Today, we would like to share a bit of history-wow. It’s a short film titled “The Old New World” by photographer and animator Alexey Zakharov of Moscow, Russia. Zakharov found old photos of New York, Boston, Detroit, Washington, D.C., and Baltimore from the early 1900s and brought them to life. Read more about the film here, or visit Zakharov’s site.
It’s #MuseumWeek, where museums around the world take to Twitter in a behind-the-scenes look at collections! Today’s theme is people. Follow us here on the blog, on Twitter and on Instagram all week to keep up with each event! #peopleMW
Although the Dittrick Museum’s collections primarily focus on medical tools and artifacts, a close look around the galleries reveals a few human specimens ever ready to greet visitors with perpetual (and sometimes toothless) smiles. Like the surgical sets and pharmaceuticals they’re featured next to, these specimens were also tools — tools used to teach students about the human body.
Our collections include many historic images of medical students engaged in dissection, often with each trainee’s name inscribed on the photo. Meanwhile, the identities of the cadavers, like our featured human specimens, remain unknown. Little information is available to answer questions such as: Who were these people? Why did they become objects of anatomical study?
For example, the young male skeleton featured in our period doctor’s office came from Dr. Charles A. Muncaster, a graduate of the Western Reserve School of Medicine, class of 1919. He had acquired the specimen during his studies in 1915, a time when an articulated skeleton sold for $45 to $75. Advertisements for osteological specimens offered no details about the source of their materials, only the quality of the articulation.
In 1968, besides the two human specimens shown above, Muncaster donated his complete obstetrical bag, providing a snap-shot of early 20th century physician-assisted childbirth. Like Dr. Muncaster, the museum’s collections have been greatly enriched by generous patrons’ donations of their professional tools. The artifacts tell not only the stories of individual practitioners, but also of patients, education and historical understandings of health and the body.
Medicine is not practiced in a vacuum; cultural and geographical context matter, and the community shapes both innovation and practice. Cleveland’s history reveals the remarkable collaboration of medical institutions and the public—it does not rest only in the hands of physicians or with distant hospital systems. Now, as then, health is everyone’s concern.
But how do we engage the public? And how can we make it plain that the public has rights–and power–to shape medicine? Historically, individuals had a greater share in shaping their care out of necessity. The Dittrick Museum’s collection of herbals and medical remedies is a testament to just how much people took health into their own hands. Dr. Culpepper’s Last Legacy (1655) contains prescriptions for do-it-yourself potions [from our instagram]:
Obviously, we are not mixing witches’ brew these days, and certainly no doctor or pharmaceutical company is going to publish recipes for homemade medicine. Then again, a resurgence in homeopathy and plenty of websites that promote home-remedies suggest that there is an audience…And a quick scan reveals plenty of misinformation, too. How can an interested public find good information about their health and health choices? Whose responsibility is it to make access to care, and even information about care, easier and more intuitive?
The patient often does not feel like an empowered part of the medical process. A few years ago, The Atlantic published a piece called “Power to the Patients” that took issue with the traditional doctor knows best mantra: “it is only by empowering patients – entrusting them with greater responsibility and putting opportunities for self-directed care into their hands – that health care can be made significantly more efficient and effective.”  But, the article goes on to admit, sorting out how you can be empowered in the midst of a health crisis is probably too late. Let’s take it a step further: do healthy people feel empowered about their health? Do they understand that they are stake-holders? Possibly not.
The New York Academy of Medicine is taking a community approach to this problem. They have a renewed dedication to “urban health,” and seek to address the broader determinants of health, and “the importance of interdisciplinary approaches to care.” Their new logo sports the phrase: Healthy Cities. Better Lives. It’s not a new idea. It’s a return to an old idea–one that thrived in cities of the 19th and early 20th centuries.
Cleveland, Ohio, is one brilliant example. Polio hit urban centers hard, leaving debilitated children in its wake. The iron lung could keep people alive, but the world needed a vaccine, and then a systematic way of implementing vaccination protocols. A combined effort of doctors, philanthropists, the media, and everyday people led to record-breaking changes. Salk’s vaccine dropped cases by 90% by 1962 in Cleveland, and led to the eradication of the disease in the rest of the US. Public awareness and empowerment did what laboratory medicine could never hope to achieve on its own. Community engagement, public empowerment, and (key in the polio crisis) access to care and information wins the day.
And that returns us to the first question. How do we engage and educate the public? Whose job is it? The short answer: it’s everyone’s job. But I want to take a moment and focus on the power of history. Museums and libraries–and institutions generally–have an important role to play. To address misunderstandings about medicine, and crucially about who controls or drives innovation, the Dittrick has developed an interactive, digital exhibit and attendant programming called How Medicine Became Modern. The exhibit will be a free-standing digital touch-screen wall, 10ft x 4ft, in the main gallery, providing the story of our shared medical past and cultivating means of seeing the relationships among culture, society, and health. But we have also begun two types of public outreach as well–“conversations” that begin with the history, then allow panels and round tables to discuss medicine today. The story of polio and others like it remind us: we are part of this story. History records more than the names of famous doctors. It demonstrates the innovation, the boldness, the concern, and the action of every day citizens.
Medical humanities, or health and humanities, is all about the human story at the core. Let’s work together to bring that story out, and to be part of it.
 Clayton M. Christensen and Jason Hwang. “Power to the Patients” The Atlantic 2009
In 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.
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.
On 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!)
Little Jane grew up safe and healthy–here is a picture of her on her High School Graduation. Thank heavens for the Health Road!
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, or Measles.” A second version appeared in 1702.  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. 
Here in Cleveland, a major outbreak of smallpox occurred as late as 1902. Only a program of community-wide vaccination 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!
 Samuel Abbott Green. A centennial address … before the Massachusetts medical society, 1881.
 City on the Edge of Disaster, Dittrick Museum
Diphtheria (Corynebacterium diphtheriae), an acute bacterial infection spread by personal contact, was the most feared of all childhood diseases. Diphtheria may be documented back to ancient Egypt and Greece, but severe recurring outbreaks begin only after 1700. One of every ten children infected died from this disease. Symptoms ranged from severe sore throat to suffocation due to a ‘false membrane’ covering the larynx. The disease primarily affected children under the age of 5. Until treatment became widely available in the 1920s, the public viewed this disease as a death sentence.
In the 1880s Dr. Joseph O’Dwyer, a Cleveland native, developed a method of intubating patients (inserting a tube to keep the airway open) to survive the life-threatening phase of diphtheria. Although neither foolproof nor simple to use, O’Dwyer’s intubation instruments comprised a life-saving last resort. Grateful patients, parents, and doctors acclaimed Dr. O’Dwyer, and hailed his instruments as modern medical marvels. Ironically, O’Dwyer lived long enough to see his invention eclipsed by progress in medical science. Diphtheria became a seldom-seen threat to children, but only so long as they had been vaccinated.
Before Dr. O’Dwyer perfected his intubation techniques, tracheotomy presented the only viable treatment for diphtheria. This procedure involved cutting open the throat without anesthetic and inserting a tube directly into the trachea. Through this tube, an attendant could maintain consistent airflow by pushing air into the lungs. Although tracheotomy has been practiced for hundreds of years, operative complications persisted until the 1960s. During the early 19th century tracheotomy remained a last resort due to the lack of anesthesia, high risk of infection, and low success rate of the procedure.
Diphtheria vaccination first appeared in the 1890s, but only became widely used in the 1920s. During this interval medical scientists labored to create a safe and effective vaccine. Antitoxin introduced in 1890 provided immunity for only two weeks. Six years later, the toxin-antitoxin mixture came into general use, providing life-long immunity. Doctors used horses to generate this antitoxin serum. Thirty years after diphtheria antitoxin first became available, Béla Schick introduced the Schick test, a cutaneous test showing if a person needed immunization. This allowed for the use of toxin-antitoxin to become widespread.
The toxin-antitoxin mixture, for all its promise, posed significant risks because it involved injecting live toxin. In 1924, Gaston Ramon developed the toxoid, a neutralized form of the toxin that would still impart permanent immunity. The toxoid-antitoxin mixtures eventually developed into the TDAP vaccine that is still in use today.
Cleveland did not escape the diphtheria outbreaks of the 19th century unscathed. In 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. Cleveland experienced deadly waves of the disease until the late 1920s when immunization became standard practice in large parts of the city. By 1938, only a handful of cases were reported.
Balto is known worldwide as the dog from the Disney movie. This story is based on the real-life 1925 serum run to Nome, Alaska. In midwinter, news reached Anchorage of an imminent epidemic in Nome. Twenty mushers and more than 100 sled dogs relayed antitoxin through dangerous, freezing conditions in an effort to stave off the outbreak. The real Balto led the sled team that made the final leg of this dangerous journey. Balto, a neutered animal, could not be used for breeding and was soon disregarded. A Cleveland businessman found Balto and his team on display in Los Angeles and, outraged at the animals’ state of neglect, worked with the Plain Dealer to have the team brought to the Cleveland Zoo. Balto was taxidermied after his death and is now on display at the Cleveland Museum of Natural History.
Guest post based upon the Dittrick Museum Diphtheria Exhibit, guest curated by Cicely Schonberg, BS, from Case Western Reserve University, Cleveland, Ohio.
Interested in learning more? Join us at the Dittrick Museum–researchers welcome!
Who was Mathieu Orfila?
In 1840, Mathieu Orfila, was summoned to the Lafarge murder trial in Paris. The Marsh test had proven inconclusive due to improper handling, and prosecution sought an expert. What made Orfila different? His methods. Piece by piece, he put the case together, eliminating all other possibilities. Orfila is also credited as one of the first to use a microscope to assess stains of blood and bodily fluids. His work refined forensics as a science.
Patient and meticulous, Orfila worked to make chemical analysis part of forensic medicine. He also made careful studies of asphyxiation, the decomposition of bodies, and exhumation. Orfila’s first treatise, Traité des poisons, greatly enhanced and built upon the work of other toxicologists (and quickly surpassed them). Published in 1813, the treatise earned him the title Father of Forensics. By the time he was called to the Lafarge case, Orfila was considered the greatest toxicologist in the world.
The judge ordered Charles Lafarge’s body to be exhumed, though months had gone by. The evidence was literally “under their noses,” and several jurors fainted at the stench as Orfila conducted the chemical test inside the courtroom. This way, everyone could witness his methodology. After painstaking work, he demonstrated definite traces of arsenic in the body, and showed that it did not come from the surrounding soil. The verdict was in: Mme. Lafarge was found guilty of murdering her husband!