Category Archives: Medical History

Smallpox and the Revolution

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From National Geographic from last spring (hat tip: Dan Franke):

How a public health crisis nearly derailed the American Revolution

George Washington confronted a smallpox epidemic with a belief in science—and a controversial plan.

When American colonists launched their revolution against Britain, they quickly encountered a second but invisible enemy that threatened to wipe out the new Continental Army: highly contagious smallpox.

But luckily for the young nation, the army’s commander was familiar with this formidable foe. George Washington’s embrace of science-based medical treatments—despite stiff opposition from the Continental Congress—prevented a potentially disastrous defeat, and made him the country’s first public health advocate.

A hard lesson

Washington’s wisdom came from personal experience with the horrors of an epidemic. “Was strongly attacked by the small Pox,” Washington wrote as a teenager in 1751, while visiting the Caribbean island of Barbados. At the time, the disease caused by the variola virus killed as many as one in two victims. Washington was lucky. After nearly a month of chills, fever, and painful pustules, he emerged with the pockmarked face typical of survivors—but alive, and with immunity to the illness.

Washington’s encounter with the virus proved fortunate for the new nation. In 1775, smallpox arrived in Boston, carried by troops sent from Britain, Canada, and Germany to stamp out the growing rebellion. Many of these soldiers had been exposed and were therefore immune, but the vast majority of American colonists were not.

In the aftermath of the battles of Lexington and Concord, Washington’s Continental Army had set up camp across the Charles River from the stricken city. To the dismay of many patriots seeking refuge from the British, the general prohibited anyone from Boston from entering the military zone. “Every precaution must be used to prevent its spreading,” he sternly warned one of his subordinates about the virus. To John Hancock, the president of the Continental Congress, Washington vowed to “continue the utmost Vigilance against this most dangerous enemy.”

By immediately isolating anyone suspected of infection and limiting outside contact, Washington “prevented a disastrous epidemic among the Continental troops,” historian Ann Becker says. In March 1776, when the British withdrew from Boston, Washington even specified that only soldiers who had suffered from smallpox be allowed into the city and its surroundings.

More at the link, including Washington’s defense of “variolation” (i.e. inoculation). I suppose this article is supposed to be “timely” but it’s good to remember that not all diseases are the same. COVID-19 does not kill one in two people, for instance. 

Medieval Cleanliness

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Katherine Harvey offers an interesting exploration of medieval hygiene, disease, and parasites on Aeon:

In the film Monty Python and the Holy Grail (1975), two minor characters spot King Arthur. They know who he is because, as one of them points out: ‘He must be a king … he hasn’t got shit all over him like the rest of us.’ The scene encapsulates an enduring belief about the Middle Ages: medieval people were dirty. Some might have heard Elizabeth I’s famous (but probably apocryphal) declaration that she had a bath once a month whether she needed it or not. In a time when only the richest enjoyed running water in their homes, very few Europeans had the resources to abide by 21st-century standards of hygiene, even if they wanted to.

At the same time, the filthiness of medieval people should not be exaggerated. Much evidence shows that personal hygiene mattered to medieval people, that they made an effort to keep clean. Popular advice books recommended washing the hands, face and teeth on rising, plus further handwashing throughout the day. Other body parts were washed less frequently: daily washing of the genitals, for example, was believed to be a Jewish custom, and thus viewed with suspicion by the non-Jewish population. Nevertheless, many households owned freestanding wooden tubs for bathing, and late-medieval cities usually had public bathhouses. Medical compendia gave recipes for washing hair, whitening teeth and improving skin. Medieval clergymen complained about the vanity of people who spent too much time fussing over their appearance.

Nor were medieval efforts to keep clean limited to the body. Delicate outer garments might be brushed and perfumed, but undergarments and household linens were frequently laundered. Advice books suggested that underwear should be changed every day, and household accounts are scattered with payments to washerwomen. Large rivers often had special jetties for the use of washerwomen: London’s was known as ‘La Lavenderebrigge’. 


Read the whole thing.

Avicenna in Ireland

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From Atlas Obscura:

Found: A Medical Manual Linking Medieval Ireland to the Islamic World

Knowledge transcends borders.

AN EXCITING LINK BETWEEN MEDIEVAL Ireland and the Islamic world has been discovered on two sheets of calfskin vellum lodged into the binding of a book from the 1500s. The sheets hold a rare 15th-century Irish translation of an 11th-century Persian medical encyclopedia. For 500 years, they sat in a family home in Cornwall with no one the wiser to their origins.

“I suppose [the owners] just took a notion to photograph it with their phone and they sent the photograph to one of the universities in England, who sent it to another university, and eventually it got to me,” says Pádraig Ó Macháin, who has spent his life with medieval Gaelic manuscripts and leads the modern Irish department at University College Cork. For him, identifying it as a medieval Irish medical text was a cinch, but he needed a little help to determine its source.

Ó Macháin, founder of Irish Script on Screen, Ireland’s first deep digitization project, where the manuscript and many more old Irish texts can be seen, shared the fragment with Aoibheann Nic Dhonnchadha, a specialist in Irish medical texts at the Dublin Institute for Advanced Studies. She identified it as a passage from the first book of the seminal five-volume The Canon of Medicine.Written by 11th-century Persian physician and polymath Ibn Sina, also known as Avicenna, the work is considered the foundational textbook of early modern medicine. While many references to Ibn Sina and his work pop up in old Irish medical texts, this is the only known evidence of a full translation of his encyclopedia. He originally wrote in Arabic, and the Irish rendition is likely translated from a 13th-century Latin version by the prolific Gerard of Cremona. “This is one of the most influential medical books ever written,” says Nic Dhonnchadha. “So the fact that it was being studied in Ireland in the 15th century was certainly a link to the Islamic world.”

More at the link.

Symbols of Medicine

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A peeve of mine, which I record for posterity:

The proper symbol of medicine is called a Rod of Asclepius, and consists of a single snake wrapped around a central pole. It is not to be confused with the Caduceus, which consists of two snakes wrapped around a winged pole, and is associated with the god Hermes.

Rod of Asclepius and Caduceus. Pinterest.

The hero Askepios was the son of the god Apollo and either Coronis or Arsinoe, both mortals. Asklepios’s attributes are a snake and a staff, combined into a single symbol. The staff seems to have been simply the sign of an itinerant physician, while the snake can be seen in many ways:

sometimes the shedding of skin and renewal is emphasized as symbolizing rejuvenation, while other assessments center on the serpent as a symbol that unites and expresses the dual nature of the work of the physician, who deals with life and death, sickness and health. The ambiguity of the serpent as a symbol, and the contradictions it is thought to represent, reflect the ambiguity of the use of drugs, which can help or harm, as reflected in the meaning of the term pharmakon, which meant “drug”, “medicine”, and “poison” in ancient Greek. Products deriving from the bodies of snakes were known to have medicinal properties in ancient times, and in ancient Greece, at least some were aware that snake venom that might be fatal if it entered the bloodstream could often be imbibed. Snake venom appears to have been ‘prescribed’ in some cases as a form of therapy.

By an interesting coincidence a healing snake-and-pole device also appears in Numbers 21:

[The Israelites] traveled from Mount Hor along the route to the Red Sea, to go around Edom. But the people grew impatient on the way; they spoke against God and against Moses, and said, “Why have you brought us up out of Egypt to die in the wilderness? There is no bread! There is no water! And we detest this miserable food!”

Then the Lord sent venomous snakes among them; they bit the people and many Israelites died. The people came to Moses and said, “We sinned when we spoke against the Lord and against you. Pray that the Lord will take the snakes away from us.” So Moses prayed for the people.

The Lord said to Moses, “Make a snake and put it up on a pole; anyone who is bitten can look at it and live.” So Moses made a bronze snake and put it up on a pole. Then when anyone was bitten by a snake and looked at the bronze snake, they lived.

It’s interesting how snakes are generally symbols of evil in the Christian tradition, but ambiguous in Greek paganism. Here, however, is a Biblical example of a snake that does some good. (And I believe this passage has been used by Christians to justify their use of apotropaic images, in apparent violation of the second commandment.)

    

Medical bodies that are on the ball will identify themselves with a Rod of Asclepius. Left to right: the Emergency Services’ Star of Life, the coat of arms of Geisel School of Medicine at Dartmouth College, and the logo of the American Medical Association, all from Wikipedia.

The Caduceus, by contrast, comes from the Greek kērukeion, and simply means herald’s staff. Since Hermes was the herald of the gods, he is often depicted with a staff of some sort, usually with something wound around it; this has been formalized as two snakes, and the wings match the wings on Hermes’s helmet and shoes. The Caduceus, therefore, represents items in Hermes’s wheelhouse, chiefly commerce.

   

Coat of arms of Jyväskylä, Finland and of Metropolitan Toronto (1954-98) featuring Caduceuses. From Wikipedia and the Online Register of Arms, Flags, and Badges of Canada.

Or rather, the Caduceus ought to represent commerce. By the same process that saw methodology replace method, or discipline replace field, a device with two snakes (and two wings!) was seen as somehow grander than a device with one. See the Wikipedia entry on the Caduceus as a symbol of medicine.

Wikipedia.

Apparently the US Army was the chief culprit here. Daniel P. Sulmasy said that “It is hard to trust a profession that cannot even get its symbols straight,” but others have noted the ironic appropriateness of the American medical profession representing itself with a symbol of commerce.

Humorism

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In the Middle Ages, the study of medicine consisted largely of mastering the theories of Galen, a Greek physician active in the second century AD. Among his insights, he imagined that, just as the physical world was made up of the four elements fire, water, earth, and air, so also were humans were made up of four humors: blood, black bile, yellow bile, and phlegm. Each person had a unique combination of humors, which determined his personality; I like to point out that the adjectives sanguine,* melancholic, choleric, and phlegmatic derive from Galen’s theory of humorism (not that any of my students has ever heard of these words, alas). Illness was caused by your humors getting out of balance: unfortunately, a naturally melancholic person who had acquired an excess of blood did not get temporarily happy, he just got sick, and it was the doctor’s job to determine the person’s unique blend of humors, and to try to bring them back in proper balance. One way to do this was to prescribe a substance with the opposite qualities of the excess humor. Humors were either hot or cold, and either wet or dry, as illustrated by this table:

HOT COLD
DRY Yellow Bile Black Bile
WET Blood Phlegm

So if you had a disease that caused an excess of phlegm (cold and wet), you took something like pepper (hot and dry) to counter it. In the opposite direction, oil of earthworms was cold and wet, and so was useful against anything producing an excess of yellow bile, which was hot and dry. And so on.

Another way to counter an excess humor was to employ some way of removing it from your body. Getting bled by leeches (or simply by being cut by a barber) was a common way to get shed superfluous blood, while purgatives (either emetics or laxatives) took care of the others.

I suppose there may have been a placebo effect with such treatments but it’s easy to see how visiting a doctor in the Middle Ages was useless at best, and positively harmful at worst.

I don’t wish to condescend to the Middle Ages too much; I am a medievalist, after all, and part of my job is to rehabilitate them from the popular notion that it was a dark, ignorant, superstitious, and backward time. Some of their theories are models of subtlety, and they make complete internal sense. The main problem is that the theories were treated as ends in themselves – and did not actually have any relation to reality. Or rather, they “worked” enough that they just kept on going.** Only with the Scientific Revolution, which featured such things as the accurate collection of data and experimentation to test one’s hypotheses, were Galen’s (and Ptolemy’s, and Aristotle’s) theories seriously challenged. And even then humorism was not completely demolished until the nineteenth century.

But there’s nothing particularly medieval about devotion to elaborate and plausible-sounding theories that aren’t really true (e.g. Marxism, Freudianism, etc.).

* I recently read an interesting use of “sanguine” on Mitch Berg’s Shot in the Dark blog, about the Korean War defector No Kum-Sok:

Parts of the story were less sanguine; while his father was already dead and his mother had fled to the south before the war, No’s uncle and all members of his family apparently disappeared. And No’s commander and five other pilots were executed.

But this use of “sanguine” is somewhat ironic. “Sanguine” generally refers to something happy or jovial. But the disappearance of No’s family and the executions of his comrades were also “bloody” in the other, more usual sense. I would have picked a different word here.

** Theodore Dalrymple once wrote that:

The Galenical theory was an article of uncritical faith for university-trained physicians. Training consisted of indoctrination, memorization, and regurgitation. No deviation was permissible, and even refinement or elaboration was hazardous. Outright challenge was professionally dangerous. The theory therefore took many centuries to overthrow; mastery of it, and the treatments it entailed, distinguished real physicians from mere empiricks and quacks.

Victorian Childbirth

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My grad school colleague Anne Huebel has penned an entry on Remedia: the history of medicine in dialogue with its present.

Managing Victorian Reproduction: Medical Authority over Childbirth in British Advice Literature

“Obey implicitly the advice and directions of your medical attendant.” Such was the advice of Dr. Thomas Bull for women in labor. Dr. Pye Henry Chavasse, Bull’s contemporary and rival in the advice literature industry, agreed. Doctors Bull and Chavasse wrote popular books on pregnancy, childbirth, and infant care in mid-nineteenth-century Britain. Like William Smellie a century earlier, they emphasized a doctor’s right to manage a woman’s health and to expect obedience in return for their medical care. Both authors described how women should regulate their lives and bodies prior to and during pregnancy, labor, and lying-in, all of which occurred in the patient’s home. On the surface, the books encouraged women to take control of their health; however, they in fact advanced the medical management of women’s bodies.

Much more at the link.

Radium Girls

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From Buzzfeed, courtesy Elizabeth Keohane:

The Forgotten Story Of The Radium Girls, Whose Deaths Saved Thousands Of Workers’ Lives

During World War I, hundreds of young women went to work in clock factories, painting watch dials with luminous radium paint. But after the girls — who literally glowed in the dark after their shifts — began to experience gruesome side effects, they began a race-against-time fight for justice that would forever change US labor laws.

Read the whole thing.

Hitler Has Only Got One Ball

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From the Guardian. No word on the testicular status of Goering, Himmler, or Goebbels:

Hitler really did have only one testicle, German researcher claims

Analysis of long-lost medical notes seems to confirm that Nazi leader suffered from cryptorchidism, or an undescended right testicle

The song sung in schoolyards by generations of British children mocking Adolf Hitler for only having “one ball” might be accurate after all.

A German historian has unearthed the Nazi leader’s long-lost medical records, which seem to confirm the urban legend that he only had one testicle.

The records, taken during a medical exam following Hitler’s arrest over the failedBeer hall putsch in 1923, show that he suffered from “right-side cryptorchidism”, or an undescended right testicle.

Notes written by Dr Josef Steiner Brin, the medical officer at Landsberg prison, state “Adolf Hitler, artist, recently writer” was otherwise “healthy and strong”.

Long thought to have been lost, the records of the examination surfaced at an auction in Bavaria in 2010 before swiftly being confiscated by the Bavarian government. They have only recently been properly studied by Professor Peter Fleischmann of Erlangen-Nuremberg University.

Normally, men’s testicles descend from inside the body into the scrotum during childhood, but Fleischmann told German newspaper Bild the records showed one of Hitler’s testicles was “probably stunted”.

The records seem to contradict long-running specualation that Hitler lost one testicle to shrapnel during the Battle of the Somme in the first world war.

That rumour was backed up by Franciszek Pawlar, a Polish priest and amateur historian, who claimed a German army medic who treated Hitler after the shrapnel incident told him about the injury.

The medical records also contradict Hitler’s childhood doctor, who told American interrogators in 1943 that the future Führer’s genitals were “completely normal”.

Wikipedia on the topic: Adolph Hitler’s Possible Monorchism.

The Tremulous Hand of Worcester

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Interesting post at the OUP blog:

Scrutinizing the script of the medieval ‘Tremulous Hand of Worcester’

DEBORAH THORPE AND JANE ALTY

SEPTEMBER 6TH 2015

How would we know if a medieval person had a neurological disorder? If we did know, would it be possible to pinpoint the type of condition? What insight can we gain about the practical impact of disorders on medieval life? Fortunately, a physical record survives that provides a reliable window into the health of medieval people—or, at least, those who were able to write.

Handwriting captures the writer’s state of health: it requires fine motor control, as well as highly-developed cognitive abilities in spatial planning, spelling, and grammar. In the period before the fifteenth-century invention of the printing press, all texts had to be written out by hand. Writing could be a profession, or an act of devotion within a religious order. Contrary to popular belief, the medieval life was not universally short and brutal—some medieval scribes lived to be 70, 80, and possibly 90 years old. Thus, medieval writing offers a wealth of insight into the lives of young and old, healthy and unhealthy people.

Historians have long been fascinated by the ‘Tremulous Hand of Worcester’. His script was first described in 1878 as “von einer zitternden hand” (“by a shaking/trembling hand”), by the German scholar Julius Zupitza. This thirteenth-century scribe, whose name remains a mystery, was probably a monk at Worcester Cathedral Priory. His handwriting appears in over 20 books, providing us with rich material for our study. However, despite the interest provoked by his distinctive, shaky script, it has never before been analysed by a neurologist. With this in mind, we created an unconventional collaboration: a medieval palaeographer (a researcher of historical handwriting) working with a neurologist with a specialist interest in movement disorders, and began to scrutinize the script.

There’s more at the link, but to get the full story you’ll have to consult the latest issue of Brain. I had known about the work of Christine Franzen; Thorpe and Alty seem poised to expand our knowledge of the Tremulous Hand.

Y. Pestis

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Interesting research being done on the microbe that caused the Black Death:

While studying Yersinia pestis, the bacteria responsible for epidemics of plague such as the Black Death, researchers have found a single small genetic change that fundamentally influenced the evolution of the deadly pathogen, and thus the course of human history.

In a paper published in Nature Communications, Wyndham Lathem, Ph.D., assistant professor in microbiology-immunology at Northwestern University Feinberg School of Medicine, and first author Daniel Zimbler, Ph.D., a Feinberg post-doctoral fellow, demonstrated how the acquisition of a single gene caused the shift of Y. pestis from causing a primarily gastrointestinal infection to a more serious and often fatal respiratory disease.

They further showed how later modifications of this gene enhanced infections associated with the bubonic plague.

…

Lathem and his team inserted the Pla gene into this strain to observe changes in the health of the lungs. They found the newly mutated strain had gained the ability to cause respiratory infection identically to modern strains of Y. pestis that cause disease today, demonstrating that the Pla gene was necessary for Y. pestis to infect the lungs. In addition, they found that no other changes to Y. pestis were required, even though the bacteria has continued to gain and lose genes over the last several thousand years.

The lab also looked at variations of the gene Pla and discovered that a single modification only found in modern strains of Y. pestis was a critical adaptation for the bacteria to spread in the body and infect the lymph nodes, a form of the infection that causes bubonic plague. According to Lathem, the surprising conclusion from this aspect of the study is that, contrary to current thinking in the field, Y. pestis may have first evolved as a respiratory pathogen before it could cause the more common form of disease, bubonic plague.

Lathem said the new research may explain how Y. pestis transitioned from causing only localized outbreaks of plague to the pandemic spread of Y. pestis such as the sixth century’s Justinian Plague and the fourteenth century’s Black Death.