While Self-Isolating, Why Not Consume Some Books and Podcasts on the History of Medicine?

So maybe you’re now more interested in the history of medicine all of a sudden. I specialized in the topic during my undergrad and I’ve found that studying the history of medicine and surgery a really good way of thinking critically about some of the ways people talk about health concerns today. How do we know what we know about how diseases work, spread, and should be treated, and how did we as a society come to learn that? Our medical knowledge today is an accumulation of observations and practices that are centuries old. It’s imperfect and incomplete. We go down dead ends. But we’re trying. Some things are well known among medical professionals, but imperfectly known among  the greater populace (and I count myself among the second group). New research is emmerging every day, adding nuance, confirming, or debunking prior knowledge – or just raising more questions. Studying the history of medicine, however, has helped me to think critically about the (mis)information flying around today. Here are a few of my favourite works on the history of medicine that may help you along this path too.

First, right off the bat, a reputable and topical modern source: the World Health Organization has assembled a “mythbusting” page, on some of the rumours and misinformation spreading about the current COVID-19 outbreak. Wash your hands (soap and water will do, if done properly), avoid crowds, stay calm, and pay attention to good sources of information on the outbreak.

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If you like to consume your learning in audio format (and I love to listen to podcasts while driving, on long walks, and while doing chores), I highly recommend these two history of medicine podcasts:

  • This Podcast Will Kill You: two disease ecologists and epidemiologists, both doctors, both named Erin, walk you through notable diseases. They always seem to start with a first-hand description of the disease, talk about how it works, how it spreads, sometimes how it’s treated, as well as how scared you should be about it. (For example: don’t worry about catching leprosy anytime soon.) Super informative and in-depth.
  • Sawbones: A Marital Tour of Misguided Medicine: Dr. Sydnee McElroy and her husband Justin McElroy talk not only history of medicine but also some dangerous alternate modern ideas about medicine. This podcast in particular is very accessible for people like me without a science background.

In terms of books, two really stick out in my mind:

  • Steven Johnson’s The Ghost Map: The Story of London’s Most Terrifying Epidemic – and How It Changed Science, Cities, and the Modern World. This is about the cholera epidemic of 1854 and how someone used maps of deaths to track down the source of the epidemic: one water pump that had a reputation for clean, clear water. It was the case that showed that cholera was waterborne, not airborne. Plus, the doctor who led this initiative was called John Snow. This book really goes in depth into the study of this epidemic and what kind of information fed into the reaction to it. How do you determine the right information to tell people to convince them (the public, but also the city) to take the right action to save lives?
  • Rebecca Skloot’s The Immortal Life of Henrietta LacksThis book isn’t about epidemics, but the cells that were taken from Henrietta Lacks in 1951 without her permission have shaped so much of modern medical research today. This book is about science and ethics of medical study and how complicated that can be.

Whenever people ask me about why I chose to study history at university, and how that’s helped me in my current career (I supervise a team of interpreters AKA educators/tour guides in a national park), I often point out the skills I developed in research and writing. Training as a historian, you really must think critically about sources of information and what you can legitimately glean from that source. There’s no such thing as unbiased material. You have to acknowledge the perspective of the person producing that document and why they may have created it. Knowing all of that, what can we learn from that source of information?

That’s equipped me to think critically about the types of information circulating in the media about this new coronavirus outbreak. There’s a lot of misinformation out there circulating widely without a source to back them up. Many well-meaning people uncritically pass it along. (I in general am an optimist and choose to believe that people generally act out of concern for each other.) There’s a real sense of urgency and a lot of fear in the face of so much that we don’t know. What we do know (or think we know) sometimes leads us down the wrong paths. Some advice circulating is actively harmful – like, don’t spray yourself all over with chlorine. Some advice is pretty innocuous and won’t hurt (i.e., eating more garlic) but is not going to be effective. As in all things, don’t put all of your eggs in one basket and assume you’re safe because, for example, you’ve been taking more hot baths lately. (Note that WHO says that extreme cold or heat outside of the body isn’t going to do anything, because your body temperature is still pretty constant.)

The World Health Organization has some good tips. Wash your hands frequently with soap and water. Don’t touch your eyes, nose, or mouth. Avoid crowds. Practice social distancing (staying several metres away from people). Keep up to date on the latest news from reputable sources.

Look out for and check in with friends and family – but know that that might mean not seeing them in person.

Stay safe out there!

The Art of Medical Photography

Consider this photograph. Well, all right, consider this cropped digital scan of a lithographic copy of a photograph. What do you see? Nothing terribly unusual in the photographic conventions of mid-nineteenth century portraiture. A respectable-looking man in military uniform sits, half-turned towards the camera.

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This image loses its perceived normalcy and becomes incredibly intriguing when you look at the rest of it, in context:

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This image is the reproduction of a medical photograph which appears in the Medical and Surgical History of the War of the Rebellion. (The “war of the rebellion” in the title is what we now call the American Civil War, 1861 – 1865) This text was a compilation of Union medical and surgical records from 1862 – 1866, compiled alongside pension records and specimens from the Army Medical Museum, which was also founded by the U.S. Surgeon General’s Office in 1862. It was published over several years about a decade after the war’s conclusion. One of the men associated with the museum and archive, George Alexander Otis, was also one of the leading men responsible for the compilation of The Medical and Surgical History. There are six massive volumes of this text, which has been described as 55 pounds worth of information. I have seen them in person, in the Health Sciences library’s special collections room at the University of Alberta. They are chock full of statistical and textual data (which has been very much noticed and studied by medical historians), but also intriguing examples of visual culture: early medical photographs.

In this example, we can see four different men who are meant to represent four “types” of ankle amputations. However, despite the clear expository and pedagogical purpose of the creation of these images, there is something more to it. There is a very clear link in the composition of these images to contemporary portraiture. Why is it that the photographer and the compiler of the text chose, time and time again, to depict the entirely of the body of these patients, instead of cropping around the “relevant” part, the injured leg? Why do we need to see the face when studying the ankle?

Body parts were depicted in this text in isolation, but most of the time that was in the context of photographed scientific specimens: skull fragments, leg bones, etc. These body parts were usually from deceased men. If the body part was attached to a live person, they were usually, with some of exceptions, depicted in their entirety, especially if it was on a full page lithographic plate. I could only find a few of examples of images in which the upper body was pictured outside of the frame, usually as smaller drawings within the text itself. In the vast majority of cases, these men were not anonymous. These lithographs are accompanied by an embarrassment of information: name, rank, battle where injured, when injured, where they were sent, the treating surgeon, the steps of their recovery, whether they applied for/received a pension… even bowel movements are described. These men are not anonymous.

Why are these men depicted in “portrait style” medical images? These are a few possible answers. Any, all, or none of them could be true.

1) Photographs were often perceived in the nineteenth century as being neutral gazes, free from subjectivity (science’s old enemy!). They were simple mechanical reproductions of “reality” as it stood before the lens. Therefore, photography is ideal for scientific purposes like this one. However, it was the early days of photography yet. Perhaps this was simple the “normal” photographic convention: how one photographed the human body. Just as common photographic portraiture took its “artistic” cues from painted portraiture, so did medical images take their cues from photographic portraits.

2) There were advantages to viewing the entirety of the patient. For example, one can see potential expressions of pain in the face. The look of the injured limb can be compared with that of the healthy one. One can also see if the injured limb if the limb can support the person’s weight, if the subject is standing and received an injury below the waist, or if an injured arm needs to be rested on the back of a chair because it cannot hold itself up.

3) Perhaps the composition of these images is not a matter dictated by photographic convention, but medical practice at the time. The Civil War marked the last gasps of the humor theory of disease in which the body must remain in constant balance through purging, bleeding, depletion/excretion, etc. In fact, bleeding had been firmly rejected only at the very beginning of the war. Nevertheless, as in the late antebellum period, many doctors continued to view their patient’s health holistically, a holdover from this idea of the body’s humors being out of balance. Thus, it makes sense to depict the entire body, because what can you learn from one part of a whole?

4) Potential respect for the dignity of veterans. Other medical images contemporary to this set, including photographs from France in the 1850s of psychiatric patients and exceptional medical cases (such as crazily bent spines or terrifying facial tumors), were depicted with far less dignifying aspects, and the patients were often made anonymous or synonymous with their conditions. One author describes the photographs serving to make the subject into object. That is not what is occurring in these American images from the Medical and Surgical History. Once again, these men were not anonymous and were not treated synonymously with their injuries. Immediately after the war, many amputees were viewed with respect by the American public: their empty sleeves were testament to the ultimate bodily portrayal of their patriotic sacrifice. The veteran was celebrated in poetry, song, and other discourse (though this idealization may have done little to actually help them economically). Nevertheless, this lack of anonymity and fairly dignified portrayal of these men as individuals may be a reflection of the respect afforded to veterans of the victorious North, as compared with the portrayals of French psychiatric patients. It may also explain the conspicuous lack of photographic portrayal of any of the injured from the 180,000 strong African American contingents of the Union army (or, rather: in my perusal of two of the six volumes I could not spot any).

Medical imaging really highlights the tensions between photography’s uses in “artistic” genres, such as portraiture, and “objective”, “scientific” ones. Drawing a hard and fast line between examples of “art” and “science” are not as straightforward as many would think.

These thoughts were originally shown to the wider world (or, at least, at Carleton University) at the Underhill Graduate Student’s Colloquium on March 7th, 2013. A seminar paper will soon follow. If this is something that interests you (as it interests me!) please don’t hesitate to message me. If you have any other intriguing examples from the early days of photography, particularly medical imaging, please share it with the rest of the class.

Further Reading

  • Dammann, Gordon E. and Alfred Jay Bollet. Images of Civil War Medicine: A Photographic History. New  York: Demos Medical Publishing, LLC., 2008.
  • Figg, Laurann and Jane Farrell-Beck. “Amputation in the Civil War: Physical and Social Dimensions.” Journal of the History of Medicine & Allied Sciences Vol. 48 Issue 4 (October 1993): 454-475.
  • O’Connor, Erin. “Camera Medica: Towards a Morbid History of Photography.” History of Photography. Vol. 23, Number 3 (Autumn 1999): 232-244.
  • Otis, George Alexander and J.J. Woodward. Reports on the extent and nature of the materials available for the preparation of a medical and surgical history of the rebellion. Philadelphia: J.B. Lippincott & Co., 1865.
  • Trachtenberg, Alan. Reading American Photographs: Images as History, Mathew Brady to Walker Evans. New York: Hill and Wang, 1999.
  • United States Surgeon General’s Office. The medical and surgical history of the war of the rebellion, 1861-65, Volumes 1 – 5. Washington: Government Prints Office, 1875. (Available in digital form online, links at the bottom of this blog post.)
  • Wells, Liz, Ed. Photography: A Critical Introduction. London and New York: Routledge, 2000.
  • For more examples of screenshots from the Medical and Surgical History, you can also visit one of my Pinterest boards in which I screen captured intriguing or representative pages.)

Dr. Mary Walker was one classy lady

Two or three years ago, while doing research on Civil War medicine at the University of Alberta, I ran across an interesting reference to a particular female doctor who served during the conflict on the Union side. Her name? Dr. Mary Walker.

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Here she is in a photograph taken around the time that she served during the war. (All images courtesy of the Digital Collections of the American Library of Congress: keyword search “Dr. Mary Walker”.)

You might notice something intriguing about what she’s wearing. Namely, it doesn’t look anything like this or this, two examples of higher-class women’s fashion from the decade of the 1860s: the largest hoop skirts that would be tolerated (which evolved into bustles in the following decades) covered by more petticoats (it wouldn’t do to have the line of the hoops show), covered, finally, by the actual dress.

That was a lot of fabric, none of which is evident in the above photograph. In fact, if you didn’t know any better, it looks like she’s wearing… men’s trousers underneath that short skirt. And you’d be right.

Dr. Walker believed that tight corsets along with voluminous skirts and petticoats were unsanitary and hampered her medical practice. So she didn’t wear them: first sporting bloomers, then, midway through the war, abandoning those for a male surgeon’s uniform. She didn’t attempt to pass as a man; she was an obviously female doctor wearing a male uniform.

“They said she was too lazy to wash her clothes,” wrote one biographer, “that she wanted to display her legs, that she was seeking publicity…”

(cited in Leonard’s Yankee Women, 109)

When she was captured by Confederate scouts in April, 1864:

“Dressed in trousers and a surgeon’s uniform, the twenty-five-year-old made such a sensation when she rode into camp [at Richmond’s Castle Thunder] that several Confederate soldiers and visiting wives mentioned the incident in their letters and diaries.”

(Schultz, Women at the Front, 177)

She continued to wear men’s clothing throughout her long life (she lived until 1919) and continually advocated for rational dress reform for women. Here, she is pictured in a man’s top hat in her old age, circa 1911.

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Dr. Walker was awarded a Congressional Medal of Honor for her contributions during the war – she was, after all, captured by the enemy – but when the American government changed its regulations decades later, they tried to revoke her medal, as she was a medical officer who had never seen combat. She refused to return it, and to make a point wore it all the time. (Honestly, just don’t award any new medals to people who don’t meet the right qualifications: don’t try to take ones that have been already awarded to awesome folks who have already proven their stubbornness!)

Here she is, pictured near the end of her life, wearing the infamous medal. Again, see how much women’s fashion has changed over the years, and how dapper and comfortable Dr. Walker looks in her old age.

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One more photograph before I leave you:

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For more information on Dr. Mary Walker and other awesome Civil War ladies, check out the following:

Leonard, Elizabeth D. Yankee Women: Gender Battles in the Civil War. New York: W.W. Norton, 1994.

Schultz, Jane E. Women at the Front: Hospital Workers in Civil War America. Chapel Hill: The University of North Carolina Press, 2004.

And of course the Digital Collections of the Library of Congress for the images: http://www.loc.gov/library/libarch-digital.html