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

December 1, 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

September 14, 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

June 1, 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

March 4, 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

January 8, 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

November 7, 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

September 3, 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)

June 12, 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

March 1, 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.

Picturing Disability Technology

February 27, 2019 - 9:47am by Melissa Grafe

Our first 2018-19 Ferenc Gyorgyey fellow, Jaipreet Virdi, Ph.D., shares an aspect of her research on disability technology through photographs and postcards, with little help from Twitter… Picturing Disability Technology Written by Jaipreet Virdi* In a 2014 article, historian Katherine Ott expressed: “Both the artifacts owned and used by people with disabilities and those that are used upon them or that are encountered in life create possibilities, impose limits, assert political and ideological positions, and shape identity.”[1] This statement has guided my research on the material culture of disability and the nature of disability as both an individual experience and a collective one. By examining how disabled people created, modified, and used technologies, tools, and machines as a medium of social interaction, my work aims to conceptualize how such objects shaped the meanings and management of disability – to understand, as Toby Siebers has written, the ways in which objects are “viewed not as potential sources of pain but as marvelous examples of the plasticity of the human form or as devices of empowerment.”[2] My research also examines representations of disability technologies: how did disabled people ascribe meanings and values to their objects? Wheelchairs, canes, walkers, braces, spectacles, hearing aids, prosthetics, and etc., all color various interactions with disability. Since most of these technologies are essential for navigating (sometimes literally) the world, visual representations of disabled people with these technologies provides us with valuable insight for understanding people’s lived experiences of disability. In photographs, for instance, everything from poses, dress, props, and the inclusion of disability technology, are visual evidence of conscious decisions to frame an image of disability. Such images enable us to perceive the kinds of technologies people used, how they adapted them to their bodies, and how they personalized them to reduce the stigma of “otherness”[3] or “freakery.”[4] The Robert Bogdan Disability History Collection at the Medical Historical Library (in the Harvey Cushing/John Hay Whitney Medical Library at Yale University) contains over 3,500 photographs and ephemera representing disability. Since the 1980s, Bogdan had collected such representations, ranging from the 1870s-when photographic images became popularized—to the 1970s at the heights of the disability rights movement. Bogdan’s 2012 collaborative book with Martin Elks and James A. Knoll, Picturing Disability: Beggar, Freak, Citizen, and Other Photographic Rhetoric (Syracuse University Press), provides a broader historical context of the collection, including a history of different types of citizen portraits. The carte de visite was the most common photographic format from 1860 to 1885, with each photograph printed from a negative and mounted on a piece of thin cardboard; some people chose to have the photograph on a postcard, so as to send messages to family and friends. Cabinet cards were also popular at the end of the nineteenth century, though they were three times larger than the carte de visite. Citizen portraits were often taken at a local studio, positioning subjects to “echo family visual rhetoric, not disability conventions”—there is no obvious attempt to conceal the disability, for it is part of the family reality as conveyed in the photograph.[5] Other photographs also use props and positioning of people to convey “normal life” within an inconsequential setting to frame an image’s ordinariness, instead of using disability to define the situation.[6] Disability technologies and other visual indicators of disability are prominently present in many of these photographs. As Bogdan points out, “their presence is not so intrusive as to change this picture’s place in the category of atypical family photograph.”[7] In this wedding portrait, for instance, the two women in wheelchairs are part of the wedding party and positioned to provide balance—the same way a photographer will arrange individuals according to height to obtain symmetry in portraits—without drawing much attention to their wheelchairs.   Wedding party with 2 women in wheelchairs, from the Robert Bogdan Disability Collection MS Col 61, Book 1: Wheelchairs.   These photos also do not tend to specifically feature the disability object, rather positioning the people within normal portraiture conventions, whether it is to show romance or familial ties. The use of additional props, moreover, were used to further confine the photographs within portraiture traditions – the disability technology, though consciously included in the photos, are not the subject of the portrait. Rather, it is the people and their relationships with each other. As Bogdan asserts, “Although some of the images were shared, even sent through the mail, they were distributed privately to intimates, family members, and friends. They were not produced for commercial public relations, to solicit money, to sell, or for personal or organizational gain.”[8] Through these images, we can see most assuredly that people with disabilities were “too busy living to be restrained by our post-structuralist worries over the cultural contingencies of what they did or who they were,” as Ott has remarked.[9]   Assorted photographs of women in wheelchairs accompanied by other people, from the Robert Bogdan Disability Collection MS Col 61, Book 1: Wheelchairs. Assorted photographs of women in wheelchairs accompanied by other people, from the Robert Bogdan Disability Collection MS Col 61, Book 1: Wheelchairs.   Assorted photographs of women in wheelchairs accompanied by other people, from the Robert Bogdan Disability Collection MS Col 61, Book 1: Wheelchairs.   One series of photographs piqued my interest: of individuals outdoors in wheelchairs that have chains attached to the wheels. This design feature appears in different styles of wheelchairs, but I have never previously encountered it in my research, either in manuscripts and archives, or in material culture collections. Inspecting the photographs, I took an educated guess: would these be for raising or hoisting the individual from the chair? My guess didn’t seem right to me, so I took my question to twitter.     As historians have discussed, crowdsourcing on social media is useful for harnessing participatory knowledge. It blurs the boundaries between specialist and non-specialist knowledge, offering new insights for working with primary sources. What seemed to me to be a questionable, confusing design feature was quite obvious to others – the wheelchair is a hand-crank, with the chains fixed to move the wheels the same way that a bicycle pedal moves a bicycle. Now, since I don’t own or ride a bicycle, chain gears were not something I was familiar with, but others have shared their knowledge to enable me to paint a better picture of how this design feature was useful for wheelchair users. The exchange on twitter formed a conversation about self-propelled wheelchairs that governed my research through the Bogdan collection and the broader history of the wheelchair. Litters, swings, cradles, carts, carrying-chairs or sedan chairs were used prior to the formation of the wheelchair as we know it, and individual chairs were not mass-produced until the mid-twentieth century to assist the increasing numbers of soldiers surviving from spinal cord injuries. Wheelchairs became associated with disability and thus, users were stigmatized and perceived as unable to contribute to society. These photographs, however, reveal the extent to which disabled people governed their own lives and sought to be self-sufficient, even taking an action pose in their studio portraits to represent their maneuverability. Man in wheelchair formed like a cart, from the Robert Bogdan Disability Collection MS Col 61, Book 1: Wheelchairs.   As Penny Wolfson has shown, users relied on their own craftsmanship or that of others to shape a mobility device for their own needs.[10] Wheelchairs could be made by adding cart wheels on dining or library chairs, by repurposing motorcycle engines, or adding gears for hand-cranked wheelchairs. While most nineteenth-century wheelchairs were manufactured by furniture makers prizing comfort, adaptability, and mobility, some users repurposed from household furniture and included crafted additions for comfort: home-sewn cushions, crocheted blankets or feet mats, and trinkets attached to spokes. These features provide us with clues into the personalized relationship between user and technology, presenting experiences of disability that were not always negative or exclusive. Moreover, photographs of disabled wheelchair users in various settings—in a field, in the streets, on the porch—indicates the challenges of maneuvering within the built environment, especially of navigating on unpaved streets. The wheels, cranks, and other design features that are visible in the photographs additionally reveal variants of disability experience. By the 1970s, wheelchairs became markers of disability as well as symbols of activism, leaving behind intimate traces of their owner(s). And those hand cranks aren’t simply designs of the past; old designs can always be made new again.   *Jaipreet Virdi is a historian of medicine, technology, and disability. She is an Assistant Professor in the Department of History at the University of Delaware. Her first book, Hearing Happiness: Fakes, Frauds, and Fads in Deafness Cures will be published by The University of Chicago Press. The Ferenc Gyorgyey Research Travel Grant generously supported this research; special thanks to the grant selection committee and to Melissa Grafe. Photograph images from the Robert Bogdan Disability Collection MS Col 61, Book 1: Wheelchairs. You can find Jai on twitter as @jaivirdi.   [1] Katherine Ott, “Disability Things: Material Culture and American Disability History, 1700-2010,” in Susah Burch and Michael Rembis (Eds.), Disability Histories (Chicago: University of Illinois Press, 2014), 119. [2] Toby Siebers, “Disability in Theory: From Social Constructionism to the New Realism of the Body,” in Lennard Davis (ed), The Disability Studies Reader (New York & London: Routledge, 2006), 177. [3] Catherine Kudlick, “Disability History: Why We Need Another ‘Other,” The American Historical Review 108.3 (June 2003): 768-793. [4] Rosemarie Garland-Thomson, Extraordinary Bodies: Figuring Physical Disability in American Culture and Literature (New York: Columbia University Press, 1997). [5] Robert Bogdan, Martin Elks and James A. Knoll, Picturing Disability: Beggar, Freak, Citizen, and Other Photographic Rhetoric (Syracuse University Press, 2012), 145. [6] Bogdan, Elks, and Knoll, Picturing Disability, 146. [7] Bogdan, Elks, and Knoll, Picturing Disability, 154. [8] Bogdan, Elks, and Knoll, Picturing Disability, 145. [9] Katherine Ott, “The Sum of its Parts: An Introduction to Modern Histories of Prosthetics,” in Katherine Ott, David Serlin, and Stephen Mihm (eds.), Artificial Parts, Practical Lives: Modern Histories of Prosthetics (New York: New York University Press, 2002), 1-42; 3. [10] Penny Lynne Wolfson, “Enwheeled: Two Centuries of Wheelchair Design, from Furniture to Film,” MA Thesis, Cooper-Hewit, National Design Museum, Smithsonian Institution and Parsons the New School for Design (2014).  
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