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Newly acquired trove of historic photos captures evolution of medicine

2 December 2020 - 3:06pm by Melissa Grafe

Written by Patricia Carey | First published on YaleNews In one image, a physician injects a Civil War veteran with morphine, a common practice that led to widespread addiction after the war. In another, a gold-framed daguerreotype from 1847, an unconscious patient sprawls on a white-draped table, surrounded by men in frockcoats and cravats, documenting one of the earliest uses of ether in operation. Then there’s the haunting postmortem photograph of a 22-year-old physician who died caring for patients in an 1849 cholera outbreak — a poignant reminder of the risks medical professionals are facing today. These are just some of the 15,400 photographs in a unique collection recently acquired by the Harvey Cushing/John Hay Whitney Medical Library at Yale that documents — in black-and-white and sometimes graphic detail — a history of medicine from 1839 to the 1970s. Among the library’s largest and most notable acquisitions to date, the collection both celebrates the evolution of medicine and bears witness to untold human pain and loss. The Stanley B. Burns M.D. Historic Medical Photography Collection includes images of physicians and medical scientists at work, operation rooms, hospital wards, laboratories, nurses and nursing, notable physicians, surgical specialties, and war medicine. There are also thousands of photos of patients and disease states. The collection is notable for its range of forms, including photo albums, framed photographs, publications, cartes de visite (small photos mounted on cardboard), cabinet cards, postcards, and personal collections assembled by noted physicians. Virtually every format is represented, including boxes of lantern slides and 253 unique daguerreotypes, ambrotypes, and tintypes from the earliest years of photography. “The Burns Collection is one of the most compelling and comprehensive visual records of medical history ever assembled,” said Melissa Grafe, the John R. Bumstead Librarian for Medical History and head of the Medical Historical Library, the medical library’s special collections repository. “From early depictions of surgery to profoundly personal family images and photo albums, it shows how deeply medicine is interwoven in human lives.” The collection’s photographic albums, some assembled by physicians, bring alive important chapters of medical history, such as the conquest of yellow fever in Cuba in 1904, the international response to the pneumonic plague epidemic in China in 1911, and facial reconstruction at Walter Reed Army General Hospital documented by medical photographer Alice Becht in 1920. “Turning the pages of these albums, I am often struck by how visible the patient is, providing some window into past lives and, in some ways, human suffering,” Grafe said. “At other times the collection is a celebration of medicine, highlighting surgical moments and medical techniques that we may take for granted today.” The wide range of materials complements many of the library’s existing collections, including striking images of mental illness published in the “Iconographie photographique de la Salpêtrière”; thousands of photo-postcards and other images that make up the Robert Bogdan Disability Collection; and more than 100 iconic portraits of Civil War soldiers. Other materials in the Burns Collection document the development of medical education. Bound volumes of Dr. Howard Kelly’s “Stereo-clinic,” for example, contain thousands of photographs of landmark operations performed by noted surgeons between 1908 and 1918. When viewed through a stereoscope, the photographs provided step-by-step 3D views of the procedures and were used to teach other surgeons. “The Burns Collection is a major milestone in a decade-long strategic effort to expand the library’s holdings of highly visual materials,” said John Gallagher, the Medical Library’s director.  “We are so eager and excited to have researchers, both here at Yale and beyond, explore this truly unique and rich visual collection.” Ophthalmologist and medical professor Stanley B. Burns, the collection’s creator, began collecting medical photography in 1975, choosing to focus on an area that until then was largely ignored. Over four and half decades, he amassed more than a million images, filling his New York townhouse and a second home with binders, boxes, and bins with labels as broad as “Nursing” and as specific as “Railway accident wounded treatment.” As a foremost expert on medical historical photographs, Burns has published widely; curated and consulted on exhibitions; and advised hundreds of films, TV series, and documentaries. Among his engagements was providing photos to an art historian seeking to show that Pablo Picasso’s “Les Demoiselles d’Avignon” was inspired by women with destructive facial syphilis. Along with the collection’s move to Yale, Burns has endowed a library fellowship to support research in the collection and related holdings of the Medical Historical Library — a gift that aims to ensure scholars will continue to make discoveries in the collection. “I have spent 45 years building an unequalled resource for understanding the origins and evolution of medical photography and exploring the history of the human relationship to disease and medicine,” he said. “I am thrilled that my collection will be preserved, appreciated, and studied for the long term at Yale.” The Burns Collection is being processed and evaluated for conservation and preservation needs; initial records are available in Orbis and Archives at Yale. As time and resources allow, portions of the collection will be digitized and made available online.

The “Great Risk” of “Opium Eating”: How Civil War-Era Doctors Reacted to Prescription Opioid Addiction

1 December 2020 - 10:50am by Melissa Grafe

Written by Jonathan S. Jones The U.S. Civil War (1861-65) sparked a massive epidemic of opioid addiction among those who fought and survived the bloody conflict. The war mobilized millions of soldiers, hospital workers, and freedom-seekers, bringing people into contact with unfamiliar microbes, insects, and animals. This mass movement of bodies and pathogens resulted in extreme outbreaks of measles, smallpox, typhoid fever, and other deadly, terrifying diseases. Brutal technological innovations like the Minié ball caused ghastly, agonizing wounds, and men who survived often spent the rest of their lives in chronic pain. Military surgeons tasked with patching up wounded soldiers and treating the sick had their jobs cut out for them. Often-times army doctors were simply civilians pressed into service by circumstance, and they fell back on fundamental therapies to mitigate sickness and suffering. Opiates, the most common medicines in antebellum America, thus became defensive weapons in Civil War’s medical arsenal, “important to the surgeon as gunpower to the ordinance,” according to one military medical handbook. Opium pills, morphine injections, and laudanum (a blend of opium and alcohol) were some of the Civil War’s most widely used medicines. Opiates were marvelous painkillers—morphine and synthetic opioids are still standard palliatives today—and the medicines were also surprisingly useful for suppressing symptoms like diarrhea and coughing. Civil War armies could not have functioned without opiates, which surgeons doled out widely during and after the war to ailing soldiers. Opiates are addictive, however, and doctors’ prescriptions all-too-predicably led to addiction for Civil War veterans. Not only was opiate addiction dangerous and unhealthy, resulting in thousands of overdose deaths between the 1860s and the early twentieth century, but the condition was also deeply stigmatized in Civil War America. Most Americans considered addiction to be an unmanly and immoral vice. Addicted veterans deserved punishment, not sympathy, according to contemporary observers. Consequently, addicted veterans faced terrible outcomes, a theme I explore in a recent journal article investigating the experience of opiate addiction for veterans. Naturally, many addicted veterans blamed the doctors who first introduced them to opiates. But how did doctors react to veterans’ blame? Did they reject charges of culpability, or admit that prescriptions lay at the root of Civil War America’s opioid crisis? Did the crisis affect how doctors practiced medicine, and if so, what did any changes mean for the course of American medicine? These are questions I address in my book manuscript, “Opium Slavery: Veterans and Addiction in Civil War America,” which is based on my dissertation (Binghamton University, 2020). In 2020-21, as a postdoctoral fellow at Penn State’s Richards Civil War Center, I am revising my book for publication. My research for this project benefited immensely from a Ferenc Gyorgyey Research Grant awarded by the Harvey Cushing/John Hay Whitney Medical Library in 2018-19. The library’s inimitable collection of nineteenth-century American medical records provided a major component of my evidentiary base, allowing me to investigate how the Civil War veterans’ opiate addiction epidemic refracted into medical practices and thought in the late-nineteenth century U.S. In particular, the Medical Historical Library holds incredibly rare clinical records that provide insights into how the Civil War-era opioid crisis altered the fundamentals of medicine, like prescribing patterns. As I argue in my book, American physicians were deeply troubled by prescription opium and morphine addiction among veterans. Doctors were widely blamed for causing the post-Civil War opiate addiction epidemic by overprescribing opiates, and this blame was dangerous for physicians, who had a perilous position in the extraordinary competitive Gilded Age medical marketplace. The nineteenth-century American medical marketplace was remarkably democratic, and sick people could turn to a bewildering array of medical practitioners for health care. Throughout the Civil War era, physicians struggled to outcompete sectarian practitioners, patent medicine sellers, and so-called “quack” doctors. Something had to be done about prescription drug addiction, many physicians worried, because the problem threatened the profession’s reputation and commercial standing. Consequently, I argue, during the 1870s and 1880s, ex-military surgeons—men like Jacob Mendes Da Costa of Philadelphia’s Jefferson Medical College—urged their colleagues to prescribe opiates sparingly, thus creating fewer cases of opiate addiction. Not to be overlooked, this shift away from opiate medicines was a radical reversal of nineteenth-century American therapeutic practices, which relied heavily on opiates to treat all manner of ailments. Da Costa was a former Union army surgeon famous in his day for conducting research on cardiac distress among Union army soldiers and veterans. In an influential 1871 medical journal article, Da Costa urged his colleagues to refrain from prescribing opiates to men suffering from chronic pain, warning that there was “great risk of making the patient an opium eater”—a dual risk for patients' health and physicians’ reputations.  I suspected that Da Costa, for his part, practiced what he preached. That’s what brought me to Yale’s Medical Historical Library. Considering his firsthand knowledge of addiction, I wanted to investigate how Da Costa’s prescribing patterns might have differed from his peers in reaction to witnessing addiction among soldiers. After the Civil War, Da Costa set up shop in Philadelphia, where he taught clinical medicine at Jefferson Medical College. At Yale during the spring of 2019, I quantified Da Costa’s patient records from the Jefferson Medical College’s public teaching clinic in Philadelphia. They document the medical histories of thousands of individuals suffering from a wide variety of painful conditions. The records include detailed prescriptions, and a sample of 1,945 cases dating from October 1870 to October 1875 indicate that Da Costa and his trainees prescribed opiates to just 371 patients, or 19%. By comparison, Yale historian John Harley Warner has found that about 42% of prescriptions from a comparable public hospital in Boston during the 1870s contained opiates—more than double the rate of Da Costa’s Philadelphia clinic. In other words, Da Costa and his medical trainees relied much less heavily on addictive opiate medicines than their contemporaries. Considering Da Costa’s vocal warnings about prescription opiate addiction—knowledge he gleaned by observing addicted Civil War soldiers and veterans—the Jefferson Medical Clinic records reveal that the Civil War veterans’ opiate addiction epidemic had important ripple effects on American medical practices. Opiate medicines, long-time staples in the doctor’s black bag, soon declined precipitously in American medicine. As I argue in my book, ex-army doctors like Da Costa, who were alarmed by veterans’ prescription opiate addiction, led the movement away from opiates. The research that led to these surprising findings would have been impossible without a Ferenc Gyorgyey Research Grant from Yale’s Medical Historical Library. By facilitating access to Da Costa’s rare clinical records, the grant played an essential role in my dissertation research and ongoing book project. About Jonathan S. Jones Jonathan S. Jones is the inaugural Postdoctoral Scholar in Civil War History at Penn State’s George and Ann Richards Civil War Era Center in 2020-21, where he is currently preparing a book manuscript on opiate addiction in the Civil War era for publication. The project is derived from his dissertation on the same topic, defended at Binghamton University in June 2020. Jonathan’s recent publications include an article in The Journal of the Civil War Era’s June 2020 issue titled “Opium Slavery: Civil War Veterans and Opiate Addiction.” After Penn State, Jonathan will be joining the Department of History at Virginia Military Institute (VMI) as an Assistant Professor starting in August 2021. Connect with Jonathan on Twitter at @_jonathansjones or at jonathansjones.net. 

Finding Fulton in the Historical Library

14 September 2020 - 3:41pm by Melissa Grafe

While Harvey Cushing was the impetus behind the formation of Yale’s Medical Library, you can find materials on the other founders, John Fulton and Arnold Klebs, within the Historical Library’s main reading room.   John Fulton, the youngest of the three founders of the Historical Library, trained in medicine and physiology at Harvard and Oxford, and came to Yale in 1930 as professor of physiology. He was already deep into collecting books when he served as a resident and disciple of Harvey Cushing at the Peter Bent Brigham Hospital. The two men shared a close friendship based on both scientific and historical interests. Like Cushing, Fulton became a bibliophile, bibliographer, and historian. His special collecting interest was physiological works from the 16th to 18th century. In addition to his major texts in physiology, Fulton authored or coauthored biographies of Harvey Cushing, Benjamin Silliman, and Michael Servetus, and bibliographies of Fracastoro’s poem Syphilis, Luigi Galvani and his nephew Aldini, Richard Lower and John Mayow, Joseph Priestley, Robert Boyle, and early works on anesthesia. Fulton became the first chairman of the Department of History of Medicine at Yale in 1951 with offices across the hall from the Historical Library offices. In 1956, Fulton wrote in his diary that his wife Lucia “had been at me to have a portrait done, and since Deane Keller [who had done Harvey Cushing’s portrait] thinks I am hopeless as a sitter and has refused to persevere with the several he started some years ago, I felt free to go to Sir Gerald.”  So began a summer of sittings for the portrait of John Fulton sitting on the left side of the fire place in the Medical Historical Library.  Sir Gerald Festus Kelly, who had painted portraits of the royal family including Queen Elizabeth, met with John Fulton for 40 sittings in the summer of 1956.  The first sitting, from 2:30-6:45, involved Fulton stepping up on his platform and sitting in a “rather stiff Victorian armchairs with sundry pillows on the seat since my arm seem to be shorter than those of most of his subjects.”  Over the course of the sitting, Fulton heard stories about Kelly’s interactions with artists such as Renoir.  Fulton was “completely fascinated by the man,” and the time passed pleasantly until a series of photographs of Fulton were taken at the end of the session. “A series of loud and devastating expletives coming out from under the hood; his private photographer would have to take his vacation at this wrong time!”  However, a secretary came in, grabbed the negatives, and stated she would develop and print them for Kelly.  Fulton went home feeling that he had had “a cosmic experience.” Ensuing diary entries capture the details of sitting for the portrait, and more on Gerald Kelly, who had a variety of humorous and interesting anecdotes about various artists and prominent figures of the 20th century.  Fulton wrote that in the final portrait, he is sitting at his desk in the Historical Library, although Kelly had never seen his desk, and used photographs to fill in details.  Behind Fulton, there are representations of his books and diaries, which he wrote in from 1915-1960.  The portrait currently hangs in the back of the Medical Historical, to the left side of the fireplace.  

The DIY Historical Herbarium

1 June 2020 - 11:03am by Melissa Grafe

Written by Alicia Petersen, PhD student, History of Science and Medicine Program (HSHM) Herbaria, collections of dried plant specimens that were (usually) adhered to sheets of paper, were very popular in 18th-century Europe. From professional botanists exploring the Americas to amateur scientists roaming the fields near their homes, many used herbaria to store preserved plants for later study. In order to better understand how early moderns “did” science, I decided to create my own herbarium (see the page below) following the guidelines for plant collection and preservation detailed in 18th-century British manuals. The simple act of following directions ended up being a bit more challenging than I had anticipated! Sitting on my bedroom floor, surrounded by an assortment of plant cuttings, I read and re-read 18th-century botanist William Withering’s instructions for plant preservation. Withering’s famous works contain directives like the following: “… specimens may be dried tolerably well between the leaves of a large folio book, laying other books upon it to give the necessary pressure: but in all cases too much pressure must be avoided.” (A botanical arrangement of British plants…, pg. xlvi) I couldn’t help thinking: that’s it? Withering fails to give his readers any indication of how much pressure is too much, a seemingly important detail. Other ambiguities led to a variety of errors on my part, including the burnt fern specimen pictured below. What’s more, when it came time to identify the specimens I’d collected, I found myself even more perplexed. Unable to rely on photographs or iPhone apps, it quickly became that 18th-century botany was like a foreign language. I needed to be fluent, but unfortunately, I only understood about every fourth word. This made for quite the adventure. The Medical Historical Library’s collections served as an important resource as I went tromping through the past. For this project, one object was particularly stunning: an actual 18th-century herbarium, complete with plant specimens that are over 250 years old. The herbarium dates back to the 1760’s and has been attributed to Frenchman Jean Seris, who is thought to have been a student at Paris’ Académie Royal de Chirurgie. While I relied on manuals like Withering’s to guide my collecting practices, I followed Seris’ example for format and layout. Perhaps my biggest takeaway from this project was the immense amount of knowledge required to engage in 18th-century natural history. Interacting with Seris’ herbarium, an object that represents knowledge in practice, provided even greater insight. By reading this “book of nature,” I was able to see 18th-century plants both through Seris’ eyes and my own. Below: Pages from Jean Seris’s Herbarium with dried specimens, 1761

Disability, Disability Activism, and the 30th anniversary of the Americans with Disabilities Act

4 March 2020 - 11:33am by Melissa Grafe

Thirty years ago, the landmark Americans with Disabilities Act (ADA) became law, prohibiting discrimination against people with disabilities in all areas of public life, including employment, schools, transportation, and public spaces.  This exhibition explores disability and disability activism leading up to the passage of the ADA in July 1990.  At a local level, the exhibition discusses disability activism at Yale today, focusing on multiple groups advocating for change across Yale's system.   On display in the Cushing Rotunda March 5th - December 2020

Explore some of the earliest printed medical books in our collection online

8 January 2020 - 9:54am by Melissa Grafe

The Cushing/Whitney Medical Library is pleased to announce that parts of our incunable collection are now available online! The effort to digitize these incunables and make them freely available worldwide was generously funded by the Arcadia Fund. The Medical Historical Library, part of the Cushing/Whitney Medical Library, contains over 300 medical and scientific incunabula, which are books, broadsides, and pamphlets printed before 1501. These incredibly rare incunables represent the earliest history of printing in Europe and the first examples of medical knowledge circulated in printed form. Many of the incunables display elements of the print and manuscript world, including marginalia, historiated initials, and some of the earliest printed depictions of the human body, often derived from manuscript illustrations. The 44 incunables digitized in this project represent ones not found online anywhere. Topics include astrology, medicine, plague, anatomy, remedies, herbals and much more. The incunable collection was donated to the Medical Library by one of our founders, Dr. Arnold Klebs (1870-1943), a Swiss tuberculosis expert and bibliophile. The last decade of Klebs’ life was especially devoted to his ambitious incunabula project. He hoped to publish a catalog with full entries for scientific and medical incunabula. In 1938, he published a short-title catalog (i.e. brief entries), Incunabula scientifica and medica, of all known scientific and medical incunabula. Klebs did not purchase many incunabula himself. Instead, he encouraged fellow bibliophile and famed neurosurgeon Dr. HarveyCushing to buy them and acted as intermediary with book dealers in Europe. Through the efforts of Klebs and Cushing, Yale’s Medical Historical Library holds one of the largest medical and scientific incunable collections in the United States. Please explore these incunables on the Cushing/Whitney Medical Library site on Internet Archive, as part of the Medical Heritage Library. You can also find other Arcadia-funded digitized texts, including medieval and Renaissance medical and scientific manuscripts, Yale Medical School theses and early Arabic and Persian books and manuscripts, in this collection. 

Plastic Surgery at Yale: Surgical Expertise, Innovation, and History

7 November 2019 - 11:02am by Melissa Grafe

NEW EXHIBITION Plastic Surgery at Yale: Surgical Expertise, Innovation, and History On view in the Cushing Rotunda from October 30th 2019 - February 24th, 2020   Surgical attempts to reconstruct the human body after injury or illness have long been at the forefront of medical innovation. The expansive field of plastic surgery emerged over centuries, now including reconstruction and cosmetics and aesthetic surgery.   In this exhibition, evolving techniques and procedures dating from ancient times through the present day are on display through a sampling of major historical plastic surgery texts from the Medical Historical Library. Discover technologies used in reconstructive and cosmetic surgery today through the models and tools on loan from Yale Plastic Surgery. Learn about innovations from Yale's own plastic surgery faculty through various publications, instruments, and the international non-profit work performed around the globe.   The exhibition, in partnership with Yale Plastic Surgery, was curated by Marc E. Walker, MD, MBA, with assistance from Melissa Grafe, Ph.D, Head of the Medical Historical Library.  

Celebrating 10 Years of the Cushing Center

3 September 2019 - 1:47pm by Melissa Grafe

Exhibition curated by Terry Dagradi and Deborah Streahle The Medical Library celebrates the first decade of the Cushing Center with a special exhibition leading up the its anniversary. Throughout his career as a groundbreaking neurosurgeon, Dr. Cushing took detailed notes on what patients told him about their serious, often mysterious ailments. He had patients sit for diagnostic photos and sketches, and he followed up with them for years after treating them. With precision, he removed and preserved their tumors and, after they died, their brains. These materials became the Cushing Brain Tumor Registry, a vast collection that medical students and scholars traveled to study until the materials fell out of use in the 1970s. Creating the Cushing Center took over 15 years, from the resurgence of interest in the collection in the 1990s to the opening of the Cushing Center during Alumni Weekend in June 2010. While the collection was originally assembled to educate the medical elite, the Cushing Center opens the Brain Tumor Registry to the public from which it came. Since opening, the Cushing Center has provided a new place of honor for the materials of the Cushing Brain Tumor Registry. The Cushing Center has also hosted workshops, meetings, and classes ranging from drawing to divinity and has inspired many projects within and beyond medicine. Serving as a unique record of neurosurgery’s early days, the space has generated abundant national and international media attention. And, as a poignant reminder of the people whose lives depended on Cushing’s expertise, the Center sparks important conversations about the ethics of collecting and displaying human tissue. Featured in the anniversary exhibition are materials that tell the story of the Cushing Center’s first decade. If you visit, consider the next decade of the Cushing Center and share your ideas, reflections, and suggestions online and on the bulletin board near the entrance.

Celebrating 90 Years of the Yale Journal of Biology and Medicine (YJBM)

12 June 2019 - 11:13am by Melissa Grafe

    Yale Journal of Biology and Medicine (YJBM) is celebrating 90 years of continuous publication. Founded in 1928 by Milton C. Winternitz, YJBM is the oldest medical student-run publication still in production and has grown to be a peer-reviewed, internationally ranked journal aimed at featuring outstanding research in all areas of biology and medicine.   Explore this exhibition featuring the accomplishments and challenges of student editorship and the vivid history of YJBM.    Exhibit to run May 30, 2019 - September 30, 2019 in the Harvey Cushing/John Hay Whitney Medical Library Rotunda

Explore Medieval and Renaissance Medical and Scientific Manuscripts

1 March 2019 - 10:35am by Melissa Grafe

The Cushing/Whitney Medical Library is pleased to announce that our medieval and Renaissance manuscript collection is now online!  The effort to digitize the manuscripts and make them freely available worldwide was generously funded by the Arcadia Fund. The manuscripts contain early medical and scientific knowledge on a variety of topics, including surgery, gynecology, medicine, herbs and remedies, anatomy, healthful living, astronomy, and mathematics.  They are handwritten in Latin, Italian, Greek, German, and English.  Some are illustrated, like MS18, De herbis masculinis et feminis [and other botanical and zoological works, including the Herbarium of Apuleius].  Turning the pages of this manuscripts reveals numerous hand-colored drawings of plants and animals, including the mandrake root. The mandrake root was valued for a variety of medical uses, including as an aid for reproduction. Mandrake root, as depicted in Harry Potter and in legend, would let out an ear piercing, killer scream when uprooted.   Other manuscripts are filled to the very edges of the paper with text, including marginalia and commentary, like MS11, which has 24 different texts including Aristotelian treatises. The earliest work is the Bamberg Surgery, dating from the 12th century and purchased, like most of this collection, by Library founder and famed neurosurgeon Dr. Harvey Cushing.  As medieval medical scholar Monica Green writes, “The Bamberg Surgery doesn’t get a lot of love in histories of surgery, because of its patchwork character. As [George] Corner himself said, “it is a notebook, a partially organized collection of notes, memoranda, prescriptions, and excerpts from other books.”  Please explore these manuscripts on Cushing/Whitney Library site on Internet Archive, as part of the Medical Heritage Library.   You can also find other Arcadia-funded digitized texts, including Yale Medical School theses and early Arabic and Persian books and manuscripts, in this collection.  The Library plans to make the medieval and Renaissance manuscripts available through Findit, Yale University Library’s Digital Collections site.
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