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.

From Fugitive Leaves: “I Love the Flu”

~Guest post courtesy of Emily T.H. Redman, an Assistant Professor of History at the University of Massachusetts, Amherst where she teaches history of science.

I love the flu.

Don’t get me wrong. I don’t love the fever and chills, the runny nose, the sore throat, or the all-encompassing ache that seems to span from deep in the bones all the way to one’s hair follicles. I don’t love the complications—the respiratory infections, the myocarditis. In particular, I really don’t love the potential for death. What I love the flu for is divorced from these horrors, and lies in the pedagogical value afforded by teaching students about the history of influenza epidemics. Influenza epidemics are fascinating on a micro level, an evolving and mutating virus hitting the body with a slightly different impact every year. But flu season hits us on another level; as we collectively respond to epidemics it shapes our cultures, ideas, and traditions.

It was for additional information about the flu, among other examples from medical history, that I came to the collections of the College of Physicians of Philadelphia in January 2014. I was planning a new seminar on the history of medicine, and sought primary source materials for both lectures and for supplemental independent student research projects. I also used my visit to look for materials useful to my other courses, which span various topics in the history of science, technology, and medicine from my home department as an assistant professor of history at the University of Massachusetts, Amherst.

Nearly every fall semester, I (shamelessly) use my position at the front of the classroom to proselytize getting a flu shot. As a historian of science, I use examples from history to make the argument that it is imperative that most healthy individuals should protect themselves from the flu, for their own health as well as the health of the collective public. With the opportunity afforded by a new seminar in the history of medicine, I came to the archives to strengthen these arguments.

One of the aspects of the 1918-1919 influenza outbreak that makes for such compelling classroom fodder is the fact that this particular strain disproportionately impacted healthy young adults. This flu was fast acting, with a shockingly high rate of mortality. It was a flu that would have ravaged, say, a community of college-aged students living in close proximity in dorms and small apartments. This morbid drama offers the perfect opportunity for teaching about epidemiology and the cultural impact of disease on populations.

The materials I collected during my time researching at the College of Physicians of Philadelphia provided me with a rich assortment of primary source materials to explicate the devastation wrought by the flu. These primary sources

London Ministry of Health. Reports on Public Health and Medical Subjects No. 4: Report on the Pandemic of Influenza 1918-1919. (London, 1920): 17.

London Ministry of Health. Reports on Public Health and Medical Subjects No. 4: Report on the Pandemic of Influenza 1918-1919. (London, 1920): 17.

are crucial, as I have found a major obstacle to teaching about the influenza outbreak (and indeed, convincing students of the need for a yearly flu shot) is debunking the myth that the common flu is at worst a mere annoyance. Many students come to the classroom assuming the flu is nothing more than a more severe cold. One student—not alone in her query—asked why people no longer die from the flu. There are many misconceptions about the disease, and a historical approach can help us address them.

 

Using materials collected during my research, I developed a lesson beginning with the origins of the influenza outbreak. This history offers a complex view of epidemiology, as the flu spread with rapidity not just by sneezes and coughs, but also by the opportunity afforded by the waning years of WWI, when soldiers congregated in close quarters and civilians joined in large celebrations to mark the end of combat. These gatherings provided the perfect storm of disease propagation.

Unfortunately, this perfect storm was met with a flu unlike most others. This was a flu with an extremely high mortality rate. The chart below dramatically depicts the devastation wrought, with the high peak at the right side of the graph signifying the sharp uptick of deaths related to the flu as compared to earlier years’ epidemics.

A similar chart underscores the relative devastation among communities, particular in cities, by the flu. The figure below charts the total deaths in Philadelphia. Though the reproduction is of poor quality, the chart shows a spike in deaths in the mid fall of 1918. Two lines draw this spike: the outermost indicates the total deaths from all causes in the city, while the inner, nesting spike indicates the total number of deaths from influenza alone. This chart is chilling. The dramatic increase of deaths in Fall 1918 is clearly due almost exclusively to the outbreak of the flu.

Such images certainly lay the groundwork for teaching about the impact of the epidemic, yet numbers and line graphs only go so far in driving home historical reality. To make the winter of 1918-1919 come alive for students, I employ a seemingly benign table of figures to create a hands-on activity that packs a punch.

United States Department of Commerce. Special Tables of Mortality from Influenza and Pneumonia in Indiana, Kansas, and Philadelphia, PA September 1 to December 31, 1918.

United States Department of Commerce. Special Tables of Mortality from Influenza and Pneumonia in Indiana, Kansas, and Philadelphia, PA September 1 to December 31, 1918.

The table below lists the number of cases of influenza (and related pneumonia) among U.S. troops in camps and barracks. I use this example to mimic, somewhat, the close proximity with which our students live (though presumably they do so in a bit more luxury than that afforded by military barracks). In class, I annotate the image, replacing the numbers with figures reflecting the size of the class. I then ask students to take index cards corresponding to the first week, then the second, and so on. Over the course of our simulated autumnal flu season, we see how many students survive into January. This never fails to hit home.

Undoubtedly morbid, this exercise is nevertheless highly effective if implemented with care. Students gripping slips of paper can look around the classroom and begin to internalize what it might have been like, in those days before flu shots, to experience such a dramatic loss of life in their community, to live in fear of succumbing to this pervasive death themselves.

This exercise brings the historical reality of the epidemic from mere charts and tables, and underscores its human aspect.

This is why I love history. Collecting source material from the past—even the seemingly dull charts and graphs full of raw data—helps us understand the social, cultural, and political impact of events of the past. As students more fully comprehend the historical import of this moment in time, I allow them to explore a rich variety of sources related to the flu. One of the most valuable resources I obtained from my visit to the archives came in the form of a thick portfolio of clippings from local Philadelphia newspapers, magazines, posters, and other ephemera produced during and after the peak of the epidemic in 1918 and 1919. The bound collection is full of examples ranging from gruesome images of mass graves within city limits, to published reminders to citizens of hygiene recommendations like handwashing, drinking water, and, improbably, rinsing fruit.

These documents enrich students understanding of the history of medicine in ways my lecturing along cannot convey. They

London Ministry of Health. Reports on Public Health and Medical Subjects No. 4: Report on the Pandemic of Influenza 1918-1919. (London, 1920): 293.

London Ministry of Health. Reports on Public Health and Medical Subjects No. 4: Report on the Pandemic of Influenza 1918-1919. (London, 1920): 293.

allow students to read and experience it as if among the historical actors they are studying. The documents provide important opportunity for critical thinking and historical analysis, placing each within a multifaceted context. The documents, the materials I collected while conducting research at the College of the Physicians of Philadelphia, are crucial tools in my attempts to teach the history of medicine.

Of course, the collections I examined contain far more than only materials on the flu epidemic of nearly a hundred years ago. I feverishly photographed text and images from myriad sources in the collection, helping develop lectures on Progressive Era mental health policies and how these were related to themes of nationalism, tied to the emergence of psychology as a scientific profession. I transcribed documents related to the Northampton Lunatic Hospital, which was once situated just miles from the classroom where I teach. I collected countless ephemera – advertisements, promotional materials, product labels, and essays by medical professionals – on various (and often appallingly humorous in their dated sexism) aspects of women’s health.

My time in the reading room was not just professionally productive, but highly enjoyable, punctuated by laughter over old texts that did not quite stand the test of time, by jaw dropping moments, and by sober reflections on the impact of disease. I left the archives armed with hundreds of photographs and dozens of pages of notes, as well as new friendships forged with staff at the Historical Medical Library and Mütter Museum. I have since directed students to the collections, with one spending time in the archives and others using digital collections for various research projects.

Scrapbook of newspaper clippings (September 14, 1918 to March 1, 1919) concerning the influenza epidemic in Philadelphia, 1918-1919. Philadelphia, PA, 1919.

Scrapbook of newspaper clippings (September 14, 1918 to March 1, 1919) concerning the influenza epidemic in Philadelphia, 1918-1919. Philadelphia, PA, 1919.

Perhaps you should take it with a grain of salt, as I’m a self-proclaimed fan of the flu, but I cannot recommend more highly the collections or the experience of working at the archives of the College of Physicians of Philadelphia.

Imperfecta: Fear, wonder, and science

~This post courtesy Beth Lander, College Librarian, Historical Medical Library, The College of Physicians of Philadelphia

On March 9, 2017, Imperfecta opens in the Mütter Museum, an exhibit curated by the staff of the Historical Medical Library, which will examine in text, image, and specimen how fear, wonder, and science shaped the understanding of abnormal human development.

One facet of this story is how people, laymen and scientists, reacted to new information in a time of discovery and upheaval.  Steve Desch, an astrophysicist from the University of Arizona, said, “Humans have a strong instinct to ignore scientific findings, until those discoveries challenge the stories we tell each other about ourselves.”  This tendency to ignore earth-shattering discoveries that fundamentally change how humans see themselves is a behavior that is as old as human existence itself.  For example:

In 1543, Copernicus confirmed that our solar system is heliocentric.  Martin Luther, a man who threw the religious world into upheaval by hammering his Ninety-Five Theses on a church door in Wittenberg 26 years before, complained that “There is talk of a new astrologer who wants to prove that the earth moves and goes around instead of the sky, the sun, the moon, just as if somebody were moving in a carriage or ship might hold that he was sitting still and at rest while the earth and the trees walked and moved.  But that is how things are nowadays: when a man wishes to be clever he must needs invent something special, and the way he does it must needs be the best!  The fool wants to turn the whole art of astronomy upside-down.”

In 1859, Charles Darwin published the “Origin of the Species.”  The theory of evolution was adjudicated in part at the Scopes Trial in 1925.  We are still adjudicating the concept of evolution in society, even when faced with antibiotic resistant strains of tuberculosis and syphilis.

In 2012, the existence of the Higgs Boson was confirmed.  The Higgs is the particle that gives other particles mass.  Without the Higgs, there can be no matter.  Without the Higgs, there is no creation.

Let’s step back about 450 years, to a period of time in which Western Europe was coming to grips with discoveries made through the exploration of Africa, the “New World,” and the far reaches of the Pacific; to a time when the printing press, first used by Johannes Gutenberg, exponentially expanded the amount of books and pamphlets available; to a time when people were challenged by, and questioned, new information.

One of the most extraordinary books to document these discoveries is Les Oeuvres by Ambroise Paré, published in 1575.  Paré was a barber/surgeon who gained invaluable experience on the battlefield.  Considered to be the greatest surgeon of his time, Paré’s works cover the spectrum of surgery, medical instrumentation, childbirth, as well as the unique and unusual.  Here, Paré shows his readers an ostrich, a bird that we would not consider unusual in any way:ostrich

However, in Paré’s work, our common ostrich is cheek to jowl with images like this:

sea-horse

Quite literally, a seahorse.  How did people in the 16th century learn about the seahorse?  Did explorers return with specimens?  Was the name transliterated from another language?  Were woodcuts like this drawn based on second-hand information?

The use of woodcuts was very similar to how we use digital images today.  They were passed from printer to printer, reused and repurposed, often tweaked or re-cut to fit the perceptions of local communities.  An excellent example of this comes from March 1512, when a child was born somewhere between Ravenna and Bologna in Italy.  This child’s birth was so depraved, so shocking, that the baby was ordered starved to death by Pope Julius II within weeks of its birth.  Known as the “Monster of Ravenna,” its birth was seen as a sign from God that the city of Ravenna had somehow sinned.  Lucca Landucci, an apothecary in Florence, wrote the following in his diary:

“We had heard that a monster had been born at Ravenna, of which a drawing was sent here; it had a horn on its head, straight up like a sword, and instead of arms it had two wings like a bat’s, and the height of its breasts it had a fio [a Y shaped mark] on one side and a cross on the other, and lower down at the waist, two serpents, and it was a hermaphrodite, and on the right knee it had an eye, and its left foot was like an eagle.  I saw it painted, and anyone who wished could see this painting in Florence.  It was evident, what evil the monster had meant for them [the city of Ravenna]!  It seems as if some great misfortune always befalls the city when such things are born.”

The great misfortune was the sack of Ravenna by French troops in April 1512 during the War of the Leagues of Cambrai.  The Pope, angered that his troops were defeated during the battle, ordered what he perceived as the divine cause of his loss put to death.

liceti4

This image of the Monster of Ravenna comes from Fortunio Liceti’s book, De Monstrorum Caussis,  which was first published in 1616, more than a century after the baby’s birth.  Why such a birth would have been considered a direct intervention by God is due partially to the concept of preformation, the idea that an embryo develops from a completely formed version of an organism.  How could people come to grips with the idea that God had placed a monster in a woman’s womb?

Images of the Monster of Ravenna changed as the woodcuts traveled across Europe.  Elements of deformities displayed changed rapidly, and began to mingle with other images of abnormal births or mythical beasts.  As the image moved across Europe, it was adapted and contextualized to mirror local or regional fears and superstitions.  To quote Armand Marie LeRoi, the author of the book Mutants: On Genetic Variety and the Human Body (2005), “When [the image] left Ravenna, it had two legs; by the time it arrived in Paris, it had only one.  In some prints it had bat wings, in others they were more like a bird’s; it had hermaphrodite genitalia or else a single large erection.”

Medical texts often represented both the popular notions of monsters as portents, or punishments from God, as well as ideas that we would recognize as having some basis in the scientific method.  Ambroise Paré used empirical observation to challenge many accepted tenets of battlefield medicine.  This use of observation is evident in his 1573 book, Deux livres de chirurgie, a book mainly about surgery, but which included a chapter about monstrous births.  In this book, Paré lists thirteen reasons why monstrous births occur:

The glory of God.

God’s wrath.

Too great a quantity of seed.

Too little a quantity of seed.

The imagination.

The narrowness or smallness of the womb.

The indecent posture of the mother, as where, being pregnant, she has sat too long with her legs crossed, or pressed against her womb.

A fall, or blows struck against the womb of the mother, being with child.

Through heredity or accidental illness.

Through rotten or corrupt seed.

Through mixture of mingling of seed.

Through the artifice of wicked spiral beggars.

Through demons and devils.

This list demonstrates the intersection between superstition and science, between preformation and epigenesis, the theory, now commonly held, that an embryo forms progressively from an undifferentiated egg cell.  The foundation for the theory of epigenesis comes from the work of William Harvey, who published Exercitationes de generatione animalium in 1651.  Thirteen chapters of this book depict the day-to-day development of chicken embryos, in which Harvey discovered the cicatricula, the area of an embryo from which generation proceeds.

Bear in mind that, during the 75-year period between Paré’s Deux livres de chirurgie and Harvey’s early work in embryology, Europe was torn apart by disease – episodes of the plague occurred across the entirety of Europe 17 times between 1494 and 1648, with an estimated mortality rate between 20 – 40%.  Europe was also torn apart by war.  The Thirty Years War began in 1620, with conservative estimates of civilian mortality between 15 – 20% of the total population.

It is no wonder, then, that humans, when challenged by new information – or a complete upheaval of their lives – need to adapt that new information and make it part of their own story in order to make sense of their world.  The story of Imperfecta is the story of how we try to synthesize new information, a synthesis that is often fraught with fear and suspicion.  I welcome you to join us on March 9th for the opening of Imperfecta.

 

Johns Hopkins’ Legacy for Nursing Education

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

As 2016 comes to a close, we gather to honor the life and legacy of Mr. Johns Hopkins on this 143rd anniversary of his death. Let us pay special attention to his legacy for nursing education.

1873, the year of Mr. Hopkins’ death, was also a momentous year for the birth of professional nursing in America.

On March 10, 1873, Johns Hopkins instructed his trustees, “I desire you to establish, in connection with the hospital, a training school for female nurses. This provision will secure the services of women competent to care for the sick in the hospital wards, and will enable you to benefit the whole community by supplying it with a class of trained and experienced nurses.” Continue reading

Searching Tobacco Archives: Sports and Chewing Tobacco

~This post courtesy Allen Smoot, UCSF Archives Intern.

Image from “The case against smokeless tobacco: five facts for the health professional to consider,” September 1980, page 4.

Image from “The case against smokeless tobacco: five facts for the health professional to consider,” September 1980, page 4.

As an intern for the UCSF Archives, I’ve been working on digitized state medical society journals and tobacco control collections. At UCSF, the Archives and the Industry Documents Library both house immense collections of tobacco-related material. In the Industry Documents Library there are millions of documents from tobacco companies about their manufacturing, marketing, and scientific research.  I narrowed in on chewing tobacco and how it became popular in the sporting world. Continue reading

The Death of Albert

Albert as a young man.

Albert as a young man.

This post is courtesy Joan Thomas, Rare Books Cataloger at the Center for the History of Medicine at the Francis A. Countway Library of Medicine of Harvard Medical School.

On December 14th, 1861, Prince Albert of Saxe-Coburg and Gotha, husband of Queen Victoria, succumbed to a lingering illness that doctors diagnosed as typhoid fever. There has been speculation that Albert may in fact have died of Crohn’s disease or ulcerative colitis, both of which involve the debilitating stomach pain from which he suffered. In an article entitled, “The death of Albert Prince Consort: the case against typhoid fever” (QJM. 86 (12) 1993: 837–841), J.W. Paulley argues as follows:

“That he had been intermittently unwell with abdominal symptoms for several months before the terminal stage of his illness, only 9 days after this sensitive and vulnerable man was confronted by an intensely personal insult, lends further support to a diagnosis of inflammatory bowel disease.”

Albert and Victoria.

Albert and Victoria.

The ”intensely personal insult” Paulley mentions was the Prince of Wales’ liaison with an Irish actress, Nellie Clifden, and the widespread rumors of blackmail and pregnancy. The stress resulting from such an embarrassing situation may have been the catalyst for the Albert’s final illness. Paulley concludes that “[s]ome patients with fulminating inflammatory bowel disease, if that is what the Prince had, decline such help, preferring to brood rather than speak, and take their bottled-up feelings of resentment to the grave.”

Deaf Education- Celebrating the legacy of Thomas Hopkins Gallaudet

~This post courtesy Katie Healey and Caroline Lieffers, doctoral students in Yale’s Program for the History of Science and Medicine, with additions by Melissa Grafe, John R. Bumstead Librarian for Medical History, Head of the Medical Historical Library.

Portrait of Thomas H. Gallaudet (1787-1851). Gallaudet is shown here wearing glasses; his name in American Sign Language is the same as the sign for GLASSES.  From Henry Barnard, A discourse in commemoration of the life, character, and services of the Rev. Thomas H. Gallaudet, LL. D. : delivered before the citizens of Hartford, Jan. 7th, 1852 : with an appendix containing history of deaf-mute instruction and institutions and other documents (Hartford: Brockett & Hutchison, 1852):

Portrait of Thomas H. Gallaudet (1787-1851). Gallaudet is shown here wearing glasses; his name in American Sign Language is the same as the sign for GLASSES. From Henry Barnard, A discourse in commemoration of the life, character, and services of the Rev. Thomas H. Gallaudet, LL. D. : delivered before the citizens of Hartford, Jan. 7th, 1852 : with an appendix containing history of deaf-mute instruction and institutions and other documents (Hartford: Brockett & Hutchison, 1852).

Thomas Hopkins Gallaudet, instrumental in the establishment of the first permanent school for deaf children in the United States, was born on December 10th, 1787. The popular account of the school’s founding states that in 1814, the young Reverend Gallaudet wondered why the daughter of his Hartford neighbor did not laugh or play with his own younger siblings. Nine-year-old Alice Cogswell was deaf, and her family and friends struggled to communicate with her. Gallaudet traced the letters H-A-T into the dirt with a stick and pointed to his hat. Alice immediately understood, and Gallaudet realized his life’s calling. After observing different methods of instruction and communication on a European voyage supported by Alice’s father, Dr. Mason Fitch Cogswell (BA Yale 1780), Gallaudet concluded that the French method of sign language was most effective. He recruited Deaf Frenchman Laurent Clerc to help establish the Connecticut Asylum for the Education and Instruction of Deaf and Dumb Persons, which opened in Hartford on April 15, 1817. Alice Cogswell was its first registered student. Now called the American School for the Deaf, this historic institution will celebrate its bicentennial in 2017.

Thomas Hopkins Gallaudet earned his bachelor’s (1805) and master’s (1808) degrees at Yale before graduating from Andover Theological Seminary in 1814.  Following his serendipitous encounter with Alice Cogswell, Gallaudet embarked on a year-long tour of European deaf schools. After a frustrating visit to the secretive Braidwood Academy in England, which taught speech and speechreading, he attended a demonstration of the French manual method—that is, sign language—in London. The National Institute of the Deaf in Paris invited Gallaudet to study French Sign Language and deaf instruction. Impressed with their curriculum, Gallaudet persuaded the esteemed instructor Laurent Clerc, a former student of the Institute, to teach deaf children in America.  A commemoration of Gallaudet’s life was printed in 1852 and is available through the Medical Heritage Library partner National Library of Medicine.

Laurent Clerc was born in La Balme, France in 1785. As he later recounted in his autobiography, he fell into a fire as a toddler, which left him deafened and scarred his cheek. His name is signed by brushing the index and middle fingers twice down the cheek. Clerc was an exceptional student and later an internationally known instructor at the National Institute of the Deaf in Paris. He left his students only reluctantly in 1816, when Gallaudet persuaded him to come help American children. During the fifty-two-day voyage across the Atlantic, Clerc and Gallaudet exchanged lessons in French Sign Language and English, and Clerc kept a diary to practice his English.  The Laurent Clerc papers (MS140)  are available for research at Yale University’s Manuscripts and Archives, and the Mason Fitch Cogswell papers (GEN MSS 920)   are at Beinecke Rare Book and Manuscript Library at Yale University.  Read an address on deaf education delivered by Clerc in 1818 through this online copy, provided by the Medical Heritage Library.

Title page from Laurent Clerc, An address, written by Mr. Clerc, and read by his request at a public examination of the pupils in the Connecticut Asylum : before the governour and both houses of the legislature, 28th May, 1818 (Hartford: Hudson & Co. Printers, 1818).

Title page from Laurent Clerc, An address, written by Mr. Clerc, and read by his request at a public examination of the pupils in the Connecticut Asylum : before the governour and both houses of the legislature, 28th May, 1818 (Hartford: Hudson & Co. Printers, 1818).

Gallaudet University in Washington D.C. was named Gallaudet College in 1894 in honor of Thomas Hopkins Gallaudet.  Founded in 1864, Gallaudet University is the world’s only liberal arts college specifically for the Deaf and hard of hearing. It remains a center of both Deaf culture and Deaf rights activism.

For more on Gallaudet and Deaf education and culture, make sure to visit, the online exhibition Deaf: Cultures and Communication, 1600 to the Present.

Female Trouble: Headaches and the Modern Woman

Who among us has not experienced the dreaded throb of cranial pain that accompanies stress and anxiety? Headaches seem to be the physiological manifestation of modern life’s tensions: perhaps more so than aches in any other part of the body, pain in the head symbolically ties together physical, mental, and emotional distresses.[1] In popular culture, headaches are also seen as a particularly female trait – think of the old misogynistic joke about a woman pleading a headache as an excuse to avoid a man’s sexual advances. While acting as humor on the basis of supposed female frailty and sexuality, the alleged headache functions to indicate the inner conflict the woman has between the different demands she faces because of her gender and her will as an individual. Managing these clashing societal demands and personal desires is, as it were, a headache.

In my reading of popular nineteenth-century American novels by women, I have noticed an emphasis on women’s headaches as an indicator of the stresses of the modernizing world. Headaches emerge as a recurring trope in these novels about women navigating new gender roles amidst changing ideas about women’s self-actualization both in the home and in the workplace. For instance, in Sara Payson Willis’s semi-autobiographical novel Ruth Hall: A Domestic Tale of the Present Time (1854), she chronicles her titular protagonist’s climb from poor widowhood to successful writer. A proxy for Willis, a.k.a. Fanny Fern, the highest-paid columnist in the United States, Ruth is plagued by headaches throughout the narrative. Elizabeth Stuart Phelps, known as the author of one of the great bestselling novels of the century, The Gates Ajar, also channeled her personal and professional frustrations in The Story of Avis (1877). Avis wants to be an artist, but the constraints of the domestic sphere force her to temper her ambitions. In both novels, the headache is a ubiquitous refrain at points of tension between these women’s private lives and the various public demands they face. But what relation did these headaches as metaphor have to contemporary medical understandings of the phenomena? How might nineteenth-century medical literature allow us to better understand these ongoing cultural stereotypes about women’s headaches?

I researched these questions at the Historical Medical Library of the College of Physicians of Philadelphia as a proud recipient of a travel research grant from the F.C. Wood Institute for the History of Medicine. Texts I hoped to investigate that are in the Library’s collection included both standard and homeopathic medical publications such as Treatise on Headaches: Their Various Causes, Prevention, and Curse (1855), Nervous Headache: For Medical Profession Only (1880), and Headache and Its Material Medica (1889).

Unexpected hazard of research: turns out that it can be a challenge for a modern reader like myself to resist sympathetic pangs of pain when you spend hours reading detailed medical descriptions of headaches! Often referred to as the “nervous headache,” the “sick headache,” and the now obsolete term “megrim,” the medical literature consistently links the phenomenon to imbalances and abnormalities – such as being a woman. I joke not! It is often a vague historical truism that “people were sexist back then,” but it can be paradigm-shifting to read the specifics of how credentialed, authoritative professionals actively engaged in pathologizing women’s existence.

Female susceptibility to headaches apparently had to do with everything from the nebulous affliction known as “hysteria,” to menstruation, to mental and emotional excesses, to excessive education and literacy. Henry G. Wright, MD, in his Headaches: Their Causes and Cures (1856) alleges that women tend toward headaches for reasons ranging from “over-nursing a child” to exertion from reading “the contents of the circulating library from sheer want of better employment.” As for male sufferers of headaches, doctors associated their pain with emasculating deviancy such as masturbation, sedentariness, and “nervous” traits of emotional disturbances and anxiety. According to James Mease, MD, in On the Causes, Cure, and Prevention of the Sick-Headache (1832), “This disease is the result of our advanced state of civilization, the increase of wealth and of enjoyments in the power of most people in this country, and, I may add, of the luxurious and enervating habits in which those in easy circumstances indulge.” Western civilization itself is feminized.

During my visit I also found other striking materials that indicate how the spread of medical knowledge grew with the further development of print technologies. There was a mass-produced pamphlet aimed at medical professionals that advertised a “nerve tonic” for headaches and other nervous ailments based on coca, known for its role in the drug cocaine. On Nervous or Sick-Headache (1873) by Peter Wallwork Latham, MD, included reproductions of colored plates that demonstrated the effect of severe headaches with aura on vision.

One thing that must be stressed: the women who were the subjects of these medical treatises were white and from the middle, if not upper, classes. The pain of poor women, women of color, and other marginalized groups did not merit the same medical attention and were sometimes not considered to exist. In his same text, Dr. Mease alleges that headaches are “unknown among the natives of our forests.”

Finally, I hope to put this discussion of women’s headaches into a broader conversation about pain in medicine. The generous time afforded to me by the F.C. Wood Institute grant enabled me to peruse many other research interests related to women and medical science. I went through materials related to J. Marion Sims, MD, considered the father of American gynecology. He built his career on developing surgeries to fix fistulas – by practising on enslaved black women. In his writings, there was no mention of their pain.

In 2015, the journal Pediatrics, published by the American Medical Association, highlighted an editorial that reviewed a broad range of scientific studies on racial discrimination and pain treatment in medicine from the 1970s onward. Perhaps the question for us should not only be what the causes and manifestations of pain are, but also whose pain gets recognized.

[1] For more on the history of pain and medicine in America, I recommend Martin Pernick’s A Calculus of Suffering.

~This post courtesy Beth Lander and Christine “Xine” Yao. Ms. Yao just earned her PhD in English at Cornell University.  Later this year she will begin her position as a SSHRC Postdoctoral Research Fellow at the University of British Columbia.  She received an F.C. Wood Institute Travel Grant from the College of Physicians of Philadelphia in 2015.

Women Veterans of World War I

Johns Hopkins Hospital Base Hospital Unit 18 Nurses in World War I, wearing gas masks, 1918.

Johns Hopkins Hospital Base Hospital Unit 18 Nurses in World War I, wearing gas masks, 1918.

The Hopkins and the Great War exhibit features the stories of several women veterans of World War I . By exploring the experiences of the female Johns Hopkins doctors and nurses, the exhibit sheds light on the opportunities women had to serve during the war and the ways in which gendered norms varied by professional training and nationality. Continue reading

Insanity, medicine and the law-The case of President Garfield’s assassin, Charles Guiteau

Title page from The Great Guiteau Trial: with life of the cowardly assassin. Philadelphia, Published by Barclay & Co., 1882.

Title page from The Great Guiteau Trial: with life of the cowardly assassin. Philadelphia, Published by Barclay & Co., 1882.

On November 28th, 1881, Charles Julius Guiteau, assassin of President James A. Garfield, took the stand on his own behalf, testifying in court until December 3rd, 1881. Guiteau’s rambling testimony documented his life and his belief that killing Garfield was necessary and divine providence. Following Guiteau’s testimony, the prosecution brought a succession of medical experts, who testified over the course of three weeks that Guiteau was not insane but “depraved,” “sane, though eccentric,” and many other descriptions skirting the definition of legal insanity.1 Guiteau’s mental state was a matter of considerable debate among medical and legal experts, as evidenced by a number of articles, pamphlets and books that are freely available through the Medical Heritage Library. Continue reading