chloroform during a royal birth signaled a safe and approved option for women during their deliveries.

Despite its once popular status, later research found that not only was chloroform toxic, but the drug also weakened a woman’s contractions during birth – resulting in the greater need to use instruments to forcibly remove the infant from the womb. Similarly, ether and the later “twilight sleep” drugs fell from favor as (hopefully) safer drugs were developed. The practice and safety of modern anesthetics, are still debated as many feminist authors today consider the use of such chemicals during birth to represent the control physicians have over their bodies and their labors [3].

Cholera and Public Pollution
Nearly everyone who has taken a public health or epidemiology course is likely to have heard the story of Snow’s brilliant mapping of a London cholera outbreak to its source – the contaminated Broad Street well-pump [1]. It’s a tale of data collection and deduction, with logic so seemingly straightforward that students leave these lectures potentially unimpressed with a man who drew maps of cases and alleged that sewage contamination could spread disease.

L0063431 Map showing deaths from Cholera in Broad Street...

We must remember, however, that we are not the people that Snow was working to convince or save.

Snow’s early articles about his tracking of cholera outbreaks were published in 1854. In them he described how contact with the “morbid matter” of the disease was possible in 19th century London. For example, “evacuations” from a cholera patient could pass “first down the sewers, then up the Thames…and afterwards through the water-pipes for a distance often of several miles…The morbid matter of cholera can be mixed with the water of a well-pump and remain even for a few hours without being destroyed” [5].

By proposing a fecal-oral route of transmission, Snow offended the sensitivities of the public and officials who were unwilling to acknowledge that their drinking water was polluted with human waste [1]. Snow’s fellow physicians also questioned his theories and accused him of exaggerating or fabricating evidence. Snow’s claims were verified in 1854 when an Italian scientist, Filippo Pacini, discovered the bacteria responsible for the spread of cholera. However, Pacini’s findings were not widely known by the scientific community until over a decade after Snow’s death [6].

John Snow’s work is most remembered for how he approached these morbid matters. Whether he was administering poison to a queen or was tracking the spread of contagion throughout a community, his work had public repercussions. He ushered in changes in the way people understood their health and bodies. But then again, such things are a matter of opinion.

About the Author:
Catherine Osborn, BA, BS
, is a graduate student in Medical Anthropology at Case Western Reserve University, the Editorial Associate at Culture, Medicine and Psychiatry, as well as a Research Assistant at the Dittrick Museum of Medical History.

References:

[1] Vinten-Johansen, Peter, Howard Brody, Nigel Paneth, Stephen Rachman, and Michael Rip. 2003. Cholera, Chloroform, and the Science of Medicine: A Life of John Snow. Oxford, UK: Oxford University Press.

[2] Snow, John. 1858. On Chloroform and Other Anaesthetics: Their Action and Administration: Edited with a Memoir of the author by Benjamin W. Richardson. London, UK: John Churchill.

[3] Wolf, Jaqueline H. 2011. Deliver me from pain: Anesthesia and birth in America. Baltimore, MD: Johns Hopkins University Press.

[4] Caton, Donald, Michael A. Frölich, and Tammy Y. Euliano. 2002. Anesthesia for childbirth: controversy and change. American Journal of Obstetrics and Gynecology, 186(5), S25-S30.

[5] Snow, J. (1857). On the origin of the recent outbreak of cholera at West Ham. British Medical Journal, 1(45), 934.

[6] Pacini, Filippo. 1865. Du Cholera Asiatique au Point de Vue de sa Cause Spécifique, de ses Conditions Pathologiques et de ses Indications Thérapeutiques par Ph. Pacini. Bruxelles: Librairie Médicale de H. Manceaux.

First Medical Publication in America? SMALLPOX!

L0038203 Illustration of face diseased with SyphilisOn January 21st, 1677, the first medical publication in America was circulating around Boston. It’s message? How to manage smallpox.

The pamphlet was a broadside, 12 inches by 17 inches, and written by Reverend Thomas Thacher. John Foster of Boston printed and sold it under the title: “A Brief Rule to guide the Common People of New England How to order themselves and theirs in the Small Pocks, of Measels.” A second version appeared in 1702. [1] Pamphlets on smallpox continued to circulate (almost as much as the disease) well into the next century–but outbreaks continued even into the early 20th century.

Smallpox is an infection caused by the virus called variola, a member of the poxvirus family. It is strictly an infection of human beings, and is a relatively contagious disease. Most infections were caused by contact with someone who had already developed the characteristic skin lesions (pox) of the disease, from contaminated air droplets, and even from objects used by another smallpox victim (books, blankets, utensils). The respiratory tract was the usual entry point for the variola virus into a human being. [2]

Here in Cleveland, a major outbreak of smallpox occurred as late as 1902. Only a program of community-wide IMAGE_3vaccination stopped the spread–through the cooperation of Cleveland’s elected officials, public health officers, the medical community, civic-minded businessmen, religious leaders, and educators. Thanks to their efforts, this would be the last smallpox epidemic in the city of Cleveland. Want to know more? Visit CITY ON THE EDGE OF DISASTER.

Medical publications remain one of the effective ways of alerting professionals about breakthroughs in identification and management of disease–interesting to think that the very first in the US served exactly this purpose!

[1] Samuel Abbott Green. A centennial address … before the Massachusetts medical society, 1881.

[2] City on the Edge of Disaster, Dittrick Museum

 

Understanding The Motion of the Heart: From Knowledge to Practice

Guest Post by Catherine Osborn, BA/BS
Graduate Student, Department of Anthropology, Case Western Reserve University

Matters of the heart are often confusing. Early scientists wondered if “the motion of the heart was only to be comprehended by God” [1]. The heart and blood were the subjects of much medical debate in the 17th century when an English physician questioned classic anatomical texts. Although previous anatomists like Vesalius had questioned traditional views, William Harvey was the first to accurately describe the circulation of blood throughout the body. Once scientists understood the regular functions of the cardiovascular system, medical pioneers explored how to manipulate the flow of blood. These later discoveries saved patients from deaths caused by conditions from surgical shock to heart disease.

Galen and Vesalius: Early Circulatory Notions

Until William Harvey’s findings were published in 1628, Galen’s work from centuries before remained the central physiological understanding of the motions of the heart and blood [1,2]. Galen taught that venous and arterial blood flowed as two different systems [3,4]. The liver was thought to produce the venous blood. In a separate system, the heart produced arterial blood and ‘spirits’ that provided heat and life to the rest of the body. According to Galen, the lungs were mainly responsible for cooling this vital blood.

Vesalius illustration from 1543 showing a two-chambered heart.

Much of Galen’s experimentation was on non-human animals, and thus his descriptions were understandably flawed [4]. For example, he described the heart as a two chambered organ divided by a septum containing invisible pores. These pores supposedly allowed blood to pass from the right to left chambers.

Despite the errors in this model, later anatomists who performed human dissections supported Galen’s description of the human heart. For example, Vesalius supported this position in the first edition of De Humani Corporus Fabrica (On the Fabric of the Human Body) in 1543, but later revised his position in the 1555 edition. In breaking with Galen’s teachings, Vesalius rejected the invisible pores without explaining how else blood could move from the right to left in the heart [3,4].

William Harvey and the “Circular Motion of the Blood”

Dr. William Harvey (1578-1657)

Dr. William Harvey (1578-1657)

Dr. William Harvey first voiced his views as a lecturing at London’s College of Physicians in 1616 [2]. Two years later, he was appointed “Physician Extraordinary” to King James I. Because the potential controvery, On the Motion of the Heart and Blood in Animals (Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus) was first published in Latin at a small printer in Frankfurt in 1628.

This work clearly detailed how blood moved from the right side of the heart, through the lungs, and then to the left chambers. He further showed that blood flowed through the arteries to the veins and back to the heart – confuting the notion of two different circulatory systems.

Harvey’s treatise included mention of how knowledge of the circulatory system could be used by physicians and surgeons when applying ligatures for amputations and bloodletting. He even suggested that the circulation of the blood could explain how medicines applied to the skin enter into the blood stream!

Figure from On the Motion of the Heart and Blood in Animals showing Harvey’s experiments with blood flow in the veins and arteries.

Figure from On the Motion of the Heart and Blood in Animals showing Harvey’s experiments with blood flow in the veins and arteries.

Despite Harvey’s clarity and prominent medical career, his research was not immediately recognized in England, and his book was only published in English twenty-five years after the first edition [2]. The 1628 and 1653 editions of On the Motion of the Heart and Blood in Animals can be found among the rare books of the Dittrick Medical History Center.

Marvels, Mavericks, and Medicine: Cardiovascular Cleveland

Harvey’s accurate account of the flow of blood allowed later physicians to therapeutically alter the circulatory system. In an upcoming talk, Dr. Brandy Schillace, Research Associate and Guest Editor of the Dittrick Museum, will discuss some of medicine’s greatest breakthroughs that occurred in Cleveland, Ohio, where pioneering physicians made history using their understandings of the motions of the heart and blood.

Crile’s canula was used to hold the veins of the donor and patient together to allow for blood flow.

Crile’s canula was used to hold the veins of the donor and patient together to allow for blood flow.

George W. Crile, Sr., a founding member of the Cleveland Clinic Foundation, is notable for pioneering techniques in blood transfusion. Crile was interested in preventing shock from major blood loss during surgery [5]. On August 6, 1906, Crile saved a young man during surgery by using the patient’s brother as a blood donor [6]. Working with silk thread and a sewing needle, Crile sutured a vein in the wrist of each man together. Upon receiving the donor blood, the patient miraculously improved in color and gained consciousness. After making improving the method, Crile used blood transfusions during WWI to triage wounded soldiers [5].

Coronary Bypass Surgery

Coronary Bypass Surgery

In 1967, Dr. René Favaloro, a young Argetine cardiovascular surgeon at the Cleveland Clinic became known as a pioneer of coronary bypass surgery in the treatment of heart disease [7]. This technique was used to regain blood flow to heart tissues after a blockage caused by heart attacks. Favaloro and his team performed many variations of bypass surgery using a section of a vein from the patient’s leg to avoid the blocked portion of a coronary artery [8]. From their research, these mavericks of medicine concluded  that their surgery, if preformed immediately after a heart attack, could save most of the heart issue [7].

From William Harvey’s descriptions of the circulatory system to later discoveries, the heart and blood remain central foci of medical study and exploration. These innovations have been used to save countless lives, such that the question now is not if “the motion of the heart was only to be comprehended by God,” but instead what more can be done by harnessing this knowledge?

Upcoming Event

For more on Marvels, Mavericks, and Medicine, Dr. Brandy Schillace will be speaking at Belt Magazine’s Happy Dog University on Tuesday, June 10th at 7:30 pm.

http://beltmag.com/marvels-mavericks-medicine-clevelands-dittrick-museum-presented-brandy-schillace/

References

[1] Harvey, William. 1628. “On the Motions of the Hearth and Blood” p. 3-75. In The Works of William Harvey, M.D. 1847 Edition. Robert Willis, trans. London.

[2] Willis, Robert. 1847. “A Life of the Author” p. xv-xxxiv. In The Works of William Harvey, M.D. London.

[3] Payne, Joseph Frank. 1896. “The Problem of Circulation” p. 35-36. In Harvey and Galen. London: Oxford University Press Warehouse.

[4] Pagel, Walter. 1967. William Harvey’s Biological Ideas: Selected Aspects and Historical Background. Switzerland: Basler Druck-und Verlagsanstalt.

[5] Loop, Floyd D. 1993. Dr. George W. Crile: The father of physiologic surgery. Cleveland Clinic Journal of Medicine. 60(1): 75-80.

[6] Nathoo, Narendra. Frederick K. Lautzenheiser, Gene H. Barnett. 2009. The first direct human blood transfusion: The forogotten legacy of George W. Crile. Neurosurgery. 64(3): 20-26.

[7] Fuster, Valentin and James T. Willerson. 2001. In memorian: René G. Favaloro, MD: The passing of a pioneer. Circulation. 103: 480-481.

[8] Captur, Gabriella. 2004. Memento for René Favaloro. Texas Heart Institute Journal. 31(1): 47-60.

 

Under Your Skin: the Anatomy Artwork of H.V. Carter

2014-05-22 10.52.12The history of Gray’s Anatomy is well known, but it’s brilliant illustrator Henry Vandyke Carter, is frequently it’s “unsung hero.” Though working tirelessly on the book that would go on to be the single most important textbook for anatomy and medical students, his contribution was “torpedoed” by Henry Gray, and he sunk into obscurity. [1] What remains are the images, displayed here, from the Dittrick Museum’s 1859 edition.

There were two authors, of Gray’s Anatomy, not one. However, as Druin Burch explains, Henry Vandyke Carter “regarded himself, sometimes with a little help from Gray, as belonging to a lower ‘genus’ of humanity, fit only to hold the worldly ladder while his ambitious colleague climbed.” [2]  Even so, the anatomy would never have gained popularity without the fine woodcuts created by Carter. Additionally, the names of muscles, nerves and bones were “written into the 2014-05-22 10.52.56body.” [2]

Carter was born today, May 22, in 1831 to somewhat more humble parents than Gray, who was a few years older. He became a student in human and comparative anatomy at the Royal College of Surgeons and earned his Bachelor’s of Medicine degree. After working with Gray to provide some of the notable, elegant, and recognizable engravings of anatomy, Carter joined the Indian Medical Service and became Professor of Anatomy at Grant Medical College in Bombay. He died of tuberculosis in 1897. Between Gray’s Anatomy and the end of his career, Carter studied leprosy and presented stained preparations of the disease bacilli at a medical meeting. [3]  His study on leprosy was considered some of the truly valuable papers of his career, “excelling in the descriptions of macroscopic anatomy of the lesions.” [3]

2014-05-22 10.52.36Carter also investigated the cause of fever among famine-stricken Indians in the 1870s. He identified Spirillum minus and brought to notice the role of spleen in “clearing the blood” of microorganisms. [3] Carter was rewarded for his achievements with the Stewart Prize of the British Medical Association–and his meritorous career also earned him the title of Honorary Physician to the queen in 1890. Even so, it is frequently his artwork rather than his life’s work that are most remembered–even if, just as frequently, his name is rarely attached.

 

[1] Michael E. Moran MD, “Gray’s Anatomy of Stones: Henry Vandyke Carter.” Urolithiasis, 2014, pp 131-144

[2] Druin Burch. “Breathing life into Gray’s Anatomy” The Lancet. Volume 371, Issue 9621, Pages 1327 – 1328, 19 April 2008.

[3]