Tag Archives: Medical History

Review: Encyclopedia of asylum therapeutics, 1750/1950s”

Book Cover

Encyclopedia of asylum therapeutics, 1750/1950s

I have been fascinated with medical history for nearly a decade now so when I saw a chance to review Mary de Young’s book “Encyclopedia of asylum therapeutics, 1750/1950s” I jumped at it. By the time it arrived I was having second thoughts, I have not read anything about the history of psychiatry, the book is an imposing 353 pages of double column text, and I had just struggled through a book that failed to catch my interest at least in part because I felt it lacked organization. This book was obviously organized, as an encyclopedia. I was concerned about its readability, how many encyclopedias compel you to keep reading? This one.

I should have expected that the early treatment for various real and imagined mental disorders would have been based on the same Greek theories of humoral balance as physical medicine was up until the middle of the 19th century. Even the same players were showing up, Dr. Benjamin Rush, a founding father, medical advisor to the Lewis and Clark expedition, and professor of medicine at the College of Philadelphia Department of Medicine turns up in more than a few entries. Benjamin Franklin came up with an electricity based treatment and, when it seemed to work, he wrote that it could have been her faith in the treatment that cured her, not the treatment. This was decades before the term “placebo effect” was even coined. So many of the “treatments” documented here by de Young were also used to treat physical illnesses and she explains them so clearly that this book is a valuable resource for any student of medical history.

If you have ever questioned why so many horror movies are set in asylums this book holds the answer. Bethlem Asylum, also known as Bedlam, and its treatment regimens are frequently discussed and they, and the rational for them, are fascinating. If someone is manic, they need a calming influence, try music, try putting them in a pink room*, try bleeding them, try bathing them in static electricity.** If they are sullen, refuse to interact with the world, raise their spirits, try music, try a green room, try bleeding, try a cat piano, a cat piano is a box containing a number of trapped cats and is equipped with a keyboard that cause a nail studded hammer to hit a cat’s tail. It is believed to be imaginary but imagine the cacophony it would create. I can imagine it would wake the dead as well as get the attention of any mental patient.

In another book that I read recently it was pointed out that in the late 1800s there was a movement painting masturbation as both evil and very dangerous. I noticed in this book a change in the language, before the late 1800s it was very possible to be institutionalized for “excessive masturbation” but then the explanation of a patient’s madness became simply “masterbation”. The extreme range of treatments for any madness that the doctors associated with sex was frightening. “Wiring”, surgical implantation of a wire into the end head of a man’s penis to stop, well, you know what it was intended to stop. This was about the same time that male babies in the US began to be circumcised, not to “prevent disease” but in an attempt to make masterbation less appealing.

More modern treatment are covered, transorbital lobotomy is accompanied by a photograph I found a little disturbing outside of a zombie movie. There is also enlightenment for social commentators on current causes. Ritual clitorectomeys are desturbing in other cultures but before we demonize them maybe we need to understand the use of the procedure, and other sexual surgeries, in our history.

The writing is clear, as clear as the topic permits anyway, and very well documented. The citations are at the end of each section, a system I find much easier to use than crowding all of them in the back of the book. As much as I enjoyed the book it is a very specialized topic. I doubt it will become a bestseller but if you are interested in medical history this book is indispensable.

* As I write this, belittling chromotherapy, the color cure, I see this article about current experiments with using colored light as a treatment. https://clinicaltrials.gov/ct2/show/NCT01782378

** I have to wonder it the ozone produced by the static electricity might have had some effect on the patient, possibly a mild euphoria from the oxygen boost?.

Advertisements

1 Comment

Filed under Book review, History, Medical History, Science, Social History

Review: The story the soldiers wouldn’t tell : sex in the Civil War.

Book cover

The Story the Soldiers Wouldn’t Tell

Dr. Thomas P. Lowry’s 1994 book, “The story the soldiers wouldn’t tell : sex in the Civil War” is still, as far as I can see, the primary book on its topic. That is not bad for a 21 year old history text, but then it is about sex, a topic Americans seem to deny exists. Lowry is a great writer, he controls the scholarly temptation to rely on a multitude of polysyllabic verbiage and keeps it simple and direct. He even manages to keep it light sometimes he is almost funny. He also is a good historian and I expect a good medical doctor. The book is well organized, he makes sure to show us what we need to know before we need to know it. the first two chapters, “Our Founding Fathers” and “The Birds and the Bees” set the stage by showing us what the relationship was between the male armies of the Revolution and the females of the era and then what Americans knew or thought they knew about sex.

General Braddock starting out on his march to Fort Dunquesne limited his army to six women per company and the British arrived in America with one woman for each ten men. Officially the woman were not there to serve the carnal desires of the officers and men but to cook and clean to remove men from those duties. Some were wives of the men or officers. The number of women following the troops as they moved from encampment to encampment and battle to battle grew. Wives and families who still depended on their men for sustenance and protection, women needing paid work who would cook and clean. Doing what men and women do they formed relationships and had sex. Some of the camp followers were willing to have sex for money.

Lowry assumes that people’s behavior and biology don’t change much is a few hundred years so he says that he expects that what Kinsey discovered in the 1940s and 50s was true in the 1840s and 50s. Then he goes to the sources to show us that maybe the people of the 19th century were the reason that Americans are still so ashamed and afraid of their biology. The Church of the Latter Day Saints and their “sister wives”, John Humphry Noyes’ Oneida Colony and its “Complex Marriage”, then there was Sylvester Graham’s views on sex, I will never look at a graham cracker the same way.

Using the soldier’s own words from letters written to home and to friends Lowry shows that the young men in the U. S. Civil War behaved like young men always have but, using statistics on the ratio of couples marrying while already expecting a child he does show that during times of unrest “illicit” sexual activity, sex outside of marriage, increases. Regardless of the praise Mark Twain and other writers gave to the originality of 19th century cursing the remaining letters and court transcripts prove otherwise.

Some of the most interesting revelations Dr. Lowry uncovered concerned venereal diseases, the medical topic that brought him to this subject. In two occupied southern cities the military officer in control set up systems of licensing prostitutes who agreed to submit to weekly medical checks. If they were found to be sick they received free treatment and were isolated from their occupation until a doctor cleared them. Both cities saw a remarkable drop in the rate of disease among the troops and the working women. I am not a student of the U. S. Civil War but apparently the Army of the Pacific, the federal troops from the Pacific area who fought against tribal nations during the war performed very poorly. Apparently many military historians have speculated why that was but Dr. Lowry may have come across the answer, very nearly half of the troops, and officers, suffered from VD during their deployments. As Lowry points out the symptoms of syphilis and gonorrhea do not make riding and fighting any easier.

Lowry gives a full chapter to love and romance, looking at the letters of longing between soldiers and their partners at home. He examines evidence of rape, officers, and clerics, who were not gentlemen, possible transvestites, contraception, abortion, and homosexuality, a term that was not invented until a generation after the war although the term “sodomy” had been in use since the late 13th century. He examines the question of Abraham Lincoln’s sexuality and comes up with what I feel has to be the final answer on that question, there is evidence to support both sides of the argument but nothing to prove either.

“The story the soldiers wouldn’t tell” was an interesting and entertaining read and with it Lowry opened a window into a seldom investigated are of American history. This is one of the better books I have read so far this year and may be the best.

Leave a comment

Filed under Book review, Gender studies, History, Medical History, Social History

Review: No Magic Bullet

book cover No Magic Bullet

No Magic Bullet

Allan M Brandt’s “No Magic Bullet: a social history of venereal disease in the United States since 1880” was first published in 1985. A new edition came just two years later, I have to assume that is because its topic was changing so quickly with AIDS becoming common knowledge. I imagine Brandt wanted a do over on what he had written about AIDS in the first edition’s introduction.

Very early in the first chapter Brandt explains that doctors at first thought that women were not affected by gonorrhea.  I was bothered by this not because I doubted it was true but because just a few pages earlier, in the introduction, Brandt wrote that AIDS was a disease of gay men without questioning what was considered true at the time. At the very least he should have mentioned that at one time gonorrhea had been considered the problem of only one gender. Why study history if we don’t use it to form questions about the present? Even in the introduction to the 1987 edition, when it was well known that there were multiple modes of transmission, he failed to mention the failure in physician’s reasoning in assuming venereal disease, any disease, is limited by gender by anything other than ease of infection. Did Brandt miss the similarity of the failed assumptions about gonorrhea and AIDS?  Did he simply choose not to mention it? I have to believe that if he had noticed it he would have mentioned it even if only to dismiss it as meaningless.

Brandt looked at only two parts of society in this “social history”. One made up of military and public health officials and the other made up of that large and vocal subset of the leisure class that makes everyone else’s behaviour their business, moralists. The military and public health professionals followed the science but often were forced to bow to pressure from the moralists.

The moralists clamor for abstinence before during and after World War I. They continued to clamor for abstinence before during and after WWII. They are still at it. Then, as now, they are only concerned with their version of morality and about other people’s behaviour, not their own. Brandt manages to overlook the opinions of working people, business men and women, minorities in regard to venereal disease. I was surprised that the book was from the 1980s and not the 1950s. People besides the powerful had their agency recognized in the 1960s, why not here?
Sometimes I feel I should make allowances for works of history that are as old as this, twenty eight years since the new edition, but I can’t bring myself to do it. Histories on on narrow topics like this are few and far between. Unlike books about Lincoln or major wars there is not a new volume on the history of VD being published every few months. A search of World Cat for the subject “Sexually Transmitted Diseases United States History” turns up only a few dissertations, several government publications that look like primary sources and Alexandrea Lord’s 2009 book “Condom Nation” which looks at government sponsored sex education from World War II to the present. Unfortunately this could be the go to book on social attitudes about VD for many more years. I hope a student interested in the subject gets creative in their readings and are able to find more than the two viewpoints Brandt offers on the subject.

Leave a comment

Filed under Book review, History, Medical History, Social History

Review: The Treatment

book cover

Martha Stephens’ “The Treatment”

This is a difficult book for me to review for many reasons. I grew up in and around Cincinnati. Cincinnati history was the topic of my capstone paper for my BA in history a few years ago. A class on medical history by a great professor at Miami University hooked me on the topic. After graduation I took to researching Cincinnati’s Dr. Daniel Drake, 1785-1852. I read everything I could to learn about the state of medicine and how it advanced during his life of practicing and teaching medicine. There were a few histories I only read the parts that covered up to the end of his life but there were some that really grabbed my interest that I read cover to cover. Harriet Washington’s “Medical Apartheid” was one of those. That is where I first heard about the Department of Defense funded radiation experiments performed in Cincinnati University Hospital from 1960 until 1972 and where I first heard of Martha Stephen’s book “The Treatment: the story of those who died in the Cincinnati radiation experiments”. It took many months for me to put my hands on a copy and I grew more eager to read it as more time passed.

I was only a few dozen pages into the book before I turned to the appendix listing all the research subjects, my grandmother had died quickly of cancer in 1973. I was happy to see that her name was not among the human guinea pigs selected for “treatment”. The author, Martha Stephens, was involved in much of the fight to expose the radiation program to the public, first as a member of the Junior Faculty Association that brought the program to the attention of the entire University of Cincinnati, not simply a few members of the medical school. (By the way, I have to point out that both the university and the medical school were founded by Dr. Daniel Drake.) Later she worked with the families of the research subjects, helping find them and helping them publicize their lawsuit. Because she was involved in the events some of the book reads like a memoir and the more she talked about herself the more I began to understand that she had been my English professor at UC’s Evening College back in the late 1970s. That, I think, is a full disclosure of my biases over this book. I feel very connected to the story, in some small way I am. I was over eager to read the book. I feel a little protective of Dr. Drake’s school and hospital and, although my degree is from Miami University nearly half my credits were from UC.

I really expected to like this book. That could play into my disappointment with it. Professor Stephens teaches English, not history. The book is disorganized and at times is more of a memoir, covering events unconnected to the subject of the work, than anything else. One of the most blatant offenses to what historical training I have was when she put words into the victims attorney at the start of the hearings. Yes, she pointed out that the speech was what she wanted him to say but I was expecting a work of history, not a fantasy on what should have happened in the eyes of the, non-lawyer, author.

Stephens also falls into the trap that makes so much scholarly writing unintelligible, writing to prove possession of a PhD rather than to clearly and precisely pass on information. I am a college graduate who has been an avid reader for over half a century, why should I need to pull out a dictionary to unravel a sentence that simply says “the apartment was small and neat?” Occasionally a literary reference can be the best way to bring out shared experiences between the author and the readers but multiple references to multiple works on one page is simply egotism.

The last third of the book did start to put the story together in a historically valid way. Sort of anyway. There was still massive gaps in the information that seemed to be equal parts inability to do historical research and editorial blind spots. This is an important story. It concerns Cold War fears, the arrogance of medical researchers brought on by big grants and a God complex. Simply told the story is this, post Hiroshima and Nagasaki it was obvious that radiation was an invisible and mysterious factor soldiers in a nuclear war would have to contend with. After an exposure how could doctors triage their patients, which ones were walking dead men due to the radiation and which should the military spend valuable resources to treat? That is the question that the Department of Defense wanted answered when they funded the University of Cincinnati Medical School’s radiation experiments.

To answer that question the radiation lab selected cancer patients to be given massive doses of radiation in single exposure over their whole body. Exactly like a soldier near an atomic explosion would suffer. Then the doctors would collect and examine blood and urine samples looking for a tell tale marker they could use to determine exposure when the dosage was unknown, as on a battlefield. Other tests were often performed, after all how often do you get a patient exposed to a near lethal dose of radiation to study? Over the twelve years of the study 115 people were irradiated. They ranged in ages from 80 years old to only 9 years old. All were said to have terminal cancer but among the many types of cancer the patients were diagnosed with there were many of the solid tumor variety that it was well understood that whole body radiation was not effective against. The patients were not told this. They were simply told that they were being taken for a “treatment”. They were not told that it could be deadly. They were not told that it was a Department of Defense study. They were not told that the doctors did not expect the patients to get any benefit from the “treatment”. To be fair they were not told that there might be a benefit. Approximately 1 in 4 patients would die within 60 days of the treatment, some that were living normal, active lives up to the day of the treatment.

Over the years various members of the university’s research board would question the program, what was its goal? Was it ethical? The objections would abruptly end for reasons unknown to Stephens until the Junior Faculty Association, which Stephens was a member of, got wind of the “treatments” and investigated. Their objections were handled quietly within the university and the program was stopped and buried.

Nearly twenty years later a woman working at the hospital, transcribing records of an old research project, came across her aunts name. She was listed as a subject, something the family never knew about. Her curiosity led to a multi-year legal action against the university, the city, the doctors, and the federal government that included a historic decision that repeatedly referenced the Nuremberg Code, a code of behavior developed by the Allies after the war crimes trials of World War Two that were to offer guidance on performing medical research without committing war crimes, sometimes referred to as crimes against humanity. According the the doctors of the UC Hospital radiation experiments the only ethical standards in existence when the study began, in 1960, were written for the ethical treatment of animals.

There is a story here that needs a good historian to bring it out. Unfortunately Stephens “The Treatment” only scratches the surface.

Leave a comment

Filed under Book review, Daniel Drake, Education, History, Medical History, Politics, True Crime, Uncategorized

Book Review: The Cholera Years: the United States in 1832, 1849, and 1866

Book Cover

The Cholera Years

“The Cholera Years: the United States in 1832, 1849, and 1866” is only tangentially a medical history. Charles Rosenberg used the opening year of the three worst epidemics of cholera in the United States as lenses through which he could take snapshots of American society. In each year examined the disease spread westward across Europe to inevitably reach the shores North America. By looking at how the medical and religious communities, public officials, and the people, those represented by newspaper editorials, reacted to the stress of the impending epidemics Rosenberg was able to clearly show how society changed over the decades.

“The nest of college-birds are three
Law, Physic, and Divinity
And while these three remain combined
They keep the world oppressed and blind.
On Lab’rers money lawyers feast
Also the Doctor and the Priest.”

This poem, from 1832, shows that popular American distrust for academics is long held. However by 1848 even the upper-class was turning its back on physicians. Today we see governors who ignore the best scientific opinions and follow their own ignorance on Ebola. It does seem that the more things change the more they stay the same. Rosenberg attributes this to the medical communities inability to cope with epidemics, the 1832 outbreak of cholera in particular. The fact is that Galenic physician’s had never been effective. What was it that changed between 1832 and 1848 that made their ineffectiveness unacceptable? Rosenberg does not really look at what caused the change, he just shows that the general attitude did change.

Originally published in 1962 Rosenberg’s book is still readable. The writing is better, in my opinion, than most of the histories published today. I recommend it to anyone interested in 19th century American history, it provides insight to the social values of the times. I do wish that someone would take a look at what caused attitudes about physicians to change. Was it competition? Thomsonians, herbalists, and Homeopathic medicine was giving the traditional physicians competition. They were saving more people by avoiding, at least in large doses, the mercury, arsenic, and other poisons that were some of traditional physicians favorite medicines. I have read how physicians reacted to the competition. One way strategy was forming a trade union, the American Medical Association, and blackballing Homeopaths. I would like to see a scholarly paper on how people reacted to the competition.

Leave a comment

Filed under Book review, History, Medical History, Politics, Science

Book Review: Cholera The Biography

Book Cover

Cholera : The Biography

History is much more than naming Kings, Presidents, and Generals. In “Cholera : The Biography” Christopher Hamlin looks at the ‘life’ of the disease that came to be known as Cholera and along the way manages to show us the development of medical science over the last two hundred years. Before Cholera there was cholera, western medicines name for the “stomach flu”, a 24 hour bout of diarrhea. In 1817 British physicians serving in colonial India noticed a new cholera. It came on with a feeling of unease then came violent vomiting and diarrhea, muscle cramps, the patient’s skin became bluish and their heartbeat unsteady and, in most cases, they died, all with within a single day.

Western medicine, essentially the same medicine practiced by Hippocrates and Galen in ancient Greece, saw disease as the imbalance of the bodies “humors” brought on by foul odors, a change in the air, or sin. Vomiting and diarrhea were good things, the body trying to restore balance. Cholera in India was obviously a result of “filth”, a catchall term for “not like us”. As cholera came closer to Paris and London, it became clear, to the physicians of Paris and London, that the cause was less “filth” and more the judgement of God.

Hamlin covers the changing attitudes toward cholera, the evolving and devolving of cholera treatment by physicians as they groped for treatments and causes and fought to maintain their status and egos. He also looks at the range of government responses to the epidemics, dancing between protecting population and protecting trade.

Cholera was the subject of what was possibly the first “disease biography”, Norman Longmate’s “King Cholera : The Biography of a Disease”, in 1966 and has been featured in other medical histories since then. I now understand why. It spans, and may have helped initiate, the scientific revolution in medical science. At the time Longmate wrote his work Cholera was seen as defeated. We had treatments, we knew the cause of it, we had preventive measures that worked. However the physicians of 1817 also knew that disease was brought on by foul odors, a change in the air, or, possibly, sin. Advances in medical science since the 1960s have changed our medical understanding as much as it changed between 1817 and 1960.

Hamlin’s writing is often fun to read, as when he is explaining how the authorities believed that since “a feeling of unease” was the first symptom reported they believed that a “feeling of unease” may be the cause of cholera. “Worry about fear (or fear of worry) was often at the heart of these {governments}efforts. You might make hysteria a crime, as McGrew notes of Russia, but any attempt to stop it would cause it.” A little science background helps but is not really necessary. At times having a strong stomach helps, there is much discussion of fecal-oral transmission and, obviously, diarrhea.

I learned quite a bit about the advancement of science in the 19th and 20th centuries from this book. Even better I came to understand the present day better after Hamlin compared the debate over the causes of cholera to the climate change debate. Neither side is likely to be convinced until the other essentially proves a negative. “Cholera : The Biography” is perhaps the most enlightening history I have read in the last year and with Ebola in the news seeing how difficult it is to quarantine a disease and how economics and ego can put ahead of public health is cause for concern.

Leave a comment

Filed under Book review, History, Science

Review: Missing Microbes

Helicobacter pylori from WiliMedia Commons

Helicobacter pylori from WiliMedia Commons

Every now and then when I finish a book I have to sit back and take a long breath and reflect. Martin J. Blaser’s Missing microbes : how the overuse of antibiotics is fueling our modern plagues is one of those books. I requested it from LibraryThing.com’s Early Reviewer program as soon as I saw it offered. For the last few years I have been studying the last 200+ years in medical history. Germ theory has existed for only a little more than half of that time. I was interested in what Dr. Blaser considered missing microbes. I had also heard a story on NPR a few months ago that stuck in my head because of its ingenuity and grossness. Some people with severe digestive disorders have been treated with a , uh, well they have the gut bacteria from a healthy donor transported into their gut. It works, their symptoms clear up.

Blaser points out that all life started out microbial and slowly formed colonies that specialized into multicellular life, into more and more complex forms of life and that all that time the multicellular life co-existed with single cell life forms. Some of them are dangerous. If Vibrio cholerae takes up residence in your gut it produces a chemical that mimics one your body naturally uses to signal the intestinal walls to move water out of the body. Cholera caused such severe diarrhea, moving water out of the body into the gut, that it could kill a health person in less than a day. Luckily most of the microbes in and on our bodies are harmless or even helpful. At least one digests food we are unable to use into forms that we can use. How many microbes are there that provide us with benefits that we don’t know about?

The star of the book is Helicobacter pylori, a spiral shaped bacteria first discovered in the early days of germ theory and quickly forgotten about. It was found in everyone’s stomach and it was impossible to grow in the lab with the existing technology. Many years later it was rediscovered in the stomachs of some people and it was blamed for very bad things ranging from ulcers to stomach cancer. How did it go from being in everyone’s stomach in the late 19th century to only some stomachs in the mid to late 20th century? Wide spectrum antibiotics.

The book makes a very good case for the theory that our overuse of antibiotics, over prescribing and using in animal feed, is not only creating Multi Drug Resistant, MRD, bugs but it is killing off potentially helpful bacteria that has co-existed with human beings for ages. After demonstrating a correlation between acid reflux disease, which can progress into nasty throat cancer, and the lack of H. pylori Blaser asks if the modern rise in allergies, asthma, autism, obesity,* and type 1 diabetes are the result of a missing beneficial bacteria.
In my opinion in a hundred years this book will be considered a major turning point in medical science. I don’t know how the medical establishment will look at it today. There is so much money wrapped up in the status quo that any change, even for the better, will be resisted. I have never been a fan of hand sanitizer and after reading this I will question my doctor about the necessity of any antibiotics he offers me. You need to read this book.

* low dose antibiotics have been given to farm animals for over 50 years to speed their growth, antibiotics are undoubtedly one factor in the obesity problem.

Leave a comment

Filed under Book review, Science