Always Read the Plaque: John Snow and the Broad Street Pump

I really enjoy reading historical plaques. They are a fascinating way of learning local history, embedded in the built landscape. At the very least, they’re an interesting insight into the history that locals are invested in commemorating.

On my recent trip to the United Kingdom, I had the pleasure of being introduced to one of the people who work at the historic Fairfax House in York (sadly, closed for cleaning while I was in the city). However, he recommended I visit one little York monument in particular, and I’m so glad I followed his advice because it commemorates a fascinating event in the history of medicine in a very evocative way. Aside from the little round blue York Civic Trust Plaque and an explanatory interpretive panel, there was this simple monument:

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John Snow was born in York (hence, why this monument is in York and not in London) but became known later in life for 1) being the anesthetist to Queen Victoria when she first started using anesthetics during childbirth and 2) proving to health professionals and the public that cholera was waterborne. During an epidemic of the disease in London in the 1850s, he made a map of where all of the dead had once lived, and discovered that what they had in common was that they all drank water from the same pump. The water from the Broad Street pump actually had a reputation for being very clear and sweet tasting, so it was very counter-intuitive that it was the cause of the outbreak, particularly as the miasma theory of disease was the dominant way of explaining how maladies spread. By removing the pump handle, he stopped the spread of the cholera epidemic. That event is what is commemorated with this simple statue.

If you would like to know more about John Snow stopping illness in its tracks and how to shift the mindsets of people when it comes to health issues, definitely read Steven Johnson’s book The Ghost Map: the Story of London’s Most Terrifying Epidemic and How It Changed Science, Cities, and the Modern World. And as always, when you encounter them, read the plaque.

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Researching the Minutia of Edwardian Daily Life for “The Beauty Doctor”

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In the spring of 1907, Abigail Platford finds herself unexpectedly adrift in New York City. Penniless and full of self-doubt, she has abandoned her dream of someday attending medical school and becoming a doctor like her late father. Instead, she takes a minor position in the office of Dr. Franklin Rome, hoping at least to maintain contact with the world of medicine that fascinates her. She soon learns that the handsome and sophisticated Dr. Rome is one of a rare new breed of so-called beauty doctors who chisel noses, pin back ears, trim eyelids and inject wrinkles with paraffin. At first skeptical, she begins to open her mind, and then her heart, to Dr. Rome. But when his partnership with an eccentric collector of human oddities raises troubling questions, Abigail becomes ensnared in a web of treachery that challenges her most cherished beliefs about a doctor’s sacred duty and threatens to destroy all she loves.

Last fall, I was approached by historical fiction author Elizabeth Hutchison Bernard to review the manuscript of her historical suspense novel, The Beauty Doctor. She had already done a tremendous amount of research but needed someone to help her fill in a few gaps as well as to ensure that she had accurately captured some of the nuances of the Edwardian era. In particular, she was concerned about subtle differences between the Victorian period, about which there has been so much written, and the Edwardian period, which was relatively short but did represent a huge shift in certain aspects of American life and culture. I soon fell into a rabbit hole of research, exploring the fascinating world of early plastic surgery and gender politics in 1907.

Conducting research for a novel, as opposed to many academic articles, had me seek out interesting details of daily life that aren’t often recorded. (Do you make note of which streets in your town are paved or unpaved? What about if there are electric street lights on the corner of your street? Did you change your clothes before you went out for a walk this afternoon, or not?) Luckily for me, the action of the novel largely takes places in New York City, one of the most documented cities in the world! Still, some details remained elusive. The Edwardian era was a time of flux when it came to technology as well as social values: an excellent backdrop for a historical drama!

A lot of research starts with a concrete question, and the author had noted in her manuscript quite a few specific ones about what she wanted me to either weigh in on or help answer with further research. Here are some of the useful resources and fascinating details I uncovered while researching The Beauty Doctor

  1. How do you start a car at this time? 1907 was very early in the history of automobiles, and they were largely considered playthings for the rich – and they were dangerous. One of my favourite sources for perceptions of cars in the early days was this podcast episode from 99% Invisible. But how do you operate a car from this time period? It was far from standardized like it is today. My best source was to simply go on youtube and watch people start vintage cars like this one. A picture – or video – is worth a thousand words!
  2. What kinds of clothing would a character wear on particular kinds of occasions? What a character wears says a lot about them as a person, and it will change depending on the situation they find themselves in. Reading historical etiquette manuals helped me get into the mindset of what was appropriate and inappropriate to wear – and remember, not all characters act according to society’s wishes. This was something that the author and I discussed frequently, as she had very definite ideas about what some of her characters should and should not do or wear. I found that her instincts about such things were quite good. For example, her character Alexandra Gagarin, the Russian countess, often wore a kimono; the Asian influence actually was quite in vogue at the time. I found collections of  historical fashion plates invaluable, particularly for characters from higher classes. Mail order catalogues are also very handy to see what an everyday person could buy, ready-made, and that’s not just limited to clothing! Of course, photographs of women and what they really wore, as opposed to illustrated fashion plates, are also incredibly useful, and fascinating to boot.
  3. Would they have said it like that? How do you check and see if a word was in use over 100 years ago? The author had actually been very careful about her selection of words and researched the origins of most all of them that were questionable. However, a second pair of eyes is always a good idea! I’d often reach for two different resources to confirm or deny my gut feeling of a word or phrase sounding too modern. Google Ngram is a nifty tool that allows you to search Google Books for the prevalence of words or phrases over time, and displays them in chart form. Here, for example, is a graph depicting the published use of the phrase “makes them tick” in published material. (It seemed to come into popular use after the Second World War.) This online etymology dictionary was incredibly handy to see when a word first joined the English language and how it has evolved over the centuries. I learned, for example, that the word “concussion” has a long history: “c. 1400, from Latin concussionem (nominative concussio) “a shaking,” noun of action from past participle stem of concutere “shake violently,” from com “with, together” (see com-) + quatere “to shake” (see quash). Modern brain injury sense is from 1540s.” A lot of words that I checked because they felt too modern to me turned out to have older origins than I anticipated! The word “boss” dates from the 1640s. The word “handy” dates back to the 1300s! And sometimes it’s just the way a word sounds, rather than its date of origin.  For example, the author liked my suggestion to use the word “position” instead of “job.” Either would have been perfectly correct, but the former has a more old-fashioned “ring” to it.
As for the medical aspects of the book, especially plastic surgery, the author was quite an expert in that herself. She did, however, ask for my help in finding some photos of operating rooms from the first decade of the 20th century, including how the doctors and nurses dressed.  Of course, most of the medical scenes in The Beauty Doctor don’t take place in a hospital but instead in a private doctor’s office set up as an operating room. There was definitely some improvisation required!
     I really enjoyed the story of The Beauty Doctor and think you will, too.  The book is available now through these fine retailers!

 

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.)

A Matter of Life or Limb

“To amputate, or not to amputate? That is the question.
Whether ‘tis nobler in the mind to suffer
Th’ unsymmetry of one-armed men, and draw
A pension, thereby shuffling off a part
Of mortal coil; or, trusting unhinged nature,
Take arms against a cruel surgeon’s knife,
And, by opposing rusty theories,
Risk a return to dust in the full shape of a man.”

American Civil War era poem, quoted in Ira M. Rucktow, Bleeding Blue and Gray: Civil War surgery and the evolution of American medicine (New York: Random House, Inc., 2005), 219.

 

While perusing my old notes on Civil War medicine for a current research project, I ran across this parody of Hamlet’s great soliloquy. It really does summarize some of the agonizing (if you’ll forgive the terrible pun) choices faced by wounded soldiers during the American Civil War.

The thing is, I feel that people, if they know one thing about Civil War medicine, it’s that it was “barbaric”. The word “butchery” comes up a lot. Piles of severed limbs, men with grimy hands wearing blood soaked aprons and wielding butcher knives.

And yes, there was some of that. But there was so much more.

People don’t tend to question the conditions that led up to such “butchery”, which, as shocking images, did of course get stuck in the popular memory a lot more than, say, the regimental surgeon who also pulled teeth if you needed it, splinted broken fingers and whined at the men to dig better latrines. (Or to use the latrines that they had been forced to dig already.)

If there are only five doctors and a handful of pre-professionalization nurses (often convalescing soldiers who aren’t quite up to snuff for regular duties but can probably hold a tray or wrap a bandage) to help you after a big battle and there are about five hundred wounded men pouring in and they all have to be treated right now… yes, you are going to have to be quick and fast at your job. Which will involve amputation.

(Incidentally: yes, they did use anaesthesia during the Civil War. Quite a lot of it, actually. Many historians estimate (guestimate?) that about 90% of operations during the war were performed with either ether or chloroform, and the 10% that didn’t were mostly in the South, which had supply line problems.)

A lot of people, by which I mean “the public” (AKA non-academics), members of the modern medical profession and even historians (I’m looking at you, military historians who just want to make a statement about the horrors of war!) still propagate exaggerations and misinformation about the state of Civil War surgery, acting outraged that the surgeons of the era couldn’t predict innovations such as germ theory (which wouldn’t happen for another decade or so), that there were a lot of unnecessary amputations, and so on. Honestly, if you’re going to be presentist like that… Just think, how perfect is medicine today, in 2013? In a hundred years, won’t people look back on our era and, shocked, exclaim, “What do you mean they cut people open during surgery? That’s barbaric! Why didn’t they use [laser whatsits]? What do you mean, some people drank ten cups of coffee a day? Didn’t they know about the horrific effects of  [X, Y, Z]?” It’s all relative, but we have a particular need to be harsh judges of medical practices in the past, perhaps because the medical profession is viewed as a sort of straight, steady line of progress, instead of the wobbly vaguely upward line I feel it really was – in fits and starts, with some backtracking, and continually changing.

But I digress. Why weren’t Civil War surgeons as bad as we think they are? For your consideration:

1) The types of ammunition being used during the Civil War were not like those of today, which move so quickly that they cauterize the wound as they go in. Minié balls and musket balls ripped through flesh and often brought bits of dirty clothing into the wound, causing it to fester. These heavy slugs were also more likely to shatter bone, which, almost invariably, grew infected.

2) Ambulance systems were still in their infancy, and so it wasn’t unusual for men to be lying on the field for over a day, sometimes up to a week, dying but not dead, before they were “rescued” and brought to a doctor. How much could a surgeon do at that point?

3) Yes, this era was pre-germ theory. But pro-sanitation! Get rid of that miasma (which everyone knows causes disease), so clean up those wounds quickly, introduce fresh air, clean bandages, get any and all filth away from the men. (Fun, shocking fact of the day: Florence Nightengale, that secular saint of a nurse, was pro-sanitation but anti-germ theory for a surprisingly long time, only giving in near the end of her life. Why? Because she felt that germ theory offered no new treatment plans, nothing different from what she was already doing.)

4) Theoretically, a more delicate operation like resection (removing a section of damaged bone) could save that man’s limb. But if you have another hundred men lying around you screaming in pain waiting for their operation, do you really have time for a longer, protracted procedure? The cost of that man’s semi-functioning limb would be the lives of several of his comrades.

So, all in all, if you are shot, say, in the upper arm, you will likely have a shattered bone with bits of whatever was on the exterior of your coat and shirt pulled in with the projectile. You are unlikely to get timely medical care because of the nature of battle, the ambulance system, and the overworked nature of the surgeons… leaving aside the roll of the dice as to whether you get a competent surgeon in the first few years – the examinations were much more stringent later in the war, but there were fewer surgeons around, too. “Laudable pus” is expected as a natural part of the healing process; your limb is going to get infected, likely badly. Amputation is, in all honesty, the best option for your survival.

Life or limb. You choose.

Further reading (and I can recommend so much further reading on this topic):

Johnson, Steven. The Ghost Map: the story of London’s most terrifying epidemic – and how it changed science, cities, and the modern world. New York: Riverhead Books, 2006.

Schmidt, James R. Civil War Medicine (And Writing): A Blog on Civil War-Era Medicine and My Own Research and Writing (AKA Shameless Self-Promotion).

Rucktow, Ira M. Bleeding Blue and Gray: Civil War surgery and the evolution of American medicine. New York: Random House, Inc., 2005.

United States Surgeon General’s Office. The medical and surgical history of the war of rebellion, 1861-65, Volumes 1 – 5. Washington: Government Prints Office, 1875. (Part III, Volume II, at least, available in its entirety here.)

Wilder, Burt G. Practicing Medicine in a Black Regiment: The Civil War Diary of Burt. G. Wilder, 55th Massachusetts. Edited and introduced by Richard M. Reid. Amherst and Boston: University of Massachusetts Press, 2010.

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