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 Elusive Past of Ivory Anatomical Models

7745-BWelcome back to the Dittrick Museum Blog!

Today, we are pleased to host guest-blogger Cali Buckley, Ph.D. Candidate in Art History, Pennsylvania State University. Cali has been doing some fascinating research on ivory anatomical models, three of which reside in the Dittrick Collection. Delicate, finely carved, and impossibly detailed, these ivory anatomical models are both fascinating and mysterious. Today, Cali will be talking to us about their curious and often uncertain past. We hope you will join us at the Dittrick Museum’s history of birth exhibit, and take a closer look for yourself!

The Elusive Past of Ivory Anatomical Models

Cali Buckley, Ph.D. Candidate, Department of Art History, Penn State University
[all images reproduced by permission of Dittrick Medical History Center, Case Western Reserve University]

The Dittrick Museum is ready to show some of the most curious and least understood objects in the history of medicine: ivory anatomical manikins. They are hand-carved and highly intricate but rarely longer than a man’s hand. Nonetheless, when the top of the body is opened, they reveal a number of minuscule ivory organs. A majority of these models have articulated arms and—for the large percentage which are female—a tiny fetus attached to his mother by a red umbilical string. There are a little over 100 of these manikins known today in collections spanning Europe and the United States, but the question remains: What were they used for?

What we do know is that most of them were probably produced in Germany and owned by male physicians. The first manikins were pioneered by the ivory carver Stephan Zick (1639–1715) of Nuremberg, who also made ivory models of the eyes and ears.[1] Often the models passed from one doctor’s hands to another’s, such as those at the Victoria and Albert Museum in London and the Huntington Library in San Marino, California.[2] Ignaz Semmelweis—who nearly eradicated puerperal fever in new mothers of the mid-nineteenth century by insisting that male ‘midwives’ wash their hands—also had a manikin, now in a museum in Budapest named for him.[3] By the 1930s the market was saturated such objects to the point that the buyers for the Wellcome Collection would not acquire any single pieces above ten pounds sterling.[4] Unfortunately, many of the sellers of these objects were killed in concentration camps, and their collections dispersed during World War II.

There are at least a few bits of text that can give us more insight into how these manikins were used. In 2007 a manikin owned by the famous French obstetrician Francois Mauriceau (1637–1709) was sold by Christie’s auction house. It bore a curious inscription transcribed by the sellers as “Bon den ßufallen ß krantheiten der Sibivangern ßeiber ud kindbetterinnen.”[5] A rendering of it into modern German might read as “von den zufallen der krankheiten der schwangeren Weiber und Kindbetterinnen” or “for the diseases befalling pregnant women and those who have just given birth.”[6].

These ivory models were once thought to have been used as tools for doctors to explain childbirth to expectant mothers, but given the evidence we do have, this scenario is unlikely.[7] The Wellcome Collection acquired a poem with one of its manikins. It was signed by the Italian obstetrician Juseph Fuardi de Fossau in 1786. The original French has been translated as:

In Life’s full bloom, when labour’s toil so near
My fellow sufferers’ lot and perils I do fear,
Come ye fair pupils, Lo, I cast aside my shame
That Midwif’ries secrets may reveal my frame.
Pierce it with keen enquiring eye, and may
The child and mother’s nature then convey
New manifold devices to your skillful art
That pining women may not henceforth smart
Through cruel untaught efforts, and not gasp
With their unborn in Death’s unpitying grasp.[8]

Fuardi points to medical students as the manikins’ primary audience while advertising and vindicating the trained physician’s role in the birthing process. He also echoes the sentiments put forth by doctors when they first began to offer their own insights into women’s medicine starting with Eucharius Rösslin in sixteenth-century Germany.

The manikins themselves can hardly be considered pragmatic given that their pieces seem to be caricatures of actual body parts and they are so small that they can barely convey any information. They were after the printed “flap anatomies” made for wide audiences to see inside the body and the much more accurate wax Venuses of Florence and Vienna. As ivories, these manikins catered to trained medics who collected ivory instruments of various sorts from models to instruments such as enema syringes and scalpel or saw handles. The material was also a signifier of wealth. Though these tiny women were not highly functional in a physical sense, they were part of a wunderkammer mentality whereby objects become symbols of the curiosities of the universe—in addition to acting as a display and preservation of affluence.

5898-AThough it is nearly impossible at this time to attribute specific manikins to their makers, they do fall into stylistic groups. The manikin on a red velveteen bed may be related to other models in the Istituto Ortopedico Rizzoli in Bologna,[9] the Victoria and Albert Museum in London,[10] and five examples owned by the Wellcome Collection in London. Another is very similar to another in the Herzog Anton Ulrich Museum, Braunschweig,[11] one in the Olbricht Collection, Essen,[12] and two in the Wellcome Collection. The supine woman on the faded and elevated platform is 7553-Bunique. There are a number of manikins that seem to be one-offs, and they likely originated from an artisan attempting to copy the format, but it is also possible that a great number of other ivory figurines were lost or destroyed due to breakage, lost parts, and their unfortunate labeling as ‘novelties’.

These manikins may not be scientifically useful, but their making was such that they performed as pieces to distinguish the male doctor as someone who was focusing on women’s medicine and was willing to purchase or commission an object dedicated to his work. Having been made in Germany at a time when men were still attempting to prove their usefulness in terms of childbirth and the education of midwives, such objects take on a new light, offering a means for male doctors to convey what they did know about the female body. Whether lying silently in their  private vitrines and cases or being ‘performed upon’ by a doctor for the eyes of curious students, these ivory ladies were instruments of a different kind.

[1] Eugene von Philippovich, Elfenbein (Munich: Klinkhardt und Biermann, 1981), 331.

[2] Information from Marjorie Trusted, The Victoria and Albert Museum. The Huntington’s manikin was owned by a Dr. Edward Bodman. I thank Dan Lewis at the Huntington Library for this information.

[3] Ákos Palla, István Örkény, Miklós Pap, László Székely, Lajos Vörösházy, ed., Nymphis Medicis (Budapest: Kossuth Press, 1962), cat. 62.

[4] This information was gleaned from the correspondence at the archives of the Wellcome Collection, London.

[6] This was sold to an anonymous bidder and the original text is no longer available.

[7] Le Roy Crummer, “Visceral Manikins in Carved Ivory,” American Journal of Obstetrics and Gynecology 13 (1927): 29.

[8] The original text is now lost. Translated in C. J. S. Thompson, “Anatomical Manikins,” Journal of Anatomy 59.4 (July, 1925): 442–447.

[9] Roberto Margotta, Medicina nei secoli (Milan: Mondadori Editore, 1967), 187.

[10] Information from Marjorie Trusted, The Victoria and Albert Museum.

[12] Hiltrud Westermann-Angerhausen and Andrea von Hülsen-Esch, Zum Sterben schön: Alter, totentanz und sterbekunst von 1500 bis heute (Schnell und Steiner, 2006), 143.



Cali Buckley is a Ph.D. Candidate in Art History at Penn State University. She is currently working on a dissertation entitled “Women of Substance: The Materiality of Anatomical Models and the Control of Women’s Medicine in Early Modern Europe.” She has examined over 75 ivory manikins across the world and is compiling a catalogue of them so that museum curators, librarians, collectors, and scholars can learn more about these objects.

Haunting Images: Photography and Dissection, An Online Exhibit

Dmuseumlogo3Welcome back to the Dittrick Musuem Blog!

Last week, we featured an online exhibit about dermatology and photography, featuring the work of William Thomas Corlett. This week, I will be presenting material that I have always found personally fascinating–a history of anatomy in pictures!

This online exhibit features photographs from our collection of approximately three hundred dissection images (yes!). Most of these intriguing photographs feature a group of students gathered around the cadaver, either actively dissecting or just posing, often wearing their best suits. The students, not the cadavers. Well, not usually.

Anatomical dissection and medical education.

Beginning in fourteenth century Italy and lasting through the eighteenth century students learned anatomy by observing dissection. Once or twice a year, the anatomy instructor dissected a cadaver with all the students in attendance, eagerly watching the proceeding. The students observed but did not do the dissection themselves. This changed in the mid-eighteenth century, first in Paris and then in London, as students increasingly performed their own dissections upon cadavers. This constituted a fundamental change in medical education, placing greater emphasis upon learning not only by seeing, but also by doing.

Medical students were understandably proud of having dissected a human cadaver. It comprised the most important initiation into a life in medicine, and took on the character of a ritual. Through dissection, they obtained invaluable anatomical information and insights that formed the cornerstone of their medical knowledge. Dissection gave more than merely utilitarian knowledge, however. Dissecting a cadaver also compelled students to come to terms with their own apprehensions and anxieties about death, and the bodies of the dead. The resolution of these issues gave medical students a sense of mastery and power. It engendered a special camaraderie among physicians, and at the same time set them apart from the rest of society. Through dissection they had been inducted into tDittrick image 2002-20-70he medical profession, even if much study remained before them. Given the centrality of this experience, it is little wonder that students sought some way to record it. The advent of photography in 1839 gave them a remarkable, compelling new means to do so.

The online exhibit features four categories: Group Portraits, Postcards, Class Photographs–and my personal favorite–Tomfoolery and Humor. Medical students occasionally made prank photographs with a humorous intent. A popular subject is having the cadaver join in a card game. Another variant features a role reversal: the medical student on the dissection table, attended by cadavers.

The most common dissection image is the group portrait showing students gathered around the dissection table in gross anatomy class, and tables are often inscribed with the school name and students’ class year!

Dittrick image 1999-34-34These amazing photographs tell stories of a unique approach to death, to science, to discovery and to the human body. They are also collected and detailed in Dissection: Photographs of a Rite of Passage in American Medicine 1880-1930, by John Harley Warner and our own James M. Edmonson (Dittrick curator). Read more about the book and get an order form here.

For more about the images and the online exhibit, visit the Dittick Museum page on haunting images–and stay tuned for more online exhibits from the Dittrick Museum of Medical History!

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.