Guest Post: The Experiments of Dr. Robert Koch: A Reconsideration of the Scientific Method for Evaluating Treatments for Tuberculosis

Today we are pleased to feature five guest posts from students in Tom Ewing’s Virginia Tech Introduction to Data in Social Context class! This post is from Christian Averill, Robbie D’Amato, Nathan Gibson, and Jonathan Silbaugh.

During the nineteenth century, a widespread desire for a cure for tuberculosis prompted intense interest in any claims of a medical breakthrough in diagnosing and treating this disease. When German physician Robert Koch announced in 1882 that he had discovered that the cause of the disease was a bacillus known as M. Tuberculosis, his discovery was widely celebrated as a major medical breakthrough. Eight years later, however, his claims to have discovered a cure for tuberculosis aroused more substantive questions about the veracity of his claims as well as the methods, findings, and analysis advanced to support these claims. This post examines some of the evidence involved in this discussion with the goal of evaluating Koch’s claims relative to standard procedures used now to discover, test, and approve cures.

Koch’s discovery of a cure for tuberculosis was hailed immediately as “The Greatest Medical Discovery of the Present Century,” as indicated by the subtitle of a widely circulated publication, Prof. Koch’s Cure for Consumption, authored by Berlin physician Dr. H. Feller (Illustration 1). In this brochure, Feller praised Koch’s quest for “the noble structure of a scientifically supported method of cure for consumption,” (p. 14) which had the “enormous significance” of potentially eliminating a disease that causes more deaths worldwide than any other cause, leading to this summary statement by Feller: “The unsatisfactory medical treatment of consumption has given place to a deliberate well considered method of action, and therapeutic science will no longer fail in consequence of social inequalities; but all, whether rich or poor, will be participators in the blessings of this wonderful discovery.” (p. 49)

Illustration 1

Illustration 1

Yet a more complicated picture emerges when other physicians and researchers attempted to replicate Koch’s findings in their own laboratories and practices. One such effort to duplicate Koch’s findings, was recorded and reported by the American physician, A. Jacobi. The records for fifty patients treated with versions of Koch’s tuberculin were published, first in the journal Medical Record, and then in a separate volume, available from the Medical Heritage Library. The patients ranged in age from infants to the elderly, with about one-half between  20-50 years. The gender distribution was almost exactly even. Most of the patients were described as having pulmonary tuberculosis, although some had the disease in their bones or skin. Illustration 2 provides a visual analysis of the data collected by Dr. Jacobi and published in his report, as classified and recorded by our research team. The left column in the graph includes the identification of the patients by first name and initial (two were anonymous), gender, age, and a brief description of the patient’s disease. Patients covered in this study received as few as one inoculation and as many as thirty two inoculations over a period of many weeks. More than one-half of patients received ten or few inoculations; only about 10% of patients received 25 or more inoculations. This graph vividly illustrates how the effort to duplicate Dr. Koch’s experiments involved a wide range of treatments, with no apparent standardization. In some cases, it appears that treatments were discontinued because patients were diagnosed with another illness, while in other cases, the wishes of patients figured prominently in the treatment regime. The share of patients with negative outcomes (no improvement or died) was 38%, slightly higher than the 34% reporting positive outcomes (condition improved and fair condition), with another 28% recording neutral outcomes (outcome not reported, treatment discontinued, or diagnosis changed).

Illustration 2: Patient Identities, Number of Inoculations, and Recorded Outcomes

Illustration 2: Patient Identities, Number of Inoculations, and Recorded Outcomes

The most revealing interpretation suggested by this visualization of the data reported by Jacobi is the apparent lack of a causal relationship between the number of inoculations and the long term outcomes for patients. As shown in Illustration 3, patients recording more positive outcomes received, on average, more inoculations, certainly by comparison to those who died, whose diagnosis changed, or whose treatment was discontinued. Yet this data also reveals the relatively small gap in average inoculations between those showing improvement (an average of 15.1) and those showing no improvement (12.9), a gap of little more than two inoculations (a difference of just 15%) in treatment regimes that produced such diametrically opposed outcomes. Jacobi’s journal articles and book are revealing of the faith shared by researchers and the public in the process of medical discovery in the early 1890s.

Illustration 3: Patient Outcomes and Average Inoculations

Illustration 3: Patient Outcomes and Average Inoculations

Jacobi’s summary of the outcomes of his trials were cautiously optimistic, because he could compare the outcomes of those undergoing treatment with the usual “very discouraging” fate of those admitted to hospitals, particularly with pulmonary tuberculosis. While praising tuberculin as “a remedy of great power for good,” Jacobi also warned against viewing it as a miracle in ways that exaggerated its potential. Yet Jacobi concluded that tuberculin had done more than other remedies — apart from climatic treatment of pulmonary tuberculosis and surgical interference in cases of local tuberculosis — and thus he expressed gratitude to “great genii like Pasteur and Koch” who “enrich the world with new discoveries in the field of pathology and therapeutics,” yet even with these great scientists, “we must not look for infallibility.” (p. 43)

Under current testing standards, medical researchers today conduct highly regimented experiments following standard protocols, human subject guidelines, and control groups. A study such as Jacobi’s would most likely not meet standard practices common to the current scientific community. In Jacobi’s study, the data was easily measured and recorded. Current researchers, by contrast, use advancing medical technology to acquire higher quality data in greater quantity.  

With the greater accessibility to high quality data, researchers today can make stronger conclusions about treatments. The data provided in Jacobi’s study did not clearly demonstrate the effects regarding the stability, safety, and effectiveness of this treatment for tuberculosis. The data produced by researchers such as Jacobi also reveal that the excitement for a TB cure caused premature conclusions about Koch’s treatment. Instead of testing to see the impact of the treatment, researchers were testing to see if his method was viable, leading to impulsive conclusions. Even though it is unclear that Koch’s treatment was viable as a cure, he still made an impact on the the cure for Tuberculosis.

References

Jacobi, A. (1891). Inoculations with Professor Koch’s “Tuberculin”. (New York: Trow’s Printing and Bookbinding Co., 1891). Articles originally published in Medical Record, February 29 and march 7, 1891. Digital version available from Medical Heritage Library and Internet Archive. Available from https://archive.org/details/101481837.nlm.nih.gov

Feller, H., Professor Koch’s Cure for Consumption (Tuberculosis) Popularly Explained (London: Ward, Lock, & Co., 1890). Digital version available from Medical Heritage Library and Internet Archive. Available from https://archive.org/details/39002011126829.med.yale.edu

Guest Post: “Phthisiophobia”: The Tuberculosis Clinic in New York City and Popular Anxieties about Public Health Dangers

Today we are pleased to feature five guest posts from students in Tom Ewing’s Virginia Tech Introduction to Data in Social Context class! The first is from Allyson Manhart, Andrew Pregnall, and Harshitha Narayanan.


TB_Infirmary_OpenToPatientsAt the beginning of the twentieth century the Treasury Department of the United States classified pulmonary tuberculosis as a “dangerously contagious disease” which meant that any immigrant found to have tuberculosis coming to the United States would be denied entrance. The ban led to a swift reaction from the physicians of the New York Academy of Medicine, many of whom argued that the ban created unnecessary fear of those with tuberculosis.

On January 2, 1902 the monthly meeting of the New York Academy of Medicine resulted in the Academy physicians proposing a resolution which rejected the Treasury Department’s new classification of pulmonary tuberculosis.  The physicians felt their plans to establish a clinic for consumptives on Blackwell’s Island was threatened by the Treasury Department’s classification and the unnecessary fear they felt it created. Less than a month later on January 31, 1902, the Tuberculosis Clinic of the Metropolitan Hospital of New York opened its door to patients who needed public healthcare, both the curable and incurable (New York Times 1902).

The Tuberculosis Clinic of the Metropolitan Hospital of New York quickly became the central destination for consumptive patients in New York City as all consumptives in other charity hospitals were removed to the Metropolitan Hospital’s clinic. In the chart above, created by the director of the Metropolitan Hospital’s clinic, we can see the number of patients who were admitted or discharged, the number of patients who died, and the patients remaining in the clinic after a six year period.

While the mortality rate of almost one-in-three patients is high compared to other hospitals, it is important to remember that the Metropolitan Hospital’s clinic took in all patients from the New York City region — regardless of whether they could be cured or not.  This raises a broader question: Who were the hospital’s patients?

TB_Infirmary_Occupations

The clinic took in 13,610 patients from 1902 to 1908. The graphic above shows the ethnic breakdown of the patients in the clinic versus the breakdown of the entire New York City population. People who were natives of the United States made up about 23% of the New York population and 42.8% of the patient population. The hospital reported that many of these patients were “born of foreign parents.” The second largest demographic group was the Irish, coming at 21.9% of the patient population. The surprising statistic was Germany’s representation. About 23% of the New York City population was German, but they only made up 8.2% of the clinic’s population. They are followed by Russia at 7.5%, Italy at 6%, Austria at 2.7%, and England at 2.5%. Ultimately, by looking at these statistics, it is easy to see that most of the consumption patients in New York City were first or second generation immigrants.

TB_Infirmary_Occupations

In addition to collecting information on the nationalities of their patients, the Tuberculosis Clinic of the Metropolitan Hospital of New York also collected data on their religions (65% were Roman Catholic and 25% were Protestant), sexes (about 80% male), age (65% were between the ages of 21 and 50), and occupations as seen in the graph above. The biggest takeaway from all of this data is that the patient population of the Tuberculosis Clinic of the Metropolitan Hospital of New York was comprised of poor first or second generation immigrants who likely worked long hours in poor paying, physically demanding service jobs,  with less than ideal conditions, and then returned home to the tenement housing — characterized by poor sanitary conditions, overcrowding, malnutrition, etc — that was so prominent throughout urban centers of the United States at the time. These considerations explain to a large degree why these immigrants were so susceptible to tuberculosis.

Interestingly, the Tuberculosis Clinic of the Metropolitan Hospital of New York was very aware of the background of their patients and the effects they were having on the City of New York hospital system. In the words of the Clinic’s director:

The municipal hospital facilities of New York City have never yet been adequate to house in comfort all the sick poor seeking municipal aid. The main reason of this is the great influx of foreigners each year who never get any further into the United States than New York City. A glance at the nationality of the patients in Tuberculosis Infirmary will show this. [Emphasis added] (New York Times 1902)

Now that we understand who the Clinic’s patients were, one final question must be addressed: What social effects did tuberculosis have on these vulnerable first and second generation immigrant populations?

The simple answer is stigma. In an address to the New York Academy of Medicine on January 2nd 1902, Dr. Sigard Adolphus Knopf, an expert on pulmonary tuberculosis, said:

To my deep regret I learned recently that new difficulties have arisen concerning the site of our future New York State Sanitarium. Phthisiophobia, an exaggerated fear of the vicinity of consumptives, is the cause. What the people must learn is that consumption is not contagious, where the sputum is destroyed. It is hard to estimate how much hardship and suffering is incurred through the fear of consumption. It leads to real inhumanity. Useful citizens may be removed from their chances at success. [Emphasis added] (New York Times 1902)

He went on to say that the classification of pulmonary tuberculosis as a dangerously contagious disease, “plac[es] a stigma wholly undeserved upon every American citizen who is suffering with consumption,” and proposed a resolution, adopted by the Academy at their next meeting, which declared the exclusion of immigrants based on their consumptive status to be “unwise, inhumane, and contrary to the spirit of American justice.” (New York Times 1902)

Ultimately, the Tuberculosis Clinic of the Metropolitan Hospital of New York took in thousands of patients in the six year period, regardless of their curability. While we did not learn when the Tuberculosis Clinic closed from our research, there is still a hospital on those Blackwell Island grounds today (whether it was renamed or is part of a new organization, we are not sure). After analyzing the ethnic and occupational backgrounds of the patients, there is substantial evidence that the majority of the patients were poor first or second generation immigrants who likely worked jobs rife with occupational hazards and lived in unsanitary tenement housing. These occupational and domestic risk factors meant that these immigrants contracted tuberculosis at a substantially higher rate, and subsequently composed the majority of tuberculosis patients in New York City. Unfortunately, as Dr. Knopf explains, tuberculosis was a great source of fear in the early 20th century, and this fear was ultimately projected onto the immigrant populations most in need of public help.

Works Cited

Mills, Walter Sands. 1908. The Tuberculosis Infirmary of the Metropolitan Hospital, Department of Public Charities, New York City. New York: M. B. Brown Company. https//catalog.hathitrust.org/Record/002086417.

New York Times. 1902. “FEAR OF TUBERCULOSIS CALLED EXAGGERATED; Dr. Knopf Says It Leads to Real Inhumanity. Exclusion of Consumptive Immigrants Denounced at Academy of Medicine — Separate Hospital Advocated.,” January 3, 1902. http://query.nytimes.com/mem/archive-free/pdf?res=940CE0D81430E733A25750C0A9679C946397D6CF.

Live Symposia TODAY on Universities and Slavery: Bound by History

In March 2016, Harvard President Drew Gilpin Faust, in an opinion piece in the Harvard Crimson, urged the university to more fully acknowledge and understand its links to slavery, stating, “The past never dies or disappears. It continues to shape us in ways we should not try to erase or ignore.”

On March 3, 2017, the Radcliffe Institute for Advanced Study at Harvard University will host a daylong conference to explore the relationship between slavery and universities, across the country and around the world.

The faculty conference organizers are Harvard professors

  • Sven Beckert, Laird Bell Professor of History
  • Evelyn Brooks Higginbotham, Victor S. Thomas Professor of History and of African and African American Studies
  • Daniel Carpenter, director of the social sciences program at the Radcliffe Institute and Allie S. Freed Professor of Government

The conference builds on the Harvard and Slavery initiative, founded in 2007, in which students and faculty—led by Beckert—began a detailed examination of Harvard’s range of connections to slavery.

This event will be webcast live, in its entirety, and videos will be available online after the conference.

How to watch the live webcast

Please use the hashtag #unislavery.

SCHEDULE

9 a.m.

WELCOME

Lizabeth Cohen, Dean of the Radcliffe Institute and Howard Mumford Jones Professor of American Studies, Harvard University

9:15 a.m.

OPENING REMARKS

Drew Gilpin Faust, President of Harvard University and Lincoln Professor of History

9:30 a.m.

KEYNOTE

Ta-Nehisi Coates, Journalist, national correspondent for The Atlantic, author of Between the World and Me and The Beautiful Struggle: A Father, Two Sons, and an Unlikely Road to Manhood

Conversation between Ta-Nehisi Coates and Drew Gilpin Faust

10:30 a.m.

BREAK

10:45 a.m.

SLAVERY AND UNIVERSITIES NATIONALLY

Moderator: Evelyn Brooks Higginbotham, Victor S. Thomas Professor of History and of African and African American Studies, Harvard University

Adam Rothman, Professor of History, Georgetown University

James T. Campbell, Edgar E. Robinson Professor in United States History, Stanford University

Craig Steven Wilder, Barton L. Weller Professor of History, Massachusetts Institute of Technology

12:15 p.m.

LUNCH BREAK

1:15 p.m.

POETRY READING

Introduced by: Vincent Brown RI ’06, Charles Warren Professor of American History and Professor of African and African American Studies, Harvard University

Natasha Trethewey RI ’01, former United States Poet Laureate, Robert W. Woodruff Professor of English and Creative Writing, Emory University

1:30 p.m.

SLAVERY AND HARVARD

Moderator: Annette Gordon-Reed RI ’16, Charles Warren Professor of American Legal History, Harvard Law School, and Professor of History, Harvard University

Sven Beckert, Laird Bell Professor of History, Harvard University

Julian Bonder, Principal, Wodiczko + Bonder and Julian Bonder + Associates; Professor of Architecture, Roger Williams University

Daniel R. Coquillette, J. Donald Monan, S.J. University Professor, Boston College Law School

Alexandra Rahman ’12, Student contributor to the Harvard and Slavery Research Project

3 p.m.

BREAK

3:15 p.m.

SLAVERY AND UNIVERSITIES GLOBALLY

Moderator: Alejandro de la Fuente, Robert Woods Bliss Professor of Latin American History and Economics; Professor of African and African American Studies and of History; Director, Afro-Latin American Research Institute, Harvard University

Hilary Beckles, Vice-Chancellor of the University of the West Indies

Max Price, Vice-Chancellor of the University of Cape Town

Christiane Taubira, former Minister of Justice (France)

4:45 p.m.

CONCLUDING REMARKS

Daniel Carpenter, Director of the Social Sciences Program at the Radcliffe Institute; Allie S. Freed Professor of Government, Harvard University

5 p.m.

RECEPTION

Medical and Public Health Ethics in the Shadow of the Holocaust: The Nazi Doctors, Jewish Resistance, Resilience and Survival

~This post courtesy of Lisa Mix, Head, Medical Center Archives Weill Cornell Medicine Samuel J. Wood Library & C.V. Starr Biomedical Information Center

The Heberden Society and the WCM Division of Medical Ethics jointly present: Michael A. Grodin, MD on Medical and Public Health Ethics in the Shadow of the Holocaust: The Nazi Doctors, Jewish Resistance, Resilience and Survival.

The lecture will take place on Monday, March 13, 2017, 5:00 pm at the Selma Ruben Conference Center, Weill Cornell Medical College Weill Greenberg Center, 1305 York Avenue Room A-B (2nd floor).

Michael Alan Grodin, MD, is Professor of Health Law, Ethics and Human Rights at the Boston University School of Public Health, and in the Center for Health Law, Ethics & Human Rights, and is Professor of Psychiatry and Family Medicine at the Boston University School of Medicine. He completed his B.S. degree at the Massachusetts Institute of Technology, his M.D. degree at the Albert Einstein College of Medicine, his postdoctoral and fellowship training at UCLA and Harvard, and he has been on the faculty of Boston University for the past 35 years. Dr. Grodin is the Medical Ethicist at Boston Medical Center and for thirteen years served as Chairman of the Institutional Review Board of the Department of Health and Hospitals of the City of Boston. He is a fellow of the Hastings Center, served on the board of directors of Public Responsibility in Medicine and Research, the American Society of Law, Medicine and Ethics, and the Advisory Board of the Center for the Philosophy and History of Science. He is a member of the Ethics Review Board of Physicians for Human Rights and co-director of Global Lawyers and Physicians: Working Together for Human Rights, a transnational NGO. He was founding director of the Boston Center for Refugee Health and Human Rights: Caring for Survivors of Torture, which received the 2002 Outstanding Achievement Award from the Political Asylum/Immigration Representation Project. Professor Grodin received a special citation from the United States Holocaust Memorial Museum in recognition of his “profound contributions – through original and creative research – to the cause of Holocaust education and remembrance.” He was a Member of the Global Implementation Project of the Istanbul Protocol Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, and an Advisor to UNESCO. Dr. Grodin was the 2000 Julius Silberger Scholar and recipient of the 2014 Kravetz Award as an elected member of the Boston Psychoanalytic Society and Institute and the American Psychoanalytic Association.

Dr. Grodin has published more than 200 scholarly papers, and edited or co-edited 7 books: The Nazi Doctors and the Nuremberg Code: Human Rights in Human Experimentation, Children as Research Subjects: Science, Ethics and Law (both in the Bioethics Series of Oxford University Press); Meta-Medical Ethics: The Philosophical Foundations of Bioethics (Boston Studies in the Philosophy of Science Series, Kluwer Academic Press); Health and Human Rights: A Reader (selected as 2nd of the top 10 humanitarian books of 1999); Perspectives on Health and Human Rights; and Health and Human Rights in a Changing World. His most recent book is Jewish Medical Resistance in the Holocaust. He is working on a new book, Spiritual Resistance and Rabbinic Response During the Holocaust.

The Heberden Society, which seeks to promote an interest in the history of medicine, was founded at the medical center in 1975. With funding from the Office of the Dean, the society sponsors a series of lectures during each academic year.

National Endowment for the Humanities Awards New York Academy of Medicine Library with Digital Projects for the Public Discovery Grant

Interactive digital “Biography of a Book” project brings to life the creation, use and collection of key historic texts in the Academy Library’s rare book collections

The National Endowment for the Humanities has awarded The New York Academy of Medicine Library $30,000 through its Humanities Digital Projects for the Public Discovery Grant program to support the development of its interactive digital “Biography of a Book” project. This innovative project aims to tell the individual and collective stories of books, ranging from the survival of one of only two extant medieval copies of an ancient Roman cookbook, to a twentieth century re-imagining of a classic work of Renaissance anatomy.

“We are extremely pleased to have the support of the National Endowment for the Humanities for our growing digital program,” said Academy President Jo Ivey Boufford, MD. “Exploring the intersections of medicine, humanities and the arts is a core priority for the Academy. This prestigious planning grant will allow us to bring some of our world-class Library’s treasures to broad public audiences.”

The Academy Library, which holds one of the most extensive rare book collections in the United States, has selected and digitized 12 rare books and manuscripts from its collection for the project, including the two earliest manuscripts: Apicius de re culinaria, a collection of recipes attributed to the second century Roman gourmand by the same name; and Guy de Chauliac’s Chirurgia Magna, or “great surgery,” a fourteenth-century illuminated manuscript and authoritative text on surgery through the seventeenth century. The goal of the project is to produce an innovative, interactive exhibit that will make these books more accessible to a broad audience through the use of timelines, side by side technologies, and digital interactives that illuminate how they were created, who used them, and who collected them.

The main goal of the “Biography of a Book” discovery phase, to be conducted between January and December 2017, is to develop a robust design document that will help to inform the prototype and implementation phases of the project.

The grant supports the convening an advisory committee comprising experts in the areas of history of medicine, history of the book, digital humanities, user research and technology. The committee will provide feedback both on content and on user experience.

“The distinguished group of scholars in the humanities and information science who have volunteered their time to help take the project forward indicates the importance of the work the Academy Library is doing to bring interdisciplinary communities together,” said Robin Naughton, PhD, Head of Digital at the Academy Library.

 

Advisory Committee Members

Denise Agosto, Professor, College of Computing & Informatics, Drexel University

Carin Berkowitz, Director, Beckman Center for the History of Chemistry, Chemical Heritage Foundation

Janet Golden, Professor of History, Department of History, Rutgers University-Camden

Anthony Grafton, Professor, Department of History, Princeton University

Heidi Knoblauch, Independent scholar (formerly Bard College)

Craig MacDonald, Assistant Professor, School of Information, Pratt Institute

Mike Sappol, EURIAS Senior Fellow, Swedish Collegium for Advanced Study, Uppsala

Pamela H. Smith, Seth Low Professor of History, Columbia University

Nick Wilding, Associate Professor, Department of History, Georgia State University

About The New York Academy of Medicine

The New York Academy of Medicine advances solutions that promote the health and well-being of people in cities worldwide.

Established in 1847, The New York Academy of Medicine continues to address the health challenges facing New York City and the world’s rapidly growing urban populations. We accomplish this through our Institute for Urban Health, home of interdisciplinary research, evaluation, policy, and program initiatives; our world class historical medical library and its public programming in history, the humanities and the arts; and our Fellows program, a network of more than 2,000 experts elected by their peers from across the professions affecting health. Our current priorities are healthy aging, disease prevention, and eliminating health disparities.

Celebrating Vivien Thomas

~This post courtesy of Phoebe Evans Letocha, Collections Management Archivist, Alan Mason Chesney Medical Archives Johns Hopkins Medical Institutions.

Vivien T. Thomas, oil portrait by Bob Gee, 1969

Vivien T. Thomas, oil portrait by Bob Gee, 1969

To commemorate February as both Black History Month and American Heart Month, the Medical Heritage Library salutes the contributions of Vivien Thomas, an African American surgical technician at Johns Hopkins.

Born in Lake Providence, Louisiana on August 29, 1910, Vivien Thomas grew up attending segregated public schools in Nashville Tennessee. In 1930 after being forced to drop out of pre-medical studies in college when his life savings were wiped out by a bank crash, Thomas took a position as a laboratory assistant to surgeon Alfred Blalock at Vanderbilt University. Thomas’ abilities as a surgical assistant and research associate were of the highest quality, and when Blalock moved to Johns Hopkins in 1941 he asked Thomas to accompany him to Baltimore.

At Johns Hopkins, Thomas collaborated with Alfred Blalock and Helen Taussig to devise the operative technique to correct a congenital heart defect, Tetralogy of Fallot, or “Blue Baby Syndrome” that robs the blood of oxygen. First performed in 1944, the anastomosis operation named the Blalock-Taussig Shunt, brought fame to Blalock and Taussig. However due to racial prejudice at the time and the academic custom of not giving credit to non-degreed lab assistants, Thomas’s contributions went unrecognized. He was a hidden figure, critical to the success of the operation. He worked out the surgical technique in the dog lab, using a clamp of his own design, and coached Blalock in the operating room through the first human operation.

Third year medical student Reginald Davis holding a child with Levi Watkins, and Vivien Thomas in front of Johns Hopkins Hospital Administration Building, 1979

Third year medical student Reginald Davis holding a child with Levi Watkins, and Vivien Thomas in front of Johns Hopkins Hospital Administration Building, 1979

As supervisor of the surgical laboratories for over 35 years, Thomas went on to train a generation of surgeons at Johns Hopkins in the delicate techniques necessary for heart and lung operations. Notable among them was Hopkins first black cardiac resident Levi Watkins, Jr, who was a pioneer in the use of the automatic implantable defibrillator, performing the first human operation in 1980, after having first tested the device on dogs with Thomas in his lab. Thomas had earlier worked with William Kouwenhoven, James Jude, and Guy Knickerbocker in contributing to the development of the closed chest electrical defibrillator.

Thomas’ achievements were finally recognized formally by Johns Hopkins with a portrait presented in 1971, and with a 1976 faculty appointment and honorary degree from the University. He retired in 1979 to write his autobiography, Pioneering Research in Surgical Shock and Cardiovascular Surgery: Vivien Thomas and His Work with Alfred Blalock (Philadelphia: University of Pennsylvania Press, 1985), later republished as Partners of the Heart: Vivien Thomas and his work with Alfred Blalock (1998). Sadly, Thomas died November 26, 1985, just as the book was published. In 2005, the Johns Hopkins University School of Medicine named one of its 4 new colleges after Vivien Thomas.

Thomas’ story was dramatized in the 2004 HBO film Something the Lord Made, and the 2003 PBS documentary Partners of the Heart.

MHL partner, the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions houses the Vivien Thomas Collection, and in 2015 published a finding aid to the processed collection. The collection includes the manuscript and its various drafts for the memoir, along with correspondence principally with Mark Ravitch, one of the surgeons Thomas had trained at Hopkins and who assisted Thomas in editing the book and securing a publisher.

The History of Higher Education in California: A Big Data Approach

In his talk at the UCSF Archives & Special Collections, Zach Bleemer will discuss how he has used data science – thousands of computer-processed versions of annual registers, directories, and catalogs –  to reconstruct a near-complete database of all students, faculty, and courses at four-year universities in California in the first half of the 20th century, including UC San Francisco (which taught both undergraduates and graduate students at the time). Visualizations of this database display the expansion of higher education into rural California communities, the rise and fall of various academic departments and disciplines, and the slow (and still-incomplete) transition towards egalitarian major selection.
Zach will also discuss his recent CSHE Working Paper, in which he uses additional digitized records to analyze the social impact of the early 20th century’s expansion of female high school science teachers and female doctors across rural California communities. He finds that newly-arrived female STEM professionals serve as important role models for young women in these rural communities, causing substantial increases in female college-going. However, these young women are no more likely to study STEM fields or become doctors themselves.
Zach Bleemer is a PhD student in Economics and Digital Humanities Fellow at UC Berkeley, where his research examines the educational and occupational decisions of young Americans. He has previously held senior research analyst positions at the Federal Reserve Bank of New York and Mathematica PolicyResearch, and has published working papers on student debt, parental coresidence, and university attendance. He is also currently a Research Associate at UC Berkeley’s Center for Studies in Higher Education and a Visiting Scholar at the Federal Reserve Bank of San Francisco.

Register for the talk which will take place Friday, March 3, from 12-1.15pm.

“A Plague of Lust”: Love, Marriage, and Venereal Disease

~This post is courtesy Melissa Grafe, John R. Bumstead Librarian for Medical History, Head of the Medical Historical Library.

Happy (belated) Valentine’s Day!  We thought we would focus on love, marriage, and venereal disease, sampling the many books on these topics that you can find in the Medical Heritage Library.

Guides for marriage are well represented in the Medical Heritage Library, as many of these popular texts deal with topics of health, pregnancy, and child rearing.  Sexual relations, if mentioned at all, are coyly alluded to within the texts, and eugenics often appears in the manuals from the early 20th century.,

The heplagueoflustbein01rose_0007althy marriage, a medical and psychological guide for wives (1916) may be helpful on the days where coping with the husband is particularly challenging.  This guide describes the art of housekeeping, miscarriage, pregnancy, “difficulty of getting exercise in town,” and much more.

Alternately, husbands also received valuable advice in manuals like The young husband, or, Duties of man in the marriage relation (1840)In this text, by William Alcott, husbands are cautioned against jealousy and suspicion, coached on “keeping cool,” and “giving presents and little things,” helpful beyond Valentine’s Day!

See others, using just a simple search of the term marriage.

On the flip side of love, sex, and marriage, the Medical Heritage Library also has a robust collection of materials on venereal disease.  We have the classic works, like Dr. John Hunter’s A treatise on the venereal disease (1791)Issued in many editions, including this 1791 Philadelphia text, Hunter believed that gonorrhea and syphilis were caused by the same disease agent, and encouraged the use of mercury for treatment, prior to the development of an effective drug, Salvarsan, in the early 20th century.

Other titles are more playful, such as The plague of lust : being a history of venereal disease in classical antiquity … (1909) by Dr. Julius Rosenbaum. Feel free to browse our texts on venereal disease here!

 

New Exhibit at the Countway Library Commemorates Harvard Medical School’s Relief Efforts during World War I

Soldiers Wounded at the Battle of the Somme Arriving at No. 22 General Hospital, 1916 [0004184]

Soldiers Wounded at the Battle of the Somme Arriving at No. 22 General Hospital, 1916 [0004184]

This post courtesy Jack Eckert, Public Services Librarian at the Center for the History of Medicine at the Francis A. Countway Library of Harvard Medical School.

Although the United States did not enter World War I until April 1917, American medical personnel were active in war relief efforts from nearly the beginning of the conflict. Harvard Medical School—its faculty and its graduates—played a key role in this relief work by providing staff for French and English hospitals and military units, and these early endeavors provided invaluable experience once America came into the war and the need to organize and staff base and mobile hospitals for the U.S. Army became critical to the war effort.

Noble Work for a Worthy End, a new exhibit at the Countway’s Center for the History of Medicine, charts Harvard’s participation in this medical relief work and experiences in military medicine and surgery through the wealth of first-hand documentation preserved by the men and women who volunteered their time and labor, sometimes at great sacrifice, to helping the sick and wounded of the First World War. Highlights of the display include records of the Harvard University Service organized by Harvey Cushing at the American Ambulance Hospital in Paris.  This unit’s brief sojourn in the spring of 1915 is documented through photographs and postcards, publications, and a copy of Elliott Carr Cutler’s daily journal of his experiences.

The Medical School’s most enduring contribution to the war effort was the Harvard Surgical Unit, which first arrived in Europe in July 1915.  Inspired by Sir William Osler, the unit provided physicians, surgeons, dentists, and nurses to staff the British Expeditionary Force’s No. 22 General Hospital at Camiers, France. The exhibit includes photograph albums, letters, drawings, newsclippings, Paul Dudley White’s diary account of a case of shell shock, medical field cards and case notes, and unusual ephemera, including an armband worn by members of the Unit and an enamel pin presented by the Harvard Corporation to the unit’s nurses, along with a testimonial of gratitude from King George V.

Final Inspection of the Harvard Unit at Fort Totten, N.Y., May 11, 1917 [0003947]

Final Inspection of the Harvard Unit at Fort Totten, N.Y., May 11, 1917 [0003947]

Once the United States entered the European conflict, Harvard faculty and students became involved with staffing base hospitals for the Army. The exhibit also chronicles the work and experiences at Base Hospital No. 5, a unit formed from Harvard and Peter Bent Brigham Hospital personnel.  Base Hospital No. 5, one of the first units to reach France, remained on loan to the British Expeditionary Force for the duration of the war, at which point it had treated some 45,000 soldiers, and, notably, sustained casualties from an air raid bombing on September 4, 1917. Photographs, a letter from Harvey Cushing describing the air raid, and records of Walter B. Cannon’s research on surgical shock are all included.

Noble Work for a Worthy End: Harvard Medical School in the First World War is on display on the first floor of the Countway Library of Medicine and open to the public, Monday through Friday, 9:00am-5:00pm. A companion online exhibit is also available here .

Celebrating Elizabeth Blackwell

blackwellThis week, the Medical Heritage Library is celebrating the life of Elizabeth Blackwell (1821-1910), the first woman to receive a medical degree in the United States and the first woman on the UK Medical Register. Elizabeth, born February 3, 1821, in Bristol, England, was the third child of Hannah (Lane) Blackwell (1792–1870) and Samuel Blackwell (1790–1838)’s nine children. Elizabeth attended Geneva Medical College from 1847 to 1849, and in 1853, she established a small dispensary in New York City with her sister, Emily (the third woman to receive a medical degree in the United States), and Dr. Marie Zakrzewska (1829-1902); the dispensary  expanded in 1857 to become the New York Infirmary for Indigent Women and Children. As an adjunct to the infirmary, Elizabeth and Emily founded the Women’s Medical College in New York in 1868. In the years following the Civil War, Elizabeth resettled in England. There, with physician and feminist Sophia Jex-Blake (1840-1912), she founded the London School of Medicine for Women in 1874. Like her sisters, Elizabeth Blackwell never married.

Elizabeth was one many remarkable Blackwell family members, who collectively advocated for abolition, women’s rights and women’s suffrage, public health measures, and prohibition. The Schlesinger Library, Radcliffe Institute for Advanced Study, Harvard University, houses the papers of the Blackwell family and has digitized the entire collection, including an extensive number of photographs.

blackwell2Elizabeth’s mark on medicine is visible — and accessible — in the Medical Heritage Library, which includes the full text of Blackwell’s Medicine as a Profession for Women (1860), the address, The influence of women in the profession of medicine (1890), and her two-volume work, Essays in Medical Sociology I (1902) and II  (1902), among others.