For the LOVE of Medical History

DailyDose_PosterOn today’s MedHum Monday, we present a post from the Dittrick Museum of Medical History. The original post (by Catherine Osborn) first appeared as part of the #MuseumWeek posts, and it demonstrates beautifully the importance of history and other humanities to the study of medicine. We provide part of this work here, but see the site for brilliant images that further illustrate the medhum intersection.

It’s not uncommon for the Dittrick Medical History Center to be referred to a bit like a cabinet of curiosities,  a niche museum, or perhaps more kindly, a “hidden treasure.” Although we’ve always worked to make collections accessible and major public engagement efforts are underway, we still often have to make the case for the (sometimes not so) implicit question “Why should I care about medical history?”

The answer tends to go a little like this:

Medical history is the history of how we come into the world. Our Re-conceiving Birth gallery is not only about doctors, nurses, and midwives — it examines the experiences of women and babies from the 18th century to the 1940s. Beyond the particular questions of labor position, pregnancy diet, and types of forceps, this gallery calls visitors’ attention to larger, still pertinent questions: Is birth a normal or pathological event? Who’s experiences and knowledge are important during labor? Should birth hurt? How are difficult decisions made when both the mother and infant are at risk?

The progression of pregnancy. Spratt, 1848.
One of several images posted on Dittrick Museum’s blog–see the original for more [For the love of Med…]
By framing these questions through history, we hope to add to modern debates that these are not new concerns and that “traditional” approaches are not singular or homogenous.

Medical history is the history of how we change and respond to our environments. Humans have faced a range of emerging health concerns through travel to new places, movement into cities, changing diets, and exposure to industrial hazards. Many of the museum’s exhibits examine both the impact of these shifts, such as crowded city-dwelling facilitating the transmission of infectious diseases, and how we respond to these novel health environments. For example, Cleveland was racked by a deadly and disfiguring smallpox epidemic in 1901 and 1902, which was halted through a coordination of efforts to develop and widely distribute a safe vaccine.

These stories speak to the dynamic relationship between humans and their environment and cautions against assumptions that medical progress has eliminated any risk of new health challenges [read more]

Friday Feature: Death by Elephant? Torture in 19th c India

fictionreboot2It’s surely one of the most gruesome capital punishments ever devised. But it gets worse, warns Tessa Harris in the second part of her blog on India’s historic torture practices. Tessa pens the bestselling fiction series The Anatomist’s Apprentice…see what has turned up in her research, where medicine and fiction intersect with cultural practice.

By Tessa Harris

Westerners have an American to thank for uncovering many of the rich and magical treasures of the Orient for the first time. Henry Clarke Warren, (1854–1899), was a scholar of Sanskrit and Pali, and became the first man to translate a number of Buddhist texts into English. These were later published in the Harvard Oriental Series. His translations provide a fascinating source of Buddhist history and thought. They revealed to the Western world the philosophies, doctrines and practices of a little understood religion, whose roots went back 2,500 years to India.

Along with the tremendous diversity, color and myths familiar to many of us today, however, Warren’s translations also revealed a darker side to Indian society. They exposed the methods of torture that were frequently practiced by rulers on their enemies or simply on petty criminals for perverted pleasure. Astonishingly, some of these disturbing customs even carried on well into the 19th century.

One of Warren’s translations, a Buddhist scripture called the Milinda Panho, belonged to the second century AD. It catalogued various methods of torture, referred to as ‘miseries’. As you’ll see, however, calling them ‘miseries’ is an understatement.  Warren helpfully included footnotes to this list by way of explanation, so we have, for example, the Kettle of gruel. This is when “they cut open the skull, and with a pair of tongs take up a heated iron ball, and throw it in; whereby the brains boil, and run over.”

In the Rahu-mouth torture, according to Warren: “they keep the mouth open by means of a peg, and burn a candle inside. Or, beginning from the roots of the ears, they dig out the teeth, so that the blood gushes forth, and fills the mouth.”

In the blades-of-grass torture, “they begin at the neck, and cut the skin downwards in blade-like strips as far as to the ankles, and then let them fall.” Warren’s translation continues: “Then they put a halter on the man, and drag him forward, so that he stumbles and falls over the blade-like strips of his own skin.”

Of course after such suffering you might imagine that death would be a sweet release. But in parts India, up until as late as the 1800s, that was never easy, either.

According to George Ryley Scott’s “History of Torture”, published in 1940, one method, peculiar to the sub-continent, was to tie the condemned man against a tree, smother him in honey and allow red ants to eat him alive. Another, apparently equally ravenous insect, was the carpet beetle.

By comparison you might be forgiven for thinking that death by elephant would be a preferred option for a condemned prisoner. For hundreds of years, this method of execution was employed by many rulers in South-east Asia. In India the practice was known as ‘Gunga Rao’. The huge, majestic animals symbolized the power that kings and chiefs exercised over local populations. As in the West (with hangings, principally), public executions were designed to engender both fear and curiosity in those who witnessed them. The elephants, were, however, specially trained so that they could not only crush a man with single blow, but also torture him slowly, pulling him limb from limb before dispensing with him, usually by standing on his head.

For one of the most graphic accounts of this custom, we turn to an English journalist.  In 1821, Thomas Byerley published the following report of an execution in Baroda in 1814. He relates how, when a slave murdered the brother of the local chieftain, he suffered the direst consequences.

About eleven o’clock the elephant was brought out, with only the driver on his back, surrounded by natives with bamboos in their hands. The criminal was placed three yards behind on the ground, his legs tied by three ropes, which were fastened to a ring on the right hind leg of the animal. At every step the elephant took, it jerked him forward, and every eight or ten steps must have dislocated another limb, for they were loose and broken when the elephant had proceeded five hundred yards. The man, though covered in mud, showed every sign of life, and seemed to be in the most excruciating torments. After having been tortured in this manner for about an hour, he was taken to the outside of the town, when the elephant, which is instructed for such purposes, was backed, and put his foot on the head of the criminal.”

There are dozens of accounts from European travelers about this gruesome practice and its many variations. In 1868, a French traveler even reported that the elephants were trained to slice criminals to pieces with “pointed blades fitted to their tusks”.

With the growth of British power on the sub-continent, however, the custom declined. These would be replaced instead by colonial rule, which had its own abuses, though most of them not so vivid to the imagination. By 1914 the author Eleanor Maddock wrote that in Kashmir “many of the old customs are disappearing – and one of these is the dreadful custom of the execution of criminals by an elephant trained for the purpose.”

One of these ‘old customs’ took much longer to disappear, however. And remarkably, although rare, it is still practiced occasionally in rural areas of India today, despite being illegal. We are talking about the Hindu practice of sati or suttee, otherwise known as the custom of a widow killing herself, usually by self-immolation. (There are, however, recorded cases where the woman was drowned or buried alive with her husband’s corpse.) Although abhorrent to most modern thinkers, the future for a widow in India up until relatively recently, was bleak. Forced to hand over her husband’s possessions to his family, she was left destitute, alone, forced to shave her head and ostracized if she did not take her own life.

If sati was performed, it appears the widow would sometimes be drugged before throwing herself on the blazing funeral pyre; sometimes she was forced onto it by family members. There are accounts, too, of some women sacrificing themselves apparently willingly, then, as the flames took hold, recanting and trying to run away.

Fanny Parkes, the wife of a minor British civil servant during the early 1800’s, has given us an extraordinary account of a sati burning that took place in 1828. It went ahead despite all attempts to prevent it, short of forbidding it, by the local British magistrate. The outcome of the extraordinary story is that the badly-burned widow was taken into custody by the British government and subsequently cared for. In 1861 a general ban on sati for the whole of India was issued by Queen Victoria. Even so, the custom did not die out completely and, even though the practice has been outlawed in modern India, there are still isolated reports of burnings in remote villages to this

Author Bio: Tessa Harris
Copyright Maureen McLean 2011After studying History at Oxford University, Tessa Harris began a journalistic career in Lincolnshire. She progressed to a London newspaper, and later a feature writer on Best magazine. After two years, she was made editor of a regional arts and listings publication, and later deputy editor on Heritage magazine. In 2005 she was made editor of Berkshire Life magazine. Tessa always had literature aspirations, and in 2000 won a European-wide screenplay writing competition for a work later optioned by a film company. The script was set in 18th century London and subsequent research led Tessa to the invention of Dr Thomas Silkstone, an American anatomist and the world’s first forensic scientist. More books.

Shadow of the Raven: Nominated for the Romantic Times Reviewers’ Choice Best Mystery Award 2015

4617911690_238x346American anatomist Dr. Thomas Silkstone hunts for justice amid a maelstrom of madness, murder, and social upheaval. In the notorious mental hospital known as Bedlam, Dr. Thomas Silkstone seeks out a patient with whom he is on intimate terms. But he is unprepared for the state in which he finds Lady Lydia Farrell. Shocked into action, Thomas vows to help free Lydia by appealing to the custodian of her affairs, Nicholas Lupton. But when Silkstone arrives at the Boughton Estate to speak to Lupton, he finds that another form of madness has taken over the village.


Book Review: Broken Hearts, The Tangled History of Cardiac Care

By Brandy Schillace

The shout of “CLEAR!” is ubiquitous on television medical drama; it seems we universally fear and dread the infamous “heart attack.” And we should. Cardiac disease remains one of the biggest killers worldwide, and yet, until the very recent past, physicians did not know what caused them or how best (and if and when) to treat them.

41VtHfQVgaL._SX334_BO1,204,203,200_David S. Jones‘ book Broken Hearts: The Tangled History of Cardiac Care first appeared in 2012. I was lucky enough to hear Dr. Jones speak at the Dittrick Medical History Center that following year–right here in Cleveland, Ohio, where many of these medical innovations took place. Claude Beck (1894-1971) devised ways to revive heart attack victims with the use of carefully controlled electricity, but Beck’s defibrillator cannot be isolated from two other innovations, the Kay-Cross Oxygenator and by-pass surgery (also developed in Cleveland and on display at the Dittrick, by the way). Oxygenators allowed for stopped-heart surgery and more delicate operations, while the defibrillator allowed doctors to re-start the heart. Then in 1958, F. Martin Sones discovered moving cine-coronary angiography, a technique for visualizing the inside of the coronary arteries, but all of these “firsts” were accomplished through risk-taking, a hallmark of Cleveland successes generally. What made the risks worth it?

David Jones calls it a slow motion rise and fall—the “epidemic” of heart disease was less a new development than a constellation of events: changing social and economic conditions (rise in cigarettes, change in diet, exercise, stress, pollution) but also income inequality…plus new diagnostic tools that let us “see” the heart and diagnose it better. And of course, the fact that it was a “business man’s” disease meant a greater focus upon it, while increased competition among and between institutions meant that suddenly, heart disease was at the center of everyone’s attention.

Jones points to this rise as instructive; once understood as an epidemic, physicians began to use surgical interventions not only as a means of helping a patient, but also as a diagnostic in the search for disease causation.  What really caused the problem and what were the best means of curing it? Plaques…or ruptures…or clots? (In the end, it’s really all three, and Jones explains the differences between types of infarction with incredible clarity). Not surprisingly, diet and lifestyle were factors well beyond the control of doctors. Patients wanted internal solutions, quick fixes, “miracles” of medicine. Enterprising doctors wanted the same. Jones’ points to the “ambiguities and inconsistencies” in medical decision making, and also how this affects perception not only of doctors but of the wider culture. His research causes us to reflect on why surgical interventions become “over-sold” in terms of their efficacy.

At the 1969 annual meeting of The Society of Thoracic Surgeons, Dr. Effler stated, “Only a few years ago papers on [myocardial revascularization surgery] were viewed with frank skepticism and the authors looked upon with suspicion…. [but] The subject of myocardial revascularization is timely and deserves more attention at surgical meetings.” He had reasons to be bold; a year earlier, Dr. Effler and his colleagues performed the first cardiac transplant in the Midwest. But Just because a surgical intervention may be performed doesn’t make it a good idea. Jones describes the neurological problems following heart lung machines, and the considerable risks of the surgeries themselves. Angiography was not always a clear picture. Some surgeries may not have been necessary. Others were undertaken but the outcomes were less advantageous than hoped. Jones’ work shows how the realization of risk led to new technique, things we take for granted today but which came about in the 60s and 70s as a result of the “epidemic” of heart disease. And risk matters. Effler lost 5 of his first 11 patients. Death was, as Jones puts it, “woven into the field.” People were ready to take risks, and there wasn’t always consensus about what risk really meant. More animal trials, or not? Risk this patient or not? Risk this procedure or not?

The answer is not an answer. It’s a story. Imagine a surgery where doctors operate with the knowledge of high mortality rates if you do, but also with the certain death of patients if you don’t—with the neurological complications that plagued procedures— with only an imperfect understanding of  what caused heart attack—and with the knowledge that your team was at the forefront as path breakers. What would it be like to make decisions in that context? And in what ways are we inheritors of that time period and that rhetoric? Jones’ research, carefully collected, expertly handled, and easy to read even for non-specialists, demonstrates not only the complexity of the disease itself but also the convoluted and politicized means by which treatment decisions are made. And re-made. And re-made. Why and how doctors (and patients) overestimate the effectiveness of medical interventions lies with a nexus of competing interests and aims, with a rhetoric of success that belies complications, and with the very interventionist model that aided original research into coronary disease and the causes of infarction (heart attack).

As both an M.D. and Ph.D., Jones has a perceptive eye and a wide lens on history. His meticulous research into archives and clear presentation make this book a public history with academic fervor. He is now at work on a follow-up, On the Origins of Therapies, which will trace the evolution of coronary artery bypass surgery.