Category Archives: Interesting Facts about Medical Practice 1880-1930

Do you want your head examined?

17 Monday Jul 2017

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In today’s culture, if someone told you that you should have your head examined, you’d probably take it as an insult. In the early 1800s, people were clamoring to have their heads examined–by those trained in the new “science” of phrenology.

Coined from the Greek “phren” (mind) and “ology” (study or discourse) by German physician Johann Spurzheim, phrenology was the “classification and study of mental faculties through measurements of the skull” (Cassedy 43). Franz Joseph Gall, a physician in Vienna, was the first to develop a theory that the brain was not one organ but many, each with a special function, and that the shape of the skull matched the shape of the brain within it. Therefore, “studying the bumps and indentations of the skull could reveal information about the size, structure, and function of the brain areas beneath it” (Janik 55).

In a time before x rays, CT scans, or MRIs, this new way of gathering knowledge about the brain and its functions proved irresistible and soon spread beyond purely scientific interest to include an emphasis on self-improvement, more humane education of children, and better health in general. The idea that anyone, not matter what his status in society, could learn about himself and then improve on his abilities and achieve success fit perfectly into the popular mindset of the times.Phrenology Head

Head readings were often done using a device invented by Gall called a craniometer that fit over one’s head and guided the person doing the reading to certain key areas of the skull. There were even do-it-yourself guides for taking a reading of one’s own head. Maps showing the various areas were published in magazines and hung in doctor’s offices. In reality, the readings basically confirmed what the person wanted to hear. As Erika Janik explained, “Readings tended to shore up prevailing attitudes and reflected contemporary beliefs about the appropriate roles of men and women” (69).

Brothers Lorenzo and Orson Fowler were extremely successful in marketing phrenology to the masses in America. At the height of their popularity, some employers even required a Fowler reading as part of the application process for a prospective worker (Janik 70).

By the 1840s, however, the popularity of phrenology began to wane as new scientific advances took center stage. But its influence lingered, especially in more rural areas, as attested by its mention in my great-grandfather’s diary as late as 1874. As part of his teacher training at Northwestern Normal School in Fostoria, Ohio, he attended a lecture on phrenology and had his head felt by a dozen students. No mention was made of their observations.

Sources:  Cassedy, James H. Medicine in America: A Short History. Baltimore: The Johns Hopkins University Press, 1991.

Janik, Erika. Marketplace of the Marvelous: The Strange Origins of Modern Medicine. Boston: Beacon Press, 2014.

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The Pandemic of 1918

14 Tuesday Feb 2017

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In the fall of 1918, American involvement in the Great War in Europe was at its peak. Ships filled with wounded troops returning from combat crowded the Eastern harbors. At least this time, recent advances in medical knowledge meant that more of the wounded were surviving–a much different scenario than had been experienced in the late Civil War. Using antibiotics, X-ray machines, improved surgical techniques, and other recent advances in medicine, doctors and nurses on the front worked valiantly to send more boys home alive.grim-reaper

But unbeknownst to the medical community, an even deadlier foe lurked in a number of locations around the world against which they had no defense. A new strain of influenza would soon make its appearance and wipe out an estimated 20 to 40 million people worldwide in less than a year. In the United States alone, “more than 25 percent…became sick, and some 675,000 Americans died during the pandemic” (History.com staff, 2010).

Known familiarly as the Spanish flu because Spain was one of the first countries to experience its devastation, this highly contagious disease hit young, healthy people particularly hard. New recruits swarming into crowded army camps around the U. S. proved a fertile field for the spread of the germ. At Camp Sherman in Ohio, for example, the flu wiped out almost 1200 men (Influenza epidemic, n.d.). And the movement of troops across Europe compounded the problem. One journalist stated that “more U.S. soldiers died from the 1918 flu than were killed in battle during the war” (History.com staff, 2010).

The Spanish flu was particularly virulent. Starting out as a mild case with the ordinary symptoms of flu, it would rapidly develop into a vicious type of bacterial pneumonia, leaving its victims gasping for breath and quickly causing death by suffocation. As noted in Billings’ article (1997), stories circulated of people becoming ill while walking to work and dying within hours. In another case, four women were playing cards late into the night, and by morning three of them were dead. In San Diego, children would jump rope to a new rhyme: “I had a little bird. Its name was Enza. I opened up the window. And in-flu-enza” (Billings, 1997).

As with modern versions of the flu, this one had no respect for social class or age or gender. In some places, whole towns came to a standstill. Schools, businesses, churches, and theaters closed.There was no mail delivery or garbage pick-up. People were required to wear masks and to refrain from shaking hands or gathering in crowds. Private homes and other buildings became temporary hospitals. Funeral parlors and grave diggers couldn’t keep up with the demand.

The shortage of doctors and nurses became particularly acute at the home front. Many medical personnel had already been pressed into service overseas, and those left in the U.S. were overwhelmed trying to care for both the wounded soldiers and the new influx of flu victims. In the small Midwest town of Willard, Ohio, Dr. Harry G. Blaine, my great-grandfather, was solicited by the Surgeon General to serve as an Army physician, but hastened to reassure his fellow citizens in Willard that he would not leave his current practice unless the need became urgent. He was one of only two physicians left in the town.

The situation could have been worse. Due to the war and all the restrictions it imposed on the public, the American people were already used to government regulations. “People allowed for strict measures and loss of freedom during the war as they submitted to the needs of the nation ahead of their personal needs” (Billings, 1997). Public health officials therefore had an easier time enforcing their rules during the epidemic. No vaccines were available to prevent this dreaded disease, but people readily obeyed imposed quarantines and restrictions on travel and thus helped to slow its spread.

The flu pandemic of 1918 paved the way for the development of the first licensed flu vaccine in the 1940s and encouraged the public to accept the role of medical science in preventing future pandemics.

References:

Billings, M. (1997). The influenza pandemic of 1918. Retrieved from         https://virus.stanford.edu/uda/

History.com/staff. (2010). 1918 flu pandemic. History.com. Retrieved from http://www.history.com/topics/1918-flu-pandemic

Influenza epidemic of 1918. (n.d.). Ohio History Central. Retrieved from http://www.Ohiohistorycentral.org/w/Influenza_Epidemic_of_1918

The Scourge of Smallpox

28 Monday Nov 2016

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hypodermic-needleIf you are age 70 or older, you may remember getting vaccinated for smallpox when you were a child. This disease that used to kill about a third of the people who contracted it and left scars on the rest is now only a faint memory, thanks to Dr. Edward Jenner from England, who developed the first vaccine back in 1796. It took, however, almost 200 years and a number of intense vaccination programs on every continent to finally declare the world free of smallpox.

Why did it take so long? A closer look at what happened in the United States will shed some light on the development of medicine in general during that time and its relationship with government.

Early attempts to control this very infectious disease involved a procedure called variolation. In this process a small amount of the pus from a person with an active case of smallpox was scratched into the arm of a well person. The well person sometimes developed similar symptoms of fever and rash but did not die from the disease. In contrast Jenner’s vaccine was created using the pus from a similar disease in cows, called cowpox.

Manufacturing this more effective vaccine in the United States finally took off in the 1870s. All a person needed was a heifer, a seed virus from a case of cowpox, the passing on of the virus to subsequent calves, and some ivory points to transfer the vaccine to humans. Although this vaccine was easy to manufacture, it was also difficult to regulate its purity. It took about 20 more years for the manufacturers to finally add glycerin to the vaccine to rid it of harmful bacteria. But by then the general public had developed a mistrust of the whole process–and a healthy dislike of government interference.

In the 1890s, control of infectious diseases was still in the hands of local and state officials. Public health programs were starting to gain popularity in many communities, but according to Michael Willrich in Pox: An American History, “No public health measure inspired more ill will than compulsory vaccination” (91). And vaccination programs targeting school children were particularly unsuccessful in regions that still had no laws mandating school attendance.

Another difficulty lay with local doctors who often had limited formal medical training and sometimes misdiagnosed the skin rash of smallpox as measles or some similar disease, thereby allowing one or two isolated cases to explode into an epidemic that would ravage entire communities.

It took the power of the federal government to finally regulate the quality of the smallpox vaccine. Under the Biologics Control Act of 1902, manufacturers of the vaccine were now required to have a federal license and to agree to unannounced inspections of their facilities.

But even with a more reliable vaccine, programs of mandated vaccination of school children, especially during threatened outbreaks of the disease, still met with fierce opposition from parents and even some school officials. The first decade of the 20th century was a time of great change in American  society. With government assuming more and more power, some citizens saw their personal liberty draining away. Even J.W. Hodge, a homeopathic doctor, declared, “Compulsory vaccination ranks with human slavery and religious persecution as one of the most flagrant outrages upon the rights of the human race” (Willrich 254).

As smallpox epidemics continued to decimate whole communities, not only in the United States but around the world, a series of intense vaccination campaigns waged by the World Health Organization finally stopped the disease in its tracks. By 1952 North America had eradicated the disease, and the other continents followed. Finally, on May 8, 1980, the World Health Assembly officially declared the world free of smallpox.

There may be no more smallpox, but the controversy over mandatory vaccinations is far from over. Questions still remain: Who has the power to make medical decisions for children? And when is the freedom of the individual to be limited for the good of all?

References consulted: (1) “History of Smallpox.” Centers for Disease Control and Prevention, 30 Aug. 2016, http://www.cdc.gov/smallpox/history/history.html. (2) Michael Willrich. Pox: An American History. The Penguin Press, 2011.

 

Resurrectionists

25 Tuesday Oct 2016

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gravestone

It was an early fall night with a full moon hanging over the horizon. A medical student and his two helpers worked feverishly, their spades sinking easily into the freshly covered grave. A hard clunk signaled that they had found their mark. Digging more carefully, they uncovered the wooden coffin and pried open the lid. The young girl’s body, still serene in death, was carefully lifted out. Her silk dress was removed and the body transferred to a straw-filled trunk.

The trunk was then sent overnight by train to Toledo, Ohio, not far up the line. With luck, it would ultimately be delivered to the Toledo Medical College as payment for the medical student’s last months of training. In Ohio there was still no formal law on the books in 1886 that allowed for legal donations of cadavers for medical school laboratories, so some schools would accept a human cadaver for dissection in lieu of tuition. Desperate students sometimes resorted to grave robbery themselves or hired “resurrectionists” to do the work for them.

Luck ran out on this particular medical student. By the time the trunk had sat awhile on the train platform in Toledo, a noxious smell led to the opening of the trunk and the discovery of the body. Foul play was at first suspected, but on closer examination of the body, the truth of the situation was quickly ascertained. When the unsuspecting medical student arrived to claim the body, he was promptly arrested. And since the student had used my great-grandfather’s railroad pass, Dr. Harry Blaine was also arrested as an accomplice.

Both of them may have gotten off with a reprimand except for the hornet’s nest of indignation that the robbery stirred up in the tight-knit farm community. The young woman, only 17 when she died of tuberculosis, had been very popular, and her grief-stricken father was out for revenge, even calling for a posse to hang the men involved!

Fortunately, the order of law prevailed. The medical student was tried and sentenced to one year in the Ohio Penitentiary. After serving his sentence, he went on to finish his studies and served as a respected doctor in a nearby community for over thirty years. Dr. Blaine was finally cleared of all  charges and remained a prominent physician in the area until his death in 1930.

This macabre tale of grave robbery made national news at the time and is still resurrected occasionally, especially around Halloween, as a reminder of how far medical education has come.

Hospital Trains in WW I

19 Monday Sep 2016

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wwi_us_hospital_train

In World War I, over 200,000 American soldiers were wounded in battles throughout France and Germany. Getting them to the American hospitals that were constantly being moved nearer to new front lines and then to the more permanent base hospitals became a logistical nightmare. With functional helicopters not invented until after this war, trains, trucks, and ambulances served to transport the wounded from the battlefield to a place of relative safety where they could be treated for their wounds and sent back to the U.S. or back into battle.

Adding to the problem were attacks by the Germans which temporarily disrupted the railroads and congestion on the few usable roads due to heavy damage from bombings and artillery fire. At times there were not enough hospital trains to quickly evacuate wounded soldiers from field hospitals or to move the hospital equipment to new locations. The American trains, shipped over by boat, were better equipped and larger than the French ones, but with the demand so high at times, the Allied Forces shared what they had.

In some of the heaviest fighting, surgeons worked 20 out of each 24 hours. One American evacuation hospital set a record for operating on 350 cases in one day during the last offensive before the Armistice!*

William Gillespie Blaine, the youngest son of Dr. Harry G. Blaine, served in the U.S. Army on Hospital Train #54 in France from early 1918 to the middle of 1919. Even though the Armistice had been signed on November 11, 1918, Will was still working later that month, “returning from a trip that has taken four days and three nights with a  trainload of sick and wounded that are being sent back to the States,” as he shared in a letter to his mother. He never mentioned any details of his work, so one can only guess at the horrors he witnessed while transporting wounded comrades to safety.

At least for the wounded of this Great War, medical advances in surgical techniques, along with the invention of diagnostic equipment like x-ray machines, greatly increased their chances of survival. And the hospital trains played a crucial role in providing interim care on their journey to recovery.

*www.history.amedd.army.mil/booksdocs/ww1/Jaffin

Watch Out for Miasma!

09 Monday May 2016

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Like “chirurgical,” the word “miasma” comes from an earlier time in medical history. It may sound more familiar, however, because one of its definitions is still in use today. If you want to say something about the dangerous influence of drugs, you could state, “My best friend got caught up in the miasma of drug addiction.” Or if you want to describe how someone managed to change his social status against all odds, you could say, “After many years of hard work and determination, he was finally free from the miasma of poverty.” So this word is still useful to describe “a dangerous, foreboding, or deathlike influence or atmosphere” (dictionary.com) or “an influence or atmosphere that tends to deplete or corrupt” (merriam-webster.com).

But up until the end of the 19th century, miasma was also the name of a popular theory to explain the origin of diseases, especially those that erupted into epidemics: cholera, typhus, typhoid, and others that occurred with regularity, like malaria and tuberculosis. The miasma theory was based on observation, as were many other medical theories of the time. People living in squalid and crowded conditions and/or near swamps seemed
Miasmato be most prone to epidemics and other diseases. Therefore, it made sense that the cause of the diseases was the poisonous miasma (clouds of small particles) in the air coming from polluted water, rotten vegetation, animal carcasses, and human waste. In other words, bad environments generated bad air, which in turn triggered diseases.

The concept goes all the way back to ancient Greece and may still be found in some people’s belief that sleeping in fresh air is beneficial to one’s health. The miasma theory did, however, provide some benefits to 19th century citizens. In an effort to control the outbreak of epidemics, towns and cities drained swamps and marshes; sanitary reformers tackled the job of cleaning up the dirty, poorly built, and densely populated city neighborhoods that had sprung up during rapid industrialization and immigration. Their attempts to improve the air quality actually ended up accidentally destroying some of the real causes of the diseases.

The miasma theory, though obviously wrong, died a slow death. Even with the development of the germ theory of infection in the mid 1800s, some people clung to belief in what they could see and smell. It took the work of people like Louis Pasteur, who proved the existence of pathogenic organisms, and Robert Koch, who isolated the bacteria that cause cholera and tuberculosis, to pave the way  for general acceptance of the germ theory. Their pioneering work, and the work of many other dedicated scientists, led eventually to the containment of most of the killer diseases of earlier centuries.

 

Dance with St. Vitus

25 Monday Apr 2016

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St Vitus DanceSt. Vitus Dance — what a strange name for a disease we now refer to as rheumatic fever! Those who suffer from the disease often make involuntary and irregular jerking movements as a result of muscle spasms. St. Vitus is the patron saint of dancers; thus the name.

Also known as Sydenham’s Chorea, the disease is a complication of untreated strep throat. Other symptoms include swollen and painful joints, a rash, and sometimes weakness and shortness of breath. The medical community of the 1800s also observed that St. Vitus Dance was accompanied by “irritability and depression, and with mental impairment.” Another reference book of the period suggested that such cases often ended in idiocy and many times insanity. It was most common in youth under 18. The only treatment at that time was complete bed rest and regular doses of iron and cod liver oil for four to six weeks.

What 19th century physicians didn’t know was that rheumatic fever could also leave behind damaged heart valves and eventual heart failure.

And that is probably what happened to Dr. Blaine’s youngest son, William Gillespie Blaine. At the age of 14, Will contracted St. Vitus Dance. With loving care from his mother and medications from his father, Will appeared to make a complete recovery within a couple of years. He went on to hold jobs on a lake steamer, a railroad, and at the Ford Motor Company in Detroit. When World War I came along, he served almost two years on a hospital train in France and returned home to continue a productive life. But by the time he reached his early forties, he must have slowed down. And in 1932 at the age of 48, he collapsed and died on a couch in his brother’s house. The silent killer had finally caught up with him.

Three years later the “wonder drug,” sulpha, was introduced to the medical community, and the incidence of rheumatic fever and other streptococcal infections decreased dramatically. Sulpha — and later penicillin and other antibiotics — completely changed the landscape of medicine. From that time on, doctors could do more than just treat the symptoms of a disease. They had the power to cure it.

The Death of Private Medical Schools

19 Tuesday Apr 2016

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Medical EducationThink of the amount of formal medical education required to become a medical doctor in the 21st century. Got that in your mind? Now contrast that with what was required in the middle 1800s in America. What a difference!

With the demand for doctors spurred on by the Revolutionary War, medical education in our newly established country forged ahead with the establishment of what were called proprietary medical schools. Founded by doctors and run for profit, these schools had only the bare necessities: a building, desks, maybe some charts of human anatomy, and possibly a skeleton and a few miscellaneous specimens. Students were taught primarily through lecture and memorization.

Entrance requirements for these schools were almost nonexistent. Many of the students had less than a high school education, and some were even functionally illiterate. As long as a student paid his tuition, he was almost always awarded a degree, whether he regularly attended lectures or not, for an equivalent of one year of study. Young men often enrolled without any real understanding of the profession, being attracted mainly by the promise of “an easy road to wealth.” (The irony was that the only physicians who made a decent living from medicine in the 19th century were those who were educated in medical schools attached to universities and who practiced in large cities where there were wealthy clients. See the previous post: “Who Pays the Doctor?”)

By 1840, twenty-six new proprietary medical schools appeared; thirty years later, there were forty-seven more. The American Medical Association and other professional organizations urged the establishment of uniform requirements for entrance to and graduation from medical schools, but they fought an uphill battle. Then came the Flexner Report of 1910, which sounded the death knell for proprietary medical education.

The report emerged from a grant that was given to the Carnegie Foundation in 1905 to aid teachers in colleges and universities in the U.S. and Canada. But the list of institutions calling themselves colleges and universities revealed no uniform definition. Many so-called “colleges” were no more than secondary schools. So in 1908 the Foundation hired Abraham Flexner to do a study of existing medical schools to determine which, if any, were indeed institutions of higher learning.

Flexner took on the task with vengeance, personally visiting 150 schools in two years. And what he found in most of them shocked him. As an example, the report on the Toledo Medical College, which Dr. Blaine attended and then served as a faculty member for a short time, revealed these conditions. The entrance requirements were “a four-year high school education or its equivalent.” That seemed to be on track. But as for laboratory facilities, “The school has nothing that can be fairly dignified by the name of laboratory. Separate rooms, badly kept and with meager equipment, are provided for chemistry, anatomy, pathology, and bacteriology. The class-rooms are bare: no charts, bones, skeleton, or museum are in evidence. There is a small library in the office …. There is a wretched little dispensary in the college building.”

As you can imagine, Flexner’s judgmental tone raised the ire of faculty members and other supporters. They had been trying, as had other proprietary schools, to obtain more equipment, lengthen the number of required sessions, and tighten up on the entrance requirements. But in that highly competitive environment, increasing the requirements simply drove students to the less demanding schools. Unwilling or unable to spend the money, proprietary schools just couldn’t keep up with the fast-changing climate of scientific progress in medical education. In fact, enrollment in these schools had already begun to taper off  before 1910. Flexner’s devastating report simply drove them all out of business. Only a small number re-emerged as departments of established universities.

In the introduction to the Flexner Report, Henry Pritchett wrote, “Our hope is that this report will make plain once for all that the day of the commercial medical school has passed.” Obviously, their hope became reality.

References:

Duffy, John. From Humors to Medical Science: A History of American Medicine, 2nd Ed. Chicago: University of Illinois Press, 1993.

Flexner, Abraham. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. NY: The Carnegie Foundation, 1910.

 

 

The Railway Surgeon

08 Tuesday Mar 2016

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In the course of research for the biography of my great-grandfather, I often travel down trainintriguing side roads which lead to new vistas of knowledge. Much of this knowledge will never find its way into the book. That’s why I like to share it here in the hope that readers of this blog will find it as interesting as I have.

This side road originated with a brief mention of Dr. Blaine receiving an appointment as surgeon for the B. & O. Railroad after he moved to Chicago Junction, OH in 1905. By that time the B. & O. had rail lines connecting Chicago, IL to Baltimore, MD, with Chicago Junction serving as a division point.

That little piece of information piqued my interest. Was the practice of hiring surgeons limited to the B. & O., or was it a common practice among all the rail lines? Hopping on the Internet, I went on a most fascinating ride, which ended at this website: http://www.railwaysurgery.org. The following information is taken from an article in that website titled “The Train Doctors: A Brief History of Railway Surgeons,” by Robert S. Gillespie.

Did you know that the railroads were some of the first enterprises, along with mining, lumber, and steel, to offer medical care as an employee benefit? Especially with the expansion of the railroads across the continent, injuries to railroad workers could occur in desolate places, far from any medical facility. Consequently, “by the early 20th century, every major railroad listed full-time doctors on its payroll.” Now Dr. Blaine might not have been a full-time employee, but he was still expected to be on call at all times to treat injured workers or even injured passengers or bystanders in the area around Chicago Junction.

To pay for this medical treatment, the railroads charged the workers a fixed amount in the form of payroll deductions and funded the rest themselves. These mandatory payments were unpopular at first and caused some unrest among the workers, but in time the benefits became more obvious and therefore the payments more acceptable. This practice of payroll deductions for medical care continues today for most employees.

Other innovations by the railroads ended up becoming accepted practice. In order to provide safer care for injured workers in remote areas, the railway surgeons developed emergency packs which were carried in the railroad cars and contained medicines and sterile dressings. These were the forerunners of our ubiquitous first aid kits.

Railroads also established their own hospitals in areas where there were no other medical facilities. Some of these became independent foundations called Employee Hospital Associations (EHAs) and gave employees more say in the management of the hospitals. In order to keep costs down, regulations put limits on what medications would be available to patients and what conditions would be treated. These strict limits and centralized approval process were radical ideas at  the time but became the basis for our modern managed care systems.

Other innovations by the railroads included the appointment of women to high positions such as division or chief surgeon. And the railway surgeons not only cared for the injured, they also “advised railroad officials on workplace safety and sanitation issues,” thus providing the foundation for what has become the specialty of occupational medicine.

So even though the last railway hospital closed many years ago and railway surgery is a specialty of the past, their innovations created out of necessity in the age of the railroad remain a vital part of our 21st century medical landscape.

What kind of word is “chirurgery”?

22 Monday Feb 2016

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Looking at WordsIn my research for the biography of my great-grandfather, I’ve come across this word, chirurgery or its related forms chirurgical and chirurgeon, a number of times. It didn’t take long to figure out that it must be a variant form of surgery, surgical, or surgeon. But where did it come from and when did it disappear from common use? I don’t think I have the complete story yet, but here’s what I know so far about this intriguing word.

It’s a known fact that English vocabulary is rife with words borrowed from other languages.And it’s also well known that many of our medical terms find their origin in Greek and/or Latin. The Latin term for surgery was chirurgia, while the Greek form was cheirourgia. But the spelling in Old French was serurghien, which was later modified to surgien. So it appears that the word in Middle English, surgerie, followed the French spelling rather than the Latin or Greek.

Then the Renaissance came along. According to the Oxford English Dictionary (OED), sometime around the 16th century, the spelling of the word in English reverted to the Greek-influenced form chirurgery, with the accompanying pronunciation of the first syllable as a k sound rather than an s, and with the accent on the second syllable. That would make it sound something like “ki-rur’-dgery.” Think of it like the first syllable in chiropractic. In both cases the “chi” means “hand” in Greek.

What I still can’t find is any evidence of when the spelling and pronunciation shifted back to our current form. The latest use of chirurgery that I could find cited in the OED was dated 1846. But I have seen it still used in documents printed in the late 1800s. So I am guessing that by the beginning of the 20th century at least, we had managed to shake off the influence of those Renaissance pundits and went back to the original spelling and pronunciation of surgery. In every dictionary I consulted, the variant chirurgery is now labeled as “archaic.”

If you have any more information about the history of this word, please share it!