Treating Clubfoot in 1839
Dr. William John Little’s (1810-1894) extensive work on deformities of the foot was the first monograph published in the English language on tenotomy – the division of a tendon. Little went on to found the Royal Orthopaedic Hospital of London. According to the introduction to this work, his interest in this field stemmed from his own experience: Little suffered an attack of infantile paralysis as a child, which was complicated by talipes (club foot). Upon entering medical school, he found that physicians knew little about the causes or treatment of the condition, and that its care was “confined to the care of the instrument maker” (vii). After completing his medical degree, Little learned of an operation performed by Dr. Stromeyer in Hanover to correct clubfoot by dividing the Achilles tendon. Little spent 1835-1836 studying with Stromeyer and underwent the operation himself, which restored the use of his foot.
Infantile Paralysis and its Attendant Deformities
Epidemic polio made its first appearance in the United States in 1894 in Vermont. In 1908, Viennese doctors Karl Landsteiner and Erwin Popper determined poliomyelitis to be a viral disease; the virus remained invisible to researchers until the invention of the electron microscope in the 1950s. Prior to the epidemics of the early twentieth century, the medical profession was familiar with a rare disease that struck children between the ages of 14 and 20 months – lending the disease its name, infantile paralysis – sometimes leaving them partially or totally paralyzed. Most cases were characterized by seized and atrophied muscles that made crawling or walking difficult.
In this 1867 text, Dr. Charles Fayette Taylor, a prominent orthopedic surgeon, describes his theory of how the condition of infantile paralysis came about, and equipment and exercises with which to treat patients soon after the onset of infantile paralysis. Each apparatus was designed to help the patient regain strength and flexibility through small movements that were easy to direct and control. Taylor’s methods were influenced by his time as a medical student in London, where he studied the “Movement Cure,” the forerunner of modern physical therapy.
Taylor’s theories about the causes of infantile paralysis also reflect then current theories of society and debility. He situated increasing rates of nervous diseases in young children in the specific context of American life: much like famed neurologist George M. Beard, Taylor believed that the “creative force” required of American intellect to develop the young nation had “diminished our physical endurance” (see page 7). As a result, affluent middle-class parents had children who inherited the tendency to nervous conditions and physical under-development.
Implements for the Hearing Impaired
Sufferers of chronic conditions and disabilities – in this case, deafness – have long been the target of purveyors of so-called “quack” cures. Quack cures and patent medicines were remedies marketed in the nineteenth through early twentieth century with colorful advertising and guarantees of cure. (For more on quack medicine, visit this exhibition by the Digital Public Library of America.)
T.H. Stilwell’s advertisement for his Organic Vibrator is a good example of the genre: after making a long case for himself as not being a quack, he outlines his theories and proposed cures for scrofula (tuberculosis in the lymph nodes of the neck) and catarrh (inflamed mucous membranes leading to chronic runny nose), both of which, he asserted, could result in deafness. Where deafness had occurred and was not curable, he proposed the use of his patented Organic Vibrator: a metal device that fit into the ear canal, designed to conduct air directly to the eardrum.
Training Schools for the Feeble-Minded
Institutionalization was common for children and adults with physical, mental, or developmental disabilities in the nineteenth century. Children who were blind, deaf, developmentally disabled, or who had epilepsy were often sent by their families or communities to state-run training schools. Conditions in these schools varied state to state, depending upon who was in charge and the funding available.
This 1859 annual report from the Pennsylvania Training School for Feeble-Minded Children provides some idea of the issues these institutions faced. The inclusion of hand-written notes such as these was intended to stand as proof of the progress being made for these children and to inspire pity from governing boards and thus generate more funds.
Schools for the Blind
This report from the Kentucky Institution for the Education of the Blind reprinted an article published in Frank Leslie’s Illustrated Newspaper in July 1880 about the subjects taught at the school. In the image above, a fourteen-year-old boy, who was reportedly completely blind, had disassembled a wooden anatomical figure, described each organ, and put it back together by feel. Other illustrations show girls learning needle crafts and pupils engaged in physical exercises. The overall emphasis of the school’s program, it can be seen, was to make the pupils as independent as possible.
Medical Studies
By the late nineteenth century, medical staff at institutions for the disabled began to implement new advances in laboratory science in order to study the causes of intellectual impairments. Often patient histories were carefully kept so that upon death, doctors could compare clinical notes to physical manifestations of disease in the body. The anatomical specimens thus collected, it should be noted, were not always taken with the patients’ (or their next of kins’) knowledge or consent. This textbook on the origins of “feeble-mindedness” uses a few photographs of such specimens to support observations on the case histories of individuals who had, for example, epilepsy. The two halves of the brain above were taken from a patient with epilepsy who died at the age of 18.
A Feeble-Minded Family
Eugenics was a social theory, popularized in the early 1900s, based on the work of Gregor Mendel in genetics in the 1860s and the writings of Sir Francis Galton. Eugenicist advocates – among whom were doctors, social reformers, social workers, and others – believed heredity was the strongest influence upon an individual’s development, and that conditions ranging from conditions of mental disability (known at the time as idiocy, imbecility, or feeble-mindedness) to epilepsy to criminal behaviors must be inherited. From this theory, proponents concluded that compulsory sterilization of such individuals would prevent them from passing these traits onto their offspring. Eugenists were able to make strong cases in favor of compulsory sterilization to state legislatures: 28 states had passed such laws by 1935.
Chart above shows the line of Martin Kallikak’s family through his lawful wife; the lower shows it through the “nameless feeble-minded girl”.
In November of 1897, an eight-year-old girl was admitted to the Training School for Feeble-Minded Girls at Boys at Vineland, New Jersey. A few years later, when the school opened a research laboratory that would document each students’ background and course of development, the young girl’s whole family was scrutinized for signs of weakness or deficiency. The result of that study was later published as The Kallikak Family (not their real name). Field workers interviewed neighbors and family who were able to describe or point to sources tracing the family back to a Revolutionary War soldier, “Martin Kallikak,” who impregnated a “nameless feeble-minded girl” before marrying a woman of reputation and family. The top chart above traces this line; males are represented by squares, females by circles, and where the individual’s condition is known, N for normal and F for feeble-minded. The bottom chart shows the line of descent from his child born out of wedlock; a family tree marked frequently by the F symbol. “We find find on the good side of the family prominent people in all walks of life,” noted Goddard. “On the bad side we find paupers, criminals, prostitutes, drunkards, and examples of all forms of social pest with which modern society is burdened.”
Goddard and his colleagues believed the only solution to this “problem,” was to sterilize the mentally disabled. The story of the Kallikaks was often repeated in pro-eugenic texts, and even became short-hand for why compulsory sterilization should be law.
Conditions in Sheltered Workshops
Changes in attitudes towards disability, court decisions that upheld civil rights, and increased federal funding for community centers all contributed towards the trend of deinstitutionalization of individuals with physical and mental handicaps in the 1970s. In response to this trend, the U.S. Department of Labor commissioned a study of conditions in sheltered workshops (or “work centers”). Sheltered workshops have their roots in the vocational and training schools that were established in the nineteenth century. By the mid-twentieth century, many had evolved into community-based workshops that, because they either primarily or solely employed workers with physical or mental handicaps, were authorized by the Department of Labor to pay lower than minimum wage. This study was meant to provide data to interested parties looking to evaluate and expand or revise such programs. The first volume of the study, published in June 1977, reported the results from surveys on hourly wages, profiles of individuals served based on type of disability, financial details, and the like. The second volume contains information based on interviews conducted with 3,400 workers representing 600 sheltered workshops. Those interviews focused specifically on the relationships between clients and their workplaces.
Defining Disability
The National Rehabilitation Association was founded in 1923 by individuals who were interested in vocational education for people with disabilities. As the introduction to this volume acknowledges, rehabilitation as a practice was established by well-meaning individuals acting more out of a sense of moral obligation than founded on clear and consistent principles. Reflecting trends in social work, rehabilitation also became increasingly professionalized, and the National Rehabilitation Association was able to hire full time staff in the 1950s and to strengthen lobbying efforts at the federal and state levels on behalf of people with disabilities. This document, the product of a seminar attended by physicians, social workers, policy makers, and academics, represents one effort to bring more careful organization to this field: by setting uniform definitions of pathology, impairment, functional limitation, and disability, clearer research goals and policy decisions could be formulated.