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.


Rediscovering the Birthing Chair: Delivering Life While Sitting Up

Blog by Anneliese Braunegg, student at Case Western Reserve University
Essay winner, USNA 287Q Gothic Science, SAGES 2015
Instructor: Dr. Brandy Schillace

Birth Chair, Dittrick Museum
Birth Chair, Dittrick Museum

Envision two women. Each is in labor, each is in pain, and each is accompanied by a professional caretaker who is assisting her in giving birth. Here the similarities end. The first woman lies on a hospital bed with her hair strewn across the pillows; she is accompanied by a doctor, and she is simultaneously pushing her baby into the world as he pulls on it with forceps. The second woman sits on a birthing chair that was brought to and assembled in her bedroom; her hair is strewn across the chair back, she is accompanied by a midwife, and she is pushing her baby into the world as the midwife guides her through the process (“Midwifery Chair, c. 1850”).

The first woman is giving birth in 2015. The second woman is giving birth in 1850 (“Midwifery Chair, c. 1850”). In the generations between the second woman’s labor and the labor of her great-great granddaughter in this hospital room in 2015, now the present day, many changes will take place in the medical world. In an “‘unexplained revolution,’” typical birthing practice will “shift from female to male midwifery practice,” and “the female midwife… castigated as a rustic or vilified as a witch,” will come to “serve,” at most, “at the pleasure of the [male] surgeon” (Schillace). Pregnancy and labor will come to be “treated [not] as a natural process [but as] a medical condition” requiring a doctor’s intervention. (“Birth Chairs, Midwives, and Medicine”).

Birth chair, Dittrick Museum
Birth chair, Dittrick Museum, circa 1920

The primary birthing method shifted from use of the birthing chair to use of the birthing bed, “not necessarily because [lying on the birthing bed] is the best position for birth but… [because] it is the most convenient position for [the] doctor,” as it allows him to view the baby more easily and use a device that midwives have not used, the forceps (“Effective Birthing Positions”). Thus modern birthing culture will be born, and while women would, over time, become doctors, and pregnancy would come, once again, to be viewed as a natural state, the main method of delivery remained the birthing bed–the birthing chair largely forgotten. This is the way the world is today; however, hospitals of the present should not dismiss the method of the birthing chair too quickly. Giving birth on a bed, though it is the modern norm, is neither the only viable birthing option nor always the best one, and the expansion of birthing options would benefit the large number of modern women who go to hospitals to give birth to their babies.

Today, when most people picture a woman giving birth, they picture the woman lying on the hospital bed; less often do people picture the woman sitting on the birthing chair. The birthing chair birthing method is still used, but is much less common. This imbalance seems to imply that giving birth on a bed is somehow safer or more efficient than giving birth on a chair; however, studies evaluating the effectiveness of birthing chairs have shown that the birthing chair is a satisfactory birthing method for most patients who use it (Liddell, H. S., and P. R. Fisher) and that the use of a birthing chair does not increase the health risk to either the mother or the baby and is therefore a safe alternative to the use of a birthing bed (Kafka, M., et al.). Additionally, studies contrasting the birthing chair and the birthing bed have found there to be “less transient cord compression in upright positions” (Cottrell, B. H., and M. K. Shannahan) such as that taken while seated in a birthing chair and have found that “patients who delivered in the [birthing] chair [have] significantly lower rates of episiotomy [surgical cutting below the vagina performed to aid delivery] and manual separation of the placenta” in comparison to patients who delivered in a birthing bed (Scholz, H. S., et al.).

Birth chair, Dittrick Museum
Birth chair, Dittrick Museum,

While the birthing chair presents “minor disadvantages such as increased soiling of the chair” and, depending on the chair’s structure, “impedes operative deliveries from the perineal floor,” the advantages were determined to outweigh the minor disadvantages, and the suggested solution to the operative delivery impediment was not the use of a bed instead of a chair but instead a combination of the two into a birthing bed that can be shifted to accommodate all positions from sitting to recumbent (Schurz, A. R., H. Concin, and M. Kobermann). The results of these five studies indicate that while the birthing chair can safely be used as an effective alternative birthing method the birthing bed. In addition, because the less conventional birthing chair birthing method has been found to be a viable, potentially advantageous alternative to the birthing bed method, it would be beneficial to explore further the advantages of other less conventional birthing methods that exist.

The most effective of these other less conventional birthing methods include the birthing bar that attaches to a bed, the birthing stool, the upright sitting position, the kneeling position, and the curled side position, and each of these methods and positions presents certain advantages for the woman in labor (“Effective Birthing Positions”). These advantages include expanding the size of the woman’s pelvis (birthing bar and birthing stool), taking advantage of gravity to help push the baby (bar, stool, and upright sitting position), providing physical support for relaxation between contractions (bar, upright sitting position, kneeling position, and curled side position), and protection from back pain and vaginal tearing (kneeling position for the former and curled side position for the latter) (“Effective Birthing Positions”). Evidently, a variety of valid birthing methods exist. However, even though these methods present certain advantages to a woman in labor and even though, in the case of the birthing chair, research was performed as many twenty years ago indicating that the method is a positive one, the bed birthing method remains the primary birthing method made available to and used by laboring women. It is time that these studies’ suggestions be effected and that hospitals make information about and access to birthing chairs available to pregnant women, and it is time that other alternative birthing methods be scientifically examined and, if also found to be valid, also be publicized and made available.

Examination chair, circa 1875, Dittrick Museum

Some birthing centers do, in fact, offer some of these alternative birthing methods, and it is noteworthy that these methods are available not only at birthing centers specifically designated as alternative but also at some mainstream hospitals. A well-regarded example of such a hospital is MIT Medical, of the Massachusetts Institute of Technology in Cambridge, Massachusetts. In addition to offering the traditional option of giving birth on a bed, the hospital states on its website that it “alternative birth experiences are also available, including birthing chairs, birthing balls, hypnobirthing, doulas, and water births” (Patient Services: Obstetrics and Gynecology”). The fact that MIT Medical presents these options on its website is important; in order for effective birthing methods currently considered alternative to become accepted as mainstream, it is vital that established, well-respected hospitals embrace these methods and clearly state their availability. In doing so, hospitals make the labors of more women safer and easier, as they become better able to accommodate the needs of all the women who come to the hospital to deliver a child.

No two births are exactly alike. The uniqueness of each birth makes it vital that hospitals pay attention to the fact that giving birth in a bed, while the most common method of birthing, is not the only viable option and not always the best one. Hospitals like MIT Medical have taken a positive step toward addressing non-bed birthing methods, but even at MIT Medical, such methods are still presented as “alternative,” misleadingly implying that they may be less reliable than the bed birthing method (“Patient Services: Obstetrics and Gynecology”). Doctors and midwives should therefore continue to expand their knowledge and provision of different birthing practices and, just as importantly, make available to pregnant women and their partners information about the variety of safe, effective birthing options that exist. In doing so, they will ensure that both the woman in the bed and the woman in the chair will be in those places because they have chosen to give birth there and that they have chosen those places because they made the informed choice that those birthing methods are the best birthing methods for them.

Works Cited

“Birth Chairs, Midwives, and Medicine.” University Press of Mississippi. UP of Mississippi, n.d. Web. 6 Feb. 2015. <;.

Cottrell, B. H., and M. K. Shannahan. A Comparison of Fetal Outcome in Birth Chair and Delivery Table Births. N.p.: n.p., 1987. PubMed. Web. 6 Feb. 2015. <;.

“Effective Birthing Positions.” Taking Charge of Your Health & Wellbeing. U of Minnesota, Aug. 2009. Web. 6 Feb. 2015. <;.

Kafka, M., et al. The Birthing Stool–An Obstetrical Risk? N.p.: n.p., 1994. PubMed. Web. 6 Feb. 2015. <;.

Liddell, H. S., and P. R. Fisher. The Birthing Chair in the Second Stage of Labour. N.p.: n.p., 1985. PubMed. Web. 6 Feb. 2015. <;.

“Midwifery Chair, c. 1850.” Dittrick Medical History Center and Museum. Allen Memorial Medical Library. 11000 Euclid Ave, Cleveland, OH 44106-1714. 27 January 2015.

“Patient Services: Obstetrics and Gynecology.” MIT Medical. Massachusetts Institute of Technology, n.d. Web. 6 Feb. 2015. <;.

Schillace, Brandy. “On the Trail of the Machine: William Smellie’s ‘Celebrated Apparatus.'” Dittrick Museum Blog. Case Western Reserve University, 4 Apr. 2013. Web. 6 Feb. 2015. <;.

Scholz, H. S., et al. Spontaneous Vaginal Delivery in the Birth-Chair versus in the Conventional Dorsal Position: A Matched Controlled Comparison. N.p.: n.p., 2001. PubMed. Web. 6 Feb. 2015. <;.

Schurz, A. R., H. Concin, and M. Kobermann. Experience with EK-Birthing Chair (Author’s Transl). N.p.: n.p., 1981. PubMed. Web. 6 Feb. 2015. <;.

Check that Temperature! Rhythm Method, Thermometers, and the Gynodate

unnamedSex, contraception, and reproduction: if you think those are topics best avoided in a museum, think again! Next week, the Dittrick hosts its annual Percy Skuy Lecture on the History of Contraception, and this time, it’s all about temperature. Hot under the collar? It might be your cycle! Leo J. Latz, a Chicago doctor, first championed the Rhythm Method (based on work by Ogino-Knaus) in the United States. In 1932 Latz published The Rhythm of Sterility and Fertility in Women, which sold over 200,000 copies by 1942; he contended that the “findings of modern science disclose a rational, natural, and ethical means to space births and to regulate intelligently the number of children.” This coming Thursday, April 9th, come hear about the use of thermometers and the rhythm method to control fertility–lecture by Dianna Day, followed by a reception upstairs in the contraception gallery The event is FREE, but please do RSVP to ensure a seat: Want to learn more about contraception’s contested history? Here are some tidbits from our archive–and we hope to see you next week!

The-Rhythm-1934-coverRHYTHM METHOD
How did it work? Latz advised avoiding intercourse for eight days: for women with a regular menstrual cycle, this began five days before ovulation, with an extra three days tacked on for safety’s sake. As a devout Roman Catholic, Latz advanced this method of fertility control as more in line with Church teachings. He published pamphlets on rhythm for priests to distribute to couples, and parish bingo games gave out his book as a prize. Many shared Leo Latz’s faith in the science behind the Ogino-Knaus findings. But applying them to birth control proved not so simple, nor straightforward. Calculating the time of ovulation can still be tricky. It varies from woman to woman, and a woman can ovulate at a different time each month. Stress, illness, or interruptions in normal routine can also alter a woman’s cycle. Despite these uncertainties, the Ogino-Knaus method caught on, as evidenced by the proliferation of rhythm method calculators after 1930. Companies produced graphs, wheels, calendars, and slide rules, which cost from 10¢ to $5. In 1955 over 65% of Catholic women surveyed said they used Rhythm… And of course, given that is was a private means of controlling fertility, many more likely took advantage.

Ironically, Leo Latz felt biting backlash for all his efforts to bring an acceptable form of contraception to Catholics. Some felt he went too far. When Latz published The Rhythm in 1932 he served on the medical faculty of Loyola University. According to Leslie Tentler, writing in Catholics and Contraception: An American History (2004), Latz “was abruptly fired from that position in August of 1934,” and this action “was almost certainly a direct result of Latz’s prominent association with the cause of rhythm.” In 1935 Latz confessed to his friend Father Joseph Reiner, S.J., that no one “knew the anguish and dishonor I …suffered, when people said: ‘I heard you were thrown out of the University.” –Jim Edmonson (see original post here)

gynodate 2009-004-frontGYNODATE
A later variant of rhythm calculator was known as the “Gynodate.” Swiss clockmaker Jaquet introduced the “Gynodate” in 1958. It combined a regular alarm clock and a gauge to calculate the “safe period” as directed by Hermann Knaus. Jaquet claimed it “indispensable for every woman for natural birth control.” The Museum of contraception and abortion in Vienna, Austria, had the associated ephemera (pictured here). The thing that we like best about the “gynodate” is its stylish concealment of its function. Looks like a nice, if simple, alarm clock when the Gynodate 2 high resdecorative bezel is closed. But lift the hinged cover and you reveal adjustable dials to set for the onset and end of the monthly period, and hence gauge the days of fertility. It’s reminiscent of oral contraceptive dispensers in the form of lipstick containers or dialpak dispensers disguised as facial powder compacts…Certainly not the first, nor the last, time that designers strived to camouflage the purpose of a medical device. Sometimes this was done to conceal an object’s function from unwitting patients (as in the case of medical furniture in the 1880s), while at other times it was done to safeguard personal dignity, as in the concealment of contraceptive purpose of the object at hand, the “gynodate”. –Jim Edmonson (see original post here)