Category Archives: History of Medicine

The Minor Horrors of War (1915)

October 15, 2019 Kate Collins

Post contributed by Steph Crowell, Trent Intern for the History of Medicine Collections.

In the spirit of the season, and in preparation for Screamfest VI here at the Rubenstein, we’ve been combing through our collections for all things creepy and unsettling. The History of Medicine has plenty of these things to go around, from medical instruments and artifacts to anatomical flap books to scary stories submitted to Duke’s old parapsychology lab (which includes the original material for the movie Poltergeist!), and much more. Being so spoiled for choice, we thought it best to ease into the festivities with some small, humble, yet significant contributors to the history of medicine: insects.

One might expect something called The Minor Horrors of War to contain stories related to the horrors of battle, the horrors of field medicine, or something equally gruesome, but this little volume takes a different direction: it talks about the how different arthropods and annelids may cause and treat illnesses for soldiers in the field. It covers lice, bedbugs, flies, mites, moths, and, leeches.

Two page spread of book showing title page and frontispiece. The frontispiece is an enlarged illustration showing a fly. — Frontispiece and title page

The wonderful thing about this book is the author’s ability to break up the technical entomological information he provides with easy-to-understand and frequently witty prose. For example, in the flies section of the book there is a particularly gruesome section on the impact of the Congo-floor-maggot, blow-flies, and others responsible for myiasis (“the presence of… larvae in the living body… as well as the disorders… caused thereby.” pp. 81). He ends this section a kind of silver lining to the discussion and says that we have “at least discovered the reason why Beelzebub was called the ‘Lord of the Flies’” (86).

Throughout the book, as you can probably tell by the images so far, are figures depicting many of the creatures being discussed. Throughout, you can see all these different kinds of creatures in varying degrees of magnification depending on the needs of the author. As shown below with a couple pictures of mites, this magnification can range from birds-eye views of different phases of an insect’s development to an incredible zoom-in that can more clearly show the reader each individual extremity and wrinkly that may be found on the insect’s body.

Finally, onto leeching. Leeching is perhaps one of the most famous uses of invertebrates in medicine (you can read a little about why that is the case here), and leeches are the creature that this author spends the most time describing. Unfortunately, you won’t find many images of a leeching session in progress but, just like in the rest of the book, there are many illustrations on the fine details of the leech itself. Despite the author’s claim that leeches are “undoubtedly degenerate earth worms” (124), he spends a great deal of time describing both medicinal leeches and exotic leeches (pictured below).

If you have some time, particularly this month, we would highly recommend stopping by for a little while and taking a look at this book. You can find the catalog record here. It’s as easy as hitting the green request button on the page- just remember to give us a couple of days’ notice of your visit so we can be sure we have time to get it ready for you.

Don’t forget to keep an eye out for news and announcements related to Screamfest VI. It’s on the 30^th this year, so be sure to leave some room in your schedule to come take a break with us! If you have any questions, as always feel free to drop by or contact us any time.

Why Do We Trust Doctors?

October 2, 2019 Kate Collins

Post contributed by Laura Smith, a Doctoral Candidate, History Department at the University of Arkansas. She is a 2019-2020 History of Medicine Collections travel grant recipient.

This question was the starting point for my dissertation research, and it has guided every research trip I have taken in my quest to understand how medical education functioned in the 1800s. The answer? It depends on the time period. In the 19^th century, this wasn’t a question easy to answer. People didn’t always trust doctors, and they didn’t really start until medical schools began to provide enough clinical experience for their graduates to consistently produce better health outcomes for patients. I came to Duke to better understand the evolution of clinical experience in medical schools of the 1800s. These pictures trace that history.

Frederick Augustus Davisson went to Lexington, KY in the 1830s on his journey to becoming a physician. He took classes at Transylvania medical school from its most notable professors, Drs. Caldwell and Dudley, men whose publications and work in their communities initially gave Transylvania a decent reputation as far as medical schools went in this era. Davisson took good notes. He recorded the books that were suggested for him to read, books popular at the time.

Page from Davisson's handwritten notebook. At the top he has written "Medical Books" and the rest of the page lists various titles. — Davisson’s entry of medical books recommended to him.

His notes also reflect that medical knowledge in the 1800s was experimental, controversial, and personal as his writings reflect the differing opinions of his professors. “Dr. Dudley thinks his own plan better than any” for treating the retention of fluid in the genitals as it is “far more certain less painful and greatly more expeditious.” Dudley used a knife to drain fluid as opposed to a needle, explaining the benefits of each to his students.

Two open pages of Davisson's notebook. Each page is filled with Davisson's handwritten cursive notes — Davisson’s notes describing Dr. Dudley’s approach to a procedure.

The idea that medical knowledge was not solidified but debated in this era hints that a major challenge to the authority of doctors was surprisingly the slander of other physicians and schools. When Dr. James Conquest Cross, a professor at Transylvania, released a pamphlet on why Louisville, KY needed a medical school, many wondered how another school could be necessary when Lexington already had Transylvania so nearby. In the pamphlet, Cross argued that Transylvania’s school offered no actual experience in hospitals, no dissections, and therefore practiced antiquated medicine. Students improved with the advice of practicing physician-instructors, but nothing compared with the experience of practicing medicine themselves. Questioning the merit of Transylvania, Cross asked, “Who has ever seen a human body opened before the medical class, for pathological purposes? Which of her numerous alumni ever made, a pathological dissection under the eyes of one of her teachers? Of that individual we confess, we are just as ignorant as we are of the inhabitants of the moon.” Until Transylvania aligned with a teaching hospital like a school at Louisville would, it could not graduate credible physicians. The Rubenstein Library’s collections show rebuttal from Transylvania, however. The medical class of 1834 defended their professors, argued they had dissecting experience, and claimed Cross invented lies because of disappointment about being refused a higher position on the faculty. If it’s difficult for us to know who to believe in this debate, it was even more difficult for the public watching this conflict unfold.

Large newspaper clipping from the March 6, 1834 edition of the Lexington Intelligencer. — Statement from the medical students at Transylvania University defending their professors.

In the end, Louisville did build a medical school. Louisville Medical Institute wooed students with the promise of study in a working hospital, and Duke’s papers from Courtney J. Clark give a rare glimpse into what that early clinical experience looked like. Clark traveled from Alabama to take courses at the Louisville Medical Institute in the same era that Davisson went to Kentucky, and while Clark had similar lecture experience from Kentucky physicians, he also had notes from real cases he studied that Davisson did not. As Clark observed patients in the Louisville Marine Hospital, he learned from his practice, but his work and the work of the LMI faculty also benefitted the poor of the community who could receive low-cost medical care. Clark recorded the prescriptions and health plans of other physicians while closely monitoring the success of patients. When most medical history books praise the progressive teaching methods of Northern schools, these notes show that the medical schools of the US South made clear attempts to give experience while attempting to foster positive relationships with their communities.

Page of handwritten notes in a notebook. — Clark’s notes describing his examination of a patient.

This comparison between two Kentucky medical schools through the notebooks of students shed light on how division within the medical community hurt physician trust. Rifts between schools like that between the cities of Lexington and Kentucky turned into ugly and public spectacles partly because for-profit schools competed so intensely for students and prestige. Ironically, long-lasting feuds between schools presented the public with a feeling that doctors could not be trusted as they could not even come to agreement among themselves, and in this way, doctors in the 1800s eroded their own medical authority.

So why do we trust doctors now? We trust doctors because most of us have agreed to trust science and evidence-based conclusions. We trust doctors when they time and again heal us. But perhaps, we also trust doctors because they appear unified, a surprisingly recent development in medical history offering a cautionary tale useful in our own professional and public divisions. Yes, even in 2019.

Featured, History of Medicine

Tobacco Ephemera: The Effects of Public Health Education on Tobacco Advertising

September 16, 2019 Kate Collins

Post contributed by Steph Crowell, Trent History of Medicine Intern.

In 2019, it can be difficult to imagine living in a world where people were allowed to smoke on airplanes, in restaurants, or even in hospitals. Duke itself is doing its part to participate in the history of tobacco regulation these days, declaring that on July 1, 2020, Duke will be one among many universities to finally be a smoke-free campus. If this is news to you, I’m happy to say that the folks at Duke Health have put together an FAQ (and a countdown to July 1).

Because this is such a significant event in Duke’s own history of medicine, we decided to take a look in the Rubenstein’s stacks to see exactly what we had on the subject of tobacco. Below is one of our findings: trading cards.

Yes, trading cards. This set of champion dog trading cards from Ardath Tobacco Company in Great Britain dates back to 1934 and contains twenty-five unique, award-winning dogs. Each card has a colored picture of the featured dog on the front, as well as text telling the avid collector the name of the dog, the breed, and the owners.

Scan showing six trading cards each illustrated with a different breed of dog — Champion Dogs, 1934, 1-5 (front), Terence Mitchell Collection of Tobacco-Related Ephemera, David M. Rubenstein Rare Book & Manuscript Library, Duke University.

On the back are more detailed, informal anatomical diagrams of the dogs pointing out their trademark features. A favorite is No. 3, the cocker spaniel, whose eyes are described as “full, not prominent, bright and merry” (pictured below). Also included on the back are the card numbers and branding.

Reverse of trading cards show in the previous image, with a black and white outline of each dogs and text describing their features — Champion Dogs, 1934, 1-5 (back), Terence Mitchell Collection of Tobacco-Related Ephemera, David M. Rubenstein Rare Book & Manuscript Library, Duke University.

Champion Dogs, 1934, 1-5 (back), Terence Mitchell Collection of Tobacco-Related Ephemera, David M. Rubenstein Rare Book & Manuscript Library, Duke University.

The collection that houses these cards is massive- it contains multiple sets of trading cards, collectible fabrics, pins, cartons and packs of cigarettes. If you’re curious about the specifics, check out the collection guide. It can be intimidating to look at given the volume of items listed, but Terence Mitchell, the collector, was conscious of this and organized everything by type and topic. As far as trading cards go, there are assorted animals, famous people, famous art pieces, pirates, pieces of architecture, and much more all from a variety of companies in the United States and Great Britain.

The cards served a functional purpose in both the packaging of cigarettes and their marketing. According to the Museum of Obsolete Media, packaging for cigarettes was a bit flimsy from the 19^th to early 20^th century so these cards were inserted to help it keep its shape. As time went on, however, and the cards began to diversify, people began to be drawn to them because they provided a unique way to see images from around the world that would have been impossible for the average person to afford to go see. It was exciting, enticing, and, most of all, cheap.

These days, because of regulations and public awareness of the negative health impact that tobacco products have on the human body, the age of tobacco trading cards has passed. Companies are forced to be clear about these dangers in their ads, on their packaging, anywhere they might be engaging the public. In a relatively short period of time, this has profoundly affected the way we view tobacco and evaluate the extent to which we will tolerate it in public spaces.

Less than a hundred years after these trading cards were printed, the FDA is still finding its legs in legislating what kinds of warnings should be included on tobacco products. Warnings have been mandatory for only a few years now (to check out all of the FDA’s requirements, check here) and are still in flux.

As these things continue to happen, it can be a comfort to be able to see for oneself exactly why these regulations and initiatives have to be put in place to begin with. This collection of ephemera is available for Researchers to view in the Rubenstein’s reading room. If you’re interested but not sure how that process works, here’s a link to our FAQ, or feel free to contact us to ask any questions you may have!

Do Your Research, Featured, From Our Collections, History of Medicine

“Physogs:” Hard to Say and to Play

April 30, 2019 Kate Collins 1 Comment

Post contributed by Taylor de Klerk, Josiah Charles Trent History of Medicine Intern

Rubenstein Library researchers take their work seriously, and we do, too. But sometimes their research includes playing games, and when that’s the case we’re more than happy to oblige!

Photograph of the Physogs game box with the lid off. In the center is a stack of cards with a head with a blank space for the face. On the left are four sets of cards, one of eyes, one of noses, one of mouths, and one of descriptions of facial features. Instruction booklets are on the right. — Original storage for game

We recently played “Physogs: The Novel Card Game,” a board game from the 1940s about physiognomy, the practice of determining an individual’s character based on their facial features. The game is based on sociologist Jacques Penry’s Character from the Face, which guides readers through using distinctive facial features as a means of identifying personality traits. Represented here as a fun game, the popularization of physiognomic practice added fuel to an already steady 20th century fire of stereotyping based on physical appearance.

To play the game, players each hold four cards and take turns drawing cards from a central pile then discarding cards into another pile in an effort to try to make their face, nose, and mouth cards match with a descriptive text card. The first player who thinks their face is accurate shouts “physogs!” just like in Bingo.

Photo of someone's hand holding four cards. One with a nose on it and two with a mouth, and a fourth with a description of a "crafty - self-centered" face. — Cards in game play

Photograph of a white woman seated at a table. In front of her is a complete Physogs card. She is looking at it. — History of Medicine curator Rachel Ingold tallies her score

After someone says “physogs,” each player compares the cards they hold to the key book, which determines points awarded. We played a few rounds and quickly learned that we’re very good at earning negative points. With subjective descriptions of nose types like “Well proportioned. Very finely textured skin,” and “Long, narrow ridge. Crude or bony appearance,” and “Broad, crude and bulbous,” it’s challenging to try to match the words to the pictures. And that’s just one facial feature!

It was also immediately apparent that all facial features represented the same skin tone: white. Additionally, many descriptors are written in a heavily gendered and sexist tone, all of which we found unsurprising for a game from the 1940s. For example, a “pleasant and cheerful” woman should be paired with “full, smiling lips, showing the teeth. Dimple at corner of mouth.” Meanwhile an “excitable and impetuous” man should be paired with lips that are “very wide and large. Lips are full yet flat in appearance, with a downward curve in centre.” These personalities are not absolutely equivalent, but give a good sense of the gendered descriptions of relatively similar characteristics.

Photograph of the various cards and instruction manuals for Physogs set up for game play.. — Physogs game setup

Photograph of the game's key book and a completed card — Comparison of a constructed face with the game’s key book

Our Physogs game experience made for an interesting Friday afternoon with the added benefit of helping a scholar conduct her research and understand the game in practice. Physiognomy’s historical use for judging people based on their looks prompted lively conversations about the 1940s-era facial descriptions and their incorporation in a game. Though physiognomy may sound like fun and games, this “science” was often appropriated for stereotyping by race or gender. Some used this practice to make conclusions about mental intelligence and criminal behavior based on one’s physical appearance, and it’s important to bear those historical uses in mind when interacting with these materials.

If you’d like to learn more about “Physogs: The Novel Card Game” or Jacques Penry’s Character from the Face, we encourage visitors to visit the Rubenstein Library online or in person. For more of the Library’s holdings about physiognomy, click here.

Archive of Documentary Arts, Bingham Center, Do Your Research, Featured, Franklin Research Center, Hartman Center, History of Medicine, Human Rights Archive, Travel Grants

Announcing our 2019-2020 Travel Grant Recipients

April 12, 2019 Kate Collins

The Rubenstein Rare Book and Manuscript Library is pleased to announce the recipients of the 2019-2020 travel grants! Our research centers annually award travel grants to students, scholars, and independent researchers through a competitive application process. Congratulations to this year’s recipients:

Sallie Bingham Center for Women’s History and Culture (Mary Lily Research Grants):

Emily Fleisher, Artist: Artistic project will include a series of drawings based on historic needlework that create a narrative about the lives of American women before 1920

Charlie Jeffries, Faculty, University of East Anglia: Your Best American Girl: Construction of Adolescent Sexualities in the US Culture Wars

Laura Kenner, Doctoral Candidate, Harvard University, History of Art and Architecture Department: Text, Sex, and Video: New York City’s Downtown/Underground Scene (1973-1996)

Nell Lake, Doctoral Candidate, Brown University, American Studies Department: Research for dissertation that will link 20th century moral discourse around care and domestic labor with 20th century politics of women’s work

Jessica Lapp, Doctoral Candidate, University of Toronto, Faculty of Information: The Provenance of Protest: An Exploration of Feminist Activist Archiving

Kaja Marczewska, Research Fellow, Coventry University, Centre for Postdigital Cultures: Distribute-it-Yourself: Judy Hogan and the History of North American Small Press in Circulation (1960s-1990s)

Jennifer Withrow, Doctoral Candidate, University of Massachusetts Amherst, Economics Department: Three Essays on Labor and Marriage Markets: Farm Crisis and Rural-to-Urban Migration in the United States, 1920-1940

John Hope Franklin Center for African and African American History and Culture:

Selena Doss – Faculty, Western Kentucky University, Involuntary Pilgrimage: Black Southerners and Territorial Separatism, 1783-1904

John Harris – Faculty, Erskine College, Pirates of New York: The United States and the Final Era of the Illegal Slave Trade, 1850-1867

Jacqueline Fewkes – Faculty, Florida Atlantic University, American Mosques: An Ethnohistory of Space, Memory, and Muslim-American Community

Crystal Sanders – Faculty, Penn State, America’s Forgotten Migration: Black Graduate Education in the Age of Jim Crow

Kali Tambree – Doctoral Candidate UCLA, Enslaved African peoples who jump off of the slave ship as it is en route to the Americas

Charles Weisenberger – Doctoral Candidate, University of Massachusetts-Amherst “The Telfair Family and the Antebellum One Percent: Slavery in the Early United States, 1735-1875”

John W. Hartman Center for Sales, Advertising, and Marketing History:

Sarah Arnold, Faculty, Maynooth University, Department of Media: Television, Technology and Gender: New Platforms and New Audiences

Mark Bartholomew, Faculty, University of Buffalo, School of Law: “Advertising Outrage and its Legal Regulation”

Rachel Kirby, Doctoral Candidate, Boston University, American and New England Studies: Study of visual representation of Southern agricultural products

Shayan Lallani, Doctoral Candidate, University of Ottowa, Department of History: Cultural Globalization in the Caribbean: Dining and the American Middle-Class Turn in Cruise Ship Tourism, 1920-2016

Adam Mack, Faculty, School of the Art Institute of Chicago, Liberal Arts Department: Limitless: Supermarkets and the Dilemma of Choice

Brent Malin, Faculty, Pittsburgh University, Department of Communications: Ordinary and Necessary: A History of the American Tax Deduction for Advertising

James McElroy, Doctoral Candidate, University of Minnesota, Department of History: Racial Segregation and Market Segregation: The Late-Twentieth Century History of the American City Supermarket, 1960-1990

Emily Morgan, Faculty, Iowa State University, Department of Visual Culture: Imagining Animal Industry: Visualizing the American Meatpacking Trade, 1890-1980

Robert Terrell, Faculty, Syracuse University, Department of History: The People’s Drink: The Politics and Culture of German Beer in the Twentieth Century

Emily Westkaemper, Faculty, James Madison University, Department of History: Career Women: Image and Reality in U.S. Popular Culture, 1940-2000

History of Medicine Collections:

Matthew Barrett, Doctoral Candidate, Queen’s University, History Department: Conduct Unbecoming an Officer and a Doctor: Medical Attitudes toward Homosexuality and the Court-Martial of Dr. Percy E. Ryberg

Kelly O’Donnell, Faculty, Thomas Jefferson University, College of Humanities and Sciences: Study of the role doctors’ wives played in the medical profession, recasting the history of American health care by focusing on the women behind the “great men” of medicine

Laura Smith, Doctoral Candidate, University of Arkansas, History Department: Southern Doctors from Southern Communities: Medical Education and Professionalization in the Nineteenth-Century South

Human Rights Archive (Marshall T. Meyer Research Travel Grants):

Meghan Gibbons, Independent Researcher: Nationalism and Maternal Protest in the US, El Salvador, and Argentina

Gabrielle Girard, Doctoral Candidate, Princeton University, History Department: Modeling Democracy: The Global History of an Argentine Human Rights Experiment, 1978-1991

Michael Jones, Doctoral Candidate, Tulane University, Department of Political Science: Blood & Peace in the Hills of Africa: Post-conflict Institutions in Comparison

Zachary Norman, Faculty, University of Utah, Department of Art & Art History: “Researching Images of Incarceration: Developing Visual Art & Studies Courses to be Taught Inside”

Mira Rai Waits, Faculty, Appalachian State University, Department of Art: Colonial Carcerality: The Birth of the Modern Prison in India

Harry H. Harkins T’73 Travel Grants for Lesbian, Gay, Bisexual, and Transgender History:

Jonathan Coleman, Independent Researcher: Anywhere, Together: A Queer History of Kentucky

Benjamin Serby, Doctoral Candidate, Columbia University, History Department: Gay Liberation and the Politics of the Self in Postwar America

Photographic Research Grants, Co-Sponsored by the Archive of Documentary Arts and the History of Medicine Collections:

Rachel Fein-Smolinski, Faculty, Syracuse University, Department of Transmedia: “Sex Lives of Animals Without Backbones: A Study of the Aesthetics of Pain and Courage Within the Western Healthcare System”

We look forward to working with you all!

Archive of Documentary Arts, Bingham Center, Do Your Research, Featured, Franklin Research Center, Hartman Center, History of Medicine, Human Rights Archive, Instruction, Manuscripts, University Archives

Developing a Code of Ethics for Rubenstein Library Instruction Sessions

April 10, 2019 Amy McDonald

So far this academic year, Rubenstein librarians have taught 132 class sessions (though we won’t finalize these numbers until the end of the spring semester). You’d think that’d be enough to fill our time, but we’ve also been meeting monthly to discuss our individual teaching practices and how to improve our students’ experiences in our class sessions. We want to inspire confident special collections researchers for life!

Through our discussions, we realized that we often returned to couple of key points about archives and primary source research in our class sessions. We’d broach those points on an ad hoc basis as they arose in classes, but we wondered if starting our class sessions off with a shared understanding of those points would be useful, reassuring, and perhaps even empowering for our students.

We’ve followed the development of codes of ethics for different spaces and organizations within (and beyond) our profession and thought that model might also work for us. Early this semester, we drafted and began implementing what we’re calling our approach to classes at the Rubenstein Library. (“Code of ethics” seemed so heady that it might have the unfortunate effect of tamping down student engagement.) Here is what we developed:

Explore and be curious! Our class sessions are interactive, hands-on opportunities to look at lots of materials, so take advantage of this time. Challenge yourself to look (even briefly) at items that don’t initially catch your interest—you might be surprised at what you discover.

Our class sessions seek to be inclusive, offering multiple perspectives, viewpoints, or lived experiences, but may not include the voices of every population for a number of reasons. Let’s talk in class about the voices that aren’t being presented.

The background, experience, and knowledge you bring to this class session are valuable. There isn’t one right interpretation of a historical document. Please listen carefully and treat everyone’s responses respectfully.

The material you encounter in this session has the potential to be uncomfortable or upsetting. Be kind to yourself and recognize your limits. You can look at something else or even step out of the room to take a break.

When working with historical documents, you may encounter racist, oppressive, or outdated language in the documents themselves or in the archival record. When we discuss these items, we will want to use terms that reflect the ways these communities describe themselves today.

Later this month, we’ll come together as a group of instructors to talk about how we’ve been able to incorporate the code into our class sessions—but informal reports suggest it’s been useful! Our practice has generally been to give students two to three minutes to individually read over the code (presented on a slide) and then talk as a class about any questions they might have and how the individual points in the code might come up in the class session.

Color photograph of librarian teaching the code of ethics to a class session. The code appears projected on a screen behind her. Students sit at a conference table in front of the screen. — A Rubenstein librarian teaches our new instruction code of ethics in a recent class session.

We see this as a living document that we’ll continue to refine and add to as needed. So please do let us know what you think and feel free to borrow or adapt our instruction code of ethics for your own class sessions!

Events, Featured, From Our Collections, History of Medicine, Readings and Talks

Event: Why Did the United States Medical School Admissions Quota for Jews End?

April 3, 2019 mlp60@duke.edu

Why Did the United States Medical School Admissions Quota for Jews End?

Date: Thursday, April 11

Time: 5:30 p.m.

Location: Holsti-Anderson Family Assembly Room, Room 153, Rubenstein Library

Contact: Rachel Ingold, rachel.ingold@duke.edu, (919)684-8549

Please join the History of Medicine Collections for our next Trent History of Medicine Lecture Series event. Edward C. Halperin, M.D., M.A. will present “Why Did the United States Medical School Admissions Quota for Jews End?” At the end of World War II anti-Semitic medical school admissions quotas were deeply entrenched in the United States. Twenty-five years later they were gone. Why did that happen and what are the implications for the current controversy regarding alleged quotas directed against Asian-Americans?

Dr. Halperin is Chancellor/Chief Executive Officer of the New York Medical College, Valhalla NY.

All are welcome and encouraged to attend. No registration is needed. A light reception will follow.

Events, From Our Collections, History of Medicine, Readings and Talks

The Newest Negroes: Black Doctors and the Desegregation of Harlem Hospital, 1919-1935

March 22, 2019 Kate Collins

Date: Tuesday, March 26
Time: 5:00 p.m.
Location: Holsti-Anderson Family Assembly Room, Room 153, Rubenstein Library
Contact: Rachel Ingold, rachel.ingold@duke.edu, (919)684-8549

Please join the History of Medicine Collections for our next Trent History of Medicine Lecture Series event. Adam Biggs will present “The Newest Negroes: Black Doctors and the Desegregation of Harlem Hospital, 1919-1935.”

Professor Biggs’s lecture will focus on the desegregation of Harlem Hospital, highlighting the conflicts an tensions that took shape as black doctors sought to merge their professional goals with the larger cause of racial improvement. Adam Biggs is faculty at the University of South Carolina Lancaster where he teaches African American Studies and US History. His research examines black doctors and their efforts to address the problem of race in early 20th century America.

All are welcome and encouraged to attend.

We thank our friends at the Bullitt History of Medicine Club at UNC-Chapel Hill for co-sponsorship.

Do Your Research, Featured, History of Medicine, Travel Grants

Gilded Age Cures for Soldiers Suffering from Opiate Addiction

February 20, 2019 mlp60@duke.edu

Post contributed by Jonathan S. Jones, historian and PhD candidate at Binghamton University

In the Civil War’s wake, thousands of veterans became addicted to medicinal opiates. Hypodermic morphine injections and opium pills were standard remedies in the Civil War era for amputations, sickness, and depression, and they often lead to addiction. Take, for example, the case of A.W. Henley, a Confederate veteran, who recalled in 1878 that, “In the army, I had to use opiates for a complication of painful diseases.” The medicine soon “fastened its iron grip on my very vitals, and held me enchained and enslaved for near fifteen years.”[i]

Historians have long recognized the causative link between Civil War medical care and the high rate of opiate addiction among veterans. However, although we know that doctors were in many ways the originators of the postwar addiction epidemic, we know surprisingly little the about the medical response to the crisis. Did American doctors ignore the opiate addiction among veterans, or did physicians seek to help veterans suffering from addiction? And if so, what did those efforts look like?

These are questions I seek to answer in my dissertation, “A Mind Prostrate”: Opiate Addiction in the Civil War’s Aftermath.” My research benefited greatly from a History of Medicine Collections Travel Grant, awarded by the Rubenstein Rare Book & Manuscript Library. The History of Medicine Collections at the Rubenstein Library includes several manuscripts and rare items that suggest answers to elusive questions about the medical responses to Civil War veterans’ opiate addiction.

THE BLAME GAME

Physicians fell under a wave of criticism after the Civil War for causing opiate addiction crisis. Veterans and observers in the media accused doctors of overprescribing opiates to ailing old soldiers and other patients, resulting in widespread opiate addiction. This criticism posed a problem for physicians—so-called “regular” doctors—because it undermined their precarious position in the hyper-competitive Gilded Age medical marketplace. Physicians had been struggling to out-compete alternative healing sects and “quacks” for decades. Being labeled the culprits for the crisis only weakened the regulars’ footing in this struggle.

CHANGING PRESCRIBING PATTERNS

In response to this professional crisis, some physicians advocated for a move away from prescribing medicinal opiates. During the 1870s and 1880s, ex-military surgeons, in particular, exhorted their colleagues in medical journals and scientific studies to prescribe fewer opiates, to substitute the drugs with supposedly less-addictive painkillers, and even to refrain from prescribing opiates altogether. As the ex-Union surgeon Joseph Woodward surmised in 1879, “The more I learn of the behavior of such cases [of overprescribing] under treatment, the more I am inclined to advice that opiates should be as far as possible avoided.”[ii] Such proposals were truly radical, considering that opiates were the most commonly prescribed medicines of the nineteenth century up to that point.

But did physicians heed these warnings? Were radical proposals merely hypothetical, or did physicians implement them in practice? To answer these questions necessitates the close analysis of late nineteenth century clinical records. I was fortunate enough to stumble across one such record in the History of Medicine Collections at the Rubenstein Library, a rare casebook from the Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases, professional home of the physician Silas Weir Mitchell.

Pages with handwriting in ink. — Casebook from the Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases, professional home of the physician Silas Weir Mitchell.

An eminent neurologist, Mitchell was one of the most vocal members of the anti-opiate camp. Mitchell—whose infamous “rest cure” inspired the feminist Charlotte Perkins Gilman to write The Yellow Wallpaper, a feminist critique of Mitchell’s methods—was a prolific writer. In many of his medical works, he railed against the habit-forming potential of medicinal opiates and doctors’ role in facilitating opiate addiction. As Mitchell explained in an 1883 work about pain management, “often, in my experience, the opium habit is learned during an illness of limited duration, and for the consequences of which there is always some one to be blamed.” He blamed doctors who were “weak, or too tender, or too prone to escape trouble by the easy help of some pain-lulling agent” for causing their patients to develop opiate addiction.[iii] Doctors must refrain from prescribing opiates empathetically, Mitchell warned, lest the medical profession continue to be blamed for the opiate addiction crisis.

Accordingly, Mitchell’s clinical records confirm that he stopped prescribing opiates to chronic pain patients, those at greatest risk for addiction, in his own clinic. Mitchell’s clinic, the Philadelphia Orthopaedic Hospital, was the cutting edge of American neurology in the late nineteenth century. Doctors working there alongside Mitchell specialized in treating chronic nervous pains, headaches, and other symptoms classified under the diagnostic category of neuralgia. During the previous decades, most of these individuals would have been treated with opiates. Indeed, Mitchell prescribed opiates heavily during the Civil War, witnessing the genesis of opiate addiction in several of his patients. Yet by the 1880s, Mitchell reversed course. The clinic’s casebook reveals Mitchell did not prescribe opiates to a single patient among the 62 individuals for which he recorded clinical notes between 1887 and 1900. Other physicians, I suspect, mirrored Mitchell’s increasingly conservative approach to prescribing opiates during the Gilded Age.

THE COMPETITION

But physicians like Mitchell were not alone in responding to the Gilded Age opiate epidemic. Ailing Americans could choose from a vast spectrum of treatments and healers to remedy their medical woes during late nineteenth century. Unlike today, regular physicians were often outcompeted by alternative healers during the Gilded Age. So-called “quacks”—at least, that is what physicians dubbed them—often impinged on physicians’ customer bases.

Dozens of entrepreneurial healers spotted new commercial opportunities amidst the rising rates of opiate addiction. They invented and marketed a diverse array of treatments for opiate addiction between the late 1860s and the turn of the twentieth century. John Jennings Moorman, the proprietor of a nineteenth century West Virginia hot springs resort, exemplified this trend. I encountered a rare copy of Moorman’s 1880 advertising pamphlet for his White Sulphur Springs resort in the Rubenstein Library. Founded in the late 1830s, Moorman marketed his exceedingly popular hot springs as a cure for a diverse spectrum of diseases during the antebellum years, from rheumatism to neuralgia, jaundice, scurvy, and others.

Blue pamphlet — Front cover of Dr. J. J. Moorman’s pamphlet about the curative properties of White Sulphur Springs in West Virginia, 1880.

Always looking to expand his enterprise, Moorman perceived an opportunity in the rising rates of opiate addiction after the Civil War. Naturally, he expanded his operation to cater to opiate addicted customers desperate for a cure. Moorman began marketing White Sulphur Springs as a treatment for “opium eating” in 1880. Prior versions of Moorman’s marketing material do not include references to opiate addiction.[iv]

Paragraph titled "Use of the Water b Opium Eaters" — Page from Dr. J. J. Moorman’s pamphlet: White Sulphur Springs, with the analysis of its waters, the diseases to which they are applicable, and some account of society and its amusements at the Springs, 1880.

As Silas Weir Mitchell’s casebook and John Jennings Moorman’s advertising pamphlet indicate, Gilded Age medical practitioners responded to the opiate addiction crisis in diverse ways, from prescribing fewer opiates to marketing hot springs therapy for addiction. The rare medical manuscripts held by the History of Medicine Collections at the Rubenstein Library thus made significant contributions to my research, unlocking answers to elusive questions about the various medical responses to Civil War veterans’ opiate addiction.

—————————————————————

[i] Basil M. Woolley, The Opium Habit and its Cure (Atlanta: Atlanta Constitution Printer, 1879), 30.

[ii] Joseph Woodward, The Medical and Surgical History of the War of the Rebellion, Pt. II, vol. I (Washington D.C.: Government Printing Office, 1879), 750.)

[iii] S. Weir Mitchell, Doctor and Patient (Philadelphia: Lippincott Company, 1888), 93.

[iv] J.J. Moorman, White Sulphur Springs, with the analysis of its waters, the diseases to which they are applicable, and some account of society and its amusements at the Springs (Baltimore: The Sun Book and Job Printing Office, 1880), 25-26.

Featured, From Our Collections, History of Medicine

Records of Births and Deaths in a 19th Century Small Town

January 14, 2019 Kate Collins

Post contributed by Taylor de Klerk, Josiah Charles Trent Intern for the History of Medicine Collections

A pair of books, nearly identical in appearance, live on the shelves of the Rubenstein Library. Both are beautifully bound and were clearly well-maintained by their original owner, Dr. Charles Brayton, who used them throughout his 19th century career. Despite their outward similarities, these books are almost exact opposites. Brayton kept one volume to document the births he attended and the other to record deaths in the same community: Stonington, Connecticut.

As a practicing physician from the 1870s to the early 1900s, Brayton provided care for many members of this community, which numbered around 6,000 to 8,000 at various points in his career. These books give us a sense of what life in 19th century New England was like, thanks to Brayton’s thorough records.

Each volume documents different types of information. The “List of Births” included the date (and sometimes time) of each birth, the child’s name and gender, the parents’ names and ages, and the baby’s surname. Dr. Brayton also sometimes described the parents’ race, where they were originally from, and any significant details about the birth. The timeline for this volume extends so far that it includes some instances where the babies Dr. Brayton had delivered later grew up and he delivered their children as well.

Photograph of an excerpt from Brayton's Record Book. It's written in cursive on slightly yellowed lined paper. It provides details like the date and time of the birth of Theodora Sylvia — Entry for birth of Theodora “Dora” Sylvia, July 3, 1877

Tracing new mothers back to their own births happens on several occasions, including for Theodora “Dora” Sylvia Holland. Dr. Brayton delivered Dora at 10:15pm on July 3rd, 1877. His notes indicate that this is Theodora A. Daveny Sylvia’s fifth labor, but there are no anecdotes or records of complications. Reading through his notes from the decades that followed, Dora’s name reoccurs several times. Dr. Brayton delivered six of her children! Dora’s first adult occurrence in this book (after her own birth of course) was in 1896 for her second labor. Mrs. Dora Sylvia Holland gave birth to a baby boy at 5:50pm on May 11, 1896.

Another photograph of an excerpt from Brayton's Record Book. It's handwritten in cursive. It lists the details of the birth of John T. Holland Jr. — Entry for birth of John T. Holland, Jr., May 11, 1896

Photograph of entry for death of William Hyde. It is written and cursive and appears to take up a whole page — Entry for death of William Hyde, M.D., September 25, 1873

Conversely, Brayton’s “Record of Deaths” lists the date of each individual’s death, their name, approximate age (if he knew), and reason of death. For some individuals, he also included their relation to other community members and their place of birth. On some occasions Brayton included even more information, such as a narrative of the events leading up to the death.

This is the case for Dr. William Hyde, who died of consumption at 64 years old after spending nearly half of his life with the disease. Dr. Brayton describes Hyde as “a good friend to me and my preceptor in the study of medicine.” Brayton undoubtedly experienced a strong reaction to the passing of his teacher. Brayton’s record goes on to eulogize Hyde by listing his family and accomplishments, though unfortunately none of his five children lived longer than Hyde himself.

Records like these shed light into the practices of those that lived centuries ago. We use these books and others to help Duke medical students and undergraduates understand the historical context of the practices that they learn about in their coursework. Dr. Brayton’s records help us see the ways of life in 19th century small-town Connecticut, even if just through the lens of one man’s professional career.

Dr. Brayton’s List of Births and Record of Deaths are available to view in the Rubenstein Library’s reading room. Click here for more information about using our collections.

Dispatches from the David M. Rubenstein Rare Book and Manuscript Library at Duke University