Drinking Patterns in America

I’ve been doing some research on medicinal alcohol for a new exhibit and came across the data for this graph-

Alcohol

I was surprised to see the huge fluctuation in the amount of beer consumed by Americans (yellow line), and also the sharp decrease in total alcohol consumed (red line) in the 1830s. What was going on?

In Mark Lender and James Martin’s book “Drinking in America: A History” (Free Press, 1987), I learned that the American colonists held on to the 17th century European belief that alcohol was good for you. It warmed you on cold nights, kept off chills and fevers, made hard work easier, aided digestion, and sustained one’s general health. It was a common practice to take “drams” at appointed hours during the day to remain healthy. It is true that at this time in many European cities, water was contaminated and unsafe to drink.  Alcohol was safer and even called “aqua vitae.”

In addition, if alcohol wasn’t used as medicine, it was often used a vehicle for medication. It was convenient and made the medication more palatable.

In 1790, a prominent American physician, Benjamin Rush, published the first medical study that suggested that constant overuse of alcohol could lead to disease and death. He correctly identified alcohol as an addictive agent and classified chronic drunkenness as a disease. You can read the full text of this groundbreaking work from the Medical Heritage Library.

Rush's Moral Thermometer showing the dangers of drinking alcohol
Rush’s Moral Thermometer showing the dangers of drinking alcohol, 1790

This research from respected member of the medical community added momentum to the pre-existing Temperance movement. I think that the drop in alcohol consumption in the 1830s can be attributed to the growing reach of the temperance movement. Some physicians probably began to question their use of alcohol as medicine (or the vehicle for it) during this time as well. Actually, the medical community continued to debate the merits of medicinal alcohol for the next 80 years!

Temperance was one of the social reforms that was pushed aside in the growing Abolition movement leading up the Civil War. That could be one of the causes of the increase in alcohol consumption in the 1850s and 1860s. The increase in beer consumption at this time is probably the result of an increase in immigration from Germany and eastern European countries.

For more information about medicinal alcohol during the early 20th century and Prohibition, see my previous blog post here.

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Dr. Betterman and the story of how modern medicine came to a small town

“All doctors have to put on a bold front. […] I am not ashamed to confess that I do not know it all. Probably never will. I do try to use the best things and methods that rational science has to officer. All medicine has much yet to learn.”

So writes Dr. Amos Betterman in his diary on March 20, 1868. Betterman was a “country doctor” practicing somewhere in northeast Ohio during a time period of much change in the medical profession. He began his medical training by “reading medicine” with a practicing doctor for 3 years. He prepared “simples” [common medication] for the doctor (since there was probably not a pharmacy nearby) and assisted him in procedures, often holding limbs while the doctor did the operation. In this time period, he remembered one routine job where they opened an abscess for a farmer at his kitchen table. The doctor had cleaned and sharped his lancet with the leather at the top of his boot and they had washed their hands AFTER the procedure. They had applied a flaxseed poultice to the wound, which was made with cotton that had been pulled from an old quilt. Betterman’s only formal training was the 2 courses of lectures he attended that were given by doctors. This was a very common way to become a doctor in the mid-1800s in America.

Dr. Betterman then began his own medical practice as a country doctor. In 1873 Betterman briefly discussed the difference between country doctors and “hospital work.” In his words a country doctor was “very cautious not to do harm.” Their main jobs were to fix broken bones, cuts, wounds, acute sickness, and attend child births. Hospital work, to him, seemed to be mostly surgery and perhaps trying new and risky treatments.

In his diary, Dr. Betterman talked candidly about the hardships of working in a rural setting- the difficult traveling conditions due to the weather and poor roads, trouble collecting bills, and the isolation he felt since it was difficult to keep up with medical news. It was hard work and long hours considering the time it took for him to travel to each patient, prepare his own medicines (sometimes gathering, drying or distilling particular ingredients), and making repeat visits. There are few other physicians nearby, so he wrote letters to other doctors if he needed another opinion on a case. He had only a few instruments, so he often improvised with the basic tools he had.

“It seems to me the psychologic side of my work is half the battle. If I can get people’s confidence, my medicine works better.”

As Dr. Betterman settled into his practice, he began to notice the significant changes occuring in the profession around him. In the 1870s, specialists were starting to emerge in Europe. These physicians had additional training in particular areas of medicine and could demand higher fees for less work. They were mostly seen in bigger cities. Over the next 20 years, American doctors would start traveling to Europe to become specialists as well.

Dr. Betterman (from Dr. Betterman's Diary, edited by Charles Elton Blanchard, Medical Success Press, Youngstown, OH 1937)
Dr. Betterman (from Dr. Betterman’s Diary, edited by Charles Elton Blanchard, Medical Success Press, Youngstown, OH, 1937)

By the 1890s, Dr. Betterman noted the increased use of laboratory tests to diagnose illnesses. Microscopy, blood examination, and urinalysis were becoming more popular. Although he was fascinated with the process and results of the new science, he also worried that physicians were losing touch with the human side of medicine and the importance of viewing each case in context of the particular patient. There was also a new drug store in his town, so the doctor was no longer making his own medicine, but using pre-made tablets. He found that his patients are “willing to pay quite well for my office treatments,” so he was traveling less and using his home office more- so much more that he planned to build a bigger office that had more space for the new diagnostic equipment that was now available.

Medical education had also undergone a big change since Dr. Betterman had “read medicine.” Betterman’s son was training to become a doctor at the University. His studies probably included much more science and anatomy work than his father had done. Admission and graduation standards were also tightening in American medical schools. It is also telling of the great change in medicine at this time that Dr. Betterman advised his son to take an internship and find work in a hospital rather than become a country doctor.

Dr. Betterman’s story has a happy ending. His new office building (built in 1894 with about 4 rooms) became the 50-bed community hospital by 1909. It had a staff of about 50 cooperating doctors, plus nurses and assistants. It attracted patients from the surrounding 50 miles, since there were no other big cities. The success of the hospital required the town to build a hotel and more restaurants. It was a great change for the small town and in many ways brought modern medicine to the residents there.

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Medical Treatments in the Late 19th Century

Travel back to a time when two thirds of Americans lived on farms or rural villages. Indoor plumbing was rare and homes were heated by sooty wood burning stoves and kerosene lamps. Work was physically difficult and accidents happened often. Serious diseases like cholera, yellow fever, typhoid fever, diphtheria, malaria, and tuberculosis are common.

Doctor Hoffman in Woodland, Washington c1910 (Courtesy of Oregon Health and Science University Archives)
Dr. Carl Hoffman in Woodland, Washington c1910 (Courtesy of Oregon Health and Science University Archives)

These are difficult conditions for a rural “country doctor” with no vaccines, no laboratory tests, and not many effective medicines.  They were responsible for treating a wide range of medical problems including broken bones, wounds, chronic conditions, and acute sickness. Surgery was often left to the work of city or hospital doctors when it couldn’t be avoided.

Treatments were almost exclusively done in the patient’s home. By the late 1800s, bleeding as the main form of treatment had fallen out of favor for most practitioners. Treatment now was mostly prescriptions combined with instructions for rest and diet (broths, gruel, warm or cold drinks). Warm baths, topical applications of medicine, wraps, and gargles were common. Any medicine that was given was applied topically to the affected area or dissolved in liquid like tea. (Injections of medicines were not common until physicians learned to make sterile solutions. Pills were difficult and time consuming to make.) Medicines were often prepared by the physician in small towns where pharmacies were not available.

In this time before antibiotics*, medicines were often given to treat the symptoms of the sickness, not the sickness itself. For example, there were many pain relievers (opium, morphine, Phenactine, and Acetanilid) and some antipyretics (fever reducers like willow bark and meadowsweet). Cathartics from a variety of plants were used to accelerate defecation and cleanse the lower GI tract. Opium could be used to counter diarrhea. Camphor was used to soothe itchy skin. Mild antibacterials such as Resorscin and camphor would be used over wounds to prevent infection. These medicines were used to make the patient comfortable and to prevent complications (dehydration, constipation, high fever, etc) while the illness ran its natural course.

meadowsweet
meadowsweet
White_Willow_Bark_Extract
Willow tree bark

Physicians who were up-to-date with medical research might be familiar with the ideas similar to the ones taught by Dr. William H. Thomson. He was a medical professor at the University of the City of New York. He published a book “Notes on Materia Medica and Therapeutics,” which was adapted from his lectures given in the 1888-1889 school year. This book gives a useful overview of the methods for treatment in the late 1800s. In this book, he divides all treatments into three broad categories: medicines, non-medicines, and disinfectants. (Non-medicines included treatments such as massage, baths, blistering, applying heat or cold, caustics, and counter-irritants.)

Medicines were further divided into Disease and Symptom categories. Symptom medication was discussed above. Disease medication was different in that it worked to treat the disease instead of the symptoms. The effective medicine available in the late 1800s was mostly used for chronic diseases or, as Dr. Thomson put it “faults in the constitution, either inherited or acquired.” These medicines usually required repeated doses to be effective. Restorative medicines in this category acted to make up deficiencies in the body. For example, iron is given for anemia. Alternative medicines were often small doses of agents that could be poisonous and the patient’s reaction to the medicine had to be watched carefully. For example, colchicum was given for gouty arthritis. The efficacy of these drugs was not well understood at the time.

Notes on Materia Medica and Therapeutics by Thomson, 1894
Notes on Materia Medica and Therapeutics by Thomson, 1894
Notes on Materia Medica and Therapeutics by Thomson, 1894
Notes on Materia Medica and Therapeutics by Thomson, 1894
Notes on Materia Medica and Therapeutics by Thomson, 1894
Notes on Materia Medica and Therapeutics by Thomson, 1894

The third category of therapeutics was disinfectants. This small group of medicines were used in the prevention of communicable disease. New research had shown that some illness were caused by living organisms that were visible only under a microscope. These diseases could be prevented or cured by killing the organism or stopping its growth in the body. The main disinfectants were carbolic, chlorine, lime, charcoal, and sulphur.

Notes on Materia Medica and Therapeutics by Thomson, 1894
Notes on Materia Medica and Therapeutics by Thomson, 1894

The method of treatment for similar illnesses could vary between doctors due to the fact that medical education was largely unregulated and so was the drug manufacturing industry. The cause of many illness were not well understood. Each doctor, therefore, had his preference for treatment based on their experience and not necessarily through medical research. It was not uncommon that patients would try home remedies before they called the doctor, which in some cases complicated the illness.

*Prontosil (1935) was the first truly effective medicine to treat a range of infections inside the body. It led the way for the antibiotic revolution in medicine.

Sources consulted:
Bordley, James III and A. McGehee Harvey. Two Centuries of American Medicine, 1776-1976. Philadelphia: Saunders, 1976. Print.

Blanchard, Charles Elton, ed. Dr. Betterman’s Diary. Youngstown: Medical Success P, 1937. Print.

Rathbun, Dr. A.J. A Friend in Need, or the Little Doctor. Youngstown: Arens and Kerr printers, 1894. Print.

Thomson, William H. Notes on Materia Medica and Therapeutics: taken from lectures delivered. William H. McEnroe, ed. New York: Trow, 1894. Print.

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Youngstown and World War I medicine

During World War I, the United States aided the Allies’ fight by setting up Base Hospitals in Europe.
Base Hospital 31 was organized in Youngstown, OH in the beginning of 1917. The $50,000 needed to supply the hospital was funded by donations from the citizens and staffed by 300 volunteers from the local medical community (50 officers, 50 nurses, 200 enlisted men). The unit was mobilized in September. After 3 months of training, they sailed from New York to Liverpool, England and finally docked at Le Havre, France on December 26th, 1917.

group of Base Hospital 31 nurses, 1918

Base Hospital 31 was located in Contexeville, France. Before the war, it was a summer health resort with many hotels. Eight of these hotels were assigned to become Base Hospital 31.

The Base Hospital operated from March 23, 1918 to February 3, 1919. The normal combined capacity of the buildings was 1,200 beds. It could be expanded to 2,000 beds to handle emergencies. It treated 3,413 medical cases and 4,585 surgical cases. The Youngstown staff treated American, French, Italian, Russian, and British troops for wounds, tuberculosis, pneumonia, influenza, poisonous gas, and psychiatric problems.

overflow ward of Base Hospital 31, 1918

The Melnick Medical Museum had a collection of approximately 75 glass lantern slides containing images taken throughout the training and operation of Base Hospital 31. Most likely, the photographer is man pictured below. This summer, the glass slides were cleaned and scanned. The originals were donated to the Mahoning Valley Historical Society, where they join other documentation on the Base Hospital.

probable photographer of Base Hospital 31 collection, 1918

The entire collection can be viewed in the Youngstown State University Archives Facebook photo album. It contains pictures of the staff, their training, the hospital facilities, the Contrexeville area, war destruction, and the local residents.

Hospital staff with local French children, 1918

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If it ain’t broke, don’t fix it

Recently, I did some light research on operating table design. I was looking for changes in design and materials so that I could help a researcher date their newly-acquired artifact. What I found was that after about 1920, operating tables didn’t change much. They all looked about the same and had similar features. The biggest differences among operating tables throughout the last 100 years are materials and electronic controls. The design is still very similar to those of the early 20th century.

electronically controlled operating table from 1973 (sold by Mueller Co.)

 

Operating tables of the early- and mid-1800s were very simple wooden planks that may have had restraints for the chest and extremities. These would have been necessary because surgery was done without anesthesia. These basic tables were made more for the surgeon’s comfort than for the patient. Operating tables or chairs would have placed the patient at a comfortable position for the surgeon to work.

1853 operating table (St. Thomas Hospital, London)

As the types of surgery increased due to the use of anesthesia and antiseptic practices, the operating tables and chairs were designed to offer a variety of surgical positions. The table was divided into multiple sections that could be manually adjusted to achieve these positions. Foot rests, shoulder braces, and stirrups held the patient in place. Channels and basins for blood and pus were added.

1889 operating table (sold by George Tiemann & Co.)

At the beginning of the 20th century, tables became aseptic and were made out of metal. Throughout the 20th century, these materials have changed with the invention of new, lighter, materials. Electronic controls have allowed for a more precise positioning of the patient.

1915 operating table (sold by Kny-Scheerer)

1928 operating table (sold by Kny-Scheerer)

1948 operating table showing possible positions (sold by Mueller Co.)

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Medical report on Lincoln Assassination found

A researcher for the Papers of Lincoln project has found a medical report from 1865 written by the first doctor to reach President Lincoln. The Times Union reports that it was found in the Surgeon General’s correspondence files at the National Archives.

Dr. Charles Leale had only been a doctor for 6 weeks when he decided to go to Ford’s Theater that fateful night. Because he was sitting about 40 feet from the President’s box, he was able to reach it before the Surgeon General and Lincoln’s family physician, Dr. Stone. Although he had first heard the report of a pistol, Leale had also seen John Booth fall to the stage with an unsheathed dagger, and assumed the President had been stabbed. He had the President’s clothes cut open to find the wound, which he believed to be near the shoulder because of the patient’s comatose state. Finding no shoulder wound, Leale examined Lincoln’s head. Before the other doctors had arrived, Leale had found the bullet hole in Lincoln’s head and had “passed the little finger of [his] left hand through the perfectly smooth opening made by the ball.”

His report goes on to describe how they moved the President to the Peterson house across the street, the examinations made there, and the condition of the President has he approached his last hours.

Dr. Leale’s official report was written by a clerk with clear and beautiful penmanship. The Papers of Lincoln project has digitized the 21-page document. It can be viewed on their “New additions” website near the bottom of the page.

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“Life in the Lung” photo exhibit

Bobby Hill, three months old, is the youngest polio victim ever treated in an Iron Lung at Cincinnati General Hospital. (1954)

The Rose Melnick Medical Museum will host a new temporary exhibit called “Life in the Lung” from Friday, July 6th to Friday, August 17th. The museum will hold special weekend hours for Summer Festival of the Arts.
Saturday, July 7th: 10am to 7pm
Sunday, July 8th: 11am to 5pm

Betty Sue Martin, 5, can still smile after 35 days in an Iron Lung at Johns Hopkins Hospital. The child was brought from North Carolina when her respiratory system was paralyzed after an attack of diphtheria. (1937)

The exhibit will feature 20 photographs of patients in respirators, many in Iron Lungs. The photographs range from 1930 to 1959, when polio was at its peak in the United States and respirators were just coming into use. Most of the photographs will be accompanied by their original captions in the exhibit.
The photographs were loaned to the museum by Steve DeGenaro, a YSU graduate of the Respiratory Care program who collects historical medical photography and lives in Poland, OH.
Admission to the museum and the special exhibit is free.

“Love is the winner” (1959)
Calvin Leonard, 30, leans over to pose with his polio-stricken bride, Margaret Schreiber, 30, following their wedding here [New York] yesterday. Margaret, paralyzed from the neck down for eight years, wears a portable respirator. They met in the hospital where Margaret was a patient and Calvin was a volunteer worker. He proposed last summer, but it was not until Christmas day that Margaret finally consented.

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More on the replica Iron Lung…

“I thought, ‘Wouldn’t it be cool if people could get into (the iron lung),’ but I couldn’t let them into the real one that we have,” said Cassie Nespor, museum curator.

Enter Andy Phillips, YSU carpenter and primary force behind the effort to build a replica “iron lung” that visitors could get in and experience the feeling patients would have had 60 years ago when the devices were used to treat polio.”

Read the full story from our campus news here.

Image

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It’s here!

The replica Iron Lung is finally here!

This custom-made Iron Lung was created so that visitors can actually go *inside* an Iron Lung and experience what it felt like to be encased in the bright yellow chamber. Polio victims would have lived like this for weeks- or even years!


It has a bed that slides out, LED lights inside, and a mirror above the head rest. It is modeled after the Emerson respirator at the museum which was built in the early 1950s.

The Emerson respirator

We hope you can visit the museum for this unique experience. Its sure to be a highlight of any trip to the Rose Melnick Medical Museum!

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Baby Shoes!

Last week, I had a call from a woman who wanted to donate something to the museum. She explained the item to me over the phone, and since we didn’t have anything like it in the collection, we made an appointment for her to bring them in. This is what she brought:

She told me that they were used to correct clubbed feet in infants. This pair of corrective shoes is from the 1950s.

Clubbed feet in infants is a common birth defect which, in most cases, can be corrected without surgery. Doctor’s aren’t sure what causes the defect, but babies are born with one or both feet rotated downward and inward. As infants, only muscles and tendons are affected. However, if the condition is left untreated, the child’s bones will become deformed as an adaption to the abnormal position of the foot. They will walk on their ankles or side of their foot, making it difficult to walk or stand for long periods of time.

A Primer on the Prevention of Deformity in Childhood by R. Raney (Elyria, OH: National Society for Crippled Children, 1941)

The treatment for clubbed feet in the 1950s depended on the severity of the deformity. For mild cases, gentle stretching by the mother or nurse would help stretch the shortened tendons, especially the heel cord. This would be continued multiple times a day for a period of months until the foot could be held in a normal position.

For more severe cases (including this donor), a series of casts were applied to the infant’s legs beginning in the first two weeks of life. These casts were changed about every two weeks, gradually stretching the muscles and tendons into a normal position. Some pediatricians advised over-correcting the position to allow for some relapse after the casts were removed (see image above).

The final step was maintenance of the position. For infants too young to walk or stand, stiff shoes were mounted to a bar. The infant would wear this apparatus as much as possible. The shoes would hold the feet in the correct position. For children who could stand or walk, special shoes were made with the toes turned out slightly and raised outer edges. Some doctors simply instructed patients to wear their shoes on the wrong feet. The straight outer side of the shoe would act as a sufficient brace to maintain the correct position.

Orthopedics: Principles and their Application by S. Turek (Philadelphia: Lippincott, 1967)

Most cases that are treated early in life can be completely corrected. This donor was encouraged to enroll in dance lessons at an early age to strengthen the muscles in her feet and ankles. She has danced most of her life and continues to this day.

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