For the LOVE of Medical History

For our final #MuseumWeek post we’re talking about why we LOVE medical history and why we hope that love is contagious! #loveMW


It’s not uncommon for the Dittrick Medical History Center to be referred to a bit like a cabinet of curiosities,  a niche museum, or perhaps more kindly, a “hidden treasure.” Although we’ve always worked to make collections accessible and major public engagement efforts are underway, we still often have to make the case for the (sometimes not so) implicit question “Why should I care about medical history?”

The answer tends to go a little like this:

Medical history is the history of how we come into the world. Our Re-conceiving Birth gallery is not only about doctors, nurses, and midwives — it examines the experiences of women and babies from the 18th century to the 1940s. Beyond the particular questions of labor position, pregnancy diet, and types of forceps, this gallery calls visitors’ attention to larger, still pertinent questions: Is birth a normal or pathological event? Who’s experiences and knowledge are important during labor? Should birth hurt? How are difficult decisions made when both the mother and infant are at risk?

By framing these questions through history, we hope to add to modern debates that these are not new concerns and that “traditional” approaches are not singular or homogenous.

Medical history is the history of how we change and respond to our environments. Humans have faced a range of emerging health concerns through travel to new places, movement into cities, changing diets, and exposure to industrial hazards. Many of the museum’s exhibits examine both the impact of these shifts, such as crowded city-dwelling facilitating the transmission of infectious diseases, and how we respond to these novel health environments. For example, Cleveland was racked by a deadly and disfiguring smallpox epidemic in 1901 and 1902, which was halted through a coordination of efforts to develop and widely distribute a safe vaccine.

These stories speak to the dynamic relationship between humans and their environment and cautions against assumptions that medical progress has eliminated any risk of new health challenges.

Medical history is the history of how we manage pain and suffering. When visitors arrive at the museum, they are greeted with display cases that detail “If you were sick in…” various years throughout history. These exhibits contextualize both the conditions and therapeutics Americans encountered in 1810, 1860, and 1910 including purgatives and emetics of humoral medicine and the sanitizing devises and techniques developed under germ theory. The types of surgeries, pharmaceuticals, and instruments used by practitioners and the popular advertisements for health restoring or ensuring products reveal the way the body and illnesses are understood.

Conceptions of the body and what it means to be healthy are not static, but reflect contemporary challenges and concerns. For example, medicine during WWI developed ways to address mass trauma in the form of gunshot, shrapnel and shell wounds and fractures through pain-free, sterile surgeries that prevented patient shock and hemorrhage. Meanwhile, home front practitioners sought to ensure the continued well-being of citizens living under rations. We’re taking a closer look at these wartime public policies and their attempts to ensure health on April 7th.

Medical history is the history of how we mediate sexual relations and family size. The museum prominently features the Skuy Collection on the History of Contraception, the world’s largest and most comprehensive collection of historical contraception artifacts. This space provides a chronological look at the way fertility has been understood and managed, starting with early texts like the 17th century Aristotle’s Masterpiece, through the 19th century Comstock Laws, the development of the birth control pill, to modern contraceptive devices. Controlling fertility is not a modern pursuit, but has been shaped through history by contemporary social and cultural values regarding family size, appropriate sexual behavior, and the alignment (or not) between biomedicine and popular beliefs about reproduction.

Today’s discussions about access to fertility controlling pharmaceuticals and procedures is part of a longer history of politicized decisions about what is best for certain bodies and for the general public at large. The gallery highlights that “best medical practices” have been occasionally overruled by social pressures against contraception, as well as how a lack of oversight in the development and use of some contraceptive technologies lead to suffering or death of unprotected citizens.

Medical history is the history of how and why we die. Even the way death is depicted — as a failure of medical treatment or an inevitable end — is shaped by the unique historical ways health has been understood. For example, diphtheria, once a deadly disease for children in the late 19th century, became both relatively treatable and preventable within a few decades through use of diphtheria antitoxin and large-scale immunization efforts.

Other exhibits tell about the detective-like work of medical practitioners in discovering the causes of death. For example, development of the stethoscope allowed physicians to hear inside the body, however what they heard was not immediately clear. Doctors used the stethoscope to listen to ill patients’ breathing and heartbeats in the early 19th century and attempted to treat their conditions. When the patients almost invariably died from their diseases, the practitioners conducted post-mortem  examinations to match the sound they’d heard with internal abnormalities. The Blaufox Hall of Diagnostic Instruments illustrates how this process led to an improved ability to diagnose pathologies in living patients while providing directed treatment for their particular needs. Understanding why and how we die improves how we interpret our bodily experiences into symptoms and causes for concern.

Our forensics collections offer a different way of understanding causes of death. New methods to detect poisons or cause of death not only reveal how our bodies function, but also speak to larger stories about personal relationships and the integration of science into courts of law.

Basically, medical history is the history of people. Through a shared focus on the biological, environmental, and social aspects of people’s lives, engaging with medical history not only allows for a more nuanced perspective on how people have lived, but tells us something about the diversity of challenges and responses that await us.

 

Mosquito or Man — “Steadily or Surely Conquered”

With the recent global attention on the Zika virus (we won’t say emergence, as Zika virus itself is not new), public health programs focused on controlling the mosquito vector enter a debate with its own long and storied past.

Pick up any early 20th century book on infectious disease management and you’ll find confident statements assuring the victory of humans over illness and death. One text from 1909 called Mosquito or Man? speaks of this inevitable triumph over disease with an air of colonial domination, stating:

The tropical world is today being steadily and surely conquered…The campaigns show that the three great insect-carried scourges of the tropics–the greatest enemies that mankind has ever had to contend with, namely Malaria, Yellow Fever, and Sleeping Sickness–are now fully in hand and giving way, and with their conquest disappears the depression which seems to have gripped our forefathers. Now the situation is full of hope. The mosquito is no longer a nightmare; it can be got rid of.

Most European and U.S. medical attention in diseases of the “tropical world” peaked only after these conditions negatively impacted colonial interests. For example, the deaths of tens of thousands of workers from yellow fever or malaria infections (from the then-unknown mosquito vector) contributed to the failure of the 19th century French attempt to construct a canal through Panama. To create such a canal—an infrastructure project which would accelerate trade and establish imperial power—required “the economic control or eradication of the disease-conveying species…that affect personal comfort or real estate value” (LePrince and Orenstein 1916, p. 3).

SprayingLarvicideorOil
Man using a knapsack carrier to spray larvicide or oil in a ditch, 1916.

By the time, the United States began their own efforts to build the Panama Canal in 1904, U.S. public health officials had already instituted extensive sanitation projects informed by new epidemiological and entomological discoveries. These measures included draining stagnant water, controlling insect-breeding areas by spraying oil and larvicide or introducing larva-eating fish, fumigating buildings, and installing mosquito netting and window screens. Although canal laborers experienced less mortality from disease than their predecessors working for the French endeavor, medical staff continued to treat thousands of cases of mosquito-borne illnesses.

The hard fought results from these projects came with their own costs. Draining wetlands and adding larvicides (a combination of resin, carbolic acid, and sodium hydroxide) and crude oil into the remaining standing water wrecked havoc on the local ecology (Becker et al. 2013, p. 408). During mosquito control efforts in Panama, mosquito brigades poured an estimated 160,000 gallons of oil poured into the water in a single year of construction (Canfield 1908). Meanwhile, the time and money required for mosquito control campaigns could not be permanently sustained, making the comparative ease of mosquito eradication through DDT a welcome alternative. Mosquito resistance to insecticides has renewed interests in vector control, but today’s program developers are additionally informed by the historical challenges of managing mosquitoes.

DitchDigging
Left: A mosquito breeding ground: shaded wetlands surrounded by brush.                 Right: The brush-free ditch dug to drain the area. 1922

Gone is the easy confidence that mosquitos “may be destroyed” (Howard 1902). Today’s public health officials instead advise people living in mosquito-endemic areas to make difficult sacrifices to preserve their health. Although an absolute victor in the “mosquito or man” competition is both ridiculous and unlikely, it is tempting to view recent events placing mosquitoes firmly in the lead. We should remember that government officials, scientists, and physicians actually made these bold claims in a time immense of suffering and death from mosquito-transmitted diseases. Perhaps a bit of this early conviction in success (sans colonialism, of course) is necessary to fuel large-scale projects and innovation, so we can live with, rather than against, this historic foe.

Appling Oil Using a Cart
Applying a layer of oil to a ditch using a horse drawn cart. Panama, 1916.

 

References:

  1. Becker, N., Zgoma, M., Petric, D., Dahl, C., Boase, C., Lane, J., & Kaiser, A. 2013. Mosquitoes and their Control. New York, NY: Springer Science+Business and Media.
  2. Boyce, R. 1909. Mosquito or Man? The Conquest of the Tropical World. London, UK: John Murray.
  3. Canfield, H. 1908. Oil and Mosquitoes: Why the sanitary department used 3,200 barrels of oil or about 160,000 gallons during the last fiscal year. The Canal Record, Volume 1, p. 3.
  4. Hardenburg, W.E. 1922. Mosquito Eradication. New York, NY: McGraw Hill Co.
  5. Howard, L.O. 1902. Mosquitoes: How They Live, How They Carry Disease, How They are Classified, How They may be Destroyed. New York, NY: McClure, Phillips, & Co.
  6. LePrince, J.A. & Orentstein, A.J. 1916. Mosquito Control in Panama: Eradication of Malaria and Yellow Fever in Cuba and Panama. New York, NY: G.P. Putnam’s Sons.
  7. Nuttall, G.H, Cobbett, L., & Strangeways-Pigg, T. 1901. Studies in relation to Malaria. Journal of Hygiene 1, 4-77.

Polio Prepared: Treatment before Vaccines

“No single event impressed me more than what happened on April 12, 1955, the day the results of the evaluation of the 1954 poliomyelitis vaccine field trials were announced. As I was making my rounds that afternoon, I was taken aback to find a banner stuck on the doors of the respirator wards that read: ‘POLIO VACCINE WORKS.’ The patients had asked the volunteers, who published an in house newsletter entitled ‘The Toomeyville Gazette,’ to spread the good news.”

Robert M. Eiben, MD; 1955; Toomey Pavilion, Western Reserve University, Cleveland, Ohio

R.W.Lovett, Treatment of Infantile ParalysisPolio. Once one of the most feared of diseases, today it seems part of a past long gone and even forgotten. But there are voices that we can still hear, the lives and times of people who suffered it’s effects, and they should not be forgotten. The iron lung may be the symbol of polio’s power, its deadly means of paralyzing the lungs and suffocating patients. These iconic devices–things termed “half way” technologies by Lewis Thomas–are tools that mitigate disease effects but do not cure. And yet, these technologies were often, as James Maxwell [2] writes, a “necessary step” on the way to eradicating disease, and could be surprising innovations in themselves. Braces and belts, now empty of the limbs they meant to correct, remain full of significance. In today’s post, we examine not the cure, but the treatment–not the vaccine, but the innovative means, developed in desperation, for treating the victims of polio.

History
An infectious disease caused by the poliovirus struck Cleveland (and other major cities around the country) in the early 20th century. Some 7000 died in New York in 1916, and many more were crippled by the disease. In the months that followed the outbreak, how were patients treated and what was done to prevent new epidemics? Unfortunately, the cause of the disease wasn’t well understood for many years. It grew worse in the warm months, and seemed to strike children most–though it could also infect adults. FDR contracted polio in 1921, suffering paralysis. Where did it come from? Why had it become an epidemic? And why did countries and cities with improved hygiene see the worst outbreaks?

One possible answer comes from research done at the time. Dr. Sabin, also the creator of the Sabin Oral vaccine, extensively researched developing nations. He found cases of the poliomyelitis virus, but not of paralysis or of its epidemic proportions. Nidia De Jesus sums up Sabin’s findings: Prior to the 20th century, “virtually all children were infected with PV”–but at a very young age, when they were still protected by maternal antibodies. In the 1900s, improved sanitation meant that children were much older when they encountered the virus–and no longer protected. [3] In other words, by cleaning up water systems (polio virus is carried in waste matter), hygienic measures protected people far longer. So long, in fact, that Franklin Roosevelt didn’t come in contact with it until swimming as an adult, long after any maternal antibodies might still be at work. There are some problems with the sanitation theory–it doesn’t explain, for instance, why paralytic polio is appearing now in countries where sanitation systems are less developed… Or why anomalous cases appeared even in Sabin’s time. [4] One thing was certain, however; new methods needed to be employed ahead of the vaccine, to deal with the disabled and afflicted.

Symptoms and Treatment
IMG_5642Three strains of polio were ultimately discovered (by David Bodian MD, PhD, in 1949), but the symptoms that alarmed physicians tended to cluster as follows: Fever, stiff neck and sore throat, stomach ache and vomiting, diarrhea, pain in the legs, and–crucially–weakness of the muscles. Paralysis often began in the extremities and moved to the lungs–and the iron lung provided relief by using a pressurized chamber to help the sufferer breath. This technology aided patients during their critical illness, but for some, the lung would be a companion for life. Other treatments focused on those who survived the disease but with permanent paralysis, weak limbs, deformity, and more. History tends to remember Dr. Jonas Salk and Dr. Albert Sabin, those who perfected the polio vaccines–but how aided those who had already contracted the disease?

Dr. John Toomey,  physician and professor at Western Reserve University Medical School, was the first to recommend physical therapy for polio sufferers, including IMG_5640-1massage. Some early treatments included casts that prohibited movement, but Toomey disliked using plaster casts, arguing that in polio treatment early detection and vigorous massage were vital. He was also among the first to realize polio entered the body through the gastrointestinal tract. [5] A young man named Robert Eiben would replace Toomey upon his death in 1950, revolutionizing treatment at the Toomey Pavilion where many of the afflicted were housed and treated. The 1959 edition of the facility’s newsletter explained that “Dr. Eiben does not treat only the disease, he treats the patient.”[6] Use of physical therapy, of stretching, bracing, practiced movement, ultimately aided in rehabilitating many patients–including Donna, whose leg brace was donated to the Dittrick Museum. “I live a full and active life,” she explains; and even today, physical therapy remains part of post-polio treatment.

Did the iron lung, the leg brace, and physical therapy eradicate the disease? No, it would take the polio vaccine and an active and engaged vaccination program to do that. However, great things have come from such innovations. The iron lung paved the way for later respirator technology; the leg brace and therapy not only revolutionized care of individuals by strengthening muscles, it also engaged  nurses in responsive care, giving them essential roles [7]. And finally, with the work of Drs. John Enders, Thomas Weller, and Frederick C Robbins (who joined the Cleveland City hospital staff in 1952 as Director of Pediatrics and Contagious Diseases), we took a step towards the cure.

[1] Lewis Thomas, “The Technology of Medicine” New England Journal of Medicine, Dec 9, 1971.

[2] James Maxwell. “The Iron Lung: Halfway Technology or Necessary Step?” Milbank Quarterly, 1986

[3] Nidia H De Jesus. Review. “Epidemics to eradication: the modern history of poliomyelitis” Virology Journal, July 10, 2007.

[4] “Polio and Sanitation” Inside Vaccines. July 1, 2010.

[5] Toomey, John. Encyclopedia of Cleveland History.

[6] Albrecht, Brian. “Dr. Robert Eiben, Cleveland’s “Polio Doc” and pediatric neurology pioneer dies at age 91.” Plain Dealer. Dec 31, 2013.

[7] SB Sepples. “Polio nursing: the fight against paralysis.” Nursingconnections. 1992 Fall;5(3):31-8.