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.

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.

The Battle Creek Sanitarium: Deliverance Through Diet

The College of Physicians of Philadelphia has launched a new digital exhibit. Founded in 1866 and rebuilt after a fire in 1903, the Battle Creek Sanitarium of Battle Creek, Michigan was a health resort which employed holistic methods based on principles promoted by the Seventh-Day Adventist Church. This mini-exhibition highlights some of the materials held at the Historical Medical Library that were produced by J.H. Kellogg, founder of The Sanitarium, including official Sanitarium publications, as well as those published by The Sanitarium Food Co. It is the first in a series of digital exhibits taken from physical exhibitions the Historical Medical Library curates for display on site in the historic headquarters of The College of Physicians of Philadelphia, home of the Mütter Museum.

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Healing Energy: Radium in America

The Historical Medical Library of the College of Physicians of Philadelphia has launched a new exhibit on the history of radiation medicine in the United States.

In the final years of the nineteenth century, researchers in physics and chemistry discovered new forms of energy, starting with x-rays in 1895. In 1896, Henri Becquerel discovered that uranium naturally emitted an invisible, previously-unknown form of energy. Following up on Becquerel’s work, the husband-and-wife team of Pierre and Marie Sklodowska Curie discovered that uranium ore contained two new elements—”polonium” and “radium”—that constantly radiated tremendous amounts of energy. The Curies came up with a new word for these emissions: “radioactivity,” Along with x-rays, this new form of energy came to be known as “ionizing radiation,” and it would forever alter the world of medicine.

The exhibit was created by Jeffrey Womack and Tristan Dahn and includes sections on the Curies, Robert Abbe, and the use of radiation in medicine.

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

A 500 Year History of Teaching and Learning Anatomy: Online Exhibit from the College of Physicians

Modern knowledge of human anatomy has its foundation in the work of Galen of Pergamon, a Greek physician, surgeon and philosopher who was born in 130 CE.  Galen’s knowledge of the human body was based on two distinct sets of observations, one derived from his work as physician to gladiators in Pergamon, and the other derived from his dissection of anatomical surrogates, such as pigs and monkeys. Continue reading

Medical Heritage Library Awarded NEH Grant for Digitization of State Medical Society Journals, 1900 – 2000

The Medical Heritage Library (MHL), a digital resource on the history of medicine and health developed by an international consortium of cultural heritage repositories, has received funding in the amount of $275,000 from the National Endowment for the Humanities for its proposal “Medicine at Ground Level: State Medical Societies, State Medical Journals, and the Development of American Medicine and Society.“ Additional funding has been provided by the Harvard Library.

The project, led by the Countway Library’s Center for the History of Medicine, will create a substantial digital collection of American state medical society journals, digitizing 117 titles from 46 states, from 1900 to 2000, comprising 2,500,369 pages in 3,579 volumes. State medical society journal publishers agreed to provide free and open access to journal content currently under copyright. Once digitized, journals will join the more than 75,000 monographs, serials, pamphlets, and films now freely available in the MHL collection in the Internet Archive.  State medical society journals will provide additional context for the rare and historical American medical periodicals digitized during the recently completed NEH project, Expanding the Medical Heritage Library: Preserving and Providing Online Access to Historical Medical Periodicals. Full text search is available through the MHL website. MHL holdings can also be accessed through DPLA (dp.la), and the Wellcome Library’s UK-MHL.

Five preeminent medical libraries, including three founding members of the MHL, are collaborating on this project: The College of Physicians of Philadelphia; the Countway Library of Medicine at Harvard University; the Center for the History of Medicine and Public Health at The New York Academy of Medicine; the Health Sciences and Human Services Library, University of Maryland, the Founding Campus (UMB); and the Library and Center for Knowledge Management at the University of California at San Francisco (UCSF).

State medical society journals document the transformation of American medicine in the twentieth century at both the local and national level. The journals have served as sites not only for scientific articles, but for medical talks (and, often, accounts of discussions following the talks), local news regarding sites of medical care and the medical profession, advertisements, and unexpurgated musings on medicine and society throughout the 20th century. When digitized and searchable as a single, comprehensive body of material, this collection will be a known universe, able to support a limitless array of historical queries, including those framed geographically and/or temporally, offering new ways to examine and depict the evolution of medicine and the relationship between medicine and society.

Project supporter and former president of the American Association for the History of Medicine, Professor of History Nancy J. Tomes, Stony Brook University, notes, “the value of this collection lies precisely in the insights state journals provide on issues of great contemporary interest. They shed light on questions at the heart of today’s policy debates: why do physicians treat specific diseases so differently in different parts of the country? Why is it such a challenge to develop and implement professional policies at the national level? How do state level developments in health insurance influence federal policy and vice versa? How do factors such as race, class, gender, and ethnicity affect therapeutic decision making? How have methods of promoting new therapies and technologies changed over time? These are issues of interest not only to historians but to political scientists, sociologists, and economists.

Not only will the state journals be of great use to researchers, but they also will be a great boon to teachers. I can easily imagine using the collection to engage medical students, residents, and practicing physicians in the conduct of historical research.”

Digitization will begin in August 2015; the project will be completed in April 2017.

About the Medical Heritage Library:

The MHL (www.medicalheritage.org) is a content centered digital community supporting research, education, and dialog that enables the history of medicine to contribute to a deeper understanding of human health and society. It serves as the point of access to a valuable body of quality curated digital materials and to the broader digital and nondigital holdings of its members. It was established in 2010 with funding from the Alfred P. Sloan Foundation to digitize 30,000 medical rare books. For more about the Medical Heritage Library, its holdings, projects, advisors, and collaborators, and how you can participate, see http://www.medicalheritage.org/.

About the NEH/Digital Humanities Program:

Created in 1965 as an independent federal agency, the National Endowment for the Humanities supports research and learning in history, literature, philosophy, and other areas of the humanities by funding selected, peer-reviewed proposals from around the nation. For more on the NEH Office of Digital Humanities visit http://www.neh.gov/odh/.

Year One of “Expanding the Medical Heritage Library” Is Complete!

We have just submitted our first year report on our second National Endowment for the Humanities-funded grant, “Expanding the Medical Heritage Library: Preserving and Providing Online Access to Historical Medical Periodicals.” Under this grant, we have been digitizing numerous 19th century American medical journals (approximately 1,863 volumes so far!) and we’ve excerpted some of the highlights below.

The College of Physicians of Philadelphia
The College staff were particularly excited about a number of our selections. Among the most significant contributions were 147 volumes comprising the four leading 19th‐century homeopathy journals (American homoeopathist/American homoeopath/American physicianHahnemannian monthly, Homoeopathic physician, and Homeopathic recorder). Additionally, we included the entire run of the Transactions of The College of Physicians of Philadelphia, which includes a complete run of all volumes published throughout more than 200 years (volumes were published in 1793 and 1841‐2002). As the holder of the journals’ copyright, the College of Physicians agreed to release these volumes freely into the public domain for this project. The Transactions include proceedings from meetings, lists of Fellows, and detailed appendices that collectively describe how the College of Physicians shaped and engaged with emerging American medical trends.

Columbia University Libraries/Information Services
Columbia digitized 71 titles, the bulk of which came from the last quarter of the 19th century and the first decades of the 20th. These were years when U.S. medicine came of age – from its disorganized, underfunded, and generally unscientific state in the immediate aftermath of the Civil War to a powerful, scientifically cutting‐edge, and lavishly financed medical establishment by the end of the First World War. Many of the journals Columbia chose to digitize were created by emerging specialties such as dermatology and venereology; pediatrics; and neurology/psychiatry. They also concentrated on public health and climatology journals knowing that these cover an unusually broad range of topics that appeal to researchers in a wide range of disciplines. Additionally, they included many New York City journals since their holdings of these were usually complete. These included the Brooklyn Medical Journal and its successor, the Long Island Medical Journal (1888‐1922); the long‐running and influential New York Medical Journal (1865‐1922); and two New York German‐language journals: the New Yorker Medicinische Monatsschrift (1852‐53) and the New Yorker Medizinische Presse (1885‐1888).

Yale University’s Cushing/Whitney Medical Library
The titles Yale chose represent a variety of themes, from deafness to dentistry. Yale choose the journals, in collaboration with partners, based on perceived need, as many of the titles were not fully available digitally, allowing Yale to fill in gaps. A significant title selected by Yale was the American Annals of the Deaf and Dumb, a Connecticut journal that holds importance as one of the oldest journals in English that focuses on the education of the deaf.

Digital Highlights: The Hahnemannian Monthly

This Friday, check out one of our journals:

This volume of the Hahnemannian Monthly includes, among other things including articles on the therapeutic use of vinegar, a full specimen of the human cerebro-spinal nervous system. The illustration is from the leading article in the February 1889 issue, “A New Preparation of the Nervous System,” by. A.R. Thomas, MD, Philadelphia.

The cadaver used was that of a 35-year old female; Dr. Weaver wanted to prepare the cadaver in the manner he did in order to demonstrate the complexity and structure of the human nervous system.

As always, for more from the Medical Heritage Library, please visit our full collection!

The College of Physicians of Philadelphia begins digitizing with Internet Archive

The Historical Medical Library of the College of Physicians of Philadelphia has just completed its first book shipment to the Internet Archive. The College is one of four sub-grantees in the NEH grant awarded to the MHL via the Open Knowledge Commons. With this shipment, The College begins digitizing over 500,000 pages of rare American medical journals, some of which only exist in a handful of libraries nationwide. Continue reading