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.


Student Research at the Dittrick

The Dittrick Medical History Center welcomes researchers from the community, the region, the nation, and abroad. We’ve been pleased to host a number of colleagues, including David Jones, Diana Day, Mike Sappol, and many others. But seasoned scholars and PhDs are not the only visitors to the collections here; Case Western Reserve University students frequently attend classes in the museum’s Zverina room. Today, we begin a three part series featuring some of their work. As always, we welcome all curious and intrepid explorers of our medical past!

Bowles Stethoscope Bowles Stethoscope from the Sharp & Sharp Catalog of Instruments, 1905.
Bowles Stethoscope from the Sharp & Sharp Catalog of Instruments, 1905.

There are few instruments more recognizable or emblematic of medicine than the stethoscope. Today’s post, from Cara Smith, will look at its history and development.

Sounds like Progress: The Stethoscope’s Impact on Medical Diagnosis and Knowledge

Medicine in the early 1800’s was a removed practice; doctors diagnosed and treated patients based on observations and conversations. During that era, physical contact and even physical observation was considered “unseemly” (Aronson 171). As a result, one can imagine the difficulties that this incurred in the field of medicine. In order to treat patients properly, doctors need direct and often physical observations, something patients of this time were not eager to provide to the prying gaze of a doctor. However, in 1816, Dr. Rene Laennec, in an imaginative improvisation, created a medical instrument that helped to break down this barrier between patient and doctor and initiate a shift in the mentality of medicine: the stethoscope (Aronson 171). At this point in time, auscultation, the art of listening to the human body to determine ailments, was already in existence.   However, this process was done in an extremely invasive and uncomfortable manner, especially for females. The doctor would place his ear directly upon the patient’s chest and try to discern the sounds coming from within, a method known as immediate auscultation (Sterne 120). Because of the social stigma surrounding direct patient care, this method was only undertaken in dire circumstances, such as the case Dr. Laennec was faced with. An already socially awkward situation was made even more so as Dr. Laennec realized that the weight of his female patient prevented him from hearing her heart (Aronson 171). Thus, to solve this issue, Dr. Laennec improvised and “rolled a quire of paper into a kind of cylinder and applied one end of it to the region of the heart and the other to my ear, and was not a little surprised… to find that I could thereby perceive the action of the heart in a manner much more clear” (Sterne 117). This seemingly simplistic adjustment was anything but simple; Dr. Laennec’s invention of the stethoscope, a device that allows doctors to obtain a direct audio of a patient’s insides from a socially acceptable distance, introduced an entire new mode of medical investigation and diagnosis that would eventually answer many questions of medicine -but would also create many unforeseen problems as well.

The invention of the stethoscope was so beneficial in answering questions of medicine because it began to melt away the social barrier placed between doctors and patients. The stethoscope was “designed to operate within the parameters of a set of social relationships, and it helped to cement and formalize those relations: the doctor-patient relationship, the structure of clinical research and pedagogy” (Sterne 116). Despite strict moral standards, the stethoscope allowed doctors to begin to transcend the stigmas of morality and privacy of the era. Patients became much more comfortable with physical examination, allowing doctors to not only diagnose and treat more effectively, but also to learn much more about the human body. Prior to the progress in the doctor-patient relationship initiated by the stethoscope, doctors had to resort to autopsy as their “primary site of knowledge” of the human anatomy (Sterne 125). While this source of data provided doctors with invaluable knowledge of the inner systems and structures of the body, the fact remained that these autopsies were performed on failed cases; patients who, unfortunately, were not provided with proper treatment either because they were not diagnosed properly or the treatment they sought simply did not exist. Armed with the stethoscope and patients’ trust, doctors were now able to begin delving into the mysteries of the living body without violating a patient’s comfort. Instead of observing human bodies in which the blood has stopped moving and the lungs have stopped breathing, doctors were able to shift the “primary site of knowledge in pathological anatomy back from the dead to the living” (Sterne 126). Thus, doctors could observe diseases and other medical problems inside of the body as they were occurring, granting them a new depth of insight. As a result, doctors were able to begin formulating a more detailed and accurate image of the human anatomy as well as the diseases that ravaged it, initiating a new era of medical investigation.

However, as with all major discoveries that initiate rapid progress, the stethoscope precipitated multiple concerns. For instance, the stethoscope created a concern of dealing with the accuracy of the information being obtained. First of all, because of the time period, many questioned the validity and accuracy of observations made with the stethoscope (Sterne 121). The philosophy of the time focused on the idea of the separation of mind and body. Descartes, a major philosopher of the time, claimed that any knowledge obtained through the human senses is inherently flawed. Because the body is separated from the “immaterial mind,” senses are easily deceived (Skirry). With this in mind, the question arises whether a diagnosis based solely on the sounds that doctors perceive to emanate from the body is valid enough to consider using as a basis for discovery, especially considering the difficulty to interpret sounds into symptoms (Sterne 132). In addition, another major problem was that many of the discoveries doctors were making in their living patients were those of diseases that had yet to be fully analyzed. Thus, the discoveries that doctors were making unfortunately caused patients great dread, as in many cases “diagnostic knowledge preceded any notion of a cure” (Sterne 129). While doctors were able to take these discoveries and eventually craft cures, the patients had to live with the dread of knowing they carried an incurable disease. Ethically, this relates to the idea of whether certain knowledge is worth the accompanying consequences. Do patients want to know if they have a disease that they will eventually die from? The patient has a right to know his or her ailment, but should the technology exist that can provide them this information if it is inherently unwanted?

In conclusion, despite the multiple drawbacks that the stethoscope inherently possesses, the stethoscope still persists today as one of the most widely recognized medical symbols. It has essentially inspired the modern medical attitude of “a diagnostically assertive domain” in which doctors depend on the “inner dynamics of the body’s organs… to infer the physical nature of the underlying pathological process” (Aronson 171). Once doctors realized the value of being able to interpret the inner workings of the human body, the idea of the stethoscope and auscultation expounded upon itself; doctors were eager to discover what other sounds they could interpret from different parts of the human body. New instruments and technologies from today reach even further inside of the body, revealing everything from broken bones to mutated DNA. As with the stethoscope, these new technologies such as X-Ray, MRI, and echocardiographs also risk moving at too fast of a pace, diagnosing patients with diseases that are currently beyond modern medicine’s healing capabilities. However, similar to the stethoscope, these developing technologies continue to play an integral role in identifying the causes of these incurable diseases, perpetuating the culture of discovery in medicine for years to come. Thus, the stethoscope can be considered one of the first steps toward the modern medical mentality; the mentality that understanding the inner workings of the body is the key to new knowledge.


Cara Smith, a native Clevelander, is currently a sophomore Biomedical Engineering major at Case Western Reserve University. Within this field, she hopes to eventually pursue further education in neural engineering as well as travel as much as possible. Apart from being a student, she is also a supplemental instructor for Principles of Chemistry for Engineers and a member of multiple wind ensembles on campus in which she plays the flute.


Works Cited

Aronson, Stanley M. “A Heart-Beat Is Amplified and Then Resonates In History.” Medicine & Health Rhode Island 95.6 (2012): 171. Academic Search Complete. Web. 13 Sept. 2014.

Skirry, Justin. “Rene Descartes (1596-1650).” Internet Encyclopedia of Philsophy. Nebraska-Wesleyan University. IEP. Web. 15 Sep 2014.

Sterne, Jonathan. “Mediate Auscultation, The Stethoscope, And The “Autopsy Of The Living”: Medicine’s Acoustic Culture.” Journal Of Medical Humanities 22.2 (2001): 115-136. Academic Search Complete. Web. 13 Sept. 2014.

[Various stethoscopes; Blaufox Hall of Diagnostic Instruments]. [c. late 1800s early 1900s]. Metal and wooden stethoscopes. Dittrick Museum of Medical History, Cleveland.


Listening to the Body: Stethoscopes in 1900

Cinemax’s The Knick transports viewers to at a New York hospital at the turn of the twentieth century to listen in on the drama between colleagues and patients. Each episode shows the variety of early instruments, ranging from x-rays to thermometers, used by doctors in 1900 to diagnose disease and trauma. While these objects were able to speak to the body’s condition — the shape of a broken bone or the magnitude of a fever, it was the stethoscope that brought the actual sounds of the heart or lungs to the diagnostic listener. What stories did these devices hear and do they have their own tales to tell?

From the Sharp & Sharp Catalog of Instruments, 1905, displaying the variety of Cammann Stethoscopes available.

Continue reading Listening to the Body: Stethoscopes in 1900