Wednesday, 1 July 2015

History Carnival 147

Happy Canada Day and welcome to History Carnival 147!  I’m excited to host this month and help showcase some of June’s best history blog posts. 

This month we have a number of fantastic posts that highlight the sheer breadth of freely available, intelligent, and accessible historical blogging.

These first two posts were some of the most thought-provoking entries I read this month.  In Seeing And Challenging Your Assumptions (Isn’t Easy), Joanne Bailey reflects on her own historical practice and the challenges in confronting underlying assumptions and reframing evidence.  Matt Houlbrook, inspired by Bailey’s post, picks up on this theme of self-reflection and self-critique in his On Being A One Trick Historian.  “Habits,” he writes, “shape and constrain how we work as historians.”  And, while useful, can “get in the way of thinking imaginatively, creatively, and differently about the past.” 

This past month, a very large number of posts focused on exploring the past to explain or shed light on the present.  At NOTCHES, Rebecca Davis explores the Religious and Reproductive Politics in the United States since WWII and highlights the often overlooked role of religious activism in defense of women’s reproductive rights.  In Obergefell Made History, and History Made Obergefell, Lara Freidenfeld emphasizes the role of sophisticated historical research in the recent Obergefell v. Hodges decision.  Likewise, Jarret Ruminski explores the history and meaning of the Confederate flag in the wake of the recent South Carolina shootings in the Twilight of the Confederate Flag.

Each of the previous posts discusses somewhat the struggle scholars have with sources and how we approach or use them.  Switching gears a bit, these next posts highlight historical practice in an increasingly digital world.  Sarah J. Young looks at sources, historical memory, and the effect of digitization in Historical Memory of the Gulag.  At The Suffrage Postcard Project, Kristin Allukian and Ana Stevenson use digital humanities approaches to “understand how feminist digital humanities practices engender new historical narratives of parenthood – motherhood and fatherhood, broadly defined – in early-twentieth-century suffrage postcards.”  Alana Farrell’s guest post at the Medical Heritage Library, The Censors of the Royal College of Physicians, calls attention to the recent digitization and uploading of several 19th century medical works.

Last, I couldn’t host the History Carnival at Panacea without some early modern medical history!  Hugh Aldersey-Williams’ A Bestiary of Sir Thomas Browne is a fascinating post on Browne’s natural philosophy work and his correction of various “vulgar errors” such as belief in the existence of unicorns and basilisks.  At the Sloane Letters Blog, Matthew DeCloedt relates an interesting story about Sir Hans Sloane, slander, and libel in Bad Blood and Indecent Expressions.  In a fun post at the Recipes Project, Annie Gray and Alun Withey recreate historical recipes in the Curative Power of Beer and Rhubarb.  While Sara Read and Jennifer Evans close Early Modern Medicine for the summer with a post on Inconvenient Incontinence in post-partum women.

Hope you’ve enjoyed a quick journey through June’s history blog posts!  As always, if you’d like to be involved in the monthly History Carnival you can email or DM the admin at the addresses found here.



Tuesday, 19 May 2015

Achoo!!!: The Humble Sneeze

The bridge of your nose tingles and your eyes start to water, after a quick intake of breath through your mouth, you can feel the pressure building in your sinuses until your body is wracked with a quick, explosive movement, expelling air, mucus, and irritants.

You have just sneezed.

Those of us with seasonal allergies are perhaps a bit too familiar with that feeling right now!

Sneezing happens when our mucus membranes are irritated by allergens, disease, or other triggers and is an attempt to forcefully expel the irritant.

What Is A Sneeze Anyway?

For some early modern medical practitioners, a sneeze was a bit more complicated.  As Robert Bayfield wrote, a sneeze was an “involuntary expulsion (by the nostrils) of the flatulent windie spirits, and sharp vapours offending the brain.”[1]  Indeed, as another author noted, sneezing was very useful to cure “obstructions of the substance of the brain.”[2]

Sneezing, it was believed, helped to remove superfluous humours from the brain.[3]

Photo via CDC/ Brian Judd (Photo Credit: James Gathany, 2009)
Jean Baptiste van Helmont questioned this assumed connection between the brain and sneezing.[4]  Comparing the “waterish snivel” and “snotty snivel” that exited his proboscis, van Helmont noted that both occurred when he inhaled powdered hellebore and tobacco.  Since both occurred quickly after nasal irritation, they were “speedily made” without any “hurting of the brain” and thus not some sort of “brain excrement.”[5]

Aside from expelling excessive brain humours, John Pechey noted, that sneezing could also be a symptom of disease or of “sharp Vapours…transmitted to the Nostrils.”[6] 

The sneeze was so commonplace - even in times of health – that Pechey wrote it “scarce deserves the Name of a Symptom.”  Yet, he continued, why would we say “God bless you” when someone sneezes if it were not sometimes dangerous?[7] 

Indeed, the origin of the wishing well the sneezer was a matter of some debate.  Some argued that the practice began with Prometheus.  Others argued that the practice was popularized in the sixth century during the time of Pope Gregory “when at Rome in a great sicknesse, men died with sneezing” during a time of epidemic disease (likely the Plague of Justinian.[8]

The humble sneeze, then, deserved a bit of respect!

Sneezing and Prognostication

For the superstitious, sneezing could be used to prognosticate whether an ill person would live or die:
Also take a handfull Rew, and stamp it with oyle of Roses, and lay it upon his head, being shaven before, if he sneeze once he shall live, if he sneeze not he shall dye: this is proved by Galen.[9]
Sneezing and Sex

A truly surprising number of midwifery texts mention sneezing.  Pechey’s The Compleat Midwife’s Practice Enlarged, for example, argues that a violent sneeze could break a hymen (and so a lack of hymen did not equal a lack of virginity).[10]

Violent sneezes were said to cause female genital and rectal prolapse and even to “loosen the Ligaments of the Womb, and so cause miscarriage.”[11]

Despite these potentially serious complications, medical practitioners thought that sneezing could also be remarkably beneficial to pregnant women during labour.  Indeed, Robert Johnson thought that it was “a good sign of deliverance” if a labouring woman naturally began sneezing.[12]

Philip Barrough wrote that inducing sneezing was particularly helpful to “strong” women who laboured for several days with a large child or even multiple children.[13] 

The sheer violence of sneezing was thought to speed up the delivery process and many practitioners listed methods of inducing sneezing fits in their labouring patients.

Pechey, for example, recommended the following powder to induce sneezing in pregnant women: 
Take of white Hellebore, half a dram, of long Pepper, one Scruple, of Castor five grains. Make a Powder: Let the quantity of a Pease be blown up the Nostrils.[14]

Inducing Sneezing

Sneezing powders with a variety of ingredients were ground into very fine powders and then blown up the nostrils with a hollow quill. 

Hannah Woolley recommended this one:
Take Cloves, Ginger, and Calamint, of each a like quantity, boyl them in White-Wine, and therewith wash the Nose within; then put in the powder of Piritrum to provoke one to sneeze.[15]
White hellebore. Photo credit: wiki user Planchon.

Paul Barbette, a French surgeon, used the following sneezing powder on John N., a fellow surgeon, who was suffering from the plague:
Take the flower of Lillies of the Valley, Leaves of Marjoram, of each half a scruple; white Hellebore, three grains: Make them into fine Powder.

As Barbette recorded, the powder encouraged his patient to sneeze “3 or 4 times” before dying.[16]

White hellebore, or sneezewort, was used frequently to induce therapeutic sneezing.  Nicholas Culpeper’s translation of the Royal College pharmacopeia lists grated white hellebore as a harsh medicine that induced sneezing, killed rodents when consumed, and could be used to treat melancholy.[17]

Sooo…suffering from seasonal allergies right now?  Just think, all that sneezing is actually making you healthier and happier ;)

Let me know what you think here or on Twitter – I’m (a sneezy) @medhistorian.

[1] Robert Bayfield, Tes Iatrikes Kartos, London: printed by D. Maxwell (1663), 148.
[2] M. Flamant, The Art of Preserving and Restoring Health, London: printed by R. Bently, H. Bonwick, and S. Manship (1697), 78.
[3] John Pechey, The Store-House of Physical Practice, London: printed for Henry Bonwicke (1695), 99.
[4] Jean Baptiste van Helmont, Van Helmont’s Works, London: printed for Lodowick Lloyd (1664), 1041-1042.
[5] Ibid.
[6] Pechey, 99.
[7] Ibid.
[8] Ibid and Alexander Ross, Arcana Microcosmi, London: printed by Tho. Newcomb (1652), 222.
[9] Philiatros, Natura Exenterata, London: printed for H. Twiford (1655), 279.
[10] Pechey, The Compleat Midwife’s Practice Enlarged, London: printed for H. Rhodes et al (1698), 286.
[11] Robert Johnson, Praxis Medicinae Reformata, London: printed for Brabazon Aylmer (1700), 242-243 and 249.
[12] Ibid., 253.
[13] Philip Barrough, The Methode of Phisicke, London: printed by Thomas Vautroullier (1583), 161.
[14] Pechey, A Plain and Short Treatise of An Apoplexy London: printed for the author (1698),18.
[15] Hannah Woolley, The Accomplish’d Lady’s Delight, London: printed for B. Harris (1675), 198.
[16] Paul Barbette, Thesaurus Chirurgiae, London: printed for Henry Rodes (1687), 392-393.
[17] Nicholas Culpeper, Pharmacopeoia Londinensis, London: printed for Peter Cole (1653),  6.

Tuesday, 31 March 2015

What's Old Is New Again: Medicine's Blast From the Past

And don't throw the past away/
You might need it some other rainy day.

'Cause everything old is new again.

Or so go the lyrics to Peter Allen’s “Everything Old is New Again.” 

Cow Bile & Onions for the Eye

Recent findings by an interdisciplinary team of scientists and Dr. Christina Lee, a scholar of health in Anglo-Saxon England, suggests that Allen’s lyrics may apply to medicine as well. 

Bald’s Leech-book, aka the British Library’s MS Royal 12 D (see also Harley MS 55, ff 1r-3r), has been a matter of scholarly interest for some time.  Compiled in the mid-10th century, possibly in Winchester, the manuscript contains a variety of medical receipts and a description of how to surgically fix a harelip or cleft lip.[1]
A facsimile of a page from Bald's Leechbook from Oswald Cockayne, Leechdoms, Wortcunning and Starcraft of Early England  (1865)
 Lee translated an eye-salve receipt which was then recreated and tested by a team of microbiologists.  As several news articles revealed, the simple salve of garlic and leeks/onion, wine, and cow bile proved extraordinarily efficacious against MRSA or methicillin-resistant staphylococcus aureus.

The BBC article on the discovery concluded that “it seems Anglo-Saxon physicians may actually have practised something pretty close to the modern scientific method, with its emphasis on observation and experimentation.”

Those who have read my work, sat in my classrooms, or know me can guess how I reacted to that rather condescending statement.[2] 


Let’s take a look at some other nonsensical sounding treatments that are still sort of used today, shall we? 

Treating Diarrhea With More Poop

John Hester’s The Pearle of Practise includes a number of very odd and very noisome sounding treatments.  The book sometimes reads like a compendium of horrifying and odd things like treating gout with the wax dripping off a roasted puppy that has been stuffed with black snails and rubbed with saffron.[3]  Or prognosticating whether or not someone would die of the plague by laying a frog on their belly.[4] 

Or the case of an empericke practitioner who cured cancer with “centumpedes” found in English pigs.  These creepy bugs were mashed in ale and consumed causing “a certaine black bugge, or worme to come forth [from the cancerous body] which had many legs, and was quicke and after that the cancker would heale quicklie, with any conuenient medicine.”[5]

Or curing shingles with a plaster of barley, vinegar, and doves dung.[6]  I could probably go on for a while.  Like I said, a veritable compendium of odd things. 

One of the treatments that caught my eye, however, simply stated that in cases of the flux or diarrhea, “diuerse Souldiars in the warres haue beene cured thereof, by setting their fundament in warme Horse dung.”[7]

Yes, diarrhea-ridden soldiers sat in fresh horse poop to cure their diarrhea.

Sounds about as useful as the centumpede cancer remedy, right? 

So have you heard about fecal transplants?

Fecal microbiota transplants or FMT is exactly what it sounds like: the insertion of foreign fecal matter into a patient – through enemas, pills etc. – to treat C. difficile (stomach pains & diarrhea), colitis, and irritable bowel syndrome to name a few.

The donated fecal matter essentially helps to repopulate the patient’s colon with healthy bacteria.

A Hole in the Head

Trepanation inevitably comes up when I’m asked about terrible early modern surgical procedures. It involves drilling a hole into the skull so deeply that the membrane surrounding the brain is exposed. 

We have archeological and textual evidence of prehistoric and premodern trepanned skulls from Asia to the Americas.  Surprisingly, trepanation wasn’t necessarily a death sentence either – many patients survived and their skulls show signs of healing.[8]

But why would anyone need a hole in their head?  Trepanation was sometimes used to treat seizures, skull fractures, migraines, and madness.  The hole was thought to release pressure  

Along with amputation, trepanning was one of the most visibly violent and extreme operations a surgeon could perform. 

Early modern surgical texts mentioned trepanation frequently and even included illustrated how-to sections for more inexperienced surgeons.

The German surgeon, Johannes Scultetus, for example, included a very detailed series of numbered images of a skull being trepanned with additional text.[9]  Both early 18th century writers, Charles Le Clerc and Belloste also included figures with their description of trepanation.  Le Clerc’s image depicts the many layers of bandages he deemed vital to dressing – and thus curing successfully – a trepanned skull.[10]  Belloste also depicted an innovative thin lead plate he used to improve the trepan process by decreased risk of sepsis.[11]

Trepanation underwent something of  a revival in the mid-20th century.  Bizarrely, self-trepanationists such as Bart Hughes advocated the procedure to increase blood flow to the brain and reach a higher state of consciousness.[12]

Today, however, modern surgeons rarely recommend trepanation except in cases of subdural hematoma.  Generally caused by head trauma, blood collects below the dura and increases pressure on the brain – trepanation just releases the pressure, the blood is suctioned out, and the skull piece is (usually) replaced promptly. 

There are a few more: maggots are now used to debride wounds, leeches are used in reconstructive surgery, and the medieval practice of variolation directly led to development of the smallpox vaccine.

Who knows what the past has in store for us?

Let me know what you think here or on Twitter - I'm @medhistorian.

[1]  For more on the manuscript see: M. L. Cameron (1983). Bald's Leechbook: its sources and their use in its compilation. Anglo-Saxon England, 12, pp 153-182.
[2] It wasn’t pretty and involved some ranting with words like epistemology, humility, and incommensurability thrown around.  On a more positive note, however, it did inspire this blog post.
[3] Hester, John.  The pearle of practise, or Practisers pearle, for phisicke and chirurgerie. Found out by I. H. (a spagericke or distiller) amongst the learned obseruations and prooued practises of many expert men in both faculties. Since his death it is garnished and brought into some methode by a welwiller of his.  London: Printed by Richard Field, dwelling in the Black-friers, (1594), 20.
[4] Ibid., 41.
[5] Ibid., 14.
[6] Ibid., 16.
[7] Ibid., 44.
[8] Zanello, Marc et al. “Report of a successful human trepanation from the Dark Ages of neurosurgery in Europe,” Acta Neurochirurgica 157, 2 (Feb 2015), 303-304.
[9] Johannes Scultetus, The Chyrurgeons Store-House, London: printed for John Starker (1674), 111-113.
[10] Charles Le Clerc, The Compleat Surgeon, London: printed for W. Freeman et al (1701), unpaginated image prior to page 1.
[11] Belloste, 78-82.
[12] Please don’t try this.

Tuesday, 10 March 2015

From Orient to Occident Part II: Acupuncture in Victorian England

N.B. This is the second half of a two-part series on acupuncture in Victorian England.  If you haven’t already done so, I’d recommend checking out Part I first.

Just to quickly recap, in the first post I discussed:
1)      acupuncture’s use in Victorian England
2)      acupuncture’s dismissal by reigning medical authorities
3)      Wakley and the Lancet published case studies to prove acupuncture’s efficacy

Wakley and the Lancet’s defense of acupuncture is fascinating – especially when contrasted with their contemporary denunciation of other inexplicable medical treatments like mesmerism, phrenology, and homeopathy.

Mesmerism or animal magnetism was attacked consistently by the Lancet after the infamous Dr. John Elliotson failed to adequately demonstrate the phenomena while in Thomas Wakley’s home.  Phrenology was slowly losing supporters, and homeopathy was almost always attacked as quackery.[1]    
Anonymous pamphlet attributed to Wakley.
Moreover, acupuncture possessed many similar characteristics to both mesmerism and phrenology.  First, all three “cures” were practiced by Dr. Elliotson.  Second, in an age when there was an effort to entrench science within medicine, there was no viable or accepted explanations for how either mesmerism or acupuncture worked. 

Case studies and experiments could take acupuncture only so far  – recorded cures via traditional acupuncture were professed to succeed in less than half of the cases in which it was employed.[2]

So we reach a bit of a conundrum.  Why didn’t Wakley and the Lancet portray acupuncture the way they treated mesmerism or homeopathy?

I would suggest that it’s simply because acupuncture needles were adaptable.

Both mesmerism and phrenology could be disproved as phenomena and thus rejected.  Acupuncture, however, in part because the Europeans were unsure as to how and when it should be used, required both wide and repeated experimentation.  Due to this experimentation, the procedures of, and occasions for acupuncture were widened considerably and changed along with the shifting medical trends of the period.

Perhaps in response to the calls for trials and experimentation, acupuncture began to be used for a wider variety of diseases in the 1830s.  In addition to the traditional cases of rheumatism, sciatica and lumbago, medical practitioners began to use acupuncture to treat cases of dropsy, hydrocele, ascites and ganglions.[3] 

Dropsy (1817)
All four of these ailments involve the accumulation of fluid.  Dropsy or oedema as it is now known commonly occurs in the ankles, hydrocele is an accumulation of liquid in a sac near the testes, ascites cause abdominal swelling due to fluid accumulation, and ganglions, also fluid filled sacs, tend to occur on the top of the wrist or foot. 

The “acupuncture” used in these cases, however, differs considerably from that practiced in the Orient.  Rather than the insertion of needles into the skin to stimulate nerves and relieve pain, acupuncture was now used to puncture cysts and release the accumulated fluid. 

This likely occurred for several reasons: first, the needle was a very visible and material object; the focus on it and its function paralleled the value and focus placed on surgical instruments at the time.  Second, as is still partially true today, they simply did not understand how acupuncture worked and thus tested its efficacy in as many cases as seemed plausible.

A more marked modification involved the coupling of electric therapy with acupuncture. 

Yes, that is as horrific as it sounds.

The treatment was reported by the Lancet as early as the 1820s, but was not recorded in any high numbers until the 1870s.

Electricity had been used in English medicine throughout the eighteenth century.[4]  The Lancet, however, only noted its use coupled with acupuncture in eight articles during the course of the nineteenth century.  The first three of these were published during the 1820s and 1830s.[5]  

Dispensing of medical electricity. Oil painting by Edmund Bristow, 1824.
The first instance was a case study of a physician who used galvano-acupuncture to treat “paralysis of the lower extremities, produced by curvature of the spine.”  The patient, a young girl who had been paralyzed for several months, consented to have acupuncture needles inserted into her back – the article states that they were driven into her spinal cord – and have these “brought into contact with the wire of a voltaic pile.”[6]  

Shockingly, the therapy was a success and the girl was able to walk again. 

The last case was recorded in 1830 and detailed the use of “electro-puncture” that is, acupuncture coupled with a galvanic battery, to treat successfully two cases of dropsy.[7]  Our knowledge of how often this treatment was used is hampered by the lack of articles published on the subject.  While the Lancet did publish one article in 1848 calling for the use of galvano-acupuncture in cases of asphyxia, it was merely a suggestion and did not include either case studies or even claims of successful use.[8]  It was not until 1879 that the periodical began publishing any significant number articles treated by galvano-puncture.

18thC French use of medical electricity.
During the late nineteenth century, physicians expanded their use of electricity as a medical treatment.   Both those on the medical fringe and regular hospital practitioners were extolling the virtues of electricity in curing a wide variety of ailments. 

It could be said that acupuncture, due to its coupling with electricity, underwent a renaissance in the latter decades of the nineteenth century.  While cures via traditional acupuncture left much to be explained and could not be professed to succeed in a half, or even a third, of the cases in which it was employed, the “advances of science” at least ensured that these electrical practitioners understood the basics of what they practiced.

In addition to the adaptation of acupuncture needles in electric therapy, it is also plausible that the continuing success of acupuncture could be linked with Victorian ideas on pain and need to control the body; the infliction of pain was seen in a positive light.[9]  As one article noted in a rather matter of fact manner, patients “watch with interest the insertion of the needles into their muscles and the transfixing of their limbs; welcoming the return of sensibility, even in the shape of pain, as a longed for boon.”[10] 

Another, in relation to sciatica, criticized traditional methods of acupuncture that only pierced the skin.  The practitioner stated that it was far more effective to pierce the nerve and that “the patient can always tell when the nerve has been pierced by pain shooting down the leg.”[11] 

From the 1820s to the 1890s, acupuncture in Britain had come a long way.  From the relatively painless therapy so extolled in the 1820s and 1830s, there emerged two far more painful treatments that better suited the scientific and medical environment.

To sum up the two blog posts: 
1) The changing representations of acupuncture in the Lancet have revealed a treatment that first served the periodical’s purpose in professionalizing medical practice.  The manner in which the ancient “cure” worked was a mystery to the Victorian medical practitioners.  The Lancet fully encouraged experimentation with this mystery treatment and included successful case studies in its defence.   
2) Acupuncture even became one of the many issues involved in the verbal sparring between the College of Physicians and professionalizing radicals such as Thomas Wakley.   
3) Perhaps in response to the periodical’s encouragement, and in part reflective of the push to entrench science within medicine, acupuncture was soon used for an even greater variety of ailments.  Despite its widened scope, it was never (in the Lancet at least) placed on the same level as many other baffling treatments such as mesmerism. 

Two possible reasons have been forwarded to explain this: First, in the 1830s, while acupuncture was used to treat ailments such as hydrocele, dropsy and ascites, it is evident that this was merely a logical extension of the needle’s form and function.  After all, if the acupuncture needle could be used to pierce the skin, why should it not be used to pierce cysts? 

Second, during the latter half of the nineteenth century, acupuncture was transformed to fit the needs and trends of the current medical marketplace.  It was first coupled with electricity and may had its life further extended by the burgeoning need to discipline the Victorian body. 

By the end of the century, acupuncture had transformed from a little known Oriental treatment to one with an Occidental – or rather a decidedly Victorian – veneer.

Let me know what you think here or on Twitter - I'm @medhistorian.

[1] For more on this, see John Epps, The Rejected Cases; With A Letter to Thomas Wakley on the Scientific Character of Homeopathy, London, Sherwood and Co. (1845); Lancet 58, 1464 (1851), 285.
[2] The words “cure” and “succeed” have to be viewed critically.  What did it mean to be “cured” of lumbago?  Was acupuncture a “success” for treating immediate pains?  Or did it dismiss entirely chronic pains? Lancet 97,2487 (1872), 567.
[3] See for example: Lancet 27, 703 (1837), 750; 28,713 (1837), 194-196; 28,721 (1837), 486-487; 29,743 (1837), 313; 115,2947 (1881), 285; 134,3436 (1889), 13-14.
[4] This was not just an English fad, other periodicals shared French and Italian experiments with electro-acupuncture i.e. Popular Science Review 10,38 (Jan 1871), 329.
[5] There are references to both galvanic and faradaic acupuncture.  Multiple articles, however, suggest the superiority of galvanic acupuncture i.e. Lancet  114,2926 (1879), 455; 114,2927 (1879), 499-502.  Iwan Rhys Morus writes more about this in Shocking Bodies: Life, Death & Electricity in Victorian England (2011).
[6] Lancet 6,157 (1826), 719.
[7] Lancet 13,335 (1830), 614-616.
[8] Lancet 51,1293 (1848), 636-637.
[9] See Iwan Rhys Morus, “Bodily Disciplines and Disciplined Bodies: Instruments, Skills and Victorian Electrotherapeutics,” Social History of Medicine 19,2 (2006), 241-259.
[10] Lancet 114,2927 (1879), 502.
[11] Lancet 141,3633 (1893), 860-861.