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.

 

Event and Gallery Opening! From Ether to Epidural by Jacqueline Wolf

IMG_5115Anesthesia: it calls to mind surgeries, treatment of shock–the rendering of a patient unconscious and free (temporarily) from pain.  But anesthesia has played an enormous role in the shifting ideas surrounding labor and birth in America generally–and right here in Cleveland. It’s more than a knock-out; it’s an ever-changing history!

On Thursday, November 19th at 6:00pm, Dittrick will share this fascinating story through a gallery opening (Childbirth in America, 1840-1940) and a talk by celebrated author and historian Jacqueline Wolf. Reproduction, birth, and women’s health in the 19th century shaped the way we practice obstetrics today. One of the biggest changes since then has been the use of obstetric anesthesia… From ether and chloroform in the 1890s, to barbiturates and narcotics in the 1950s, to the “natural” childbirth movement of the 1970s, each generation of American women has faced a very different birth experience! In this opening lecture, Jackie Wolf will explain how and why women’s obstetrician’s views of labor pain and its appropriate treatment changed over time. Dr. Wolf has explored this topic in her evocative Deliver me from Pain (2009), and will share her more recent insights.

IMG_5116The lecture is free, the gallery will be open late, and a reception will be provided in the museum space itself. We hope you will join us for the opening–to see the new permanent exhibit and the birth-chair platform (a generous gift from the Cleveland Medical Library Association), and to hear from a leading researcher in the field!

Exhibit: Childbirth in America 1840-1940, curated by Catherine Osborn in collaboration with Jim Edmonson and Anna Claspy.

Talk: Ether to Epidural: Obstetric Anesthesia in Historic, Medical, and Social Context, Jacqueline Wolf, PhD

Location: Dittrick Medical History Center and Museum, 3rd floor Allen Memorial Medical Library.

RSVP: Jennifer Nieves at 216-368-3648 or email jks4@case.edu

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.

On the Trail of the Machine: William Smellie’s “Celebrated Apparatus”

Last week, Dr. Edmonson (curator of the Dittrick Museum), provided a kind introduction to my work. Today, I am happy to continue the tale with part one of a two-part series.

       This journey took place over the course of three years, on two continents–and through the wonderful collections of several museums, beginning with our own Dittrick. I give you the tale–of a trail.
–Brandy Schillace, PhD
_________________________________________ 
On the Trail of the Machine: William Smellie’s “Celebrated Apparatus”
What is the lifespan of a medical device? Most generally, the utility of any instrument determines its tenure in medical practice—and subsequent models evolve to replace their predecessors. Amanda Carson Banks tracks just such an evolution in her work on birthing chairs (1999); studying this material helps us to understand why both the definitions and the practices of birth underwent radical change over time.[i] Her work points to a powerful connection between social history and its artifacts—something also provided by scholars such as Brigitte Jordan (Birth in Four Cultures) and numerous anthropological accounts from more specific contexts. But what occurs when we begin not with the artifact itself, but its disappearance?
            The question above occurred to me for the first time five years ago, while I was working on my dissertation. While researching a chapter on Augustan women’s education and mechanical habits (now an article with Feminist Formations 25.1 as  “’Reproducing’ Custom”), I came across the most unusual constellation of references. Described, variously, as “this most curious machine,” “this mock woman,” and the “celebrated Apparatus,”[ii] Dr. William Smellie’s mechanized obstetrical manikin seemed to be both science and spectacle, a mechanical woman that “gave birth” to leather dolls before eager students of man-midwifery.  Such an image teased my imagination, so naturally, with the dissertation complete, I went looking for more information about its history and whereabouts. Strangely, however, though crucial to the training of at least 900 man-midwives in ten years, the machine simply vanishes from the records! There are a number of well-preserved and well-documented versions of Madame de Coudray’s birthing machines; I’ve seen the primary one at the Musée Flaubert et d’histoire de la Médecine in Rouen, France, and the Dittrick museum has a simplified model from the same period. Remarkably, however, I could find no images, no models, no sketches and no copies of Smellie’s device. Surely, I thought, it must be somewhere… and so the search began.
            I was already familiar with the extensive collection of birth-related material at the Dittrick Medical History Museum, and so naturally began by contacting Dr. Edmonson. This connection, my curiosity, and what has been at times described as bull-dog-like tenacity, inaugurated a two-year exploration not of the lifespan of the artifact, but its afterlife, a task as fraught with difficulty as any exhumation. In a strange counter to material culture analysis, I had to define what was not by rendering as plain as possible what was—the history surrounding the device itself. What I have pieced together from student notes, detractors and sale catalogs presents a most unusual and often-contradictory picture.
The device emerged during the passionately debated shift from female to male midwifery practice. In a relatively short space of time, man-midwifery developed from the rare intervention of surgeons to a robust practice, wherein the female midwife (if not castigated as a rustic or vilified as a witch) served at the pleasure of the surgeon. This “unexplained revolution”[iii] has captured the attention and imagination of many—from medical historians like Adrian Wilson and Lisa Foreman Cody to literary critics like Bonnie Blackwell and Meghan Burke. A confluence of events led to this shift, including changes in the “bodily and social event” of childbirth with the advent of lying-in hospitals, as well as changes in fashion, politics, and social structure (in the Foucaultian sense).[iv]  It is also true that cases like the Rabbit Breeder of Godalming brought midwifery to embarrassing public notice; in 1727 Mary Toft mimicked birth pangs and contractions and fooled a number of midwives and surgeons into believing she had given birth to a brood of (dead of “still born” rabbits). The case was finally overturned by surgeon Sir Richard Manningham’s threat of live vivisection upon Toft, who confessed to the hoax. In this new model, the mystery of female anatomy would be rendered plain not only through better anatomies, but in part through surgeon’s instruments—and this emphasis gave “birth” to remarkable inventions.
Mechanical automations of various sorts gained popularity in the eighteenth century. There were also a number of obstetrical manikins in use during the period, but Smellie’s mechanized obstetrical phantoms deserve to be treated in a class by themselves. Described as a mechanical genius, Smellie—and his devices—earned the awe of students and even detractors. One of his pupils writes:
[Dr. Smellie was] An uncommon Genius in all sorts of mechanicks, which after having shewed itself in many other Improvements he manifested in the machines which he has contrived for teaching the Art of Midwifery. Machines which Dr. Desaguliers, who frequently visited him, allowed to be infinitely preferable to all that he had ever seen of the same kind, and which I (from having seen those that are used at Paris) will aver to be by far the best that were ever invented.[v] 

The apparatus” allowed Smellie to “perform and demonstrate all the different kinds of Delivery with more Deliberation, Perspicuity and Fulness than can be expected on real Subjects.”[i] Even the leather delivery dolls were considered more “life-like” than the child-cadavers used by M. Grégoire’s training school in Paris, for “the Coldness of the Child, the Flabbiness of the Parts, and the skin’s coming off at the least Touch, makes the Delivery seem much less natural than that of the Leather Children.”[ii] The machine itself was “composed of real Bones, mounted and covered with artificial Ligaments, Muscles and Cuticle […] and the Contents of the Abdomen are imitated with great Exactness.[iii] Similar descriptions are to be found among advertisements, tucked into arguments of detractors, and in contemporary pamphlets. Perhaps more mysterious yet is the extended description provided by Dr. Peter Camper.
Tune in next week for Part II, where I explore some of the stranger aspects of Camper’s descriptions and discuss the machine’s even more mysterious disappearance!

About Brandy Schillace 

A medical humanist, literary scholar and writer of Gothic fiction, Dr. Brandy Schillace spends her time in the mist-shrouded alleyways between medical history and literature. She is the Managing Editor, Culture, Medicine, and Psychiatry and has worked as an assistant professor of literature. She also leads interdisciplinary conferences abroad for IDnet and spends a lot of her time in museums and medical libraries.

[i] Banks, Amanda Carson. Birth Chairs, Midwives, and medicine. (Jackson: University of Mississippi, 1999): (xix).
[ii] Qtd. from Bonnie Blackwell, “Tristram Shandy and the Theatre of the Mechanical Mother,” ELH 68, no. 1 (2001): 81-133, 91.
[iii] Ibid.
[iv] Wilson, Making, 6.
[v] Johnstone, R.W. William Smellie, The Master of British Midwifery.Edinburgh: E. & S. (Livingstone LTD., 1952), 25.
[vi] Ibid.
[vii] Blackwell. Tristram, 94. The quote was recorded in Glaister and is from 1750.
[viii] Qtd. In Johnstone, William, 25.