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.

 

Architecture! Designing for Health in the Early 20th Century

It’s #MuseumWeek, where museums around the world take to Twitter in a behind-the-scenes look at collections! Today’s theme is architecture. Follow us here on the blog, on Twitter and on Instagram all week to keep up with each event! #architectureMW

Rapid population growth and industrialization at the turn of the 20th century meant many Clevelanders faced a variety of health concerns associated with urban living. With large numbers of the city’s workers employed in factories, industrial accidents and occupational hazards from chronic exposure to toxic substances like lead or mercury increased at alarming rates. In recognition of these workplace dangers, many local factory owners implemented safety protocols (like not eating lunch at your lead smelting station), mandated medical check-ups, and redesigned workplaces to facilitate airflow and increase light to reduce industrial.

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The Willard Storage Battery Company received accolades from public health researchers who considered its functional architecture — a series of long buildings to increase the number of windows in each workspace — a successful way to eliminate hazardous materials while limiting the numbers of employees exposed to dangerous lead-processing areas. Although images of the factory from 1923 may trouble modern sensitivities regarding OSHA requirements, these architectural details assisted in decreasing negative health events, while improving worker retention, and productivity.

The starting and lighting battery
The architectural design of the Willard Storage Battery improved airflow, available light, and reduced exposure to occupational hazards. 1923.
lead smelter
Lead smelters in the Willard Storage Battery Co. of Cleveland, OH. 1923.

Hospitals also adopted architectural features thought to promote health and limit disease spread. In keeping with conventional wisdom of the benefits of fresh air, Lakeside Hospital featured both public verandas facing the lake for charity patients and private solariums for paying patients. While domestic touches adorned private rooms, architects designed operating rooms and clinical spaces for utilitarian purposes — namely, maintaining a well-lit, aseptic environment.

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These hygienic architectural details became available consumer products for middle class Clevelanders seeking to make their homes both modern and sanitary. Through an integration of public health findings with design, the much local architecture reflects historic attempts to reduce illness and improve wellbeing.

Touch and Go: Cars, Health and Cleveland’s First Traffic Signals

Today’s Google doodle reminds us of the innovation and order brought by Garrett Morgan’s creation of the traffic signal. Cleveland became the first city to install these devices on August 5th, 1914 at the bustling Euclid Avenue and E. 105th St. intersection — on the current campus of Cleveland Clinic, just down the street from CWRU and our museum [1,6].

The traffic signal became a necessary fixture in light of alarming statistics about the dangers of automobiles and their fatal accidents in the early 20th century. From when the U.S. Census Bureau began collecting information in 1906 to 1914, the number of automobile fatalities per 100,000 population increased from 0.40 to 4.28 [7]. City traffic made automobiles even more dangerous, with Cleveland having the 3rd highest number traffic deaths in 1917 with 19.8 per 100,000 population!

The Cleveland Plain Dealer published an article in 1914 entitled “How Health is Injured in Riding in Automobiles” that examined how the increased pace of life brought on by the private automobile and other technologies allowed for more productivity at the cost of over-exertion [2]. Exhausted drivers posed a danger to themselves and other citizens. The human mind, focused now only on driving to and from work, did not have, the article’s author claimed, the same exercise it could have on the street car or when walking. Popular writers and practitioners alike saw this state of singularity as having a damaging effect on the nerves if drivers did not seek other mental and physical activities [5]. Public health campaigns sought to make driving safer for distracted drivers by initiatives that included Morgan’s traffic signals and crossing guards [3].

Dr. Samuel Kelley, a Cleveland pediatrician, posing with his automobile, 1910.
Dr. Samuel Kelley, a Cleveland pediatrician, posing with his automobile. From JAMA Vol. LVI(15), 1910.
This uptick in mortalities accompanied the boom in automobiles on U.S. streets to nearly 2 million vehicles by 1917 — some of which were ambulances and physicians’ cars. The National Automobile Chamber of Commerce reported in 1921 that over 65% of physicians drove their own passenger vehicles for private and business use [4]. Dr. Samuel Kelley, professor at Cleveland’s Western Reserve University and a prominent local pediatrician, utilized his car to attend to his extensive private practice, going as far to extoll his car’s virtues in a 1910 JAMA volume [3].  Lakeside Hospital employed ambulances to quickly transport patients to their downtown location.

Lakeside Hospital Ambulance, c. 1910.
Lakeside Hospital Electric Ambulance, c. 1905. In 1912, gas-powered ambulances replaced these vehicles for transport to Lakeside. Courtesy of the University Hospital Archives.
Despite the dangers of automobile transportation, improvements in car design and traffic regulation led to eventual decreases in the number of accidents per vehicle and safer, more expedient treatment by medical attendants. Garrett’s development and installation of the traffic signal 101 years ago continues to reduce injury and add some order to the chaos of 21st century life.

References:

[1] Garrett, Morgan A. Nov. 20, 1923. U.S. Patent US1475024 A. http://www.google.com/patents/US1475024

[2] “How Health is Injured by Riding in an Automobile.” Dec. 15, 1914. Cleveland Plain Dealer. p. 35.

[3] Kelley, Samuel W. 1910. Choose a moderately heavy car with a long wheel-base and big wheels. Journal for the American Medical Association 54(15): 1257.

[4] National Automobile Chamber of Commerce. 1921. Facts and Figures of the Automobile Industry. New York, NY. http://catalog.hathitrust.org/Record/100114589

[5] Motorvehical safety increasing. 1921. The Journal of the Society of Automotive Engineers 8(5):486.

[6] Street Crossing Traffic Signals, Cleveland, Ohio. 1914. Engineering News 72(23):1130.

[7] U.S. Department of Commerce, Bureau of the Census. 1919. “Violent Deaths Excluding Suicide.” p. 61. In: Mortality Statistics. Washington, DC.

A Grave Matter: Legislating Dissection

It’s 1855 in Cleveland, Ohio and you need a surgeon. There were quite a few local options including the physicians out of the Cleveland Medical College and the Western Homeopathic College of Cleveland. In soliciting one of these (mostly) men, you assume that they have the adequate experience to perform whatever operation you need. But where did they get it?

Cleveland Medical College c. 1865
Cleveland Medical College c. 1865

Continue reading A Grave Matter: Legislating Dissection

Grave Robbing for “The Benefit of the Living”

Rattle his bones over the stones,
He’s only a pauper, whom nobody owns. [1]

Imagine you are a sick pauper living in Cleveland, Ohio in 1855. For shelter and medical attention, you stay at the newly built City Infirmary, where faculty and students of the Cleveland Medical College offer their services. Alas, your illness cannot be cured and you die – friendless and alone. Your body is taken to the Potter’s Field in Woodland Cemetery across town. But there it is not to stay.

Map of Cleveland in 1861, with the relative locations of Woodland Cemetery, the Cleveland Medical College, and the Cleveland Infirmary marked.
Map of Cleveland in 1861, with the relative locations of Woodland Cemetery, the Cleveland Medical College, and the Cleveland Infirmary marked.

Continue reading Grave Robbing for “The Benefit of the Living”

Deadly Diphtheria: the children’s plague

V0017055 A ghostly skeleton trying to strangle a sick child; symbolisDiphtheria (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.

Diphtheria throatBefore 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 000244_540deadly 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!

The Dittrick Museum Online Exhibits: SmallPox

Dmuseumlogo3Welcome back to the Dittirck Museum Blog!

Did you know that Dittrick has digital exhibits? Our website hosts several “online” exhibits, guest-written by talented people. Today, I will be presenting from “Small Pox: A city on the edge of Disaster,” written by Patsy Gerstner, PhD. The full online exhibit may be found on the Dittrick website, under online exhibits.

[From Patsy Gerstner] …In the early years of the 20th century, the city of Cleveland experienced a major outbreak of smallpox. This epidemic brought the city to the edge of disaster in 1902. Only a program of community-wide vaccination halted the spread of this dreaded infectious disease. This was not easy to achieve, and came about only through the effective 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.

We can trace the course of the epidemic and the city’s response through newspapers, city council archives, medical journals, and public health reports. These sources chronicle the sequence of events and identify the major “players,” but do not adequately relate the horror that smallpox evoked in the minds of Clevelanders. A unique documentation of the epidemic does survive, however, in a remarkable collection of photographs. Homer J. Hartzell, a young physician caring for smallpox patients at the city’s “pest house,” captured the epidemic on film. While he may have done so out of scientific interest, these photos speak to us across time, conveying the suffering and disfigurement brought by this terrible disease. This exhibit tells the tale of the epidemic, and shares these images publicly for the first time. Further photographic documentation survives in the Corlett Collection. Dr. William T. Corlett was professor of dermatology and syphilology at Cleveland’s Western Reserve University School of Medicine, he documented his work with photography throughout his career… (read more)

Collection of photographs, Homer J. Hartzell:

smallpox victimDr. Homer J. Hartzell headed the Cleveland infectious disease hospital during the city’s last smallpox epidemic, in 1901-1902. Hartzell kept a personal photographic log of the epidemic, as seen in the photos presented here. Some 75 glass negatives, 40 lantern slides, and a small album came to the Dittrick in 1986, along with Hartzell’s own camera used to capture the epidemic.Photo left: Hartzell’s Pony Premo E camera which sold for $8.00 in the Rochester Optical Company Catalogue in 1898.

For more photos from this collection, visit the Dittick website!

In the coming weeks, we will be presenting material for additional online Dittrick exhibits, including dissection, artifacts, dermatology, and birth control!

About the blogger

Brandy Schillace is a medical humanist, literary scholar and writer of Gothic fiction. She is the Managing Editor for Culture, Medicine, and Psychiatry, a guest curator for Dittrick Museum, and a SAGES fellow for Case Western Reserve University (she has also worked as an assistant professor of literature at Winona State). She runs the Fiction Reboot and Daily Dose blogs, leads interdisciplinary conferences abroad for IDnet, and spends a lot of her time in museums and medical libraries.