Blood Rises – Tension and Truth in The Knick

“More suction, Bertie.” – Dr. Thackery

           “I’ve lost the pedal pulse.” – Nurse

“Blood rises, air becomes scarce. Which man can survive the longest? Care to wager, Bertie?” – Dr. Thackery

(Soderbergh, The Knick, ep. 4)

Cover of "Elecktromedizinische Apparate," 1898.

During the showdown between Dr. Edwards and Dr. Gallinger over an exsanguinating patient in Cinemax’s The Knick, it was clear who was not most likely to survive. In this scene, Dr. Edwards, a “colored” physician is not allowed to physically assist in a procedure using a galvanized wire to treat an aneurism, despite the fact that he was the coauthor of a paper describing its success. While verbally instructing Dr. Gallinger, a white physician who is unfamiliar with the procedure, Dr. Edwards becomes silent – daring Gallinger to either pass over the scalpel or let the patient die.

Is such a scene a work of modern fiction? As inspired by the New York Academy of Medicine’s amazing posts on the series, we ask: What was it like to perform such innovative procedures at the turn of the twentieth century? Let’s find out!

In 1899, Dr. Forest Willard at the University of Pennsylvania provided case reports on “aneurism of the thoracic aorta” and its “treatment by introduction of wire and electricity” (p 256). This paper, one year before the scene in the fictional Knickerbocker Hospital, reads with a similar dramatic style:

Galvanic Battery from "Elektro-Medizin Apparate," 1898.

Galvanic Battery from "Elektromedizinische Apparate," 1898.

As the conditions were growing worse, and rupture certainly approaching, the patient consented to accept the risks of the only operation that offered any chance of success, the introduction into the sac a certain quantity of wire as a framework or skeleton, each coil of which might form a nucleus for coagulation, producing eddies in the sac and final consolidation. (p. 256)

The basics of this procedure are as follows: A patient presents with an aneurism, a ballooning of a weakened blood vessel that may burst and lead to death. A physician makes a nick in the vessel and inserts a cannula that will shield the walls of the vessel from the electricity. A coil of wire, anywhere from 5 to 225 feet long, is inserted (quickly!) through the cannula into the sac of the aneurism, and the free end of the wire is connected to a galvanic battery. The wire becomes charged to begin coagulation of the blood. After a variable amount of time, the current is disconnected, the cannula is removed, but the wire coils are left behind to serve as a structure for the clot (Siddique et al., 2003).

From D.D. Stewart in 1901. This heart of an autopsied patient showing the coils within the hardened aneurysm.
From D.D. Stewart in 1901. This heart of an autopsied patient showing the coils within the hardened aneurysm.

One of the major differences between these historical and fictional accounts is the use of ether during such a procedure. Willard mentions that “aside from the first shock at the sight of spouting blood, the patient suffered no serious inconvenience…and he talked cheerfully throughout the operation” (p. 257). Instead, Dr. Gallinger’s patient lays unresponsive and unaware of the conversation above him. Imagine had he not been anesthetized and had witnessed the men play a game of chicken with his life!

Who would have needed this surgery? Based on the age of the patient in The Knick, the “etherized” male would have likely been syphilitic – as the tertiary stages of the disease lead to inflammation and aneurism. Five of Willard’s cases were patients with syphilis who were occasionally “of intemperate habits” or simply “drunkard[s]” (p. 259).

The hardened anuerysm would remain visible as a large lump on the patient’s chest (Stewart 1901) after the surgery. Unfortunately although “life [was] prolonged and made much more comfortable,” post-operative patients typically died only months later (Willard 1899, p. 261).

Stewart 1901. A patient a few months after surgery displaying a harden aneurysm.
From D.D. Stewart in 1901. Patient a few months after surgery with a harden aneurysm.

Will the young patient at The Knick survive? He may have served simply as a backdrop for the interpersonal tensions between the main characters. Historically, twentieth century doctors followed up on these cases for equally self-serving reasons. Autopsies allowed physicians to retrieve the remaining coil of wire, determine the success of their work, and to fine-tune their pioneering methods.

References:

Reiniger, Gebbert, & Schall. 1989. Elektromedizinische Apparate und Ihre Handhabung. Siebente Auflage. Erlangen.

Siddique, Khawar, Jorge Alvernia, Kenneth Fraser, and Guiseppe Lanzino. 2003. Treatment of aneurysms with wires and electricity: A historical overview. Journal of Neurosurgery  99:1102-1107.

Soderbergh, Steven. Sept. 5, 2014. Season 1, Episode 4 “Where’s the Dignity?” The Knick. Cinemax.

Stewart, D. D. 1901. “The galvanic current in the treatment of saccular aneurisms.” In An International System of Electro-Therapeutics for Students, General Practitioners, and Specialists. Horatio R. Bigelow and G. Betton Massey, eds. 2nd edition. Philadelphia, PA: F.A. Davis Company.

Willard, Forest. 1899. “Aneurysm of the thoracic aorta of traumatic origin; Treatment by introduction of wire and energy.” University of Pennsylvania Medical Bulletin XIV(7): 256-261.

Book Review: My Notorious Life by Kate Manning

NotoriousToday on the Fiction Reboot | Daily Dose, we present a review of My Notorious Life!  This work is based upon the true story of Anne Lohman, also known as Madame Restell, a prominent New York midwife enveloped in scandal, who died by suicide in 1879. The Dittrick Museum will host Kate Manning for a short talk and book signing on Sept 19th; RSVP to jks4@case.edu.

“Women’s Private Matters”: Thoughts on My Notorious Life by Kate Manning
Reviewed by–Anna Clutterbuck-Cook

Halfway through Kate Manning’s historical bildungs roman, My Notorious Life (Scribner, 2014) the young protagonist confronts her husband. Axie Ann (Muldoon) Jones has just performed her first abortion for Greta, childhood friend. Axie’s husband Charlie returns home and, upon learning of the abortion, turns angrily to his wife: “You want to tempt the devil on is, is that right? And the traps?” he accuses, “Is that what you’re doing there, then, [in your office] on Chatham Street?”

 –None of your business, I said. –It’s women’s private matters.

He stared at me like I was a stranger. Like he imagined in grim pictures what I done with Mrs. Evans [her teacher]. What I done for my friend. I feared what he thought of me, and how I would disgust him, and that he would leave me. –What else would you have me do? I cried. –Leave Greta on the road? (231).

 This exchange brings into stark relief the key tension around which My Notorious Life turns. Axie’s angry outburst — it’s women’s private matters! — is both a vicious indictment and and a powerful act of protection. By keeping her work in the shadows, particularly away from the scandalized and ill-informed eyes of men, Axie is able to care for her patients. Yet that same distance, the willful unknowingness of men regarding the experiences of women, isolates Axie personally and professionally — ultimately endangering not only her livelihood but her very life.

Loosely based on the real-life case of Madame Restell, a self-trained female physician who ran afoul of moral crusader Anthony Comstock and New York’s sensationalist press in the late nineteenth-century, Notorious is the fictional autobiography. Irish-American orphan Axie narrates her own life with a compelling voice that is by turns prickly, desperate, angry, generous — a complicated child grown into a complicated woman. We meet Axie as a child, separated from her ailing immigrant mother and sent West on an orphan train with her younger brother and sister — siblings who weave in and out of the narrative as actual and imagined characters, haunting Axie’s life long after they are separated and placed with different families. Resistant to relocation, Axie is returned to New York and ends up an unpaid housemaid-apprentice to a midwife, Mrs. Evans, who also “fixes” women who come to hear with unwanted pregnancies.

Our contemporary reproductive health landscape has its roots in the nineteenth-century world vividly fictionalized in the pages of My Notorious Life. As historians have ably documented — see, for example, Leslie Reagan’s seminal history When Abortion Was a Crime: Women, Medicine, and the Law in the United States, 1867-1973 (University of California Press, 1997) — midwifery and abortion occupied an uncertain space in the constellation of nineteenth-century health care. The reproductive lives of women had long been attended to by other women. However, as the modern medical profession evolved, the relationship between midwives and female physicians (denied access to medical schools) and the male medical establishment became contentious. Abortion — technically outlawed after “quickening” but largely ignored until the mid-1800s — became a cause du jour for reformers, ostensibly concerned for women’s safety, and medical men interested in the potentially lucrative business of women’s health services. These nineteenth-century battles lay the groundwork for a politicization of reproductive health care that remains in place to this day — as anti-abortion protests and lawsuits over birth control make clear.

It’s women’s private matters. The story of Axie’s life is overwhelmingly a story of women.* Men appear as charity workers, religious and political leaders, physicians, and occasionally lovers. Yet even Charlie, Axie’s husband, never completely emerges from the shadows despite his continual presence on the page. His motivations and emotional landscape remain shrouded. His courtship of Axie is perfunctory, their early marriage rocky, his understanding of her profession limited to its ability to stabilize family finances.

Instead, it is relationships between women that form the emotional core of My Notorious Life: Axie’s narrative is woven together by the threads of her connection to her mother, her sister, the midwife-physician to whom she is apprenticed, her friend Greta, her daughter, the women who seek out her services. Axie’s is a fully realized female world of love and ritual, moral complexity, anger, violence and loss. Against this rich tapestry of female relationships, characters like Charlie appear as distant players. In the end, My Notorious Life is a sweeping, melodramatic narrative worthy of its nineteenth-century protagonist — one which takes women’s private matters and makes them of more public concern.

*I’ve used binary terms throughout because those reflect the language used in the novel, the apparent identities of the characters, and the social framework of their world.

ABOUT THE REVIEWER
Anna Clutterbuck-Cook is a historian, librarian, and writer who serves as reference librarian at the Massachusetts Historical Society and is currently researching mid twentieth-century Christian understandings of human sexual diversity. She lives in Jamaica Plain, Massachusetts with her wife, two cats, and over one thousand books. You can find her online at thefeministlibrarian.com.

The Microscope: A Crucial “Lens” of History

gentlemanPicture for a moment the toxicologist, bending over his microscope to isolate and identify toxins–the biologist seeking new species in creek water–the geneticist parsing the double helix. Think of the physician, the scientist, even the micro-engineers. Now imagine those same specialists without one crucial piece of equipment: the microscope. Where would we be without this so-important “lens”?

The first “light microscope” owes its invention to Zacharias Jansen in the 1590’s, but interest in magnification began much earlier. The Romans explored the properties of glass and how, depending on curve and angle, it could make small objects appear larger. Later developments gave us the magnifying glass and even eye glasses (first made in the 13th century by Salvino D’Armate of Italy). The leap forward began with Jansen and his father, however, two Dutch eye-glass makers. Jansen’s device, which might remind us more of a telescope than a microscope, consisted of 3 sliding tubes fitted on either end with a glass lens. It magnifies 3x when the tubes were compressed, and 9x when fully extended to 18 inches. [1]

Isaac Beeckman provided the earliest known representation of a microscope (in print) in 1631, and members of the Accademia dei Lincei in Rome called it the “microscopium” as early as 1625. [2] Early models were not powerful enough to provide science with any considerable advantage. Anton van Leeuwenhoek (1632-1723), a Dutch cloth-merchant, made his own lenses, and his new lens tube had magnifying power of 270x. He later developed an instrument with a glass phial so that he could view blood circulation in the tail of a fish! [2]

L0043503 Robert Hooke, Micrographia, fleaNothing is so constant as change, and the microscope evolved from simple to compound; Robert Hooke’s Micrographia (1665) popularized their use. Hooke devised a side-pillar microscope on a solid base for use at a table, and John Marshall provided a stage plate in 1700. [2] Hooke looked at all sorts of objects, and what he saw opened new worlds of possibility. Snow crystals, the thin edge of a razor, or–and more dramatically–the flea. For the first time, a common household pest revealed itself an enormous creature with body hairs–all of which were rendered in detail at 18 inches across. He also pictures a louse, rendering it nearly two feet across when the image is unfolded. Imagine the impact of such a discovery–there were monsters in the house! [1]

Hooke described the flea as “adorn’d with a curiously polish’d suite of sable Armour, neatly jointed. . .” [3] But not everyone was impressed; some ridiculed Hooke for paying attention to “trifling” pursuits: “a Sot, that has spent 2000 £ in Microscopes, to find out the nature of Eels in Vinegar, Mites in Cheese, and the Blue of Plums which he has subtly found out to be living creatures.” [3] And yet, the book was a best seller in it’s day–and remains a curious volume even to the modern eye. Additional improvements, such as stabilizing distortion and aberration, made using the microscope possible Museum_dittrick-howardnot only for the specialist but for the lay-person; by the 19th century, microscopes were used by science, medicine, and an interested public.

Today, the microscope continues to fascinate. What child hasn’t looked on in wonder at salt crystals? Or seen something as inconsequential as dust or a droplet of water come to stunning new life? Here at the Dittrick, the microscope appears center stage in hospital medicine and in forensics, and a history of the microscope (through its evolution) may be explored in the Millikin Room on the 2nd floor. Come see medical and scientific history through its most crucial lens!

 

REFERENCES

[1] “Who invented the microscope?” A Complete History of the Microscope. <http://www.history-of-the-microscope.org/history-of-the-microscope-who-invented-the-microscope.php&gt;

[2] “Microscope, Optical (Early).” Instruments of Science, An Historical Encyclopedia. Eds. Robert Bud, Deborah Jean Warner. London: The Science Museum and SMAH, Smithsonian, Garland Publishing, 1998.

[3] “Robert Hooke.” History. University of California Museum of Paleontology, Berkely, CA. <http://www.ucmp.berkeley.edu/history/hooke.html&gt;

OUTBREAK! Rising Above in the Time of Cholera

L0040131 Blue stage of the spasmodic Cholera

Cholera Victim, “blue stage”: Wellcome Library, London

The recent outbreak of Ebola in parts of Africa–and the frightened posts and live-tweets that accompanied two infected health workers as they returned to the US–give us a glimpse not only of an epidemic’s power but of our private terrors. Self-preservation, fear of the unknown, and a desire to protect the boundaries of nations, persons, bodies and cells brings out the best and worst in us. History provides both sides; the uninfected locked up with the infected in 14th century plague houses, left to starve and suffer in the dark–or doctors like Cleveland’s Horace Ackley, who personally combated and contained an outbreak of Asiatic cholera in Sandusky in 1849. In the middle of the contest, we find the patient, caught between doctors and systems and, in our modern world as much as the historical one, political machinations.

L0073461 Illustration depicting cramped and squalid housing conditions

Squalid living conditions: Wellcome Library, London

The US cholera epidemic of 1832 began with an immigrant ship. After landing at Quebec with cases of Asiatic cholera, panic (and disease) swept the entire Great Lakes region. The epidemic killed thousands of people in Europe and North America resulting in wide spread panic. When it hit NY, 100,000 people fled, almost half those living there![1] The poor and immigrants were frequently blamed–why? The disease spread through infected water supplies, but many assumed squalor itself was the culprit. To make matters worse, people made an incorrect correlation between poverty and morals, so that filthy living conditions equated to a kind of loose living. The poor died–what was that to people of “good clean living?” But of course, cholera was no respecter of persons.

Since no one understood the disease, treatment basically consisted in waiting out the symptoms–which included violent vomiting; the loss of fluids put patients into shock. Prof Horace Ackley of Cleveland advocated the use of calomel, a mercury compound used as a purgative–it also killed bacteria. During the Sandusky outbreak of 1849, he gave patients five grains every five minutes in a tablespoonful of ice cold water. [2] But the significance of Ackley’s treatment consisted not so much in the medicine but the method. While people were fleeing the disease epicenter, Ackley was on the move within an hour, driving 60 miles without a stop except to water the horses. He took charge of the town, helped the sick, procured supplied, and buried the dead. He worked for two weeks to stop the progress of the disease, and in all that time “did not remove his clothes, except to change his linen, nor sleep in a bed.” [3] As a medical professional, he risked his own health to serve others.

Similarly, the Ebola infected health workers recently flown back to the Emory facility in Atlanta risked their lives to treat those in outbreak locations in Africa. Ebola has no known cure at present, just as cholera had no sure in the mid 1800s. The fear that drove people to blame the poor or to isolate and avoid them returns, this time along national lines. Despite assurances that they represent no threat, and despite the high tech treatment facility in Atlanta, many still railed against their return. CNN carried an article earlier this week, citing twitter hashtags that read “The road to hell was paved with good intentions.” [4]  Many feel the aid workers should be left in Africa–they might be citizens, but, through disease, they have been “othered,” and even blames. Dr. Bruce Ribner, who heads the center at Emory, countered that sentiment by reminding us that the doctors risked first–treating the ill with humanity and integrity.

L0044151 Portable Cholera Laboratory

Portable Cholera Lab, 1893: Wellcome Library, London

In the modern age, we frequently forget how precariously health is balanced, or how quickly the smallest of enemies can invade our borders. History teaches us the terror of outbreak, but we should endeavor to remember the humanity as well. Today’s outbreak of Ebola has been confined to West Africa, and the calamity, says Dr. Margaret Chan, head of the World Health Organization, can be stopped if the rest of the world steps up to provide resources. [4] We have more to learn from those who engage–like Ackley, but also like John Snow, who discovered cholera’s water-born nature, Spanish physician Jaime Ferrán who cultivated bacteria and vaccinated  50,000 people during a cholera epidemic in Valencia, or Robert Koch, who successfully isolated the cholera bacillus in pure culture and spread his discovery abroad. Let’s hope to see this latest outbreak among those we’ve successfully fought before.

  1. Cholera Epidemic, 1832
  2. Columbus Medical Journal: A Magazine of Medicine and Surgery, Volume 3
  3. Waite, Frederick Clayton. Western Reserve University Centennial History of the School of Medicine Cleveland; Western Reserve University Press, 1946.
  4. Greg Botelho, Ben Brumfield and Chelsea J. Carter. “2 Americans infected with Ebola in Liberia coming to Atlanta hospital” CNN, August 2, 2014

Brandy Schillace, PhD, is research associate and guest blogger for the Dittrick Medical History Center.

The Spring-Lancet, A “Bloodstain’d Faithful Friend!”

The origins of blood-letting date back to Hippocrates in ancient Greece when the practice was recommended to both prevent as well as remedy illness. Galen also supported therapeutic bleeding because it fit with his humoral theory. According to humoral theory, illness is caused by an imbalance of the body’s four humors: blood, yellow bile, black bile, and phlegm [1]. Thus, maintaining a balance of humors by the removal of excess blood was thought to preserve health.

The spring-lancet was predated by the thumb lancet (15th century) and fleams (17th and 18th centuries) [2]. Both these devices required the user to apply pressure manually on the blades against the patient in order make an incision.

ThumbLancetAndFleamBased on the earliest records, the first spring-lancet likely originated in Austria during the 18th century. To use the lancet, the practitioner would pull back a lever, coiling the interior spring. When the lever was released and the spring recoiled, the silver blade would drive into the patient [3]. Proponents of the spring-lancet claimed it provided greater precision in nicking a vein so blood could flow steadily from the incision. These devices served two purposes: the general removal of blood from the body (usually in the spring, as humoral theory proposed that the volume of blood was highest during that season) and the localized draining of blood from an inflamed area. Thus the former prevented illness, while the latter treated it.

SpringLancet

One of the benefits (?) of this design is that it allowed “untutored” bleeders the ability to make an incision over superficial veins. Thus, individuals without precise knowledge of the circulatory system could be fairly confident that they could remove blood without harming other vessels [4]. However, the French still preferred thumb lancets as they were less complicated and easier to use for physician/surgeons who were not ignorant of anatomy.

In the United States, the spring-lancet was much more economical than using other methods. One practitioner writing in 1813 stated “one spring-lancet, with an occasional new blade, will serve [a physician] all his life” [5, p. 281]. These devices were frequently very ornate and decorated with symbols that had a personal meaning to the owner. Unfortunately, spring-lancets were not indestructible. The spring could corrode due to trapped moisture acquired during use and cleaning [2]. Additionally, the mechanical complexity of the device made thorough cleaning difficult – making the transmittance of disease (not then a contemporary concern) much more likely. Despite these flaws, through at least the 1830s, every physician “without a single exception, carried a spring-lancet in his pocket, and daily used it” [6, p. 4].

In 1841, J.E. Snodgrass of Baltimore celebrated his apparatus in a poem entitled “To My Spring-Lancet.” The following stanzas allude to the frequent usage (and infrequent cleaning) of the spring-lancet for an American physician.

I love thee, bloodstain’d, faithful friend!
As warrior loves his sword or shield;
For how on thee did I depend
When foes of Life were in the field!  

Those blood spots on thy visage, tell
That thou, thro horrid scenes, hast past.
O, thou hast served me long and well;
And I shall love thee to the Last! [7]  

The conviction of Dr. Snodgrass’s ode may have been in response to the growing research and criticism against the efficacy of bloodletting. In the 1840s and 1850s, debate about the practice reached a peak when Dr. Hughes Bennett noted that rates of mortality from pneumonia decreased in a direct proportion to the decline in bloodletting [8]. Despite this, many physicians continued to use the spring-lancet to therapeutically bleed their patients. For example, Dr. A.P. Dutcher, at one time the President of the Cleveland Academy of Medicine, considered bloodletting to be “the most prompt and effective of all the known agencies that we possess to subdue inflammation” [9, p. 543].

Although the benefit of bloodletting as disease treatment was convincingly challenged in the mid-19th century, some physicians continued the practice for the next one hundred years. Fortunately, the growing acceptance of germ theory, as well as improved knowledge of the immune response, ushered in new aseptic surgical techniques. The reusable spring-lancet was no longer carried in every physician’s pocket, but instead “only found on the shelves of the medical curio cabinet” [10, p. 90].

N0029189 Pinprick device used in blood tests

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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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