On Sharing #histmed Images

For those who follow me on Twitter or the FTHOQ Facebook page, you already know I share a lot of images on the history of medicine. I’ve come across many of these images while browsing through online archives collection data for my research on experiences of hearing and hearing loss in twentieth-century America. I’m particularly interested in the cultural history of deafness from a medical standpoint and frequently find myself drawn to all sorts of representations of hearing, sound, and artefacts. Sometimes I come across a new digital archive by clicking on a link on the one I’m already looking through, and off I go, spending hours carefully scrolling through images and records.

I initially started sharing images on the history of medicine (#histmed on Twitter) as I conducted research in London on materials related to my dissertation. I expanded my postings when I started collecting materials for my course on the History of Medicine. I kept a file on my desktop of remarkable sources of images and objects I hoped one day to share with my students. There were many that never made the cut for lectures and I wanted a platform to share them—hence, I started posting on my Twitter account and later created the FTHOQ Facebook page to post additional details that went beyond the 140-character limit. I aim to post as much details on sources and archive repositories as I can, but sometimes I find great things on Google Images that have no additional data and I post the image in the hopes someone else can fill in the blanks.

twitteract

Sharing images has been a great way for me to participate in fruitful conversations about cultural frameworks of health and healing. At the back of my mind, I’m overly aware of the risks of decontextualizing these images and using them for “entertainment.” Daniel Goldberg drew my attention to a great post written by Richard Barnett for the WellcomeLibrary blog. Barnett discusses some of the ethical concerns he encountered while writing his book, The Sick Rose: Disease and the Art of Medical Illustration (2014), particularly on the implications of looking at pictures of people’s suffering and diseased bodies. Is it appropriate? Another form of entertainment? Barnett raises crucial issues that I think all historians should think about when we share images of bodies with an audience. I might say that I share these images—and some that even I find gruesome enough to warrant a “WARNING” or “SENSITIVE” prelude on my tweet—as a way to educate my audience on the horrors of medical practice, but even I cannot ignore the shock element that is clearly embedded in that tweet. Especially when it comes with a warning note.

Barnett expresses: “I might comfort myself with the thought that I am deepening my readers’ understanding of these images by setting them in context.” Too often, I’ve come across images that have been grossly misinterpreted or miscategorised. Many more do not identify the source or provide any context. Setting them in context almost provides merit for sharing them: I’m not just passing them around, but trying to address their historical place and value. The most interesting discussions and that arise from sharing these images come from my audience, whose inquisitive questions inspires me to ignore my to-do list for the day and dig up as much information I can about a particular image. But what happens when we don’t provide the context of a particular image? Have we stripped away its meaning? The popularity of twitter handles like The Retronaut or HistoryPics indicates that people love looking at the past; but too often errors are pointed out.

I haven’t kept a precise analysis of the images I’ve posted and how they were shared as an indicator of how people are “reading” the images and learning from them. My audience is not wide enough for that. But I have been aware of the thoughts that go behind my postings and how I’ve been aware not to offend, decontextualize, or even muddle the historical merit of these images. Last summer I kept a schedule based on particular themes I would post in relation to the research I intended to do. For instance, I would post images on epidemic diseases in India one week, prosthetic artifacts the next, and so forth. I had scheduled surgical amputations the same week the Boston Marathon bombings occurred. Of course none of these images were shared at that time; it seemed cruel, insensitive, and above all, opportunistic.

My favourite images to share are the ones that make us think twice about the authority of medicine. Products developed by “quack” doctors, illogical remedies, strange and outrageous technologies, and the theatre of surgery. These images reminds me how much medicine has changed, how the rules of practice has transformed, and how people in the past thought about their bodies, their health, and sought out explanations. These historical experiences with health and illness are captured in images, These images, as Barnett writes,

are, to borrow a phrase from Claude Lévi-Strauss, good to think with…They should shock us, move us, jolt us out of any sense of complacency over our individual or collective well-being; something would be wrong if they did not. They are a magnificent historical and aesthetic resource, and a record of human suffering and of attempts to understand and to relieve it. We would be all the poorer if they were concealed; equally, they should not become mere visual shorthand for a kitsch, knowing and emptily ironised attitude to sickness, suffering and death.

 I’m glad people like how I share images. The repositories I come across are wonderful and as a scholar, I’m thankful to all the individuals who have digitized these images, allowing me to get a better glimpse into the past.

 

 

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19th Century Indian Women in U.S. Medical School Part II

“It is not more difficult to prove that Asiastic women have made good as Christian physicians. In India we point to Dr. Karmarkar and Dr. Joshi…”[1]

Since my original posting on three Indian women who attended the Women’s Medical College of Pennsylvania, I’ve gotten several inquiries for more information on their stories. There’s plenty of information on Joshi (see my comment on the original post), so I did some more research on Gurubai Karmakar. This is only a preliminary start—I plan to eventually sketch out a fuller story of the experiences of Joshi, Karmarkar and Chatterjee.

Photo of Gurubai
Photo of Gurubai Karmarkar. From: Allen & Mason, A Crusade of Compassion for the Healing of the Nations (1919).

Gurubai Karmarkar attended the Women’s Medical College while her husband, Rev. Sumantrao Karmarkar studied at the Hartford Theological Seminary during from 1888s onwards. Both of their studies appeared to complement with their posts as Christian missionaries. In 1893, they returned to India and Karmarkar took up a position at the American Marathi Mission in Bombay, where she would work for over thirty years.

Her position at the American Mission not only made her well known in Bombay (Mumbai), but provided her with opportunities to represent India in missionary conferences around the world. She gave lectures on the state of women in India and how medical missionaries can help elevate their social standing. An 1893 volume of Life and Light for Woman, published by the Woman’s Board of Missions, mentions Karmarkar’s speech at the semi-annual meeting on June 1, 1893:

“Mrs. Gurubai Karmarkar, of Bombay, a graduate of the Women’s Medical College of Philadelphia, and about to return to India to engage in medical and evangelistic work, spoke impressively of the origins, the evils, and the sad results of child marriage in India, of the sufferings of the child widows, of the blessing which medical missionaries can carry with them, and the necessity of work among the women and in the homes. India would have been a Christian country by this time if it had not been for its women. Educate and convert these, and you will Christianize India.”

At the meeting, Karmarkar adorned a sari and the meeting records also refer to a Mrs. Vaitse and a Mrs. Miyagawa, who also wore their national dresses.

Karmarkar attended the Young Women’s Christian Association (YWCA) meetings in Paris (1906) and Stockholm (1914).[2] Supposedly, in 1919 she also attended the first International Conference of Women Physicians held at the YWCA headquarters in New York, which had attendees from 32 countries for 6 weeks; I haven’t been able to verify Karmarkar’s attendance.

She also appeared to have attended a meeting of the American Board of Commissioners for Foreign Missions in October 1917 in Columbus, Ohio. She shared her notes on the medical work being done in India for lepers and the “criminal caste.” It’s likely her work with lepers inspired the American physician and surgeon, Arley Isabel Munson Hare (1817-1941) who also studied at the Women’s Medical College. Hare graduated in 1902 and eventually made her way to Bombay, staying with Karmarkar until she began her medical/evangelical mission working with lepers in Solapur.

Karmarkar was especially noted for her work with famine-struck children. An 1898 volume of Life and Light for Woman, describing the role missionaries play in the Indian famine and Karmarkar’s part:

“While the height of the suffering may have passed…we must not forget the terrible scars that it has left in its train…Weakened bodies, each one an easy prey to disease, hundreds of families where the bread winner had died, leaving helpless women and children absolutely penniless, widows and orphans whose little all has gone to buy food, men and women hopeless and helpless, sitting down by the roadside without the energy and courage to take up again the struggle for existence, present a pitiful picture indeed. One instance has come to our notice of a child rescued by Mrs. Karmarkar, and adopted as their own by her husband and herself, is described as follows: “She was almost starved; the hair on her head looked like grass, and long hair had grown on her face till she looked more like a monkey than a human being. Mrs. Karmarkar oiled the face, and gently pulled out one of those long hairs after another until not a trace of them remains. She has been cared for and wisely trained, until she has grown to be an attractive, obedient, and sweet mannered child.”

The Bombay mission Karmarkar worked at also played a crucial role during the plague outbreak of 1916. Many people came to the overcrowded dispensary for inoculation and Karmarkar found “wonderful door of opportunity [to improve public health] through her professional visits to the homes of all classes, from the poor women of the weaver castes to Wealthy Parsi and Mohammedan ladies, some of who is always ready to come to them when their call of distress comes to her ear.”[3] After her retirement, she donated funds to open the “Dr. Gurubai Karmarkar Wing” at Lincoln House in Bombay, now the Nagpada Neighborhood House.[4]

Photo of Gurubai  Karmarkar with a patient,c.1915. Congregational Library Exhibit
Photo of Gurubai  Karmarkar with a patient, c.1915. Congregational Library Exhibit

I leave you with Karmarkar’s own words, written in the 1898 Life and Light for Woman:

Although my going to Baroda [Vadodara] was an altogether unexpected step, yet on looking back upon a year of labor, with many thrilling and instructive experiences crowding into my memory, I earnestly thank God for his manifest guidance and help. The position of physician is a secular one, yet there was nothing in my office calculated to interfere with my freely speaking on spiritual matters, and showing an example of what a Christian life means. Almost without exception the homes of the people, from the smallest to the greatest, have been pleasantly thrown open to welcome me. But amid much that gladdens and cheers one, there is a deeper and predominant feeling of keen sorrow and concern for the thousands of women victims of the present system of Indian life, and realization of the imperative need of more penetrating and thorough Christian influence, to lighten the gloom of error and superstition which hangs like a cloud over the lives of rich and poor alike. Provision has been made for a certain amount of education, but the effectiveness and the results that might be expected are largely crippled by the fact that in Baroda the purdah system is more rigidly enforced than in many other states. One night at twelve o’clock I was called to see a woman who had given birth to a child, and was suffering from high fever. Upon examination I found that there was no serious complication, and concluded that she would speedily recover. But the fever still remained, and the parents became still more frightened on account of the plague prevailing in the city. Upon further scrutiny I noticed that the people of the house had a large lamp burning night and day in the room, in addition to a couple of charcoal braziers. So I determined seriously to interfere with the existing sanitary arrangement of the sick chamber. I ordered the lamp to be removed; had the bed dragged from its dark corner to the vicinity of the window, substituting some warm clothing for charcoal fires. That very night there was a decided change for the better, and after a few days that patient was completely well. This occurred in an educated household, where custom compelled them to have dark rooms vitiated by charcoal fumes and other unsanitary measures, even, to the detriment of their own kith and kin. Roughly, I have medically treated about 11,000 women and children, a large number of whom have shown signs of deep gratitude, which must inevitably tend to remove from their minds any pre-existing prejudice against Christian workers.

 

NOTES.

[1] Belle J. Allen and Caroline Atwater Mason, A Crusade of Compassion for the Healing of the Nations: A Study of Medical Missions for Women and Children (West Medford, Mass., 1919).

[2] Frances Dyer, Looking Back over Fifty Years. Women’s Board of Missions (Boston, MA, 1917).

[3] 107th annual report of the American Board of Commissioners for Foreign Missions, 1917 (p.119)

[4] V.P. Rao, “Genesis, Rise and Socio-Cultural Development of Maharashtra” (2012).

Syphilitic Invasions of the Ear

The Chirurgeon’s Apprentice has a wonderful post on Georgian prostitution and syphilis, which inspired me to dig up my research notebooks and uncover what nineteenth-century aurists wrote about syphilis and deafness. Syphilis is a fascinating topic. In nineteenth-century London, people were quite aware of the gruesome and devastating aspects of the disease. The memoirs of Reverend Frederick Gilby (1865-1949), for instance, documented a “tragic case” of a poor deaf and dumb child at the Bow and Bromley Workhouse Infirmary who began to develop syphilitic symptoms.

Aurists were aware that syphilitic invasions of the ear were not uncommon occurrences. Most of them agreed on the symptoms of syphilitic deafness, though they may have disagreed on the stages of the disease or which part(s) of the ear the disease was presented. Matthew Berkeley Hill (1834-1892), for instance, argued deafness in syphilis occurred at the late stages of the disease and presented in the tiny bones of the ear.[1] By the 1870s, it was agreed that syphilitic deafness included symptoms of: damage to the eighth cranial nerve, tinnitus, a gradual loss of hearing, with periods of remission, and evidence of damage in the tympanic cavity.[2]

John Cunningham Saunders (1773-1810), founder of the London Infirmary for Eye and Ear Diseases, believed that proximate causes of syphilis and nervous deafness (hearing loss due to defective or damaged nervous system) were the same.  “Constitutional deafness” (selective, temporary deafness) also included deafness caused by syphilis. The Irish aurist William Wilde (1815-1878) defined syphilitic deafness as “syphilitic myringitis.” He described the disease as being rooted in the tympanum (bony cavity of the middle ear, behind the eardrum):

[T]he deafness which sometimes accompanies the secondary form of syphilis is generally believed to be caused by inflammation, and ulceration extending from the throat through the Eustachian trumpet [tube] into the middle ear.[3]

The aurist Joseph Toynbee (1815-1866) also discussed deafness arising from syphilis, though he didn’t go into much detail on its root causes. In The Diseases of the Ear (1860), he outlined a case of 28 year old “H.L.” who came to see him on June 25, 1853 for treatment of deafness and afflicted symptoms arising from syphilis:

[He has] suffered for several months from sore throat, consequent upon an attack of secondary syphilis: for two months has complained of deafness in both ears, so as not to hear any except a loud voice. The deafness is accompanied by constant singing [tinnitus], which is increased when the head is on the pillow, and it varies much…The treatment pursued was the use of the nitrate of silver to the fauces, and the administration of steel wine. On July 2d he told me that three or four days previously he heard quite well in the morning, and the improvement lasted for two days, since which he has been gradually getting deaf again. By perseverance in the treatment for a month he perfectly recovered.[4]

James Hinton (1822-1875), aural surgeon at Guy’s Hospital, also noted that 1 in 20 of his patients manifested symptoms of syphilitic deafness. Hinton also assisted in the research of English surgeon Jonathan Hutchinson (1828-1913), who was collecting data on inherited syphilis.

L0008502 Portrait of Sir J. Hutchinson.
Jonathan Hutchinson

Hutchinson studied at St. Bartholomew’s Hospital and was a member and fellow of the Royal College of Surgeons; his remarkable surgical career led to appointments in several of London’s hospitals, including the Lock Hospital, the London Hospital, and Blackfriars Hospital for Diseases of the Skin. His work on syphilis was the first to connect various symptoms to form diagnosis—what’s now called the Hutchinson Triad, in which symptoms of notched teeth, interstitial keratitis, and deafness, could provide a firm diagnosis of congenital syphilis.

photo 2
Types of interstitial keratitis, from Hutchinson’s A Clinical Memoir
L0021139 "Syphilitic malformations of the permanent teeth".
Types of notched teeth, from Hutchinson’s A Clinical Memoir

In A Clinical Memoir of Certain Diseases of the Eye and Ear as a Consequent of Inherited Syphilis (1863), Hutchinson states that deafness frequently follows the presence of keratitis and in the majority of cases, the deafness was complete and permanent. He found syphilitic deafness occurred in cases of diseases of the cranial bones extending towards the internal and middle ears; of these cases, otorrhoea (inflammation of the ear with excessive discharge) was an invariable symptom.

Deafness in greater or less degree is frequent in the subjects of inherited syphilis. In some instances it advances to the almost total abolition of the perception of sound. These extreme cases are however exceptional, and more commonly only the hearing is only partially lost.[5]

Symptoms of syphilitic deafness were indicative of the progressive nature of the disease. As Hutchinson explained, deafness is usually symmetrical, in that it appears in both ears at the same time. In none of his cases did he find any changes in the tympanic membrane (eardrum), although the membrane was often abnormal in some way. The stages of hearing loss are rapidly passed through; a patient’s hearing could drastically diminish in six months from perfect hearing, to totally deaf, without any marked degree of pain. In cases of inherited syphilitic deafness, Hutchinson observed that deafness usually appears in five years either before or after puberty.

“Herdito-syphilitic deafness,” Hutchinson declared, had a poor prognosis. Its progressive nature meant there was little chance of permanent improvement, even in spite of the “cautious use” of specific remedies prescribed from the onset of symptoms. Six months to a year was the usual time “for the completion of the process and the entire abolition of the function.”[6]

NOTES

[1] Matthew Berkeley Hill, Syphilis and Local Contagious Disorders (1868).

[2] Deborah Hayden, Pox: Genius, Madness, and the Mysteries of Syphilis (2003), p.80.

[3] William Wilde, Practical Observations on Aural Surgery (1853), p.252.

[4] Joseph Toynbee, The Diseases of the Ear: Their Nature, Diagnosis, and Treatment (1860), p.235.

[5] Jonathan Hutchinson, A Clinical Memoir of Certain Diseases of the Eye and Ear as a Consequent of Inherited Syphilis (London: 1863), p.174.

[6] Hutchinson, p.183.

Cures of all Kinds

Breathing into the ear to relieve deafness (19th Century)
From: The Magnetic and Botanic Family Physician.
By: D Younger
Published: E. W. Allen.London 1887
An ear cleaner at work; by an unnamed Dehli painter, commissioned by Colonel
James Skinner. Watercolour 1825 (Delhi)
The surgeon Capiomont stitching the ear of general Oudinot at the battle of Wagram, 1809. Watercolour by F. Pils.
An operator making an incision behind the ear of a seated patient, two assistants restraining the patient, and six other people in the room. Oil painting attributed to Joachim van den Heuvel.
An operator extracting “pierres de tête” from behind a man’s ear, with four other people in attendance. Oil painting by a follower of Pieter Jansz. Quast.

All images from Wellcome Collection.

What do you do when you’re sick?

I like to ask my students this question at the beginning of the term to help them get a mindset of what disease and illness was like in the early modern period and medieval ages. When confronted with the inevitable reality of disease, how did people of the Middle Ages react? Of the different forms of healing available, what factors determined which ones they turned to? Availability was one such factor, but we must also consider other factors such as the cost of services and treatment, the healer’s reputation, their suitability to treating the disease as well as explaining its underlying causation, as well as the past experience of the sick themselves, their family, and friends. More importantly, reliability was an ideal attribute to be found in practitioners.

Patients consulted astrologers, empirics, wise-women, midwives, nuns or priests known for their magical or miraculous healing powers, knowledgeable friends, as well as physicians or surgeons. They sought out healers and choose the one that most pleased them.

Physicians were, of course, expensive—but money was not the only consideration. Medical decision-making was a complex process. Medieval and early Renaissance patients were medically promiscuous. They often and perhaps even always consulted several different types of practitioners at the same time, or one after the other. This was true of both the rich and poor; the rich did not rely exclusively on physicians. To a large extent, patients perceived no firm cultural barrier between different medical practitioners, and behaved accordingly.

Moreover, as Gianna Pomata writes in Contracting a Cure: Patients, Healers, and the Law in Early Modern Bologna (1998), the transaction between healer and patient was regulated by a business-like arrangement, known as the healing contract that dates back to the thirteenth century. Here’s an example of a contract from Bologna outlined in Pomata’s book, undersigned in 1244 by Rogerio de Bruch of Bergamo and Bosco the wool carder in Genoa:

          “In the name of the Lord, amen.

I, Rogerio de Bruch of Bergamo, promise and agree with you, Bosco the wool carder, to return you to health and to make you improve from the illness that you have in your person, that is in your hand, foot, and mouth, in good faith, with the help of God, within the next month and a half, in such a way that you will be able to feed yourself with your hand and cut bread and wear shoes and walk and speak much better than you do now. I shall take care of all the expenses that will be necessary for this; and at the time, you shall pay me seven Genoese lire; and you shall not eat any fruit, beef, pasta—whether boiled or dry—or cabbage. If I do not keep my promises to you, you will not have to give me anything. And I, the aforementioned Bosco, promise to you, Rogerio, to pay you seven Genoese lire within three days after my recovery and improvement.”

The promise of a cure is obviously a key feature in the agreement between healer and patient. To the patient, it was valuable because it outlined exactly what was to be expected from the healer and that payment was to be dismissed if cure was not provided—it was a legal binding document that could protect him from fraud as well. To the healer, it served to win the trust of potential clients, to showcase his learned medicine and prognosis. In addition, to those patients seeking out self-help, practitioners would actually build their authority on the difficulty of treatment and the dangers of treating selves without proper medical knowledge.