tag:theconversation.com,2011:/uk/topics/history-of-medicine-8658/articles
History of medicine – The Conversation
2024-03-05T14:00:11Z
tag:theconversation.com,2011:article/221061
2024-03-05T14:00:11Z
2024-03-05T14:00:11Z
Hispanic health disparities in the US trace back to the Spanish Inquisition
<figure><img src="https://images.theconversation.com/files/578113/original/file-20240226-18-qx2l6e.jpg?ixlib=rb-1.1.0&rect=346%2C479%2C3693%2C2076&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Class, gender and religion influenced health care in early modern Spain and Latin America.</span> <span class="attribution"><a class="source" href="https://www.nationalgallery.org.uk/paintings/diego-velazquez-christ-in-the-house-of-martha-and-mary">Diego Velázquez/The National Gallery</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Many of the significant <a href="https://www.pewresearch.org/science/2022/06/14/hispanic-americans-experiences-with-health-care/">health disparities and inequities</a> Hispanic communities in the United States face are tied to a long history of health injustice in the Hispanic world.</p>
<p>The health landscape of early modern Hispanic societies, particularly from the late 15th to 18th centuries, was a <a href="https://history.wisc.edu/publications/The-Gray-Zones-of-Medicine-Healers-and-History-in-Latin-america/">complex interplay</a> between professional and nonprofessional providers shaping health care. The convergence of Indigenous, African and European practices, both in Spain and the Americas, affected how clinicians treated their patients.</p>
<p>This all played out against the <a href="https://doi.org/10.1017/CHO9781139032698.009">backdrop of the Inquisition and colonization</a>, when the Catholic Church prosecuted heresy. Consolidating religious norms promoted health care through charitable activity, such as the creation of hospitals, but also created challenges between the authority of the Catholic Church and competing health care initiatives. </p>
<p><a href="https://www.bowdoin.edu/profiles/faculty/mboyle2/index.html">My research</a> focuses on how health and medical practices in early modern Latin America and Spain are represented through cultural artifacts, including literature, recipe books, the Inquisition and convent records. In our book, my colleague <a href="https://charleston.edu/spanish/faculty/owens-sarah.php">Sarah Owens</a> and I explore how <a href="https://utorontopress.com/9781487505189/health-and-healing-in-the-early-modern-iberian-world/">gender norms affected</a> medicine and health care. We also consider how popular representations of health and medicine in culture inform widely held beliefs and biases about these experiences.</p>
<p>Understanding the historical roots of health disparities in Hispanic communities can <a href="https://salud-america.org">help address them</a> both locally and globally today. </p>
<h2>Interplay of medical practices</h2>
<p>Latin America and Spain in the late 15th to 18th centuries were home to a <a href="https://www.routledge.com/Medical-Cultures-of-the-Early-Modern-Spanish-Empire/Slater-Lopez-Terrada-Pardo-Tomas/p/book/9780367669225">number of medical practices</a>, including traditional medical knowledge and remedies and the professionalization of medicine through new universities and licensing systems. </p>
<p>Early modern <a href="https://doi.org/10.4000/aes.3633">medical humanists</a>, or Renaissance clinicians, took up medical treatises by the ancient Greek and Roman physicians, including those of Galen and Hippocrates, and revived them in the context of “learned” medical instruction through European universities. The study of <a href="https://doi.org/10.1017/CBO9781139027649.015">Paracelsianism</a>, or the theories of Swiss physician Paracelsus, though more contested among practitioners because of its connections to the supernatural and occult, also affected a variety of health practices across early modern Spain and colonial Latin America. With the publication of anatomical treatises at the start of the 16th century, including the work of Renaissance physician <a href="https://lccn.loc.gov/2021667096">Andreas Vesalius</a>, the study of anatomy slowly and dramatically changed medical practice.</p>
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<a href="https://images.theconversation.com/files/578303/original/file-20240227-28-t93eef.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white engraving of four people surrounding the bedside of a man lying prone, with one of the people tending to a wound on his back by candlelight" src="https://images.theconversation.com/files/578303/original/file-20240227-28-t93eef.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578303/original/file-20240227-28-t93eef.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=797&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578303/original/file-20240227-28-t93eef.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=797&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578303/original/file-20240227-28-t93eef.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=797&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578303/original/file-20240227-28-t93eef.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1002&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578303/original/file-20240227-28-t93eef.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1002&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578303/original/file-20240227-28-t93eef.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1002&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An 18th century engraving depicts a woman soothing a wound on Don Quixote’s back.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/yca32vbf/images?id=j557f5kw">William Hogarth/Wellcome Collection</a></span>
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<p>Traditional healing practices varied significantly but often provided accessible and <a href="https://doi.org/10.1089/heq.2021.0099">culturally compatible care</a>, including reduced language barriers. Many people in Hispanic communities still rely on these practices today. Discussions about the legitimacy and health effects of folk remedies in Latin America, such as varieties of herbal and holistic medicine and other <a href="https://doi.org/10.1186/1746-4269-7-9">animal-based remedies</a>, are ongoing.</p>
<h2>Gender and medicine</h2>
<p>As health care became more professionalized during the early modern period, some women found ways to practice medicine in more formalized contexts, while others continued to work as healers or herbalists. These practices alternated between <a href="https://iberian-connections.yale.edu/articles/healing-in-madrid/">success and suspicion</a> during the Spanish Inquisition. Accusations of sorcery and witchcraft along with sexualities outside heterosexual norms often collided with practices of health and medicine. </p>
<p>But just as pregnancy and child–rearing are not the only medical events that shaped early modern women’s lives, women medical providers <a href="https://utorontopress.com/9781487505189/health-and-healing-in-the-early-modern-iberian-world/">weren’t only witches</a>. Nuns in Arequipa prepared treatments in convents, and mothers and daughters made medicine within households in Madrid.</p>
<p>From Fernando de Rojas’ 1499 tragicomedy “<a href="http://dx.doi.org/10.17613/1xhs-0330">La Celestina</a>,” about the go-between who crafts love potions and repairs hymens, to the 2019 Colombian TV series “<a href="https://www.netflix.com/title/80205595">Siempre Bruja</a>,” about a 17th century Afro-Colombian witch who finds herself in present-day Cartagena, the cultural legacy of witchy women healers in the Hispanic world continues to be deeply felt.</p>
<h2>Class, race, geography and language</h2>
<p>The transfer of plants, animals and diseases across the Atlantic also profoundly affected health outcomes. </p>
<p>European diseases <a href="https://blogs.lse.ac.uk/latamcaribbean/2020/08/07/the-history-of-epidemics-in-latin-america-has-much-to-tell-us-about-covid-19/">such as smallpox</a> <a href="https://theconversation.com/how-smallpox-devastated-the-aztecs-and-helped-spain-conquer-an-american-civilization-500-years-ago-111579">devastated Indigenous populations</a>. Meanwhile, plants from the Americas offered <a href="https://brill.com/display/title/34839?language=en">novel treatments</a> for a number of illnesses globally. Peruvian <a href="https://doi.org/10.1186/1475-2875-10-144">cinchona bark</a> is a natural source of quinine that proved effective against malaria, a disease prevalent in both Europe and the Americas. Other plants <a href="https://utorontopress.com/9781487527204/chocolate/">such as cacao seeds</a> found various medicinal and ritual uses, including relieving exhaustion or anxiety or improving weight gain.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/5FpPpn086eI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The Columbian Exchange was not mutually beneficial.</span></figcaption>
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<p>But access to this range of treatment methods was unequal, especially <a href="https://nursingclio.org/2018/02/22/health-care-in-colonial-peruvian-convents/">across social class and geography</a>. Wealthier nobility in urban centers often had much greater access to scarce resources across the Iberian empire. </p>
<p>Health outcomes were also often linked to <a href="https://uncpress.org/book/9781469630878/the-experiential-caribbean/">racial and ethnic hierarchies</a>. Patients were classified as Spanish, mestizo – mixed European and Indigenous – or African slaves in treatment records. These documents show evidence of uneven access to care, while there is also evidence that some exchanges in care practices <a href="https://doi.org/10.1111/1468-0424.12553">across these hierarchies</a> were possible.</p>
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<a href="https://images.theconversation.com/files/578307/original/file-20240227-20-vpjsg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Yellowed manuscript with written text inscribed in ink down the page" src="https://images.theconversation.com/files/578307/original/file-20240227-20-vpjsg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/578307/original/file-20240227-20-vpjsg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=915&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578307/original/file-20240227-20-vpjsg8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=915&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578307/original/file-20240227-20-vpjsg8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=915&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578307/original/file-20240227-20-vpjsg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1149&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578307/original/file-20240227-20-vpjsg8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1149&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578307/original/file-20240227-20-vpjsg8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1149&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">‘Grammar of the Castilian Language’ codified Spanish.</span>
<span class="attribution"><a class="source" href="https://www.loc.gov/item/2021667003">Antonio De Nebrija/World Digital Library via Library of Congress</a></span>
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<p>Forced displacement as well as language discrimination also affected health access and outcomes. Spanish wasn’t <a href="https://www.publicbooks.org/whose-spanish-anyway/">standardized as a language</a> until the publication of Antonio de Nebrija’s “<a href="https://www.jstor.org/stable/44015843">Grammar of the Castilian Language</a>” in 1492, inscribed to Queen Isabel with the reminder that “language has always been the companion to empire.” </p>
<p>For example, while Arabic and Hebrew were widely spoken throughout the Iberian Peninsula before the forced expulsions of the Inquisition, politics around language resulted in centuries of stereotypes and discrimination against Muslim and Jewish medical providers, who had to navigate <a href="https://www.routledge.com/Medicine-Government-and-Public-Health-in-Philip-IIs-Spain-Shared-Interests/Clouse/p/book/9781138246379">alternative licensing methods</a> to practice medicine in Spain and its colonial territories. </p>
<h2>Understanding the story of medicine</h2>
<p>More than 400 years later, inequities in and commodification of Hispanic health and wellness continue. </p>
<p>Luxury travelers are sold wellness via <a href="https://oursoulfultravels.com/wellness-spas-in-mexico/">Mayan purification rituals</a>, among other assorted local remedies and practices that can be purchased, marketed and monetized. Wood from the Palo Santo tree, which healers have used for centuries for spiritual cleanings and pain relief, continues to be grown all over the Americas, including Mexico, Peru and Ecuador, and is now bought and sold globally to bring “<a href="https://www.womenshealthmag.com/life/a30793415/what-is-palo-santo/">good vibes</a>.”</p>
<p>Considering these early modern health practices and inequities allows for deeper engagement with health care systems today. Informed critical thinking about medicine and health care <a href="https://www.insidehighered.com/news/2018/10/16/2018-jefferson-lecture-focuses-contribution-humanities-medicine">across disciplines</a> is a powerful way to consider how these histories continue to shape current values and practices, including <a href="https://doi.org/10.5744/florida/9781683402619.001.0001">ongoing disparities in health care</a>.</p>
<p>One such discipline is <a href="https://theconversation.com/literature-inspired-my-medical-career-why-the-humanities-are-needed-in-health-care-217357">narrative medicine</a>. Using the tools of the humanities, physicians can broaden their view of their patients from simple metrics to human beings with stories to tell. This process involves perceiving and incorporating patients’ personal experiences, valuing narration of the past and recognizing the significance of the encounter between doctor and patient. While much of this research focuses on English-language narratives, cross-cultural and bilingual research <a href="https://www.lclark.edu/live/news/48656-neh-grant-to-support-bilingual-materials-for">in Spanish</a> is expanding the field. </p>
<p>It is estimated that by 2060 there will be more than <a href="https://latino.ucla.edu/research/latino-population-2000-2020/">111 million Latinos</a> in the United States. Understanding the historical legacies that have shaped wellness and care practices, including the factors that determine care quality and access, can promote more equitable and culturally nuanced health outcomes.</p><img src="https://counter.theconversation.com/content/221061/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Margaret Boyle received funding from the Fulbright Program and the George A. and Eliza Gardner Howard Foundation Fellowship for this research.</span></em></p>
Early modern societies in Latin America and Spain saw a convergence of traditional medical knowledge and the professionalization of medicine. The resulting differences in access to care endure today.
Margaret Boyle, Associate Professor of Romance Languages and Literatures, Director of Latin American, Caribbean, and Latinx Studies Program, Bowdoin College
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/218992
2024-03-01T13:33:52Z
2024-03-01T13:33:52Z
The tools in a medieval Japanese healer’s toolkit: from fortunetelling and exorcism to herbal medicines
<figure><img src="https://images.theconversation.com/files/578362/original/file-20240227-20-ng0qz.jpeg?ixlib=rb-1.1.0&rect=0%2C0%2C979%2C466&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An 'onmyoji,' an expert on yin and yang, performs divination with counting rods in an Edo-period illustration.
</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Tamamonomae_Onmyoji.jpg">Kyoto University Library/Wikimedia</a></span></figcaption></figure><p>“The Tale of Genji,” often called <a href="https://www.penguinrandomhouse.com/books/530271/the-tale-of-genji-by-murasaki-shikibu/">Japan’s first novel</a>, was written 1,000 years ago. Yet it still occupies a powerful place in the Japanese imagination. A popular TV drama, “Dear Radiance” – “<a href="https://www.nhk.jp/p/hikarukimie/ts/1YM111N6KW/">Hikaru kimi e</a>” – is based on the life of its author, Murasaki Shikibu: the lady-in-waiting whose experiences at court inspired the refined world of “Genji.”</p>
<p>Romantic relationships, poetry and political intrigue provide most of the novel’s action. Yet illness plays an important role in several crucial moments, most famously when one of the main character’s lovers, Yūgao, <a href="https://www.gutenberg.org/cache/epub/66057/pg66057-images.html#page_92">falls ill and passes away</a>, killed by what appears to be a powerful spirit – as later happens <a href="https://www.gutenberg.org/cache/epub/66057/pg66057-images.html#page_250">to his wife, Aoi</a>, as well.</p>
<p>Someone reading “The Tale of Genji” at the time it was written would have found this realistic – as would some people in different cultures around the world today. Records from early medieval Japan document numerous descriptions <a href="https://academiccommons.columbia.edu/doi/10.7916/d8-46cs-wq63">of spirit possession</a>, usually blamed on spirits of the dead. As has been true in many times and places, physical and spiritual health were seen as intertwined.</p>
<p>As <a href="https://ealc.wustl.edu/people/alessandro-poletto">a historian of premodern Japan</a>, I’ve studied the processes its healing experts used to deal with possessions, and illness generally. Both literature and historical records demonstrate that the boundaries between what are often called “religion” and “medicine” were indistinct, if they existed at all.</p>
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<a href="https://images.theconversation.com/files/578356/original/file-20240227-28-gqyl6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An intricate illustration of a ceremony attended by people in robes, with the background covered in a golden color." src="https://images.theconversation.com/files/578356/original/file-20240227-28-gqyl6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578356/original/file-20240227-28-gqyl6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578356/original/file-20240227-28-gqyl6g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578356/original/file-20240227-28-gqyl6g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578356/original/file-20240227-28-gqyl6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578356/original/file-20240227-28-gqyl6g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578356/original/file-20240227-28-gqyl6g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A 17th-century scroll, ‘Maboroshi no Genji monogatari emaki,’ showing the funeral of Genji’s wife, Aoi.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/leaves-of-wild-ginger-from-the-phantom-genji-scrolls-mid-news-photo/1206222207?adppopup=true">Heritage Art/Heritage Images via Getty Images</a></span>
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<h2>Vanquishing spirits</h2>
<p>The government department in charge of divination, the Bureau of Yin and Yang, established in the late seventh century, played a crucial role. Its technicians, known as <a href="https://nirc.nanzan-u.ac.jp/journal/6/issue/186">onmyōji</a> – yin and yang masters – were in charge of divination and fortunetelling. They were also responsible for observing the skies, interpreting omens, calendrical calculations, timekeeping and eventually a variety of rituals.</p>
<p>Today, onmyōji appear as wizardlike figures in <a href="https://books.bunshun.jp/sp/onmyoji">novels</a>, <a href="https://www.viz.com/twin-star-exorcists">manga</a>, <a href="https://www.youtube.com/watch?v=LEiZuDTEq6A">anime</a> and <a href="https://en.onmyojigame.com/">video games</a>. Though heavily fictionalized, there is a historical kernel of truth in these fantastical depictions.</p>
<p>Starting from around the 10th century, Onmyōji were charged with carrying out iatromancy: divining the cause of a disease. Generally, they distinguished between disease caused by external or internal factors, though boundaries between the categories were often blurred. External factors could include local deities known as “kami,” other kami-like entities the patient had upset, minor Buddhist deities or malicious spirits – often revengeful ghosts. </p>
<p>In the case of spirit-induced illness, Buddhist monks would work to winnow out the culprit. Monks who specialized in exorcistic practices were known as “genja” and were believed to know how to <a href="https://www.penguinrandomhouse.com/books/300922/the-pillow-book-by-sei-shonagon">expel the spirit from a patient’s body</a> through powerful incantations. Genja would then transfer it onto another person and force the spirit to reveal its identity before vanquishing it.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/578368/original/file-20240227-26-dx583p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A faded picture of a broom, branch with a few leaves, and a fan, as well as Japanese script on top of it." src="https://images.theconversation.com/files/578368/original/file-20240227-26-dx583p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/578368/original/file-20240227-26-dx583p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=665&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578368/original/file-20240227-26-dx583p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=665&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578368/original/file-20240227-26-dx583p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=665&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578368/original/file-20240227-26-dx583p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=836&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578368/original/file-20240227-26-dx583p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=836&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578368/original/file-20240227-26-dx583p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=836&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A 19th century print by Kubo Shunman shows objects representing the New Year’s ceremony of exorcising demons.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/objects-representing-the-ceremony-of-exorcising-demons-one-news-photo/1338629689?adppopup=true">Heritage Images/Hulton Archive via Getty Images</a></span>
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<h2>Court physicians</h2>
<p>While less common than spirit possessions, the idea that physical factors could also cause illness appears in sources from this period. </p>
<p>Since the late seventh century, the government of the Japanese archipelago had established a bureau in charge of the well-being of aristocratic families and high-ranking members of the state bureaucracy. This <a href="https://rekihaku.repo.nii.ac.jp/records/2657">Bureau of Medications</a>, the Ten’yakuryō, was based on similar systems in China’s Tang dynasty, <a href="https://search.worldcat.org/title/3414658">which Japanese officials</a> adapted for their own culture.</p>
<p>The bureau’s members, whom scholars today often call “court physicians” in English, created medicinal concoctions. But the bureau also included technicians tasked with using spells, perhaps to protect high-ranking people from maladies.</p>
<h2>Not either/or</h2>
<p>Some scholars, both Japanese and non-Japanese, compare the practices of members of the Bureau of Medications with what is now called “traditional Chinese medicine,” or just “medicine.” They typically consider the onmyōji and Buddhist monks, meanwhile, to fall under the label of “religion” – or perhaps, <a href="https://search.worldcat.org/title/7306973">in the case of onmyōji, “magic</a>.”</p>
<p>But I have found numerous signs that these categories do not help people today make sense of early medieval Japan.</p>
<p>Starting in the seventh century, as a centralized Japanese state began to take shape, Buddhist monks from the Korean Peninsula and present-day China brought healing practices to Japan. These techniques, such as herbalism – treatments made of plants – later became associated with court physicians. At the same time, though, monks also employed <a href="https://doi.org/10.1093/acrefore/9780199340378.013.980">healing practices rooted in Buddhist rituals</a>. Clearly, <a href="https://academiccommons.columbia.edu/doi/10.7916/d8-46cs-wq63">the distinction between ritual and physical healing</a> was not part of their mindset.</p>
<p>Similarly, with court physicians, it is true that sources from this period mostly show them <a href="https://rekihaku.repo.nii.ac.jp/records/2657">practicing herbalism</a>. Later on, they incorporated simple needle surgeries and moxibustion, which involves burning a substance derived from dried leaves from the mugwort plant near the patient’s skin.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/578349/original/file-20240227-28-9evlnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A drawing showing the outline of the human body from behind and in front, with one arm outstretched, and Chinese characters written on it." src="https://images.theconversation.com/files/578349/original/file-20240227-28-9evlnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578349/original/file-20240227-28-9evlnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=453&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578349/original/file-20240227-28-9evlnl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=453&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578349/original/file-20240227-28-9evlnl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=453&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578349/original/file-20240227-28-9evlnl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=569&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578349/original/file-20240227-28-9evlnl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=569&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578349/original/file-20240227-28-9evlnl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=569&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An 18th-century engraving identifying parts of the body treated by moxibustion.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/engraving-of-the-meridian-points-on-the-human-body-which-news-photo/90731089?adppopup=true">Science & Society Picture Library via Getty Images</a></span>
</figcaption>
</figure>
<p>However, they also incorporated ritual elements from various Chinese traditions: spells, divination, fortunetelling and hemerology, the practice of identifying auspicious and inauspicious days for specific events. For example, moxibustion was supposed to be avoided on certain days because of the position of a deity, <a href="https://cir.nii.ac.jp/crid/1520853832664346880">known as “jinshin</a>,” believed to reside and move inside the human body. Practicing moxibustion on the body part where “jinshin” resided in a specific moment could kill it, therefore potentially harming the patient. </p>
<p>Court physicians were also expected to ritually “rent” a place for a pregnant woman to deliver, <a href="https://doi.org/10.3390/rel12110907">producing talismans</a> written in red ink that were meant to function as “leases” for the birthing area. This was done in order to keep away deities who might otherwise enter that space, possibly because childbirth was believed to be a source of defilement. They also used hemerology to determine where the birthing bed should be placed.</p>
<p>In short, these healing experts straddled the boundaries between what are often called “religion” and “medicine.” We take for granted the categories that shape our understanding of the world around us, but they are the result of complex historical processes – and look different in every time and place.</p>
<p>Reading works like “The Tale of Genji” is not only a way to immerse ourselves in the world of a medieval court, one where spirits roam freely, but a chance to see other ways of sorting human experience at work.</p><img src="https://counter.theconversation.com/content/218992/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alessandro Poletto does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
In medieval Japan, healing might mean taking medicine, undergoing an exorcism or sidestepping harm in the first place by avoiding inauspicious days.
Alessandro Poletto, Lecturer in East Asian Religions, Arts & Sciences at Washington University in St. Louis
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/220831
2024-01-30T13:35:29Z
2024-01-30T13:35:29Z
Backlash to transgender health care isn’t new − but the faulty science used to justify it has changed to meet the times
<figure><img src="https://images.theconversation.com/files/571543/original/file-20240125-15-cirbso.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5778%2C3252&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anti-trans legislation adjudicates the bodily autonomy of those who do not conform to gender norms.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TransgenderRights/5105bf799bb64a7b88d180c1a410463a">Carolyn Kaster/AP Photo</a></span></figcaption></figure><p>In the past century, there have been three waves of opposition to transgender health care. </p>
<p>In 1933, when the Nazis rose to power, they <a href="https://daily.jstor.org/90-years-on-the-destruction-of-the-institute-of-sexual-science/">cracked down on</a> transgender medical research and clinical practice in Europe. In 1979, a research report critical of transgender medicine <a href="https://doi.org/10.7326/M22-1480">led to the closure</a> of the most well-respected clinics in the United States. And since 2021, when <a href="https://www.npr.org/2023/06/20/1183344228/arkansas-2021-gender-affirming-care-ban-transgender-blocked">Arkansas became the first U.S. state</a> among now <a href="https://www.lgbtmap.org/equality-maps/healthcare_youth_medical_care_bans">at least 21 other states</a> banning gender-affirming care for minors, we have been living in a third wave.</p>
<p>In my work as a <a href="https://gsrosenthal.com">scholar of transgender history</a>, I study the <a href="https://theconversation.com/gender-affirming-care-has-a-long-history-in-the-us-and-not-just-for-transgender-people-201752">long history of gender-affirming care</a> in the U.S., which has been practiced since at least the 1940s. Puberty blockers, hormone therapies and anatomical surgeries are <a href="https://www.latimes.com/opinion/story/2023-03-28/opinion-gender-affirming-care-is-not-new-or-experimental">neither experimental nor untested</a> and have been safely administered to cisgender, transgender and intersex adults and children for decades.</p>
<p>On the other hand, the archives of transgender medicine demonstrate that backlash against these practices has historically been rooted in pseudoscience. And today, an anti-science movement that aims to <a href="https://www.scientificamerican.com/article/the-antiscience-movement-is-escalating-going-global-and-killing-thousands/">discredit science altogether</a> is fueling the fire of the current wave of anti-trans panic.</p>
<h2>The 1930s − eugenics and sexology collide</h2>
<p>In the 1920s, the new science of hormones was just reaching maturation and <a href="https://uncpress.org/book/9781469674858/wondrous-transformations/">entering mainstream consciousness</a>. In the field of sexology – the study of human sexuality, founded in 19th century Europe – scientists were excited about research on animals demonstrating that removing or transplanting gonads could effectively change an organism’s sex.</p>
<p>In 1919, the German sexologist <a href="https://theconversation.com/the-early-20th-century-german-trans-rights-activist-who-transformed-the-worlds-view-of-gender-and-sexuality-106278">Magnus Hirschfeld</a> founded the <a href="https://www.scientificamerican.com/article/the-forgotten-history-of-the-worlds-first-trans-clinic/">Institut für Sexualwissenschaft</a> in Berlin, which became the world’s leading center for queer and transgender research and clinical practice. Hirschfeld worked closely with trans women as co-researchers throughout the 1920s. Several trans women also received care at the institute, including <a href="https://doi.org/10.1080%2F26895269.2020.1749921">orchiectomies</a> that halted the production of testosterone in their bodies.</p>
<p>Within months of Hitler’s rise to power in early 1933, a <a href="https://www.hmd.org.uk/resource/6-may-1933-looting-of-the-institute-of-sexology/">mob of far-right students</a> broke into and shuttered the institute for being “<a href="https://daily.jstor.org/90-years-on-the-destruction-of-the-institute-of-sexual-science/">un-German</a>.” Some of the <a href="https://collections.ushmm.org/search/catalog/pa26364">most famous images</a> of Nazi book burning show the institute’s library set ablaze in an outdoor plaza.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white photo of person in uniform throwing books into a bonfire" src="https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=478&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=478&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=478&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=600&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=600&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571540/original/file-20240125-21-rigby5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=600&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Members of the Nazi party confiscated and burned ‘un-German’ books, including those from the Institut für Sexualwissenschaft.</span>
<span class="attribution"><a class="source" href="https://collections.ushmm.org/search/catalog/pa26364">United States Holocaust Memorial Museum, courtesy of National Archives and Records Administration, College Park</a></span>
</figcaption>
</figure>
<p>Nazi ideology was based on another prominent field of science of that time: <a href="https://www.genome.gov/about-genomics/fact-sheets/Eugenics-and-Scientific-Racism">eugenics</a>, the belief that certain superior populations should survive while inferior populations must be exterminated. In fact, Hirschfeld’s sexology and Nazi race science had common roots in the Enlightenment-era effort to <a href="https://doi.org/10.1080/17496977.2020.1794161">classify and categorize</a> the world’s life forms. </p>
<p>But in the late 19th century, many scientists went a step further and <a href="https://theconversation.com/proposed-1920s-orphanage-study-just-one-example-in-history-of-scientific-racism-37015">developed a hierarchy of human types</a> based on race, gender and sexuality. They were inspired by <a href="https://www.britannica.com/topic/social-Darwinism">social Darwinism</a>, a set of pseudoscientific beliefs applying the theory of survival of the fittest to human differences. As race scientists imagined a fixed number of human races of varying intelligence, sexologists simultaneously sought to classify sexual behaviors as innate, inherited states of being: <a href="https://www.beacon.org/A-Queer-History-of-the-United-States-P1426.aspx">the “homosexual”</a> in the 1860s and <a href="https://www.digitaltransgenderarchive.net/news/2016-08-die-transvestiten-sexology-and-pivotal-moments-in-trans-history">the “transvestite,”</a> a term coined by Hirschfeld himself, in 1910.</p>
<p>But where Hirschfeld and other sexologists saw the classification of queer and trans people as justifications for legal emancipation, eugenicists of the early 20th century <a href="https://encyclopediavirginia.org/entries/eugenic-sterilization-in-virginia/">in the U.S.</a> and <a href="https://encyclopedia.ushmm.org/content/en/article/eugenics">Europe</a> believed sexually transgressive people <a href="https://theconversation.com/forced-sterilization-policies-in-the-us-targeted-minorities-and-those-with-disabilities-and-lasted-into-the-21st-century-143144">should be sterilized</a> and ultimately eradicated.</p>
<p>Based on this premise, the Nazis <a href="https://www.cornellpress.cornell.edu/book/9781501765155/pink-triangle-legacies/">murdered thousands of LGBTQ people</a> in the Holocaust.</p>
<h2>The 1970s − making model citizens</h2>
<p>In the 1950s and 1960s, transgender medicine bounced back in the U.S. Scientists and clinicians at several universities began experimenting with new <a href="https://press.uchicago.edu/ucp/books/book/chicago/H/bo156724705.html">hormonal and surgical interventions</a>. In 1966, Johns Hopkins became the <a href="https://soundcloud.com/hopkins-medical-archives/gender-identity-clinic-press-conference-1966">first university hospital in the world</a> to offer trans health care. </p>
<p>By the 1970s, trans medicine went mainstream. <a href="https://www.hup.harvard.edu/books/9780674013797">Nearly two dozen university hospitals</a> were operating gender identity clinics and treating thousands of transgender Americans. Several trans women and men wrote <a href="https://www.theparisreview.org/blog/2021/01/29/the-conundrum-of-conundrum/">popular autobiographical accounts</a> of their transitions. Trans people were even <a href="https://americanarchive.org/catalog/cpb-aacip_507-cc0tq5s22t">on television</a>, talking about their bodies and fighting for their rights. </p>
<p>Yet trouble was brewing behind the scenes. Jon Meyer, a psychiatrist at Johns Hopkins, was skeptical of whether medical interventions really helped transgender people. In 1979, Meyer, along with his secretary Donna Reter, published a <a href="https://doi.org/10.1001/archpsyc.1979.01780090096010">short academic paper</a> that ushered in the second wave of historic backlash to trans medicine.</p>
<p>In their study, Meyer and Reter contacted previous patients of the Johns Hopkins Gender Identity Clinic. To understand whether surgery had improved patients’ lives, the authors developed an “adjustment scoring system.” They assigned points to patients who were in heterosexual marriages and had achieved economic security since their operations, while deducting points from those who continued to engage in gender nonconformity, homosexuality, criminality, or sought mental health care.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white image of transgender artist Coccinelle smiling beside her husband Francis Paul Bonnet" src="https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571547/original/file-20240125-31-t8e03l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some researchers defined a successful medical transition as one that resulted in visible conformity to gender norms and heterosexuality.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/artiste-transgenre-coccinelle-et-son-mari-francis-paul-news-photo/1505597233">Reporters Associes/Gamma-Rapho via Getty Images</a></span>
</figcaption>
</figure>
<p>Meyer and Reter believed that gender-affirming surgeries were successful only if they made model citizens out of transgender people: straight, married and law-abiding.</p>
<p>In their results, the authors found no negative effects from surgery, and no patients expressed regret. They concluded that “sex reassignment surgery confers no objective advantage in terms of social rehabilitation,” but it is “subjectively satisfying” to the patients themselves. This was not a damning conclusion. </p>
<p>Yet, within two months, Johns Hopkins had <a href="https://doi.org/10.7326/M22-1480">shuttered its clinic</a>. <a href="https://www.nytimes.com/1979/10/02/archives/benefits-of-transsexual-surgery-disputed-as-leading-hospital-halts.html">The New York Times</a> reported that universities would feel pressure to similarly “curtail their operations and discourage others from starting to do them.” Indeed, only a <a href="https://doi.org/10.7326/M22-1480">handful of clinics remained</a> by the 1990s. Transgender medicine did not return to Johns Hopkins <a href="https://www.washingtonpost.com/national/health-science/long-shadow-cast-by-psychiatrist-on-transgender-issues-finally-recedes-at-johns-hopkins/2017/04/05/e851e56e-0d85-11e7-ab07-07d9f521f6b5_story.html">until 2017</a>.</p>
<p>In requiring trans patients to enter straight marriages and hold gender-appropriate jobs to be considered successful, Meyer and Reter’s study was <a href="https://doi.org/10.1007/BF02115944">homophobic and classist in design</a>. The study exemplified the <a href="https://nyupress.org/9781479899371/trans-medicine/">pseudoscientific beliefs</a> at the heart of transgender medicine in the 1960s through the 1980s, that patients had to conform to societal norms – including heterosexuality, gender conformity, domesticity and marriage – in order to receive care. This was not an ideology rooted in science but in bigotry.</p>
<h2>The 2020s − distrust in science</h2>
<p>As in the 1930s, opposition to trans medicine today is part of a broad reactionary movement against what some far-right groups consider the “<a href="https://www.theguardian.com/world/2023/sep/15/project-2025-policy-manifesto-lgbtq-rights">toxic normalization</a>” of LGBTQ people. </p>
<p>Legislators have <a href="https://theconversation.com/penguin-random-house-pen-america-authors-and-parents-sue-florida-county-for-removing-books-on-race-and-lgbtq-themes-205945">removed books with LGBTQ content</a> from libraries and <a href="https://www.newsobserver.com/news/politics-government/article254903187.html">disparaged them as “filth</a>.” A recent law in Florida <a href="https://www.them.us/story/florida-trans-bathroom-law">threatens trans people with arrest</a> for using public restrooms. Both Florida and Texas have pursued efforts to <a href="https://www.them.us/story/texas-attorney-general-ken-paxton-state-data-on-trans-texans">compile data on their trans citizens</a>. Donald Trump’s <a href="https://www.theatlantic.com/magazine/archive/2024/01/trump-lgbtq-transgender-community-protections/676139/">campaign platform</a> calls for a nationwide ban on trans health care for minors and severe restrictions for adults.</p>
<p>And similar to the 1970s, opponents of trans medicine today frame gender-affirming care as a “debate,” even though <a href="https://glaad.org/medical-association-statements-supporting-trans-youth-healthcare-and-against-discriminatory/">all major U.S. medical associations</a> support these practices <a href="https://www.ama-assn.org/press-center/press-releases/ama-states-stop-interfering-health-care-transgender-children">as medically necessary</a> and lifesaving. </p>
<p>But widespread <a href="https://www.bostonreview.net/articles/andrew-jewett-science-under-fire/">distrust in science and medicine</a> in the <a href="https://www.thenation.com/article/society/anti-science-is-a-systematic-issueand-its-not-going-away/">wake of the COVID-19 pandemic</a> has affected how Americans perceive trans health care. Prohibitions on gender-affirming care have occurred simultaneously with the relaxing of pandemic restrictions, and some scholars argue that the movement against trans health care is part of a <a href="https://blogs.lse.ac.uk/gender/2022/04/11/what-anti-gender-and-anti-vaccines-politics-have-in-common-the-construction-of-gender-and-the-covid-19-pandemic-in-right-wing-discourses/">broader movement</a> aimed at discrediting scientific consensus.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Back of person wearing trans flag at the back of a legislative hearing room with a rotunda" src="https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571550/original/file-20240125-28-zetkg0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A rash of legislation restricting access to gender-affirming care claims to protect the health of children, despite lack of support from major U.S. medical associations.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TransgenderHealthMissouri/442b19097c7f44a0a0864c4046aa5acb">Charlie Riedel/AP Photo</a></span>
</figcaption>
</figure>
<p>Yet the adage “<a href="https://www.nsta.org/journal-college-science-teaching/journal-college-science-teaching-mayjune-2022/why-do-people-say-i">believe in science</a>” is not an effective rejoinder to these anti-trans policies. Instead, many trans activists today call for diminishing the role of medical authority altogether in <a href="https://www.americanscientist.org/blog/macroscope/its-time-to-stop-gatekeeping-medical-transition">gatekeeping access to trans health care</a>. Medical gatekeeping occurs <a href="https://doi.org/10.1080/26895269.2022.2100644">through stringent guidelines</a> that govern access to trans health care, including mandated psychiatric evaluations and extended waiting periods that limit and control patient choice. </p>
<p>Trans activists have <a href="https://filtermag.org/wpath-trans-nonbinary-health-care/">fought with the World Professional Association for Transgender Health</a>, the organization that maintains these standards of care, by demanding greater bodily autonomy and depathologizing transsexuality. This includes pivoting to an <a href="https://doi.org/10.1093/jsxmed/qdad019">informed consent model</a> where patients make decisions about their own bodies after discussing the pros and cons with their doctors. Trans activists have been rallying against medical authority since the early 1970s, including calling for <a href="https://www.digitaltransgenderarchive.net/downloads/th83kz57z">access to hormones and surgeries on demand</a>.</p>
<p>It is not clear how the current third wave of backlash to transgender medicine will end. For now, trans health care remains a question dominated by medical experts on one hand and people who question science on the other.</p><img src="https://counter.theconversation.com/content/220831/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>G. Samantha Rosenthal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
For as long as trans medicine has been around, so has its opposition. The tactics of prior waves of anti-trans policies are still in play today.
G. Samantha Rosenthal, Associate Professor of History, Roanoke College
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/217264
2024-01-28T19:05:20Z
2024-01-28T19:05:20Z
Medicare turns 40: since 1984 our health needs have changed but the system hasn’t. 3 reforms to update it
<figure><img src="https://images.theconversation.com/files/571353/original/file-20240125-29-9x8icz.jpg?ixlib=rb-1.1.0&rect=0%2C57%2C7719%2C4513&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/selective-focus-photography-of-assorted-color-balloons-Hli3R6LKibo">Ali Goldstein/Unsplash</a></span></figcaption></figure><p>Forty years ago, Medicare as we know it today was born. It was the reincarnation of the Whitlam government’s Medibank, introduced in 1975 but <a href="https://www.sciencedirect.com/science/article/abs/pii/0277953684902661">dismantled</a> in stages by the Fraser Liberal government. </p>
<p>Medibank was developed in the 1960s by health economists <a href="https://grattan.edu.au/news/remebering-richard-scotton-co-founder-of-medicare/">Dick Scotton</a> and <a href="https://openresearch-repository.anu.edu.au/bitstream/1885/159512/1/Daring_to_Dream.pdf">John Deeble</a>, when disease prevalence was different and the politics of reform were diabolical. </p>
<p>But the nation has changed since 1984, and so have our health needs. Medicare is now struggling to ensure the access to health care for millions of Australians we were once promised. </p>
<p>Let’s look at how we got here – and three radical changes we need to keep the Medicare promise into the future: making it cheaper to see a GP; paying less for blood and imaging tests; and covering dental care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-you-live-in-a-bulk-billing-desert-its-hard-to-see-a-doctor-for-free-heres-how-to-fix-this-204029">If you live in a bulk-billing ‘desert’ it's hard to see a doctor for free. Here's how to fix this</a>
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</em>
</p>
<hr>
<h2>Free hospital care, but you might pay to see a GP</h2>
<p>One of my first jobs in the health system, in the days before Medicare and Medibank, was acting in charge of revenue collection for three public hospitals. A small subset of people could get free, albeit stigmatised, care. </p>
<p>We had bad debts, because some people couldn’t afford to pay their hospital bills and I was allowed by policy to recommend that some be written off. But for others I had to seek court authorisation to seize their wages to pay off their hospital debt. </p>
<p>Medibank changed that. Now all Australians can get public hospital care without any financial barrier.</p>
<figure class="align-center ">
<img alt="Doctor draws blood from patient" src="https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Before Medicare and Medibank, patients often faced hospital care debts.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-laying-in-a-hospital-bed-next-to-a-man-dkZQfm1LLQE">National Cancer Institute/Unsplash</a></span>
</figcaption>
</figure>
<p>But the financial barriers to seeing a GP or a private specialist (out of hospital) have remained. Doctors continue to charge what they like, with Medicare often only covering a portion of their fees. This has left many patients facing significant out-of-pocket payments.</p>
<p>When Medicare was designed, medical care was provided mostly by solo medical practitioners working in practices they owned. It was a one-to-one professional relationship, with the patient paying the practitioner for each service. </p>
<p>Over time, general practice evolved into group practices organised as partnerships. Next, they <a href="https://onlinelibrary.wiley.com/doi/10.5694/mja2.51038">consolidated and corporatised</a>. A handful of corporates now provide all <a href="https://www.accc.gov.au/system/files/public-registers/documents/ACL%20Healius%20%20-%20Statement%20of%20Issues.pdf">private pathology</a> (which tests blood and other tissues) and <a href="https://www.jacr.org/article/S1546-1440(07)00614-X/fulltext">radiology</a> (which provides imaging services) and a large proportion of GP care. </p>
<p>Corporates have not made the same inroads into most other specialties. But since the 1980s, states have reduced public hospital outpatient services. So patients are now more reliant on private medical specialists for care referred by their GP.</p>
<h2>Much has changed, but cost of living pressures remain</h2>
<p>Health-care needs have changed. As we live longer, we live with more diseases, many of which are chronic. The care required increasingly involves many different health providers and includes non-medical specialties such as podiatry, physiotherapy and psychology. </p>
<p>When Medicare was introduced, university education was offered for only a few of these professions. But their training has evolved and so too what they can do. This is particularly the case for nursing. It has evolved from an apprenticeship model to a profession with its own specialties. A subset – nurse practitioners – have the authority to diagnose and prescribe medication.</p>
<p>Broader technology trends have also had an impact on health care, as with all other sectors. Virtual care and telehealth <a href="https://theconversation.com/what-can-you-use-a-telehealth-consult-for-and-when-should-you-physically-visit-your-gp-135046">proved their worth</a> during the early years of the COVID pandemic, just as generative AI is beginning to show its promise now.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ai-can-help-detect-breast-cancer-but-we-dont-yet-know-if-it-can-improve-survival-rates-210800">AI can help detect breast cancer. But we don't yet know if it can improve survival rates</a>
</strong>
</em>
</p>
<hr>
<p>Medicare was first and foremost about efficiently removing financial barriers to access. It was introduced as part of an <a href="https://www.jstor.org/stable/20635272">agreement with the Labor movement</a> about reducing costs of living and, in particular, ensuring people could attend a doctor without having to worry about how they would pay for the visit.</p>
<p>However, <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/2022-23#data-downloads">about 1.2 million Australians</a> deferred or missed out on seeing a GP because of cost in the 2022-23 financial year. Lower-income Australians have higher rates of missing out on care. </p>
<p>Medical fees aren’t regulated and so consumers face a lottery – not knowing whether a fee will be charged and having no control over that decision. Only about 52% of all Australians were <a href="https://www.health.gov.au/sites/default/files/2023-08/medicare-statistics-per-patient-bulk-billing-dashboard-2022-23.pdf">always bulk-billed</a> in 2022-23, down from 66% a year earlier. </p>
<p>So how can we get Medicare back on track towards its goal of universal health care for all Australians? Here are three radical reforms we should prioritise. </p>
<h2>1. Make GP care affordable for all</h2>
<p>Rebates are currently subject to political whim. The Liberal government (in office from 2013 to 2022) froze rebates, leading to increases in average out-of-pocket payments and reduced bulk-billing.</p>
<p>The first step in reducing costs as a barrier to GP care should be introduction of independent fee-setting. </p>
<p>Canadian Medicare – which was the model for Australia’s system – mostly has <a href="https://journals.sagepub.com/doi/full/10.1177/0840470421994304">no out-of-pocket payments</a>. Fees are set by negotiations, not politicians’ whims, and this is <a href="https://laws-lois.justice.gc.ca/eng/acts/C-6/page-1.html#h-151558">enshrined in legislation</a>. </p>
<p>With independent fee-setting in place, a new scheme of “participating providers” should be introduced. Under such a scheme, practices would bulk-bill everyone, and participate in agreed quality-improvement programs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-if-medicare-was-restricted-to-gps-who-bulk-billed-this-kind-of-reform-is-possible-203543">What if Medicare was restricted to GPs who bulk billed? This kind of reform is possible</a>
</strong>
</em>
</p>
<hr>
<p>If fees are set independently and fairly, extra billing over and above the fee is unjustifiable. Non-participating practices would not be eligible for Medicare benefits. </p>
<p>It’s anticipated the vast majority of practices would agree to participate. In Canada, the participation rate is roughly 100%, and bulk billing in Australia is <a href="https://www.health.gov.au/resources/publications/medicare-quarterly-statistics-bulk-billing-by-primary-health-network-september-quarter-2023-24">still over 75%</a>.</p>
<p>Participating practices should also be eligible for additional grants to employ other health professionals to provide a more comprehensive range of services – such as physiotherapists and psychologists – to meet the contemporary needs of a population with increasing chronic illness. </p>
<p>If successful, these changes would mean all Australians can access a GP and other primary care services without any out-of-pocket costs.</p>
<h2>2. Deal with diagnostics</h2>
<figure class="align-center ">
<img alt="Blood vials" src="https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The cost of processing tests varies.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/green-pink-and-purple-plastic-bottles-0jE8ynV4mis">Testalize.me/Unsplash</a></span>
</figcaption>
</figure>
<p>Despite the evolution of ownership and market structures, pathology and radiology services are still reimbursed by fees for each service (with complex rules about rebates when multiple tests are performed simultaneously). </p>
<p>But while both industries are expensive to set up and buy or lease equipment, the cost of processing an additional test or image is low and sometimes close to zero. This means Medicare pays pathology and radiology providers much more than the tests or images cost.</p>
<p>Both industries are also ripe for further technological change, with the quality of generative AI rapidly improving, and costs likely to further reduce.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/blood-money-pathology-cuts-can-reduce-spending-without-compromising-health-54834">Blood money: pathology cuts can reduce spending without compromising health</a>
</strong>
</em>
</p>
<hr>
<p>The uncapped fee-for-service model for pathology and radiology needs to be replaced by one in which the benefits of technological change are shared between shareholders and taxpayers, rather than all accruing to the former. </p>
<p>This could be done by replacing fee-for-service payments with a payment model used in the corporate world. Private and public providers could be <a href="https://grattan.edu.au/report/blood-money-paying-for-pathology-services/">invited to tender</a> to provide these services in certain areas, with conditions around geographic access, quality and no out-of-pocket payments for consumers. </p>
<p>The same model could also apply to other technology-intensive types of health care, such as radiotherapy for cancer.</p>
<p>These changes might be cost-neutral for government, and save consumers the $24 they currently pay out of pocket on every pathology test that is not currently bulk-billed and $122 on each non-bulk-billed diagnostic imaging test.</p>
<h2>3. Cover dental care too</h2>
<figure class="align-center ">
<img alt="Boy undergoes dental treatment" src="https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dental care is largely unaffordable.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/boy-in-blue-long-sleeve-shirt-drinking-from-a-feeding-bottle-loBRFqXm1QA">Lafayett Zapata Montero/Unsplash</a></span>
</figcaption>
</figure>
<p>A major omission from Medicare from the start, and a source of continuing inequity, is oral health care. More than two million Australians <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/2022-23#data-downloads">missed out</a> on oral health care because of cost in 2022-23.</p>
<p>A new scheme to <a href="https://grattan.edu.au/report/filling-the-gap/">slowly expand universal protection</a> against the costs of oral health care should be phased in over the next decade. This would eventually mean all preventive and basic dental care would be available for everyone, with no out-of-pocket payments. </p>
<p>This would require a parallel expansion of the oral health workforce (dentists and <a href="https://www.dentalboard.gov.au/Registration/Oral-Health-Therapist.aspx">oral health therapists</a>) and development of new payment models based on a participating practice model rather than simply introducing another unregulated schedule of oral health fees paid via Medicare.</p>
<p>Innovation <a href="https://www.health.gov.au/sites/default/files/2023-12/nhra-mid-term-review-final-report-october-2023.pdf">needs to be built into the Australian health system</a>. However, the foundations for innovation must be based on Medicare’s founding principles of addressing financial barriers to provide universal and equitable health care to all Australians. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/expensive-dental-care-worsens-inequality-is-it-time-for-a-medicare-style-denticare-scheme-207910">Expensive dental care worsens inequality. Is it time for a Medicare-style 'Denticare' scheme?</a>
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</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/217264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett, like all Australians, benefits from Medicare.</span></em></p>
The health care world has changed a lot in 40 years, but Medicare hasn’t. Here are three areas for radical forms to the system that will achieve its aims of universal health care for all Australians.
Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of Melbourne
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/213702
2023-11-02T12:33:22Z
2023-11-02T12:33:22Z
Modern medicine has its scientific roots in the Middle Ages − how the logic of vulture brain remedies and bloodletting lives on today
<figure><img src="https://images.theconversation.com/files/556715/original/file-20231030-17-ssa8rd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6022%2C4092&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This 15th-century medical manuscript shows different colors of urine alongside the ailments they signify.</span> <span class="attribution"><a class="source" href="https://www.cam.ac.uk/stories/curious-medieval-medicine#group-section-Urine-flasks-Ev4T29vMqZ">Cambridge University Library</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Nothing calls to mind nonsensical treatments and bizarre religious healing rituals as easily as the notion of Dark Age medicine. The “Saturday Night Live” sketch <a href="https://www.youtube.com/watch?v=edIi6hYpUoQ">Medieval Barber Theodoric of York</a> says it all with its portrayal of a quack doctor who insists on extracting pints of his patients’ blood in a dirty little shop. </p>
<p>Though the skit relies on dubious stereotypes, it’s true that many cures from the Middle Ages sound utterly ridiculous – consider <a href="https://doi.org/10.2307/2853665">a list</a> written around 800 C.E. of remedies derived from a decapitated vulture. Mixing its brain with oil and inserting that into the nose was thought to cure head pain, and wrapping its heart in wolf skin served as an amulet against demonic possession.</p>
<p>“Dark Age medicine” is a useful narrative when it comes to ingrained beliefs about medical progress. It is a period that stands as the abyss from which more enlightened thinkers freed themselves. But <a href="https://doi.org/10.1093/shm/hkp052">recent research</a> pushes back against the depiction of the early Middle Ages as ignorant and superstitious, arguing that there is a consistency and rationality to healing practices at that time.</p>
<p>As a <a href="https://www.binghamton.edu/history/faculty/profile.html?id=megleja">historian of the early Middle Ages</a>, roughly 400 to 1000 C.E., I make sense of how the societies that produced vulture medicine envisioned it as one component of a much broader array of legitimate therapies. In order to recognize “progress” in Dark Age medicine, it is essential to see the broader patterns that led a medieval scribe to copy out a set of recipes using vulture organs. </p>
<p>The major innovation of the age was the articulation of a medical philosophy that validated manipulating the physical world because it was a religious duty to rationally guard the body’s health.</p>
<h2>Reason and religion</h2>
<p>The names of classical medical innovators like <a href="https://www.bl.uk/medieval-english-french-manuscripts/articles/medical-knowledge-in-the-early-medieval-period">Hippocrates and Galen</a> were well known in the early Middle Ages, but few of their texts were in circulation prior to the 13th century. Most intellectual activities in northern Europe were <a href="https://doi.org/10.1017/9781107323742.023">taking place within monasteries</a>, where the majority of surviving medical writings from that time were written, read, discussed and likely put into practice. Scholars have assumed that religious superstition overwhelmed scientific impulse and the church dictated what constituted legitimate healing – namely, prayer, anointing with holy oil, miracles of the saints and penance for sin. </p>
<p>However, “<a href="https://doi.org/10.1017/tdo.2020.4">human medicine</a>” – a term affirming human agency in discovering remedies from nature – emerged in the Dark Ages. It appears again and again in a text monks at the monastery of Lorsch, Germany, wrote around the year 800 to defend ancient Greek medical learning. It insists that Hippocratic medicine was mandated by God and that doctors act as divine agents in promoting health. I argue in my recent book, “<a href="https://www.pennpress.org/9780812253894/embodying-the-soul/">Embodying the Soul: Medicine and Religion in Carolingian Europe</a>,” that a major innovation of that time was the creative synthesis of Christian orthodoxy with a growing belief in the importance of preventing disease.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/556716/original/file-20231030-21-ppngib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Medieval manuscript page with an illustration of a robed physician on the left column of the page and a cross on the right column." src="https://images.theconversation.com/files/556716/original/file-20231030-21-ppngib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/556716/original/file-20231030-21-ppngib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=847&fit=crop&dpr=1 600w, https://images.theconversation.com/files/556716/original/file-20231030-21-ppngib.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=847&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/556716/original/file-20231030-21-ppngib.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=847&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/556716/original/file-20231030-21-ppngib.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1064&fit=crop&dpr=1 754w, https://images.theconversation.com/files/556716/original/file-20231030-21-ppngib.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1064&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/556716/original/file-20231030-21-ppngib.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1064&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This ninth-century manuscript juxtaposes a physician with Christ’s cross.</span>
<span class="attribution"><a class="source" href="https://portail.biblissima.fr/en/ark:/43093/ifdatac55003a71476025ab60b3182cddfa4bc3288658f">Bibliothèque nationale de France</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Establishing an intellectual framework for medical study was an accomplishment of early medieval scholars. Doctors faced the risk of being lumped together with those who dealt in sorcery and pagan folklore, a real possibility given that the men who composed the Greek medical canon were pagans themselves. The early medieval scribes responsible for producing the medical books of their age crafted powerful arguments about the <a href="https://doi.org/10.1093/jhmas/51.4.438">respectability and piety</a> of the doctor. Their arguments manifest in <a href="https://portail.biblissima.fr/en/ark:/43093/ifdatac55003a71476025ab60b3182cddfa4bc3288658f">illustrations that sanctified the human doctor</a> by setting him parallel to Christ.</p>
<p>This sanctification was a crucial step in including medicine as its own <a href="https://doi.org/10.1017/CBO9780511599507.014">advanced degree program</a> at the first universities that were established around 1200 in Europe. Thus began the licensing of healers: the elite “<a href="https://www.jstor.org/stable/44443265">phisici</a>” – the root of the English word “physician” – trained at the university, along with empirical practitioners like surgeons, herbalists and <a href="https://doi.org/10.17077/1536-8742.1057">female healers</a> who claimed a unique authority to treat gynecological illnesses.</p>
<p>Today, religious dogmatism is often equated with <a href="https://berkleycenter.georgetown.edu/responses/insights-on-vaccine-hesitancy-from-religious-people-s-view-of-science">vaccine hesitancy</a> and resistance to basic scientific truths <a href="https://content.time.com/time/subscriber/article/0,33009,1090909-1,00.html">like evolution</a>. But deeply religious thinkers of the past often saw rational medicine as an expression of faith, not something endangering it. Herbal remedies were <a href="https://www.earlymedievalmedicine.com/project-updates#h.k44h7eurfg88">scribbled into the margins</a> of early medieval works on theology, history, church sacraments and more. This suggests that book owners valued such knowledge, and people of all classes were actively exchanging recipes and cures by word of mouth before writing the most useful ones down. </p>
<h2>The body in nature</h2>
<p>Though the Dark Ages is a period from which no case histories survive, we can still form a picture of an average healing encounter. Texts from that period emphasize the need for the doctor <a href="https://www.jstor.org/stable/44443671">to be highly learned</a>, including being well read in philosophy, logic, arithmetic and astronomy. Such knowledge enabled healers to situate their observations of sick bodies within the rules that governed the constant transformations of nature.</p>
<p>There was no way to perceive the internal state of the body via technology – instead, healers had to be excellent <a href="https://www.jstor.org/stable/44444831">listeners and observers</a>. They sought to match the patient’s description of suffering with signs that manifested externally on the body. The inside of the flesh could not be seen, but the fluids the body excreted – sweat, urine, menstrual blood, mucus, vomit and feces – carried messages about that invisible realm to the outside. The doctor’s diagnosis and prognosis relied on reading these “excreta” in addition to sensing subtle changes in the pulse.</p>
<p>Medieval people were detailed investigators of the natural world and believed the same forces that shaped the landscape and the stars operated inside bodies formed from the same four elements of earth, water, air and fire. Thus, as the <a href="https://digital.library.mcgill.ca/ms-17/folio.php?p=1v&showitem=1v_1MedicineI_3Bloodletting1#note06">moon’s waxing and waning</a> moved the ocean tides, so did it cause humors inside the body to grow and decrease. </p>
<p>The way the seasons withered crops or <a href="https://www.jstor.org/stable/44445287">provoked tree sap to flow</a> might manifest in the body as yellow bile surging in the summer, and cold, wet phlegm dripping in the winter. Just as fruit and meats left untouched began to rot and putrefy, so did dregs and undigested material inside the body <a href="https://web.archive.org/web/20120306142353/https:/prospectbooks.co.uk/books/978-1-903018-52-1">turn poisonous if not expelled</a>. Standing water in ponds or lakes generated slime and smell, and so were liquids sitting stagnant in the body’s vessels seen as breeding grounds for corrupt vapors. </p>
<p>In this sense, the <a href="https://muse.jhu.edu/article/255044/pdf">menstrual cycle</a> was representative of all bodies, undergoing internal transformations according to seasonal cycles and periodically purged in order to release pent-up fluids.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/3ymSgO26YW8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Bloodletting is currently used as a treatment only for very specific blood disorders.</span></figcaption>
</figure>
<p>According to this logic, health depended above all on maintaining the body’s relationship to the physical environment and ensuring that substances were passing through their proper transformations, whether it was food turning into humors, blood disseminating throughout the body, or excess fluids and wastes leaving the body. Bloodletting was a rational therapy because it could help rebalance the fluids and remove toxins. It was visible and tangible to the patient, and, to the extent that we now better understand the <a href="https://theconversation.com/in-research-studies-and-in-real-life-placebos-have-a-powerful-healing-effect-on-the-body-and-mind-173845">placebo effect</a>, it may well have offered some kind of relief. </p>
<p>Fasting, purging, tonics and, above all, <a href="https://doi.org/10.1515/9783110336337-009">monthly dietary regimens</a> were also prominent tools healers used to prevent and relieve sickness. Several medical books, for instance, specified that consuming drinks with cinnamon in November and pennyroyal in August could recalibrate the body’s temperature in winter and summer because one drink was warming while the other was cooling.</p>
<p>Some <a href="https://www.pbs.org/newshour/health/centuries-old-potion-made-bile-garlic-stop-mrsa#">medieval remedies</a> – such as one produced from wine, cow bile, garlic and onion to heal eye infections – were later proven to be likely effective in treating sickness. But whether these remedies worked isn’t the point. For medieval doctors, vulture brains and cow bile operated according to the same logic that continues to inform research today: Nature operates in mysterious ways, but rational deduction can unlock the hidden mechanisms of disease. The M.D. has direct roots in the Dark Age elevation of “human medicine.”</p>
<p>Before mocking medieval doctors, consider how popular <a href="https://www.washingtonpost.com/wellness/2022/01/11/are-detox-juice-cleanses-necessary/">juice cleanses and detox regimens</a> are in the 21st century. Are we really so far from humoral medicine today?</p><img src="https://counter.theconversation.com/content/213702/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Meg Leja does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Your doctor’s MD emerged from the Dark Ages, where practicing rational “human medicine” was seen as an expression of faith and maintaining one’s health a religious duty.
Meg Leja, Associate Professor of History, Binghamton University, State University of New York
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/211729
2023-10-09T19:19:19Z
2023-10-09T19:19:19Z
A short history of insomnia and how we became obsessed with sleep
<figure><img src="https://images.theconversation.com/files/544431/original/file-20230824-23-3k83z1.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/statue-gold-sleep-mask-gypsum-david-1909455499">Shutterstock</a></span></figcaption></figure><p><em>This article is the first in The Conversation’s six-part series on insomnia, which charts the rise of insomnia during industrialisation to sleep apps today. Read other articles in the series <a href="https://theconversation.com/au/topics/insomnia-series-144018">here</a>.</em></p>
<hr>
<p>French author Marie Darrieussecq writes in her 2023 memoir <a href="https://www.textpublishing.com.au/books/sleepless-a-memoir-of-insomnia">Sleepless</a>:</p>
<blockquote>
<p>The world is divided into those who can sleep and those who can’t. </p>
</blockquote>
<p>It’s a big call. But insomnia is <a href="https://pubmed.ncbi.nlm.nih.gov/29916377/">a well-recorded</a> preoccupation in history. It <a href="https://doi.org/10.5664/jcsm.26929">includes</a> difficulty falling asleep, or staying asleep, and comes with daytime distress and anxiety. </p>
<p>There are <a href="https://theconversation.com/explainer-what-is-insomnia-and-what-can-you-do-about-it-36365">many, varied reasons</a> why people have insomnia. These include biological changes <a href="https://pubmed.ncbi.nlm.nih.gov/32469116/">as we age</a> or because of <a href="https://journals.healio.com/doi/10.3928/00485713-20191106-04">our hormones</a>, physical or mental health issues, the medicines we take, as well as how and where we live and work.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-insomnia-and-what-can-you-do-about-it-36365">Explainer: what is insomnia and what can you do about it?</a>
</strong>
</em>
</p>
<hr>
<h2>Insomnia is a form of torture</h2>
<p>Sleep deprivation is literally a <a href="https://www.psychologytoday.com/au/blog/dreaming-in-the-digital-age/201412/why-sleep-deprivation-is-torture">form of torture</a>. Roman consul Marcus Atilius Regulus is allegedly the first person in recorded history to <a href="https://alextardiff.wordpress.com/2010/02/26/marcus-atilius-regulus-a-historiography-and-transformation-from-roman-history-to-legend/">die of insomnia</a>.</p>
<p>In about 256 BCE he was handed over to Rome’s enemies, the Carthaginians, who apparently tortured him to death. They did this by amputating his eyelids and forcing him to stare at the Sun.</p>
<p>As horrible as this sounds, the legend doesn’t stand up. There are <a href="https://www.cambridge.org/core/journals/harvard-theological-review/article/convicts-gibbet-and-the-victors-car-the-triumphal-death-of-marcus-atilius-regulus-and-the-background-of-col-215/A24256342370590EF069DBDDEB796E9F#">no reliable accounts</a> of how Regulus died. But even though sleep-deprivation torture may not have killed Regulus, it continues to be used <a href="https://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=3927&context=mlr">in many countries</a> today.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Regulus Returning to Carthage" src="https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=500&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=500&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=500&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=629&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=629&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544428/original/file-20230824-25-emgtx3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=629&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Legend has it that Roman consul Regulus died of insomnia. But the evidence doesn’t stack up.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Lens,_Cornelis_-_Regulus_Returning_to_Carthage_-_1791.jpg">Andries Cornelis Lens/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>One of the best early descriptions of insomnia is by English clergyman Robert Burton in his book <a href="https://www.bl.uk/collection-items/burtons-anatomy-of-melancholy-1628">The Anatomy of Melancholy</a> (1628). </p>
<p>Burton knew insomnia was both a <a href="https://royalsocietypublishing.org/doi/10.1098/rsfs.2019.0087">cause and a symptom of depression</a>. He also recommended avoiding eating cabbage, which “<a href="https://royalsocietypublishing.org/doi/10.1098/rsfs.2019.0087">causeth troublesome dreams</a>” and not going to bed straight after eating the evening meal. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-whats-the-link-between-insomnia-and-mental-illness-49597">Explainer: what's the link between insomnia and mental illness?</a>
</strong>
</em>
</p>
<hr>
<h2>Then came industrialisation</h2>
<p>But we need to look at industrialisation – when a country moves from mostly farming to mostly manufacturing using machinery – for clues to the level of insomnia we see in Western nations today. </p>
<p>In countries without industrialisation, insomnia is quite rare. Only <a href="https://pubmed.ncbi.nlm.nih.gov/29916377/">around 1-2%</a> of the population will experience it. Compare this with modern United Kingdom, where the estimated insomnia rates are <a href="https://doi.org/10.1111/1467-9566.12820">10-48%</a>, depending on the study. A 2021 report said <a href="https://www.sleephealthfoundation.org.au/special-sleep-reports/chronic-insomnia-disorder-in-australia">14.8% of Australians</a> had symptoms meeting criteria for chronic (long-term) insomnia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Powerloom weaving in 1835" src="https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=487&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=487&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544429/original/file-20230824-15-aojo9c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=487&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The shift to working in factories using machines also shifted our sleep habits.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Powerloom_weaving_in_1835.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>As Western countries modernised, things we now associate with insomnia became part of people’s lives. These include <a href="https://doi.org/10.1093/sleep/zsac104">artificial lighting</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/16793001/">clocks</a>. There was also more <a href="https://academic.oup.com/sleep/article/40/2/zsw055/2662183">ambient noise</a>, and <a href="https://pubmed.ncbi.nlm.nih.gov/31828298/">changes in diet</a> and <a href="http://dx.doi.org/10.1136/oem.2003.011379">housing</a>. So our <a href="https://theconversation.com/did-we-used-to-have-two-sleeps-rather-than-one-should-we-again-57806">sleep habits shifted</a> as a result of this new way of living and working.</p>
<p>At around the same time, the Enlightenment era of flourishing new sciences in the late 18th century gave us the term “<a href="https://royalsocietypublishing.org/doi/10.1098/rsfs.2019.0074">insomnia</a>” and where there is “insomnia”, there must be “insomniacs”. So “insomniacs” became a diagnostic term for people struggling with sleep.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-we-used-to-have-two-sleeps-rather-than-one-should-we-again-57806">Did we used to have two sleeps rather than one? Should we again?</a>
</strong>
</em>
</p>
<hr>
<h2>The 19th and 20th centuries</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hospital ward for insomniacs (1910),G.E. Studdy" src="https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=868&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=868&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=868&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1090&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1090&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544425/original/file-20230824-6888-v3vzox.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1090&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This 1910 cartoon plays on our long-held quest for sleep.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/egb89yd4/images?id=dwsz6qh9">Wellcome Collection</a></span>
</figcaption>
</figure>
<p>Medical cures for insomnia began to spread – some of them probably effective. </p>
<p>For example, in the 19th century Grimault & Co’s “<a href="https://www.pointshistory.com/post/a-sovereign-remedy-grimault-co-s-asthma-cigarette-empire">Indian Cigarettes</a>” were advertised in <a href="https://trove.nla.gov.au/newspaper/article/63619299?searchTerm=insomnia%20grimault">Australia</a>. They contained cannabis.</p>
<p>The 19th century was also the birthplace of modern medical ideas about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610616/">anxiety</a>, which we now know can <a href="https://www.sleepfoundation.org/mental-health/anxiety-and-sleep">cause</a> insomnia.</p>
<p>Romanian philosopher Emil Cioran (1911-1995) had <a href="https://partiallyexaminedlife.com/2020/08/14/the-influence-of-insomnia-on-the-life-and-work-of-emil-cioran/">chronic insomnia</a>. His 1934 book <a href="https://press.uchicago.edu/ucp/books/book/chicago/O/bo3620043.html">On the Heights of Despair</a> (the title speaks for itself) describes the loneliness and isolation of insomnia – the feeling of being cut off from the rest of humanity. </p>
<p>So many famous modern writers and artists had insomnia that it’s now <a href="https://digitalcommons.uri.edu/cgi/viewcontent.cgi?article=1324&context=oa_diss">almost a cliche</a>. <a href="https://www.washingtonexaminer.com/weekly-standard/victor-hugo-alas">Victor Hugo</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29982086/">Franz Kafka</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/26459675/">Marcel Proust</a> and <a href="https://archive.nytimes.com/opinionator.blogs.nytimes.com/2010/02/25/a-thousand-and-one-sleepless-nights/#:%7E:text=In%20Ernest%20Hemingway's%20short%20story,bed%20with%20the%20lights%20out.">Ernest Hemingway</a> all struggled with sleeplessness. </p>
<p>In Hemingway’s short story <a href="https://muse.jhu.edu/article/440974/summary">Now I Lay Me</a>, his soldier narrator and alter ego says:</p>
<blockquote>
<p>I myself did not want to sleep because I had been living for a long time with the knowledge that if I ever shut my eyes in the dark and let myself go, my soul would go out of my body.</p>
</blockquote>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bottle for Veronal crystals" src="https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=826&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=826&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=826&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1038&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1038&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544419/original/file-20230824-31-d30k0i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1038&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Veronal was one of a range of new drugs that promised easy sleep.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/zyxns96e/images?id=wkj5h9yz">Science Museum, London</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>It’s also no coincidence <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424120/">the first barbiturate drugs</a> were discovered in this era. Barbital, <a href="https://www.drugfoundation.org.nz/matters-of-substance/archive/august-2016/veronal-who-remembers-veronal/">marketed as Veronal</a>, was just <a href="https://doi.org/10.1002/dta.301">one of a range of new drugs</a> that promised easy sleep to those who struggled. </p>
<p>These drugs made people relaxed and sleepy by switching on the <a href="https://doi.org/10.1111/epi.12025">body’s gamma-aminobutyric acid (GABA) system</a>. This part of our nervous system works to inhibit processes in the body that would otherwise keep us awake. But these drugs can inhibit these processes too much. Suicides and accidental deaths by sleeping pill overdose became <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760168/">sadly common</a> in the following decades.</p>
<p>The famous home encyclopedia <a href="https://books.google.com.au/books/about/Enquire_Within_Upon_Everything.html?id=cW5FAQAAMAAJ&redir_esc=y">Enquire Within Upon Everything</a> provided a scientific-sounding cure for insomnia:</p>
<blockquote>
<p>Nervous persons, who are troubled with wakefulness and excitability, usually have a strong tendency of blood on the brain, with cold extremities. The pressure of the blood on the brain keeps it in a stimulated or wakeful state […] rise and chafe the body and extremities with a brush or towel, or rub smartly with the hands to promote circulation, and withdraw the excessive amount of blood from the brain, and they will fall asleep in a few moments. A cold bath, or a sponge bath and rubbing […] will aid in equalising circulation and promoting sleep.</p>
</blockquote>
<p>Now, “<a href="https://www.sleepfoundation.org/sleep-hygiene">sleep hygiene</a>” means something different to taking a cold bath. It’s the process of quieting your body and mind before bedtime.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/counting-the-wrong-sheep-why-trouble-sleeping-is-about-more-than-just-individual-lifestyles-and-habits-210695">Counting the wrong sheep: why trouble sleeping is about more than just individual lifestyles and habits</a>
</strong>
</em>
</p>
<hr>
<h2>Which brings us to today</h2>
<p>In the 21st century, Western living has added two new sleep disturbers to the mix. We drink huge amounts of <a href="https://doi.org/10.1016/j.envpol.2019.113343">caffeine</a>. We also go to bed with handheld devices – with their <a href="https://amerisleep.com/blog/future-of-sleep/">bright lights</a> and <a href="https://doi.org/10.1016/j.isci.2021.102497">constant dopamine hits</a> that stimulate us and stop us sleeping.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1679239587393306624"}"></div></p>
<p>Our problems with insomnia show no signs of going away. This is partly because our economy is increasingly organised around sleep-depriving work. In the United States, production workers are the <a href="https://www.sleepadvisor.org/sleep-deprivation-by-profession/">most likely to</a> have sleep disorders, possibly because of shift work. In the United Kingdom, professional soccer players are <a href="https://www.spectator.co.uk/article/the-premier-leagues-sleeping-pill-problem/">over-using sleeping drugs</a> to help them wind down after the adrenaline rush of a game.</p>
<p>In Australia, the financial cost of poor sleep is an estimated <a href="https://treasury.gov.au/sites/default/files/2019-03/360985-Sleep-Health-Foundation-and-Australasian-Sleep-Association.pdf">A$26 billion a year</a>, mainly through lost productivity or accidents. This means there’s a good financial incentive to address the problem.</p>
<p>And if the global <a href="https://www.alliedmarketresearch.com/insomnia-market">insomnia market</a> is anything to go by, insomnia is big business and getting bigger. This is projected to reach US$6.3 billion by 2030, largely driven by increased diagnoses and therapy, as well as the use of sleep aids, such as <a href="https://theconversation.com/is-tracking-your-sleep-a-good-idea-190231">sleep apps</a>.</p><img src="https://counter.theconversation.com/content/211729/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philippa Martyr does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Insomnia is torture, literally, and getting enough sleep a modern obsession. Here’s why.
Philippa Martyr, Lecturer, Pharmacology, Women's Health, School of Biomedical Sciences, The University of Western Australia
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/214424
2023-10-05T16:36:02Z
2023-10-05T16:36:02Z
Physician associates: a solution for healthcare staff shortages or a colonial throwback?
<figure><img src="https://images.theconversation.com/files/552150/original/file-20231004-27-tr5u8y.jpg?ixlib=rb-1.1.0&rect=25%2C0%2C5628%2C3771&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/multiethnic-group-people-wearing-lab-coats-1926462233">SeventyFour/Shutterstock</a></span></figcaption></figure><p>Before the COVID pandemic, the global health workforce needed as many as <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00532-3/fulltext">6.4 million more medical doctors</a>, and the gap between demand for health workers and supply is growing. As you might expect, the shortage is most acutely felt in low- and middle-income countries. </p>
<p>The latest <a href="https://www.who.int/data/gho/data/themes/topics/health-workforce">World Health Organization (WHO) statistics</a> show that 30 countries have fewer than two doctors for every 10,000 people. Twenty-seven of these are in Africa, while the remaining three are Pacific Island nations.</p>
<p>Wealthier countries are notorious for plugging gaps in their health workforce by recruiting overseas doctors and nurses. “Medical brain drain” is a complex phenomenon, driven by <a href="https://books.google.co.uk/books/about/A_Heart_for_the_Work.html?id=czX-cS9aDgQC&redir_esc=y">more than money</a>. Yet some commentators consider it yet another instance of the west “looting” human capital from Africa and other formerly colonised regions.</p>
<p>In England, the <a href="https://www.nhsemployers.org/publications/nhs-long-term-workforce-plan-2023-what-employers-need-know">government</a> has chosen to address the health worker shortage by investing in new roles. One role that will be significantly expanded is that of “physician associate”. These medics work in GP surgeries and in hospitals.</p>
<h2>Not quite doctors</h2>
<p>A physician associate is someone trained to a standard below that of a doctor. Though a recent title and qualification <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044953/">in the UK</a>, the concept of a physician associate is not new. There is plenty of historical data about the use of medical assistants or auxiliaries to run health services on the cheap. </p>
<p>Much of the historical evidence about the benefits and pitfalls of “not quite” doctors comes from world regions most affected by health worker shortages today. </p>
<p>When European colonial powers decided to offer health services to colonised populations, especially in rural areas, they could not recruit nearly enough European doctors. Instead of improving employment conditions or expanding education for local people, colonial states opted to create subprofessional medical schools and qualifications. </p>
<p>They were known as “African” doctors in <a href="https://doi.org/10.2307/j.ctv2s0jd98.12">Senegal</a>. Assistant medical officers in Sudan. So-called “native” medical auxiliaries in <a href="https://eprints.gla.ac.uk/147771/">Algeria</a>, <a href="https://doi.org/10.2307/j.ctv2s0jd98.12">Cameroon</a>, Congo, Madagascar, <a href="https://www.jstor.org/stable/43305135">Tanzania</a>, Uganda and <a href="https://doi.org/10.1080/17531050701218841">Zambia</a>. The list goes on. </p>
<p>Colonial states typically restricted recruitment into subordinate medical roles to racialised men. Training varied, but usually offered an abridged university curriculum oriented towards infectious diseases (especially diseases stigmatised as “native” or “tropical”, like <a href="https://eprints.gla.ac.uk/147736/">syphilis</a>), manual tasks and administrative skills.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/could-super-nurses-make-up-for-the-shortfall-in-doctors-74933">Could super nurses make up for the shortfall in doctors?</a>
</strong>
</em>
</p>
<hr>
<p>Locally trained medical assistants often became linchpins of colonial health services, but they were not always accepted by patients or other medical professionals. In the 1950s, <a href="https://iris.who.int/handle/10665/38944?&locale-attribute=zh">the WHO recognised their usefulness</a> for expanding the health workforce. Yet most subprofessional medical schools closed with decolonisation. </p>
<p>Newly independent states aspired to physician-led health services. Medical assistant roles were seen as “<a href="https://doi.org/10.1016/S0140-6736(73)90986-0">a colonial invention</a>” designed to restrict opportunities for non-Europeans. Some of the professionals steering postcolonial health services had once been auxiliaries themselves and understood the challenges experienced by this category of health worker.</p>
<h2>Deep concern</h2>
<p>We are a historian and a medical consultant with an interest in postgraduate education. We work with very different kinds of data, but share a deep concern with how healthcare works. </p>
<p>Across our different contexts, past and present, we find similar unsettled questions. These have nothing to do with the calibre or dedication of individual physician associates. They have everything to do with fairness.</p>
<p>Histories of colonial medicine suggest that when you create two-tier systems for accessing careers in medicine, the “lesser” track will map onto existing inequalities in the surrounding society. In the UK today, this may mean people from economically disadvantaged backgrounds and school leavers affected by the regional awarding gap are more likely to train as physician associates.</p>
<figure class="align-center ">
<img alt="A black female medical professional" src="https://images.theconversation.com/files/552336/original/file-20231005-27-r8wzzx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552336/original/file-20231005-27-r8wzzx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552336/original/file-20231005-27-r8wzzx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552336/original/file-20231005-27-r8wzzx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552336/original/file-20231005-27-r8wzzx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552336/original/file-20231005-27-r8wzzx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552336/original/file-20231005-27-r8wzzx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The physician associate role could embed existing inequalities in healthcare systems.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-american-nurse-holding-digital-tablet-2056112471">DC Studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>Are physician associates an extra pair of hands assisting the doctor, or are they a substitute for the doctor? Historically and today, the line between associate and doctor has been difficult for managers and professionals to define, let alone for patients to understand. </p>
<p>In Algeria under French colonial occupation, patients were often unaware that the medical auxiliary treating them was not a real medical doctor. Although French officials touted medical auxiliaries as a means of reducing healthcare inequalities, the result was <a href="https://doi.org/10.1080/13507486.2021.1990867">a two-tier healthcare system</a>, with restricted services in rural and neglected areas. </p>
<p>Colonial-era medical auxiliaries in Algeria and elsewhere confronted a limited career ladder and inferior employment conditions. Their qualifications were not recognised internationally. They were locked into subordinate roles and faced workplace harassment.</p>
<p>Medical training and roles in colonial states are different from that being proposed in the UK today, but inequalities have not gone away. </p>
<p>How will physician associates’ status, responsibilities, and remuneration relate to other health workers such as nurses and junior doctors? How will they cope with negativity or confusion surrounding their position? Does career progression include filling all the roles of a doctor? </p>
<p>To mitigate the issues associated with changes to the health workforce, we must first acknowledge them. In the UK, at least, there is little sign that this is happening.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gp-crisis-how-did-things-go-so-wrong-and-what-needs-to-change-208197">GP crisis: how did things go so wrong, and what needs to change?</a>
</strong>
</em>
</p>
<hr>
<p>When US government officials and medical faculties considered a new auxiliary role from the 1960s, they <a href="https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.57.9.1663">learned</a> from models in formerly colonised states. Today, physician assistants in the US are a significant and more established part of the workforce, but interprofessional conflicts and difficulties occur. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121704/">It has not been shown</a> that the US model would meet the needs of the UK.</p>
<p>Without an open, transparent, evidence-led approach to new professional roles, we risk damaging the trust of patients and frontline health workers. As policymakers in the UK and other nations affirm their commitment to investing in the health workforce, they should look to colonial experiences as a bellwether.</p><img src="https://counter.theconversation.com/content/214424/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
‘The doctor will see you now.’ Except they probably won’t.
Hannah-Louise Clark, Senior Lecturer, Global Economic and Social History, University of Glasgow
Mark Toshner, Associate Professor, Respiratory Medicine, University of Cambridge
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/208658
2023-09-03T20:02:28Z
2023-09-03T20:02:28Z
Simon Schama’s history of 18th and 19th century disease outbreaks speaks powerfully to the present
<figure><img src="https://images.theconversation.com/files/543587/original/file-20230821-93007-4ympol.png?ixlib=rb-1.1.0&rect=0%2C5%2C3946%2C2970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cholera, Le Petite Journal (1912).</span> <span class="attribution"><span class="source">Bibliothèque nationale de France/Wikimedia Commons</span></span></figcaption></figure><p>Pandemics. Quarantine. Vaccines. These concepts have been at the forefront of our minds for over three years now. Having lived through the height of the COVID pandemic, it would be easy for us to imagine we have just experienced something unique in human history. </p>
<p>In <a href="https://www.simonandschuster.com.au/books/Foreign-Bodies/Simon-Schama/9781471169892">Foreign Bodies: Pandemics, Vaccines and the Health of Nations</a>, Simon Schama illustrates that this is about as far from the truth as possible. He examines the reactions to outbreaks of smallpox, cholera and plague in the 18th and 19th centuries, focusing on some key individuals – people who are often left out of the grand narrative of scientific progress.</p>
<hr>
<p><em>Review: Foreign Bodies: Pandemics, Vaccines and the Health of Nations – Simon Schama (Simon & Schuster)</em></p>
<hr>
<p>Schama specialises in Jewish and French history, and some have suggested he is not necessarily the right person to write a history of public health responses to diseases of pandemic proportions. But as a historian of medicine and public health, I find it quite revolutionary to see a historian of Schama’s ilk examining the field. </p>
<p>I was ten years old when I watched his BBC series <a href="https://www.imdb.com/title/tt0273359/">A History of Britain</a>. It was the first time in my life I genuinely understood that history was something that can never truly be “known”, but was something to be studied and interrogated for its nuances and hidden stories. To read Schama writing about an area of history I am personally invested in is genuinely exciting.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=925&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=925&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=925&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1162&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1162&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542912/original/file-20230816-21-lgegoq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1162&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
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<p>In Foreign Bodies, Schama demonstrates that the histories of medicine and public health are deeply entwined with broader understandings of social history. He shows that, far from being a separate field of study, some of the “big picture” histories readers associate with him have indeed been heavily influenced by disease outbreaks and the reactions to them. </p>
<p>By leading the reader through broad sweeps of history, featuring relatively well-known figures and events, Schama places the histories of vaccinology and other advances in medicine and public health in their broader content. This is what Schama does best: he uses the macro history to highlight the intricacies of the micro histories.</p>
<h2>The ‘other’</h2>
<p>One of the striking themes in Foreign Bodies is Schama’s acknowledgement of the parallels between our ancestors’ responses to outbreaks of new and terrifying diseases and the ways we have sought to place the blame for COVID. We have a natural tendency to look for an “other” to blame – people from other cultures that we do not truly understand. </p>
<p>This is exemplified by <a href="https://www.bbc.com/news/world-asia-india-55050012">Waldemar Haffkine</a>, the central figure in much of Schama’s narrative. Of Jewish origin, Haffkine was the “other”: a person whose ancestors have often borne the blame for pandemics throughout European history. In the 14th century, for example, at the time of the Black Plague, it was believed that Jewish people were poisoning wells. There were trials and executions as the suffering populations sought desperately to find a reason for the cruel fate that had befallen them.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=884&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=884&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=884&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1111&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1111&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543580/original/file-20230820-146262-it2dl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1111&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Waldemar Haffkine (1860-1930).</span>
<span class="attribution"><span class="source">Wellcome Images/Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Schama turns this narrative on its head. He highlights the substantial role of individuals like Haffkine in advancing revolutionary science. Haffkine is the hero of the story: a talented and dedicated scientist, who revolutionised the fields of immunology and vaccinology through his work to vaccinate the population of India against cholera and plague. Through Haffkine, Schama demonstrates that some of the greatest advances in medical science come not from the core of the medical establishment, but rather from those on the periphery. </p>
<p>As Schama indicates, however, Haffkine still had to earn the patronage of more well-known members of the medical establishment. This came in the form of Sir Joseph Lister, the <a href="https://www.sciencemuseum.org.uk/objects-and-stories/medicine/listers-antisepsis-system">famed pioneer</a> of antiseptics in surgery. That it was necessary for Haffkine to gain the support of such an influential figure to establish his worth as a scientist highlights the intersection of medical science and politics.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/diseases-gave-us-the-rise-of-christianity-the-end-of-the-aztecs-and-public-sanitation-how-might-future-plagues-change-human-history-201569">Diseases gave us the rise of Christianity, the end of the Aztecs and public sanitation. How might future plagues change human history?</a>
</strong>
</em>
</p>
<hr>
<h2>Inoculation</h2>
<p>Another key example in Foreign Bodies is the pioneering work of <a href="https://www.britannica.com/biography/Lady-Mary-Wortley-Montagu">Lady Mary Wortley Montagu</a>, an English aristocrat whose husband was appointed ambassador to the Ottoman Empire in the 18th century. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=978&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=978&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=978&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1228&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1228&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543579/original/file-20230820-177767-ejqrek.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1228&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lady Mary Wortley Montagu with her son Edward – Jean Baptiste Vanmour (c.1717).</span>
<span class="attribution"><span class="source">Public domain</span></span>
</figcaption>
</figure>
<p>During her time in Turkey, Lady Montagu was exposed to the traditional practice that would come to be known in European medical circles as inoculation (or variolation). This was the practice of deliberately infecting children with smallpox in order to induce a mild case of the disease, preventing them from contracting the virus naturally and suffering its disfiguring and potentially fatal effects.</p>
<p>Lady Montagu had been disfigured by an attack of smallpox herself. She sought to protect her own children from suffering the same fate. In doing so, she introduced English high society to the concept of inoculation. </p>
<p>This is yet another case of the “other” – a woman – revolutionising the way in which medicine was practised. And in this case, the “othering” is even more evident. Inoculation was seen as counterproductive to many in the English medical establishment and viewed with suspicion in broader society. Many resisted the notion of deliberately infecting children with a potentially deadly disease. The suspicion was compounded by the fact that Lady Montagu had brought the practice back to Europe from Turkey.</p>
<p>Schama highlights that the form of inoculation Lady Montagu introduced to English society was not, in fact, an entirely new concept within the British Isles. He touches on the fact that versions of inoculation were already practised in Wales and the Scotish Highlands. According to Schama, this helped the wider medical establishment to accept the practice – once they had noted that inoculation was not truly “foreign”, but in fact “home-grown” to some extent. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-prepare-for-future-pandemics-we-can-learn-from-the-oecds-top-two-performers-new-zealand-and-iceland-198973">To prepare for future pandemics, we can learn from the OECD's top two performers: New Zealand and Iceland</a>
</strong>
</em>
</p>
<hr>
<h2>Medicine and politics</h2>
<p>Schama’s examination of smallpox prophylaxis in Europe ends before <a href="https://www.britannica.com/biography/Edward-Jenner">Edward Jenner</a>’s discovery of vaccination in 1796, which substituted the less-dangerous cowpox virus for smallpox in the inoculation procedure. That is a different story, however, to the one Schama is telling. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=750&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=750&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=750&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=943&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=943&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543581/original/file-20230821-239355-6ttzir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=943&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Edward Jenner (1749-1823) – James Northcote.</span>
<span class="attribution"><span class="source">Public domain</span></span>
</figcaption>
</figure>
<p>Foreign Bodies is heavily invested in the history of the intersection of medicine and politics. Schama examines the role of the great European powers of the 18th and 19th centuries in the management of pandemics and the proliferation of life-saving medical procedures, such as vaccination. Central to this narrative is the acknowledgement that, while our medical knowledge and the acumen of our public health regimes have improved drastically since the times of Haffkine and Lady Montagu, the political issues have hardly changed.</p>
<p>The parallels between the ways in which previous generations sought to blame the “other” and the ongoing suspicion that COVID may have artificial origins are obvious throughout. Schama’s reflections on the ways people reacted to outbreaks of cholera, plague and smallpox show that we have never truly lost our suspicion of the “other”, nor have we grasped the notion that humanity generally brings these pandemics upon itself. </p>
<p>There is a link between continuous <a href="https://www.frontiersin.org/articles/10.3389/fmicb.2020.631736/full">economic expansion and the rise of epidemic diseases</a>, sometimes to pandemic proportions, and it is fascinating to read Schama reflecting on this theme throughout Foreign Bodies. </p>
<p>Perhaps the most striking example is the British unwillingness to heed public health warnings during the opening of the Suez Canal, when they refused to implement basic quarantine principles in the wake of a cholera outbreak. Of course, the rules of quarantine did apply to non-European travellers, as Schama demonstrates, indicating once again where the blame was being squarely placed. </p>
<p>There is an extensive list of disease outbreaks that Schama could have chosen to explore this concept. One of the most obvious examples would be the Spanish Flu pandemic that followed World War I. The “Spanish Flu”, as it came to be called – despite the fact <a href="https://www.britannica.com/event/influenza-pandemic-of-1918-1919">its place of origin is uncertain</a> – carries many of the same “othering” tropes and perhaps most closely resembles COVID in this regard.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543582/original/file-20230821-177767-vwidum.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Simon Schama.</span>
<span class="attribution"><span class="source">Financial Times/Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>It would be impossible for Schama to incorporate every pandemic into this one volume. His choice of three of the most feared epidemic diseases in history – smallpox, cholera and plague – is enough to demonstrate his point. The choice covers viral (smallpox) and bacterial (cholera and plague) diseases at critical points in their history, when globalisation was spreading new strains between previously disparate populations.</p>
<p>At the core of Foreign Bodies is Schama’s understanding that “all history is natural history”. No matter how much we believe our knowledge and our technological capabilities have evolved, we are still at the mercy of the natural world.</p>
<p>COVID has only further demonstrated this point, as Schama notes in his reflections on the pandemic. Quarantined, away from the bustle of regular life, he reflects in his prologue on the way nature quickly reclaimed territories that we have moulded and shaped for our own needs – the cities, the suburbs, even the carefully curated and manicured green spaces that surround us. </p>
<p>Schama shows that pandemics are an ongoing feature of our existence on this planet. He also provides a devastating insight into our likely future responses to disease outbreaks. If you want to believe scientific knowledge will eventually prevail, he observes, “it is probably best not to ask a historian”. </p>
<p>Foreign Bodies provides a perhaps bleak, but truthful, view of our world today, as we continue to struggle with COVID and anticipate the looming threat of whichever disease will become the next great pandemic.</p><img src="https://counter.theconversation.com/content/208658/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ella Stewart-Peters does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
No matter how much we believe our knowledge and our technological capabilities have evolved, pandemics prove we are still at the mercy of the natural world.
Ella Stewart-Peters, Affiliate, College of Medicine and Public Health, Flinders University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/190518
2023-04-27T12:31:56Z
2023-04-27T12:31:56Z
‘Got polio?’ messaging underscores a vaccine campaign’s success but creates false sense of security as memories of the disease fade in US
<figure><img src="https://images.theconversation.com/files/523213/original/file-20230427-22-64ll1p.jpg?ixlib=rb-1.1.0&rect=55%2C130%2C3285%2C2434&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For much of the 20th century, Americans were used to seeing people bearing the signs of past polio infection.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/boy-helps-his-brother-a-polio-victim-confined-to-a-news-photo/526756448">Genevieve Naylor/Corbis via Getty Images</a></span></figcaption></figure><p>“<a href="https://twitter.com/sofia_vignolo/status/1129501200716636160">Got Polio? Me neither. Thanks, Science.</a>”</p>
<p>Messages like this are used in memes, posters, T-shirts and even some billboards to promote routine vaccinations. As this catchy statement reminds people of once-feared diseases of the past, it – perhaps unintentionally – conveys the message that polio has been relegated to the history books.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Leonardo DiCaprio meme 'Remember that time you got polio? Nope? Me neither? Thanks Science!'" src="https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This pro-science message uses a popular ‘cheers’ meme format.</span>
</figcaption>
</figure>
<p>Phrasing that aims to encourage immunizations by highlighting their accomplishments implies that some diseases are no longer a threat.</p>
<p>Few people today know much about polio. In 2022, only one-third of surveyed adults in the U.S. were <a href="https://www.annenbergpublicpolicycenter.org/what-u-s-adults-know-and-believe-about-polio-and-the-bivalent-covid-booster/">aware that polio has no cure</a>. Moreover, a 2020 poll had found that <a href="https://news.gallup.com/poll/276929/fewer-continue-vaccines-important.aspx">84% of adults viewed vaccinating children as important</a>, a 10% decline from 2001. The COVID-19 pandemic amplified anti-vaccination messaging, while also <a href="https://doi.org/10.1002/hsr2.516">delaying routine immunization</a>.</p>
<p>Vaccine-preventable diseases are far from eradicated. Measles outbreaks in unvaccinated or under-vaccinated American communities have begun resurfacing in the past few years, despite a <a href="https://www.cdc.gov/measles/elimination.html">2000 declaration</a> that the virus had been eliminated in the U.S. <a href="https://wonder.cdc.gov/nndss/static/2019/annual/2019-table2l.html">Pertussis cases have been on the rise</a>, with more than 18,000 cases reported in 2019. And in July 2022, polio reappeared in an unvaccinated New York man – the first U.S. diagnosis since 1979. This case helped return attention to polio, causing at least some young adults to <a href="https://www.nytimes.com/2022/08/17/health/polio-vaccine-history-millennials.html">wonder about their own vaccination status</a>.</p>
<p>A shift in focus to <a href="https://polioeradication.org">immunization in developing countries</a> has further lulled Americans into a false sense of security. While global approaches have been effective and are certainly needed, as the author of “<a href="https://www.umasspress.com/9781625345288/constructing-the-outbreak/">Constructing the Outbreak: Epidemics in Media and Collective Memory</a>,” I suggest that the celebratory messaging is no longer as effective as it once was and runs the risk of making it seem as if polio only lives in history books.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="semicircle of patients in iron lungs use mirrors to watch a TV" src="https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=463&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=463&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=463&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=582&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=582&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=582&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Polio patients at Baltimore’s Children’s Hospital watched television from inside the iron lungs that breathed for them.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/iron-lung-victims-get-television-set-baltimore-md-iron-lung-news-photo/515427562">Bettmann via Getty Images</a></span>
</figcaption>
</figure>
<h2>Campaigning against a devastating disease</h2>
<p>Before vaccines, polio – called infantile paralysis or poliomyelitis – was the most feared childhood disease in the U.S. Frequently affecting elementary school kids, the disease sometimes presented like a cold or flu – fever, sore throat and headache. In other cases, limb or spinal pain and numbness first indicated that something was wrong. Paralysis of legs, arms, neck, diaphragm or a combination could occur and, depending on the area affected, render patients unable to walk, lift their arms, or breathe outside of an iron lung.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="magazine add with images of kids with polio asks for donations" src="https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=780&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=780&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=780&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=980&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=980&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=980&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Full page ads like this one from 1953 solicited funds to help polio patients.</span>
<span class="attribution"><span class="source">March of Dimes</span></span>
</figcaption>
</figure>
<p>Only time could <a href="https://doi.org/10.1136%2Fbmj.1.4602.465">reveal whether the paralysis was permanent</a> or would recede, sometimes to return decades later as <a href="https://www.ninds.nih.gov/health-information/disorders/post-polio-syndrome">Post-Polio Syndrome</a>. Enough people were infected in outbreaks in the 1930s, 1940s and early 1950s that the effects of paralytic polio were quite visible in everyday life in the form of braces, crutches, slings and other mobility devices.</p>
<p>Thanks to the National Foundation for Infantile Paralysis, beating polio became a national priority. The NFIP grew out of President Franklin Delano Roosevelt’s Warm Springs Foundation. <a href="https://theconversation.com/what-fdrs-polio-crusade-teaches-us-about-presidential-leadership-amid-crisis-137215">Roosevelt himself had been partially paralyzed</a> by polio, and the NFIP provided funds for public education, research and survivors’ rehabilitation.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Eleanor Roosevelt smiles with a young boy holding a 'Mothers March on Polio' scroll" src="https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=760&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=760&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=760&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=955&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=955&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=955&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Eleanor Roosevelt helped inaugurate the Mothers’ March on Polio to raise money to fight the disease.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-mothers-march-on-polio-was-inaugurated-december-10-1953-news-photo/535083978">Bettmann/CORBIS via Getty Images</a></span>
</figcaption>
</figure>
<p>Its campaigns were prolific and diverse, combining interpersonal and mass communication strategies.</p>
<p>From FDR “Birthday Ball” celebrations to parades and elementary school fundraising competitions, various groups raised money. <a href="https://www.umasspress.com/9781625345288/constructing-the-outbreak/">High schoolers performed polio-themed plays</a>, putting the disease itself on trial in “The People vs. Polio.” People passed around collection boxes at movie theaters and other public gatherings.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="text of three 'I will not' and 'I will' points" src="https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1569&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1569&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1569&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1972&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1972&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1972&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An ad placed in Vogue in 1952 laid out the ‘Polio Pledge.’</span>
<span class="attribution"><span class="source">National Foundation for Infantile Paralysis</span></span>
</figcaption>
</figure>
<p>Campaigns used every medium. Brochures and short films raised awareness of the threat of polio, emphasizing the need for funding to support patient rehabilitation and scientific research. The National Foundation for Infantile Paralysis generated scores of radio scripts and hired Frank Sinatra, Elvis Presley and other famous voices to read them. <a href="https://youtu.be/fOkJAIPkxRA">Judy Garland, Mickey Rooney</a>, <a href="https://www.youtube.com/watch?v=BOXw-Px-X-8&t=4s">Lucille Ball</a> and other Hollywood stars also joined the fight. Comic strips and cartoons featuring Mickey Mouse and Donald Duck rallied for March of Dimes funds to help polio patients.</p>
<p>Starting in 1946, the NFIP featured children with crutches and braces who had survived polio as “<a href="https://www.marchofdimes.org/about/news/memoriam-donald-anderson-first-poster-child-1940-2014">poster children</a>” asking for funds to help them walk again. News stories covered outbreaks and polio epidemics, detailing the devastation of the disease on individuals, families and communities, while advising families how to reduce risk through the “Polio Pledge for Parents,” which provided a <a href="https://nyshistoricnewspapers.org/lccn/sn83031653/1952-07-17/ed-1/seq-4/">list of do’s and don'ts</a> during summer months.</p>
<h2>From public enemy No. 1 to success story</h2>
<p>The work of the National Foundation for Infantile Paralysis yielded unprecedented and continuous success, providing hospitals with equipment during epidemics and supporting the development of vaccines. Following the largest vaccine trial in history, on April 12, 1955, the Poliomyelitis Vaccine Evaluation Center announced that Jonas Salk’s vaccine was <a href="https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.45.5_Pt_1.575">80%-90% effective</a> against paralytic polio and officially <a href="https://theconversation.com/the-great-polio-vaccine-mess-and-the-lessons-it-holds-about-federal-coordination-for-todays-covid-19-vaccination-effort-152806">ready for general use</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="families in line outside a school with a sign 'Entrance for polio shots' in 1955" src="https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Once a vaccine was available, people lined up to protect themselves and their families from the virus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/san-diego-california-first-and-second-graders-at-the-kit-news-photo/514704620">Bettmann via Getty Images</a></span>
</figcaption>
</figure>
<p>Over the next decade, the NFIP shifted its focus to widespread immunization, again using both mass media and local campaigns. With Salk’s vaccine, and then Albert Sabin’s, polio cases fell quickly, from the peak of 57,879 cases in 1952 to <a href="https://doi.org/10.2307/4593032">only 72 cases in 1965</a>, with the <a href="https://www.cdc.gov/polio/what-is-polio/polio-us.html">last naturally occurring U.S. case in 1979</a>.</p>
<p>The repeated declaration of what polio vaccines could and were accomplishing was <a href="https://www.npr.org/sections/health-shots/2021/05/03/988756973/cant-help-falling-in-love-with-a-vaccine-how-polio-campaign-beat-vaccine-hesitan">strategically effective</a> in persuading more people to get their shots. The American public of the 1960s and 1970s had lived through repeated polio epidemics and knew both the fear of contracting the disease and its visible aftereffects. As of 2021, <a href="https://immunizationdata.who.int/pages/coverage/POL.html?CODE=USA&ANTIGEN=POL3&YEAR=">92.7% of Americans</a> were fully protected by the vaccine, though these rates have been in decline since 2010 and <a href="https://www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/data-reports/index.html">fluctuate by region</a>.</p>
<p>Public health rhetoric that <a href="https://doi.org/10.1016/j.vaccine.2011.10.005">focused on this vaccine success story</a> worked around the world in the late 1980s and 1990s. Gradually, though, the perceived threat in the U.S. of polio and other vaccine-preventable diseases dissipated over generations as vaccinations largely eliminated the risk. Most people in developed countries <a href="https://www.fda.gov/consumers/consumer-updates/vaccines-protect-children-harmful-infectious-diseases">lack firsthand experiences</a> of just how terrifying these diseases are, having never experienced polio, diphtheria, measles or pertussis, or lost family members to them.</p>
<p>At the same time that polio has been largely forgotten in the U.S., <a href="https://theconversation.com/covid-19-misinformation-scientists-create-a-psychological-vaccine-to-protect-against-fake-news-153024">anti-vaccination messages have been spreading disinformation</a> that distorts the risk of vaccines, ignoring the realities of the diseases they immunize against.</p>
<p>Rhetoric from polio vaccine campaigns in the 1950s and 1960s emphasized the risks of not getting immunized – acute illness, life-changing pain and paralysis or even death. In the 21st century U.S., immunization campaigns no longer emphasize these risks, and it’s easy to forget the potentially deadly repercussions of skipping vaccines.</p>
<p>I believe pervasive public health messaging can counter anti-vaccination disinformation. A reminder for the American public about this still dangerous disease can help ensure that “Got Polio?” does not become a serious question.</p><img src="https://counter.theconversation.com/content/190518/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine A. Foss does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Polio vaccines have been a massive public health victory in the US. But purely celebratory messaging overlooks the ongoing threat if vaccination rates fall.
Katherine A. Foss, Professor of Media Studies, Middle Tennessee State University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/201752
2023-03-27T12:25:04Z
2023-03-27T12:25:04Z
Gender-affirming care has a long history in the US – and not just for transgender people
<figure><img src="https://images.theconversation.com/files/516795/original/file-20230321-2376-1glr1q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2953%2C1971&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Enforcement of binary gender norms has led to unwanted medical interventions on intersex and cisgender children.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctors-carrying-newborn-baby-girl-at-hospital-royalty-free-image/668808357">Javier Valenzuela/EyeEm via Getty Images</a></span></figcaption></figure><p>In 1976, a <a href="http://lgbthistory.pages.roanoke.edu/wp-content/uploads/sites/40/2020/02/Long-Road-from-Man-to-Woman.pdf">woman from Roanoke, Virginia, named Rhoda</a> received a prescription for two drugs: estrogen and progestin. Twelve months later, a local reporter noted Rhoda’s surprisingly soft skin and visible breasts. He wrote that the drugs had made her “so completely female.” </p>
<p>Indeed, that was the point. The University of Virginia Medical Center in nearby Charlottesville had a clinic specifically for women like Rhoda. In fact, doctors there had been prescribing hormones and performing surgeries – what today we would call gender-affirming care – for years.</p>
<p>The founder of that clinic, <a href="https://www.washingtonpost.com/local/obituaries/milton-edgerton-trailblazing-plastic-surgeon-for-children-and-transgender-patients-dies-at-96/2018/07/16/28bcae0a-8836-11e8-8aea-86e88ae760d8_story.html">Dr. Milton Edgerton</a>, had cut his teeth caring for transgender people at Johns Hopkins University in the 1960s. There, he was part of a team that established the nation’s first university-based Gender Identity Clinic in 1966.</p>
<p>When politicians today refer to gender-affirming care as new, “<a href="https://www.advocate.com/health-care/mississippi-governor-ban-transgender-care">untested</a>” or “<a href="https://www.desmoinesregister.com/story/news/politics/2023/03/07/iowa-lawmakers-approve-gender-affirming-care-ban-for-transgender-youth/69980950007/">experimental</a>,” they ignore the long history of transgender medicine in the United States. </p>
<p>It’s been nearly 60 years since the first transgender medical clinic <a href="https://www.scientificamerican.com/article/the-forgotten-history-of-the-worlds-first-trans-clinic/">opened in the U.S.</a>, and 47 years since Rhoda started her hormone therapy. Understanding the history of these treatments in the U.S. can be a helpful guide for citizens and legislators in a year when <a href="https://www.vice.com/en/article/5d378d/anti-trans-bills-2023">a record number of bills</a> in statehouses target the rights of transgender people.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Christine Jorgensen standing before a set of microphones at a press conference" src="https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=488&fit=crop&dpr=1 600w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=488&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=488&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=613&fit=crop&dpr=1 754w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=613&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=613&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Christine Jorgensen, who received gender-affirming treatments in the 1950s, was one of the first trans celebrities in the U.S.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/new-york-new-york-christine-jorgensen-arriving-at-idlewild-news-photo/515992248">Bettmann/Getty Images</a></span>
</figcaption>
</figure>
<h2>Treating gender in every population</h2>
<p>As a trans woman and a <a href="https://gsrosenthal.com">scholar of transgender history</a>, I have spent much of the past decade <a href="https://uncpress.org/book/9781469665801/living-queer-history/">studying these issues</a>. I also take several pills each morning to maintain the proper hormonal balance in my body: spironolactone to suppress testosterone and estradiol to increase estrogen.</p>
<p>When I began HRT, or hormone replacement therapy, like many Americans I wasn’t aware that this treatment had been around for generations. What I was even more surprised to learn was that HRT is often prescribed to cisgender women – women who were assigned female at birth and raised their whole lives as women. In fact, many providers in my region already had a <a href="https://uncpress.org/book/9781469665801/living-queer-history/">long record of prescribing hormones to cis women</a>, primarily women experiencing menopause.</p>
<p>I also learned that gender-affirming hormone therapies have been prescribed to cisgender youths for generations – despite what contemporary politicians may think. Disability scholar Eli Clare has written of the history and continued practice of <a href="https://www.dukeupress.edu/brilliant-imperfection">prescribing hormones</a> to boys who are too short and girls who are too tall for what is considered a “normal” range for their gender. Because of binary gender norms that celebrate height in men and smallness in women, doctors, parents and ethicists have approved the use of hormonal therapies to make children conform to these gender stereotypes <a href="https://www.penguinrandomhouse.com/books/292342/normal-at-any-cost-by-susan-cohen/">since at least the 1940s</a>.</p>
<p>Clare describes a severely disabled young woman whose parents – with the approval of doctors and ethicists from their local children’s hospital – administered puberty blockers so that she would never grow into an adult. They deemed her mentally incapable of becoming a “real” woman. </p>
<p>The history of these treatments demonstrates that hormone therapies and puberty blockers have been used on cisgender children in this country – for better or for worse – with the goal of regulating the passage from girlhood to womanhood and from boyhood to manhood. Gender stereotypes concerning the presence or absence of secondary sex characteristics – too tall, too short, too much body hair – have all led parents and doctors to perform gender-affirming care on cisgender children.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/5dJduGC3HyQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Enforcement of binary gender norms has led to unwanted medical interventions on intersex children.</span></figcaption>
</figure>
<p>For over half a century, legal and medical authorities in the U.S. have also approved and administered surgeries and hormone therapies to force the bodies of intersex children to conform to binary gender stereotypes. I myself had genital surgery in infancy to bring my anatomy into alignment with expectations for what a “male” body should look like. In most cases, intersex surgeries are <a href="https://doi.org/10.1001/amajethics.2021.550">unnecessary for the</a> <a href="https://www.wgbh.org/news/science-and-technology/2019/10/24/medically-necessary-or-cruel-inside-the-battle-over-surgery-on-intersex-babies">health or well-being</a> of a child.</p>
<p>Historians such as Jules Gill-Peterson have shown that <a href="https://www.upress.umn.edu/book-division/books/histories-of-the-transgender-child">early advances in transgender medicine</a> in this country are deeply interwoven with the <a href="https://theconversation.com/trans-kids-in-the-us-were-seeking-treatment-decades-before-todays-political-battles-over-access-to-health-care-157481">nonconsensual treatment of intersex children</a>. Doctors at Johns Hopkins and the University of Virginia practiced reconstructing the genitalia of intersex people before applying those same treatments on transgender patients.</p>
<p>Given these intertwined histories, I contend that the current political focus on prohibiting gender-affirming care for transgender people is evidence that opposition to these treatments is not about the safety of any specific medications or procedures, but rather their use specifically by transgender people.</p>
<h2>How transgender people access care</h2>
<p>Many transgender people in the U.S. have deeply complicated feelings about gender-affirming care. This complexity is a result of over half a century of transgender medicine and patient experiences in the U.S.</p>
<p>In Rhoda’s time, medical gatekeeping meant that she had to live “full time” as a woman and prove her suitability for gender-affirming care to a team of primarily white, cis male doctors before they would give her treatment. She had to mimic language about being “<a href="https://doi.org/10.1177/1363460717740258">born in the wrong body</a>” – language invented by cis doctors studying trans people, not by trans people themselves. She <a href="https://ojs.stanford.edu/ojs/index.php/intersect/article/view/2056">had to affirm</a> she would be heterosexual and seek marriage and monogamy with a man. She could not be a lesbian or bisexual or promiscuous. </p>
<p>Many trans people still need to jump through similar hoops today to receive gender-affirming care. For example, a diagnosis of “<a href="https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria">gender dysphoria</a>,” a designated mental disorder, is sometimes required before treatment. Many trans people argue that these preconditions for access to care should be removed because being trans is an identity and a lived experience, not a disorder.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KomI-XiiJw0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Transgender people undergo more evaluations to obtain gender-affirming care than do cisgender people.</span></figcaption>
</figure>
<p>Feminist activists in the 1970s also critiqued the role of medical authority in gender-affirming care. Writer Janice Raymond decried “<a href="https://www.worldcat.org/title/transsexual-empire-the-making-of-the-she-male/oclc/29548586">the transsexual empire</a>,” her term for the physicians, psychologists and other professionals who practice transgender medicine. Raymond argued that cis male doctors were making an army of trans women to satisfy the male gaze: promoting iterations of womanhood that reinforced sexist gender stereotypes, ultimately ushering in the displacement and eradication of the world’s “biological” women. The origins of today’s gender-critical, or <a href="https://theconversation.com/why-the-words-we-use-matter-when-describing-anti-trans-activists-130990">trans-exclusionary radical feminist</a>, movement are visible in Raymond’s words. But as trans scholar Sandy Stone wrote in her <a href="https://doi.org/10.1215/02705346-10-2_29-150">famous reply to Raymond</a>, it’s not that trans women are unwilling dupes of cis male medical authority, but rather that we have to strategically perform our womanhood in certain ways to access the care and treatments we need.</p>
<h2>The future of gender-affirming care</h2>
<p>In many states, especially in the South, where I live, governors and legislatures are introducing bills to ban gender-affirming care – <a href="https://www.washingtonpost.com/nation/2023/02/28/anti-trans-bills-gender-affirming-care-adults/">even for adults</a> – in ignorance of history. The consequences of hurried legislation extend beyond trans people, because access to hormones and surgeries is a basic medical service many people may need to feel better in their body.</p>
<p>Prohibitions on hormone therapy and gender-related surgeries for minors could mean ending the same treatment options <a href="https://www.nbcnews.com/think/opinion/gender-affirming-care-isnt-just-for-trans-people-rcna54651">for cisgender children</a>. The <a href="https://www.courier-journal.com/story/opinion/2023/03/06/kentucky-anti-trans-bill-impacts-intersex-kids-forces-gender-choice/69965192007/">legal implications for intersex children</a> may directly clash with <a href="http://www.kslegislature.org/li/b2023_24/measures/documents/sb180_00_0000.pdf">proposed legislation</a> in several states that aims to codify “male” and “female” as discrete biological sexes with certain anatomical features. </p>
<p>Prohibitions on hormone replacement therapy for adults could affect access to the same treatments for menopausal women or limit access to hormonal birth control. Prohibitions of gender-affirming surgeries could affect anyone’s ability to <a href="https://www.cbsnews.com/news/texas-bill-ban-gender-affirming-care-transgender-adults/">access a hysterectomy or a mastectomy</a>. So-called cosmetic surgeries such as breast implants or reductions, and even facial feminization procedures such as lip fillers or Botox, could also come under question. </p>
<p>These are all different types of gender-affirming procedures. Are most Americans willing to live with this level of government intrusion into their bodily autonomy? </p>
<p>Almost every <a href="https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2021-4-26-Bill-McBride-opposing-anti-trans-bills-Final.pdf">major medical organization</a> in the U.S. has come out against new government restrictions on gender-affirming care because, as doctors and professionals, they know that these treatments are <a href="https://doi.org/10.1016%2Fj.xcrm.2022.100719">time-tested and safe</a>. These treatments have histories reaching back over 50 years.</p>
<p>Trans and intersex people are important voices in this debate, because our bodies are the ones politicians opposing gender-affirming care most frequently <a href="https://www.nbcnews.com/nbc-out/out-politics-and-policy/arkansas-lawmaker-hearing-asks-transgender-woman-penis-rcna70787">treat as objects of ridicule and disgust</a>. Legislators are developing policies about us despite the fact that most Americans say they <a href="https://www.pewresearch.org/fact-tank/2021/07/27/rising-shares-of-u-s-adults-know-someone-who-is-transgender-or-goes-by-gender-neutral-pronouns/">do not even know a trans person</a>. </p>
<p>But trans and intersex people <a href="https://www.washingtonpost.com/dc-md-va/2023/03/23/transgender-adults-transitioning-poll/">know what it is like</a> to have to fight to access the care and treatment we need. And we know the joy of finally feeling comfortable in our own skin and being able to affirm our gender on our own terms.</p><img src="https://counter.theconversation.com/content/201752/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>G. Samantha Rosenthal is co-founder of the Southwest Virginia LGBTQ+ History Project</span></em></p>
The first transgender medical clinic opened in the US in the 1960s. But cisgender and intersex children began receiving similar treatments even earlier – often without their consent.
G. Samantha Rosenthal, Associate Professor of History, Roanoke College
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/189683
2022-09-07T23:12:32Z
2022-09-07T23:12:32Z
World’s earliest evidence of a successful surgical amputation found in 31,000-year-old grave in Borneo
<figure><img src="https://images.theconversation.com/files/483199/original/file-20220907-938-1d1rn.jpg?ixlib=rb-1.1.0&rect=0%2C79%2C1200%2C637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Tim Maloney</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Modern medicine seems to advance with time thanks to research breakthroughs. Hence it’s often thought that further into the past, only simpler medical practices existed.</p>
<p>The medical expertise of foraging communities such as hunter-gatherers has been thought to be rudimentary and unchanging. It’s been argued that shifts towards settled agricultural life within the past 10,000 years were what created new health problems and advances in medical culture; this includes surgery.</p>
<p>Published <a href="https://www.nature.com/articles/s41586-022-05160-8">today in the journal Nature</a>, we report a discovery shattering this longstanding trope of popular imagination – the skeleton of a young adult from Borneo whose lower left leg was amputated in childhood by a prehistoric surgeon 31,000 years ago.</p>
<figure class="align-center ">
<img alt="The outline of a skeleton visible on a cave floor" src="https://images.theconversation.com/files/483168/original/file-20220907-26-3kwx9h.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483168/original/file-20220907-26-3kwx9h.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483168/original/file-20220907-26-3kwx9h.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483168/original/file-20220907-26-3kwx9h.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483168/original/file-20220907-26-3kwx9h.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483168/original/file-20220907-26-3kwx9h.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483168/original/file-20220907-26-3kwx9h.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Oldest burial of a modern human currently known from Island Southeast Asia, dating to 31,000 years ago.</span>
<span class="attribution"><span class="source">Tim Maloney</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>This finding pre-dates the previous <a href="https://www.nature.com/articles/npre.2007.1278.1">oldest known evidence</a> for amputation surgery by a staggering 24,000 years. It suggests that human medical knowledge and surgical procedures were far more advanced in the distant past of our species than previously thought.</p>
<h2>The Borneo discovery</h2>
<p>In 2018, some of the earliest known rock art was found in caves of East Kalimantan, Borneo, dating to <a href="https://www.nature.com/articles/s41586-018-0679-9">40,000 years ago</a>.</p>
<p>The following year, archaeologists from Griffith University, University of Western Australia, and Indonesian institutions of archaeology and conservation (Arkeologi, Bahasa dan Sastra, Pusat Riset Arkeometri BRIN / Balai Pelestarian Cagar Budaya Kalimantan Timur) searched remote caves in dense rainforest for archaeological finds that could shed light on the lifeways of these early artists. </p>
<figure class="align-left ">
<img alt="A green and blue map with the outlines of several countries" src="https://images.theconversation.com/files/483361/original/file-20220907-15616-pplied.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/483361/original/file-20220907-15616-pplied.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=466&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483361/original/file-20220907-15616-pplied.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=466&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483361/original/file-20220907-15616-pplied.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=466&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483361/original/file-20220907-15616-pplied.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=585&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483361/original/file-20220907-15616-pplied.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=585&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483361/original/file-20220907-15616-pplied.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=585&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Map showing the location of the area.</span>
<span class="attribution"><span class="source">Maria Kottermair</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Led by local Dayak colleagues, the team travelled to a remote camp via a multi-day canoe and hiking journey. It was accessible only by boat at certain times of the year.</p>
<p>During these field trips, in early 2020 the team conducted archaeological excavation within Liang Tebo cave. There, they uncovered a complete human burial, with grave goods of brightly coloured red ochre pigments and stone burial markers.</p>
<p>Upon closer analysis of the leg bones of the remains, an unexpected discovery emerged.</p>
<figure class="align-center ">
<img alt="Close-up of an orange clay-like substance next to a bone covered in sand" src="https://images.theconversation.com/files/482653/original/file-20220905-24-5b3m99.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/482653/original/file-20220905-24-5b3m99.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/482653/original/file-20220905-24-5b3m99.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/482653/original/file-20220905-24-5b3m99.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/482653/original/file-20220905-24-5b3m99.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/482653/original/file-20220905-24-5b3m99.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/482653/original/file-20220905-24-5b3m99.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ochre nodule next to the jaw bone.</span>
<span class="attribution"><span class="source">Tim Maloney</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Evidence for amputation at 31,000 years</h2>
<p>Multiple dating techniques (radiocarbon, uranium-series, and electron-spin-resonance) confirmed the burial had taken place 31,000 years ago, making it Southeast Asia’s oldest known grave. Skeletal analyses confirmed the lower left limb had been surgically amputated; the way the bone tissue had changed over time (known as “<a href="https://en.wikipedia.org/wiki/Bone_remodeling">bone remodelling</a>”) matched clinical cases of successful amputation that hadn’t become infected.</p>
<p>The healed bone confirms an injury that wasn’t fatal to the patient, implying the surgeon or surgeons likely understood the need to manage and treat it. They were able to prevent infection after the invasive surgery, allowing the person to survive into adulthood.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/483166/original/file-20220907-22-qysseh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Yellowed bone remains on a black background, one shown in close-up detail" src="https://images.theconversation.com/files/483166/original/file-20220907-22-qysseh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/483166/original/file-20220907-22-qysseh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=673&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483166/original/file-20220907-22-qysseh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=673&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483166/original/file-20220907-22-qysseh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=673&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483166/original/file-20220907-22-qysseh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=846&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483166/original/file-20220907-22-qysseh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=846&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483166/original/file-20220907-22-qysseh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=846&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Left: Left and right legs with pelvic girdle demonstrating complete absence of left lower leg. Right: Close up of tibia and fibula showing remodelled bone.</span>
<span class="attribution"><span class="source">Tim Maloney</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Medical developments in tropical rainforests</h2>
<p>In the tropical rainforests of Borneo, hot and humid conditions create the perfect breeding ground for various microbes, and therefore increase the chances of getting a wound infected. But the rainforests also have astonishingly rich plant species diversity. This vast “natural pharmacy” may have prompted early flourishing in the use of botanical resources.</p>
<p>The surgeons treating the amputation patient could have drawn upon locally available botanical resources before, during, and after the procedure. Such medicinal plants could have provided anaesthetics and antimicrobial remedies preventing infection.</p>
<figure class="align-center ">
<img alt="View of a green landscape from the inside of a stone cave" src="https://images.theconversation.com/files/483163/original/file-20220907-21-28059s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483163/original/file-20220907-21-28059s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483163/original/file-20220907-21-28059s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483163/original/file-20220907-21-28059s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483163/original/file-20220907-21-28059s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483163/original/file-20220907-21-28059s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483163/original/file-20220907-21-28059s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tropical rainforest at Liang Tebo.</span>
<span class="attribution"><span class="source">Tim Maloney</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Surviving a childhood amputation and living into adulthood among rainforest caves of Borneo also suggests a high degree of community care. A community that painted complex figurative art had also seemingly mastered the complexities of surgical amputation 31,000 years ago.</p>
<p>Sea levels being much lower at this time, Borneo was still connected to Asia. This means the survivor of this surgery also lived close to the potential departing shorelines of ice-age Asia, from where the world’s first mariners departed earlier still, eventually reaching what is now Australia.</p>
<p>This new finding adds to a growing body of evidence that the first modern human groups to reach our part of the world tens of thousands of years ago had medical knowledge and skills beyond what was previously thought.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/65-000-year-old-stone-swiss-army-knives-show-early-humans-had-long-distance-social-networks-184648">65,000-year-old 'stone Swiss Army knives' show early humans had long-distance social networks</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/189683/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Ryan Maloney receives funding from the Australian Research Council FT170100025, as well as DP220100462. </span></em></p><p class="fine-print"><em><span>Adam Brumm receives funding from the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Adhi Oktaviana is PhD Candidate at Griffith University, Australia and Researcher at Research Center of Archaeometry, BRIN, Indonesia </span></em></p><p class="fine-print"><em><span>Dr India Ella Dilkes-Hall receives funding from Forrest Research Foundation. </span></em></p><p class="fine-print"><em><span>Maxime Aubert receives funding from the Australian Research Council, The National Geographic Society, and Google.</span></em></p><p class="fine-print"><em><span>Melandri Vlok is a member of the research team.</span></em></p><p class="fine-print"><em><span>Renaud Joannes-Boyau receives funding from the Australian Research Council. </span></em></p>
An astonishing discovery from the oldest known grave in Southeast Asia has revised medical history – the previous known amputation surgery was just 7,000 years ago.
Tim Ryan Maloney, Research fellow, Griffith University
Adam Brumm, Professor, Griffith University
Adhi Oktaviana, PhD Candidate, Griffith University
India Ella Dilkes-Hall, Forrest Foundation Prospect Fellow, The University of Western Australia
Maxime Aubert, Professor, Griffith University
Melandri Vlok, Postdoctoral research associate, University of Sydney
Renaud Joannes-Boyau, Associate Professor, Southern Cross University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/186042
2022-08-17T02:38:06Z
2022-08-17T02:38:06Z
5 drugs that changed the world (and what went wrong)
<figure><img src="https://images.theconversation.com/files/477820/original/file-20220805-19484-orrk38.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/classic-drugstore-museum-interior-glass-bottles-1164873649">Shutterstock</a></span></figcaption></figure><p>It’s hard to measure the impact of any one drug on world history. But here are five drugs we can safely say made a huge difference to our lives, often in ways we didn’t expect.</p>
<p>They have brought some incredible benefits. But they’ve usually also come with a legacy of complications we need to look at critically. </p>
<p>It’s a good reminder that today’s wonder drug may be tomorrow’s problem drug. </p>
<h2>1. Anaesthesia</h2>
<p>In the late 1700s, English chemist Joseph Priestley <a href="https://www.ch.ic.ac.uk/rzepa/mim/environmental/html/n2o.htm">made a gas</a> he called “phlogisticated nitrous air” (nitrous oxide). English chemist Humphry Davy thought it could be used as pain relief in surgery, but instead it became a <a href="https://journals.physiology.org/doi/full/10.1152/ajplung.00206.2014">recreational drug</a>. </p>
<p>It wasn’t until 1834 that we reached another milestone. That’s when French chemist Jean-Baptiste Dumas named a new gas <a href="https://www.worldofmolecules.com/solvents/chloroform-molecule.html">chloroform</a>. Scottish doctor James Young Simpson used it in 1847 <a href="http://dx.doi.org/10.1136/fn.86.3.F207">to assist a birth</a>.</p>
<p>Soon anaesthesia was more widely used during surgery, bringing <a href="https://theconversation.com/a-short-history-of-anaesthesia-from-unspeakable-agony-to-unlocking-consciousness-74748">better recovery rates</a>. Before anaesthesia, surgical patients would often die of shock from the pain.</p>
<p>But any drug that can make people unconscious can also cause harm. Modern anaesthetics are still dangerous because of the <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/general-anaesthetics">risks</a> of suppressing the nervous system.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Chloroform bottle on display" src="https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477576/original/file-20220804-16645-r90l2r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Before anaesthesia, surgical patients would die of shock from the pain.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/25182210@N07/5828813781">dynamosquito/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-short-history-of-anaesthesia-from-unspeakable-agony-to-unlocking-consciousness-74748">A short history of anaesthesia: from unspeakable agony to unlocking consciousness</a>
</strong>
</em>
</p>
<hr>
<h2>2. Penicillin</h2>
<p>What happened in 1928 to Scottish physician Alexander Fleming is one of the classic stories of accidental drug discovery. </p>
<p>Fleming went on holiday, leaving some cultures of the bacterium streptococcus on his laboratory bench. When he came back, he saw some airborne penicillium (a fungal contaminant) had <a href="https://academic.oup.com/jimb/article/36/6/775/5993612">stopped the streptococcus</a> from growing.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Penicillin growing on Petri dish" src="https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=482&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=482&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477582/original/file-20220804-19-fruewv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=482&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Antibiotics saved millions of lives but we’re now suffering from their popularity.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/86257416@N02/14720615367">Antony Scimone by MMU Engage/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Australian pathologist Howard Florey and his team stabilised penicillin and <a href="https://www.nobelprize.org/prizes/medicine/1945/florey/biographical/">carried out the first human experiments</a>. With American financing, penicillin was mass-produced and changed the course of World War II. It was used to treat <a href="https://news.wisc.edu/d-day-invasion-was-bolstered-by-uw-madison-penicillin-project/">thousands of service personnel</a>.</p>
<p>Penicillin and its descendants are enormously successful front-line drugs for conditions that once killed millions of people. However, their widespread use has led to <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/antibiotic-resistant-bacteria">drug-resistant strains of bacteria</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-of-the-scariest-antibiotic-resistant-bacteria-in-the-past-five-years-100654">Five of the scariest antibiotic-resistant bacteria in the past five years</a>
</strong>
</em>
</p>
<hr>
<h2>3. Nitroglycerin</h2>
<p>Nitroglycerin was invented in 1847 and displaced gunpowder as the most powerful explosive in the world. It was also the first modern drug to treat <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/heart-conditions-angina">angina</a>, the chest pain associated with heart disease. </p>
<p>Factory workers exposed to the explosive began to experience <a href="https://doi.org/10.1046/j.1440-1681.2000.03240.x">headaches and flushing in the face</a>. This was because nitroglycerin is a vasodilator – it dilates (opens) the blood vessels. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tweet about Dr Murrell's experimentation with nitroglycerin" src="https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=678&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=678&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=678&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=852&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=852&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477595/original/file-20220804-15-crz7lm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=852&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">London physician William Murrell experimented with nitroglycerin on himself and tried it on his angina patients.</span>
<span class="attribution"><a class="source" href="https://twitter.com/search?q=William%20Murrell%20nitroglycerin&src=typed_query&f=top">Twitter</a></span>
</figcaption>
</figure>
<p>London physician William Murrell <a href="https://www.acs.org/content/acs/en/molecule-of-the-week/archive/n/nitroglycerin.html">experimented</a> with nitroglycerin on himself and tried it on his angina patients. They got almost immediate relief.</p>
<p>Nitroglycerin made it possible for millions of people with angina to live relatively normal lives. It also paved the way for medications such as blood pressure-lowering drugs, beta-blockers and statins. These medicines have <a href="https://www.health.harvard.edu/heart-health/blood-pressure-drugs-may-extend-life-even-for-frail-older-people">extended lives and increased the average lifespan</a> in Western countries.</p>
<p>But because people’s lives are now extended, there are now higher rates of deaths from <a href="https://news.cancerresearchuk.org/2015/02/04/why-are-cancer-rates-increasing/">cancer and other non-communicable diseases</a>. So nitroglycerin turned out to be a world-changing drug in unexpected ways. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-australians-die-cause-2-cancers-58063">How Australians Die: cause #2 – cancers</a>
</strong>
</em>
</p>
<hr>
<h2>4. The pill</h2>
<p>In 1951, US birth control advocate Margaret Sanger asked researcher Gregory Pincus <a href="https://www.nma.gov.au/defining-moments/resources/the-pill">to develop an effective hormonal contraceptive</a>, funded by heiress Katharine McCormick. </p>
<p>Pincus found that progesterone helped to stop ovulation, and used this to develop a trial pill. Clinical trials were conducted on vulnerable women, notably in Puerto Rico, where there were <a href="https://www.pbs.org/wgbh/americanexperience/features/pill-puerto-rico-pill-trials/">concerns</a> about informed consent and side effects.</p>
<p>The new drug was released by GD Searle & Co as Enovid in 1960, with US Food and Drug Administration approval. This was granted because the risk of pregnancy was seen as <a href="https://www.pbs.org/wgbh/americanexperience/features/pill-us-food-and-drug-administration-approves-pill/">greater than</a> the risk of side effects, such as blood clots and strokes.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1523846612958814210"}"></div></p>
<p>It took ten years to prove a link between oral contraceptive use and serious side effects. After a 1970 US government inquiry, the pill’s hormone levels <a href="https://www.pbs.org/wgbh/americanexperience/features/pill-senate-holds-hearings-pill-1970/">were lowered dramatically</a>. Another outcome was the <a href="https://www.pbs.org/wgbh/americanexperience/features/pill-senate-holds-hearings-pill-1970/">patient information sheet</a> you will now find inside all prescription drug packets.</p>
<p>The pill caused <a href="https://www.nma.gov.au/defining-moments/resources/the-pill">major global demographic changes</a> with smaller families and increased incomes as women re-entered the workforce. However, it’s still raising questions about how the medical profession has <a href="https://www.journals.uchicago.edu/doi/abs/10.1086/715419">experimented on women’s bodies</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-to-expect-when-coming-off-the-pill-and-5-things-to-do-before-you-do-183367">What to expect when coming off the pill, and 5 things to do before you do</a>
</strong>
</em>
</p>
<hr>
<h2>5. Diazepam</h2>
<p>The first benzodiazepine, a type of nervous system depressant, was created in 1955 and marketed by drug company Hoffmann-La Roche as <a href="https://pubmed.ncbi.nlm.nih.gov/24007886/">Librium</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Valium bottles and dropper" src="https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=706&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=706&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=706&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=887&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=887&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477589/original/file-20220804-12-i4s7ip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=887&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Valium was onced used to help people engage with psychotherapy.</span>
<span class="attribution"><a class="source" href="https://collection.sciencemuseumgroup.org.uk/objects/co193001/bottled-valium-carton-plastic-pipette-instructions-sedative-controlled-drug-diazepam">Roche/Science Museum/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>This and related drugs were not sold as “cures” for anxiety. Instead, they were supposed to <a href="https://theconversation.com/how-to-reduce-dependency-on-drugs-like-valium-with-alternative-therapies-72571">help people engage in psychotherapy</a>, which was seen as the real solution.</p>
<p>Polish-American chemist Leo Sternbach and his research group chemically <a href="https://www.washingtonpost.com/archive/politics/1980/01/20/adventurous-chemist-and-his-pill/16cd98f6-00a6-4f5c-8e86-08451ed3451b/">altered Librium in 1959</a>, producing a much more powerful drug. This was diazepam, marketed from 1963 as Valium.</p>
<p>Cheap, easily available drugs like these had a huge impact. From 1969 until 1982, Valium was the <a href="https://drugabuse.com/benzodiazepines/valium/history-and-statistics/">top-selling pharmaceutical</a> in the United States. These drugs created a culture of managing stress and anxiety with medication.</p>
<p>Valium paved the way for modern antidepressants. It was more difficult (but not impossible) to <a href="https://pubmed.ncbi.nlm.nih.gov/29123931/">overdose on these newer drugs</a>, and they had fewer side effects. The first SSRI, or selective serotonin reuptake inhibitor, was fluoxetine, <a href="https://www.pbs.org/wgbh/aso/databank/entries/dh87pr.html">marketed from 1987 as Prozac</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-chemical-imbalance-theory-of-depression-is-dead-but-that-doesnt-mean-antidepressants-dont-work-187769">The chemical imbalance theory of depression is dead, but that doesn't mean antidepressants don't work</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/186042/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philippa Martyr does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Each of these five drugs have brought some incredible benefits. But they’ve usually also come with a legacy of complications.
Philippa Martyr, Lecturer, Pharmacology, Women's Health, School of Biomedical Sciences, The University of Western Australia
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/182726
2022-07-19T17:34:43Z
2022-07-19T17:34:43Z
Warsaw Ghetto’s defiant Jewish doctors secretly documented the medical effects of Nazi starvation policies in a book rediscovered on a library shelf
<figure><img src="https://images.theconversation.com/files/474632/original/file-20220718-76232-8ep20p.jpg?ixlib=rb-1.1.0&rect=120%2C111%2C1165%2C793&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The book includes haunting photos from inside the ghetto, along with its record of the medical effects of starvation.</span> <span class="attribution"><span class="source">'Maladie de Famine," American Joint Distribution Committee</span></span></figcaption></figure><p>In 1942, a group of starving Jewish scientists and doctors in the Warsaw Ghetto were collecting data on their starving patients. They hoped their research would benefit future generations through better ways to treat malnutrition, and they wanted the world to know of Nazi atrocities to prevent something similar from ever happening again. They recorded the grim effects of an almost complete lack of food on the human body in a rare book titled “<a href="https://www.worldcat.org/title/maladie-de-famine-recherches-cliniques-sur-la-famine-executees-dans-le-ghetto-de-varsovie-en-1942/oclc/613124708">Maladie de Famine</a>” (in English, “The Disease of Starvation: Clinical Research on Starvation in the Warsaw Ghetto in 1942”) that we <a href="https://dl.tufts.edu/concern/pdfs/h415pr96d">rediscovered in the Tufts University library</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/474374/original/file-20220715-4647-pxtnux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="yellowed frontispiece of a book" src="https://images.theconversation.com/files/474374/original/file-20220715-4647-pxtnux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/474374/original/file-20220715-4647-pxtnux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=830&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474374/original/file-20220715-4647-pxtnux.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=830&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474374/original/file-20220715-4647-pxtnux.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=830&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474374/original/file-20220715-4647-pxtnux.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1042&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474374/original/file-20220715-4647-pxtnux.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1042&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474374/original/file-20220715-4647-pxtnux.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1042&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This French translation was donated to the Tufts University library in 1948.</span>
<span class="attribution"><span class="source">'Maladie de Famine,' American Joint Distribution Committee</span></span>
</figcaption>
</figure>
<p><a href="https://scholar.google.com/citations?user=HyTsVigAAAAJ&hl=en&oi=ao">As scientists who</a> <a href="https://scholar.google.com/scholar?q=irwin%20rosenberg&btnG=&hl=en&as_sdt=0%2C22">study starvation</a>, its biological effects and its use as a weapon of mass destruction, we believe the story of how and why Jewish scientists conducted this research in such extreme conditions is as important and compelling as its results. </p>
<p>The clandestine project’s lead doctor, Israel Milejkowski, wrote the books’s foreword. In it, he explains:</p>
<blockquote>
<p>“The work was originated and pursued under unbelievable conditions. I hold my pen in my hand and death stares into my room. It looks through the black windows of sad empty houses on deserted streets littered with vandalized and burglarized possessions. … In this prevailing silence lies the power and the depth of our pain and the moans that one day will shake the world’s conscience.”</p>
</blockquote>
<p>Reading these words, we were both transfixed, transported by his voice to a time and place where starvation was being used as a weapon of oppression and annihilation as the Nazis were systematically exterminating all Jews in their occupied territories. As scholars of starvation, we were also well aware that this book catalogs many of the justifications for the <a href="https://www.icrc.org/en/doc/war-and-law/treaties-customary-law/geneva-conventions/overview-geneva-conventions.htm">1949 Geneva Conventions</a>, which made starvation of civilians a war crime.</p>
<iframe src="https://embed.acast.com/60087127b9687759d637bade/63ce902162c0100011034184" frameborder="0" width="100%" height="190px"></iframe>
<p><iframe id="tc-infographic-561" class="tc-infographic" height="100" src="https://cdn.theconversation.com/infographics/561/4fbbd099d631750693d02bac632430b71b37cd5f/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>A defiant medical record</h2>
<p>Within months of their 1939 invasion of Poland, Nazi forces created the infamous Warsaw Ghetto. At its peak, more than <a href="https://www.jstor.org/stable/26627292">450,000 Jews were required to live in this small, walled-off area</a> of about 1.5 square miles (3.9 square kilometers) within the city, <a href="https://doi.org/10.2307/4065270">unable to leave even to look for food</a>.</p>
<p>Although Germans in Warsaw were allotted a <a href="https://hekint.org/2022/01/06/the-warsaw-ghetto-hunger-study/">daily ration of about 2,600 calories</a>, physicians in the ghetto estimated that Jews were able to consume only about 800 calories a day on average through a combination of rations and smuggling. That’s about half the calories volunteers consumed in <a href="https://doi.org/10.1093/jn/135.6.1347">a study on starvation</a> conducted near the end of World War II by researchers at the University of Minnesota, and less than a <a href="https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf">third of the average energy needs of an adult male</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/474375/original/file-20220715-16-4kqicm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="emaciated naked patient sits on hospital bed with nurse behind" src="https://images.theconversation.com/files/474375/original/file-20220715-16-4kqicm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/474375/original/file-20220715-16-4kqicm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=742&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474375/original/file-20220715-16-4kqicm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=742&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474375/original/file-20220715-16-4kqicm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=742&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474375/original/file-20220715-16-4kqicm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=932&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474375/original/file-20220715-16-4kqicm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=932&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474375/original/file-20220715-16-4kqicm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=932&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Even before mass deportations to death camps, many thousands of Jews died because of conditions within the Warsaw Ghetto.</span>
<span class="attribution"><span class="source">'Maladie de Famine,' American Joint Distribution Committee</span></span>
</figcaption>
</figure>
<p>When the Nazis designated the district of the Warsaw Ghetto, it enclosed two hospitals, one serving Jewish adults and another for Jewish children. The hospitals were allowed to continue to treat patients with whatever resources they could obtain, but Jews in general were <a href="https://www.archives.gov/publications/prologue/2010/winter/nuremberg.html">forbidden from conducting research</a>. Nevertheless, starting in February 1942, a group of Jewish doctors in the ghetto defied their captors by meticulously and secretly gathering data and observations on multiple biological aspects of starvation.</p>
<p>Then on July 22, 1942, Nazi forces entered the ghetto and destroyed the hospitals and other critical services. Patients and some of the doctors were killed outright or deported to be gassed, their laboratories, samples and some of their research destroyed.</p>
<p>With their own demise approaching, the remaining doctors spent the last nights of their lives meeting secretly in the cemetery buildings, transforming their data into a series of research articles. By October, as they put the finishing touches on the book, about <a href="https://encyclopedia.ushmm.org/content/en/article/deportations-to-and-from-the-warsaw-ghetto">300,000 Jews from the ghetto had already been gassed</a>. The physicians’ own data showed that another 100,000 had been killed through forced starvation and disease.</p>
<p>With final deportations of the few surviving Jews underway and his own death imminent, Milejkowski wrote of the dark, yawning emptiness of the ghetto at that moment, and the horrifying conditions the doctors had labored under to conduct and record the research. </p>
<p>Milejkowski had words for not only the reader, but also his dear colleagues, many of whom had already been executed.</p>
<blockquote>
<p>“What can I tell you, my beloved colleagues and companions in misery. You are a part of all of us. Slavery, hunger, deportation, those death figures in our ghetto were also your legacy. And you, by your work, could give the henchman the answer ‘Non omnis moriar,’ [I shall not wholly die].”</p>
</blockquote>
<p>The team’s act of resistance through science was its way to wring something good out of an evil situation, to show the world the quality of the Jewish doctor, but mostly to defy the Nazis’ intent to erase their existence.</p>
<p>With death knocking on the door, the doctors smuggled their precious research out of the ghetto to a sympathizer who buried it in the cemetery of the Warsaw hospital. Less than a year later, all but a few of the 23 authors were dead.</p>
<p>Immediately after the war, the manuscript was dug up and taken to one of the few surviving authors, Dr. Emil Apfelbaum, and the American Joint Distribution Committee in Warsaw, a charity whose main purpose at the time was to help <a href="https://www.jdc.org/video/75-years-later-remembering-jdcs-role-in-saving-wwii-survivors">Jewish survivors</a>. Together, they made the final edits and printed the six surviving articles, binding them into a book along with photos taken in the ghetto. Apfelbaum died just a couple of months before the final printing, broken by his years in the ghetto.</p>
<p>In 1948 and 1949, the American Joint Distribution Committee disseminated 1,000 copies of the French translation to hospitals, medical schools, libraries and universities across the U.S. It was one humble, crumbling copy of this book that waited to be “rediscovered” about 75 years later in the basement of a Tufts University library.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/474631/original/file-20220718-61161-bd2k07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="black and white photo of an emaciated boy lying on a bed" src="https://images.theconversation.com/files/474631/original/file-20220718-61161-bd2k07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474631/original/file-20220718-61161-bd2k07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=453&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474631/original/file-20220718-61161-bd2k07.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=453&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474631/original/file-20220718-61161-bd2k07.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=453&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474631/original/file-20220718-61161-bd2k07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=569&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474631/original/file-20220718-61161-bd2k07.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=569&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474631/original/file-20220718-61161-bd2k07.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=569&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many of the ghetto’s inhabitants had no other diseases beyond the effects of starvation.</span>
<span class="attribution"><span class="source">'Maladie de Famine,' American Joint Distribution Committee</span></span>
</figcaption>
</figure>
<h2>The book’s grim descriptions</h2>
<p>Based on observations of thousands of deaths from starvation, this research from the Warsaw Ghetto provides insight into the biological progression of starvation that scientists now are just beginning to understand.</p>
<p>For example, many Warsaw Ghetto residents who died of starvation were otherwise free of disease. The ghetto researchers found that while an otherwise healthy body diminished through starvation apparently had a decreased need for vitamins, the need for certain minerals remained. They saw few cases of scurvy (vitamin C deficiency), night blindness (vitamin A deficiency) or rickets (vitamin D deficiency). But they did see significant osteomalacia, a softening of the bones, as the body mined them for their stores of minerals.</p>
<p>When the doctors provided sugar to the severely malnourished, their energy-starved cells quickly absorbed it. This demonstrated that the ability to quickly absorb and use energy remained to the end, suggesting that energy was the single most important factor in starvation, not other micro- or macronutrients.</p>
<p>Each of these observations invites us as scientists to explore further. And with these lessons we can hope to prevent deaths or long-term harm from starvation through better treatment for the severely malnourished.</p>
<p>As scientists studying starvation today, it would be <a href="https://www.ama-assn.org/system/files/2019-01/code-of-medical-ethics-chapter-7.pdf">unthinkable and unethical to starve people</a> to learn how the human body adjusts and changes during the end stages of extreme starvation. Even if researchers go into a famine-stricken population to learn about starvation, they immediately treat the victims, erasing the very object of their research.</p>
<p>Partly as a result of the experience of the Warsaw Ghetto, the Geneva Conventions made <a href="https://ihl-databases.icrc.org/applic/ihl/ihl.nsf/Article.xsp?action=openDocument&documentId=ACF5220D585326BCC12563CD0051E8B6">intentional mass starvation a crime</a>, further strengthened by a U.N. Security Council Resolution <a href="https://www.un.org/press/en/2018/sc13354.doc.htm">as recently as 2018</a>. Nevertheless, this inhumane aspect of war <a href="https://theconversation.com/starving-civilians-is-an-ancient-military-tactic-but-today-its-a-war-crime-in-ukraine-yemen-tigray-and-elsewhere-184297">remains to this day</a>, as evidenced by current events in <a href="https://www.politico.eu/article/the-starvation-of-a-nation-how-putin-is-using-hunger-as-a-weapon-in-ukraine/">Ukraine</a> and <a href="https://www.economist.com/leaders/2021/10/09/ethiopia-is-deliberately-starving-its-own-citizens">Tigray</a>, Ethiopia.</p>
<p>Though “Maladie de Famine” has never been totally lost or forgotten, the lessons from the doctors’ research have faded to semi-obscurity. Eight decades after the destruction that ended their studies, we hope to shine a renewed light on this work and its enduring impact on physicians’ understanding of starvation and how to treat it. The unique data and observations regarding severe starvation that the Warsaw Ghetto doctors, despite their own suffering, presented in this precious book can even now help safeguard others from that same fate.</p>
<hr>
<p><em>The Joint Distribution Committee, which holds the copyright for “Maladie de Famine,” has allowed Tufts University to post a freely accessible <a href="https://dl.tufts.edu/concern/pdfs/h415pr96d">scan of the book</a> online.</em></p><img src="https://counter.theconversation.com/content/182726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
The story behind the research can be as compelling as the results. Recording the effects of starvation, a group of Jewish doctors demonstrated their dedication to science – and their own humanity.
Merry Fitzpatrick, Research Assistant Professor of Nutrition Science and Policy, Tufts University
Irwin Rosenberg, Professor Emeritus of Nutrition and Medicine, Tufts University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/182114
2022-07-13T12:30:09Z
2022-07-13T12:30:09Z
Manuscripts and art support archaeological evidence that syphilis was in Europe long before explorers could have brought it home from the Americas
<figure><img src="https://images.theconversation.com/files/473438/original/file-20220711-26-m03ndy.jpg?ixlib=rb-1.1.0&rect=233%2C137%2C2193%2C1714&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Does a painting from 1400 depict one of Jesus' torturers as suffering from 'saddle nose,' a common effect of syphilis?</span> <span class="attribution"><a class="source" href="https://www.clevelandart.org/art/1945.115">Detail of an Austrian painting c. 1400 of the Passion of Christ, The Cleveland Museum of Art</a></span></figcaption></figure><p>That the arrival of Europeans in the New World in 1492 led to a massive shift in the ecological landscape has been widely accepted <a href="https://www.smithsonianmag.com/history/alfred-w-crosby-on-the-columbian-exchange-98116477/">for the past 50 years</a>. Suddenly a trans-Atlantic exchange – maize for wheat, tomatoes for apples, tobacco for horses – meant that plants and animals were moving between continents for the first time.</p>
<p>It was the same for pathogens, according to historian Alfred W. Crosby and his influential book “<a href="https://www.worldcat.org/title/columbian-exchange-biological-and-cultural-consequences-of-1492/oclc/930378865&referer=brief_results">The Columbian Exchange</a>.” Diseases like smallpox and measles, brought to the Western Hemisphere by the invaders, soon killed <a href="https://theconversation.com/how-smallpox-devastated-the-aztecs-and-helped-spain-conquer-an-american-civilization-500-years-ago-111579">almost the entire Indigenous population</a>. In return, Europeans fell prey to <a href="https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm">syphilis, a venereal disease</a> they picked up from the native people. Crosby’s idea about the exchange of diseases was an interesting one and it made for a good story, suggesting that with the arrival of syphilis in Europe justice of a sort had been done.</p>
<p>The only problem is that this syphilis scenario is wrong, according to <a href="https://doi.org/10.1002/ajpa.23988">ongoing research by paleopathologists</a>, scientists who study skeletal remains for evidence of disease. After decades of painstaking work, they have concluded that the syphilis-causing spirochete bacterium <em>Treponema pallidum</em> already existed in the Old World long before Columbus boarded his ship and sailed to Hispaniola.</p>
<p>As a <a href="https://scholar.google.com/citations?user=K6x0M5sAAAAJ&hl=en&oi=ao">women’s historian</a> who has studied documents and artworks for <a href="https://muse.jhu.edu/article/842358">evidence of syphilis in the medieval period</a>, I believe the paleopathologists are right. Like skeletal remains, paintings show life as it was. Even manuscripts, although more open to interpretation, can reveal the truth once readers open their minds to new possibilities. Here’s a sample of the evidence that <a href="https://www.arc-humanities.org/9781802700480/medieval-syphilis-and-treponemal-disease/">Europeans suffered from syphilis long before they reached the Americas</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="microscopic image of long white worm-like shapes" src="https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473689/original/file-20220712-13-wzc26o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"><em>Treponema pallidum</em> is a spiral-shaped bacterium that causes the disease syphilis.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/treponema-pallidum-dark-field-preparation-syphilis-image-news-photo/509391914">CDC/Susan Lindsley/Smith Collection/Gado via Getty Images</a></span>
</figcaption>
</figure>
<h2>Evidence from bones and teeth in the Old World</h2>
<p>In a cemetery in West Sussex, U.K., archaeologists uncovered the <a href="https://doi.org/10.1002/ajpa.22630">skeleton of a young man</a> with extensive damage to his skull, clavicles, arms and legs – a combination typical of syphilis. He died in the sixth century. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="skull with hole and areas where bone looks rotted away" src="https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=604&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=604&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=604&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=759&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=759&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473456/original/file-20220711-18-t1llj6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=759&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">View of a human skull damaged by late-stage syphilis, the kind of evidence paleopathologists can look for.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Skull_damage_from_neurosyphilis.jpg">Canley/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>In St. Polten, Austria, a medieval cemetery holds the <a href="https://doi.org/10.1127/anthranz/2015/0504">remains of a child</a> age 6 with deformed teeth consistent with a diagnosis of treponematosis, perhaps a case of <a href="https://www.cdc.gov/std/syphilis/stdfact-congenital-syphilis.htm">congenital syphilis</a>, when the <em>Treponema pallidum</em> bacteria are passed from mother to child during pregnancy or birth.</p>
<p>In Anatolia in western Turkey, the <a href="https://doi.org/10.1002/oa.802">skeleton of a teenager</a> revealed not only the same deformed incisors as in St. Polten, but also damage to the entire skeleton below the head. Involvement of both teeth and bones in the same specimen, and especially the large number of bones affected in this case, points to syphilis. The victim died in the 13th century – a couple hundred years before Columbus set sail. </p>
<p>And so it goes. While the absolute number of cases is not large, <a href="https://doi.org/10.1002/ajpa.22630">they keep turning up</a>. Some of the evidence appears in the remains of people who <a href="https://www.worldcat.org/title/origine-de-la-syphilis-en-europe-avant-ou-apres-1493-actes-du-colloque-international-de-toulon-25-28-novembre-1993/oclc/884173338&referer=brief_results">lived more than 2,000 years ago</a>.</p>
<p>There is an outstanding issue, however. Damaged bones and teeth seem to hold proof of pre-Columbian syphilis, but there is a possibility that they point to another form of the disease instead. <em>Treponema pallidum</em> appears in several strains. The subspecies that causes syphilis is the deadliest. But two other subspecies of the bacteria cause less serious, if still painful and unsightly, diseases called <a href="https://rarediseases.org/rare-diseases/bejel/">bejel</a> (also known as endemic syphilis) and <a href="https://www.who.int/news-room/fact-sheets/detail/yaws">yaws</a> that are <a href="https://www.merckmanuals.com/home/infections/bacterial-infections-spirochetes/bejel-yaws-and-pinta">not usually transmitted sexually</a>. Nowadays all three can be treated with antibiotics.</p>
<p>How then, to distinguish between the three subspecies and prove that the venereal form had existed in Europe all along?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="detail of medieval painting of Jesus in crown of thorns amid crowd" src="https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=579&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=579&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473707/original/file-20220712-13-it6ehd.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=579&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In an early 15th-century painting, a discerning historian’s eye sees two soldiers (one in yellow, one behind red plume) with facial features indicative of advanced syphilis leading Christ to his crucifixion.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Master_of_the_Karlsruhe_Passion_-_Disrobing_of_Christ.jpeg">The Disrobing of Christ from the Karlsruhe Passion (detail), c.1440. Staatliche Kunsthalle Karlsruhe, Strasbourg</a></span>
</figcaption>
</figure>
<h2>Writers and artists recorded other evidence</h2>
<p>Documentary and artistic evidence can help settle the issue. Of all the pathogens known to humanity, only treponemes produce <a href="https://doi.org/10.1001/archderm.1970.04000070080012">such widely divergent outcomes based on climate and culture</a>, an important clue for finding evidence in manuscripts.</p>
<p>This fact explains my theory that medieval elites suffered more severely from treponematosis than peasants. Their wealthy lifestyle would have protected them from childhood infections their social inferiors picked up in their crowded and unsanitary households. But those childhood sicknesses would have had the benefit of triggering some future immunity in the peasantry.</p>
<p>If members of the elite reached sexual maturity without having had milder infections while growing up, they would be highly susceptible to contracting the disease for the first time during intercourse. A sore on the genitalia contains a massive dose of infectious bacteria compared with the small doses found on the shared clothing or bedding of the peasantry. Peasants who suffered a recurrence of the disease as adults could likely fend it off successfully because of their prior immunity. I contend this was not true for elites who then suffered more devastating illnesses.</p>
<p>In addition to dying young themselves, infected elites risked giving their children congenital syphilis, which often proved fatal to the next generation. Elites and their children died in such high numbers that some noble families <a href="https://global.oup.com/academic/product/the-crisis-of-the-aristocracy-1558-to-1641-9780198213147">had trouble maintaining their bloodlines</a>, a point noted long ago without making a potential connection to syphilis.</p>
<p>One royal who <a href="https://muse.jhu.edu/article/842358">I believe almost certainly died of syphilis</a> was king Edward IV of England (1442-83). One of his councilors wrote that he died of an illness difficult to cure even in a person of lesser status, a cryptic comment not previously understood by historians. But his statement perfectly fits the difference between venereal and endemic syphilis, evidence that suggests both diseases existed in 15th-century England. The <a href="https://yalebooks.yale.edu/book/9780300073720/edward-iv/">king’s symptoms and reputation for sexual promiscuity</a> help confirm my diagnosis.</p>
<p>Evidence for the presence of syphilis in the Old World also comes from art.</p>
<p>Doctors know that <a href="https://doi.org/10.1001/archderm.1970.04000070080012">syphilis can result in</a> “<a href="https://phil.cdc.gov/Details.aspx?pid=17626">saddle nose</a>,” in which spirochetes invade a patient’s nose and cause it to collapse in a distinctive way. Medieval artists from as early as the 12th century depicted this deformity in their work.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Side view of man with a collapsed nose, paired with medieval painting of Jesus and a persecutor" src="https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=459&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=459&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473690/original/file-20220712-9214-kddbhp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=459&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In a medieval painting, one of Christ’s tormentors has facial features reminiscent of a syphilis patient’s saddle nose.</span>
<span class="attribution"><a class="source" href="https://www.bl.uk/manuscripts/Viewer.aspx?ref=yates_thompson_ms_13_fs001r">L: British Journal of Plastic Surgery, Vol. 10, McLaren + Penney, The reconstruction of the syphilitic saddle nose: A review of seven cases, Pages 236-252, Copyright 1957–1958. R: The Taymouth Hours, England, mid-14th century. British Library, MS Yates Thompson 13, fol. 120v.</a></span>
</figcaption>
</figure>
<p>I believe they intended to show venereal and not endemic disease because they use saddle nose in depictions of sinful figures, including the men who tortured Christ or killed babies on the orders of King Herod.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Front view of man with a collapsed nose, paired with drawing of a monster with a snub-nosed face on a pair of legs" src="https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=367&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=367&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=367&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=461&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=461&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473692/original/file-20220712-31783-6pl4a3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=461&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A gryllus displaying the saddle nose deformity in a drawing from the early 1300s.</span>
<span class="attribution"><a class="source" href="https://www.bl.uk/manuscripts/Viewer.aspx?ref=stowe_ms_17_fs001r">L: British Journal of Plastic Surgery, Vol. 10, McLaren + Penney, The reconstruction of the syphilitic saddle nose: A review of seven cases, Pages 236-252, Copyright 1957–1958. R: The Maastricht Hours, Liège, early 14th century. British Library, MS Stowe 17, fol. 151r.</a></span>
</figcaption>
</figure>
<p>Even the silly gryllus, a medieval monster with a face and legs but no body, was a symbol of human depravity.</p>
<p>Examples abound. Historians have ignored good evidence – as plain as the nose on your face, so to speak – because they believed in the Columbian exchange. Regarding syphilis, however, that intellectual framework now appears outdated.</p><img src="https://counter.theconversation.com/content/182114/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marylynn Salmon does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
The idea that Europeans brought new diseases to the Americas and returned home with others has been widely accepted. But evidence is mounting that for syphilis this scenario is wrong.
Marylynn Salmon, Research Associate in History, Smith College
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/177696
2022-04-01T12:46:13Z
2022-04-01T12:46:13Z
Medieval illustrated manuscripts reveal how upper-class women managed healthy households – overseeing everything from purging, leeching and cupping to picking the right wet nurse
<p>What type of images come to mind when you think of medieval art? Knights and ladies? Biblical scenes? Cathedrals? It’s probably not some unfortunate man in the throes of vomiting. </p>
<p>It might surprise you to learn this scene is found in a luxurious book from the Middle Ages made with the highest-quality materials, including abundant gold leaf. Known as an illustrated manuscript, it was made entirely by hand, as virtually all books were before the <a href="https://www.britannica.com/technology/printing-press">adoption of the printing press</a>. </p>
<p>Why would such an opulent art form depict such a mundane topic?</p>
<p>Scholars believe that around 1256, a French countess commissioned the creation of a health manual to share with her four daughters just as they were forming their own households. Known as the “Régime du corps,” or “regimen of the body,” the book was widely copied and became extremely popular across Europe in the late Middle Ages, specifically between the 13th and 15th centuries. Over 70 unique manuscripts survive today. They offer a window into many aspects of everyday medieval life – from sleeping, bathing and preparing food to <a href="https://www.metmuseum.org/toah/hd/medm/hd_medm.htm">bloodletting, leeching and purging</a>. </p>
<p>I’m an <a href="https://scholar.google.com/citations?user=HypjDKAAAAAJ&hl=en&oi=ao">art historian</a> who recently published a book called “Visualizing Household Health: Medieval Women, Art, and Knowledge in the Régime du corps” <a href="https://www.psupress.org/books/titles/978-0-271-09059-7.html">about these magnificent illustrated copies</a>. What’s fascinating to me about the “Régime du corps” is how it depicts the responsibilities of women in wealthy medieval households – and how domestic management advice was passed down among them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/454256/original/file-20220324-9510-163m7nr.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A painting of two women in medieval dress – one hands a jar to the other." src="https://images.theconversation.com/files/454256/original/file-20220324-9510-163m7nr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454256/original/file-20220324-9510-163m7nr.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=550&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454256/original/file-20220324-9510-163m7nr.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=550&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454256/original/file-20220324-9510-163m7nr.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=550&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454256/original/file-20220324-9510-163m7nr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=691&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454256/original/file-20220324-9510-163m7nr.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=691&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454256/original/file-20220324-9510-163m7nr.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=691&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In a chapter on caring for one’s complexion, two women exchange a remedy. ‘Le Régime du corps,’ circa 1265-70.</span>
<span class="attribution"><span class="source">British Library, MS Sloane 2435. ©The British Library Board.</span></span>
</figcaption>
</figure>
<h2>Glimpsing relationships</h2>
<p>The illustrations, which are usually located at the start of each chapter, convey information not often found in other historical records. Even if the images are idealized, they reveal an extraordinary amount about the clothes, objects and furnishings of the period. They also show interactions among people that reflect the culture and society in which these books were made. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/454234/original/file-20220324-17-fvxoo3.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A painting of two medieval women standing next to eacb other. One woman is reaching out and feeling the other's exposed breast." src="https://images.theconversation.com/files/454234/original/file-20220324-17-fvxoo3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454234/original/file-20220324-17-fvxoo3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=581&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454234/original/file-20220324-17-fvxoo3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=581&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454234/original/file-20220324-17-fvxoo3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=581&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454234/original/file-20220324-17-fvxoo3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=731&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454234/original/file-20220324-17-fvxoo3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=731&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454234/original/file-20220324-17-fvxoo3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=731&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A potential wet nurse is assessed by another woman. ‘Le Régime du corps,’ 14th century.</span>
<span class="attribution"><span class="source">MS Fr. 12323. © Bibliothèque nationale de France.</span></span>
</figcaption>
</figure>
<p>In a scene accompanying the chapter on caring for one’s newborn, two women are depicted opposite each other. Closer inspection shows the well-dressed woman on the right is reaching across and grabbing the exposed breast of the woman in more simple attire. This scene – seemingly one of aggression and violation – depicts the evaluation of a potential wet nurse. </p>
<p>Wet nurses were used throughout the Middle Ages by some elite families who could afford them, but choosing a good wet nurse was critical, loaded with life-and-death implications. Aldobrandino of Siena, the author of the “Régime du corps,” warns that an unhealthy nurse can “kill children straight away,” pointing to very real anxiety around this important decision. The different clothing and headwear communicate each woman’s social status. The elite woman’s gesture also makes clear who has the power in the scene.</p>
<p>Across “Régime du corps” manuscripts, upper-class women are presented with clothing, objects and gestures that convey authority, often in dialogue with those who are shown as laborers of various kinds. Servants within elite households are also illustrated, especially in the chapters about various foods and their health benefits. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/454235/original/file-20220324-21-ssh8vc.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A painting of two women in medieval dress standing next to two large sacks of grain against a blue background." src="https://images.theconversation.com/files/454235/original/file-20220324-21-ssh8vc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454235/original/file-20220324-21-ssh8vc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454235/original/file-20220324-21-ssh8vc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454235/original/file-20220324-21-ssh8vc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454235/original/file-20220324-21-ssh8vc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454235/original/file-20220324-21-ssh8vc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454235/original/file-20220324-21-ssh8vc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Two servants with sacks of grain. The Bute Painter, ‘Le Régime du corps,’ circa 1285.</span>
<span class="attribution"><span class="source">MS Arsenal 2510, © Bibliothèque nationale de France.</span></span>
</figcaption>
</figure>
<p>Both men and women are shown sifting rice, making wine and managing livestock. The manuscripts’ creators chose not only to make such mundane and repetitive work visible but to treat the high-status physician and milkmaid as equally valid subjects for depiction.</p>
<h2>Medieval health maintenance</h2>
<p>In the Middle Ages, the health of family members, from infancy to old age, was maintained through a variety of strategies that aimed for balance in the body. The “Régime du corps” recommended a wide range of treatments, including the release of bodily fluids through purging or bloodletting to maintain such balance.</p>
<p>Cupping, or the placement of heated glass cups onto the skin, was among the procedures overseen by surgeons, because it involved scratching or perforating the skin before applying suction. Across “Régime du corps” manuscripts, it is not uncommon to see physicians and other male practitioners represented, implying that elite households made use of such professionals. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/454237/original/file-20220324-21-1egwztf.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A painting of one woman applying a large jarlike object against the bare back of another woman." src="https://images.theconversation.com/files/454237/original/file-20220324-21-1egwztf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454237/original/file-20220324-21-1egwztf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=624&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454237/original/file-20220324-21-1egwztf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=624&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454237/original/file-20220324-21-1egwztf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=624&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454237/original/file-20220324-21-1egwztf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=784&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454237/original/file-20220324-21-1egwztf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=784&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454237/original/file-20220324-21-1egwztf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=784&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A woman administers cupping treatment. ‘Le Régime du corps,’ circa 1265-70.</span>
<span class="attribution"><span class="source">British Library, MS Sloane 2435. © The British Library Board.</span></span>
</figcaption>
</figure>
<p>But women are also shown administering treatments, including in several cupping scenes. A practitioner’s humble clothing and headdress signal her class as a worker.</p>
<p>Such images show that medieval health care involved many tools – medicine, surgical treatments, food, prayer and charms – and a wide range of individuals offered their services both within and outside of the home. Women sometimes administered such care professionally, but they also did so through oversight of their own households. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/454431/original/file-20220325-29-o7ltx8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An ornate hand lettered book is open showing colorful illustrations painted amid the text, many depicting grain growing." src="https://images.theconversation.com/files/454431/original/file-20220325-29-o7ltx8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454431/original/file-20220325-29-o7ltx8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454431/original/file-20220325-29-o7ltx8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454431/original/file-20220325-29-o7ltx8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454431/original/file-20220325-29-o7ltx8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454431/original/file-20220325-29-o7ltx8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454431/original/file-20220325-29-o7ltx8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A 15th-century copy of the ‘Régime du corps’ open to a section on food.</span>
<span class="attribution"><span class="source">British Library, MS Sloane 2401. © The British Library Board</span></span>
</figcaption>
</figure>
<p>The “Régime du corps” offered owners images that reflected their world – showing women asserting authority over the care of their families, providing treatment and contributing to a well-run household. The elite owners of these exquisite books were also provided with an added benefit: Possession of such manuscripts was undoubtedly a symbol of status and evidence of conspicuous consumption.</p>
<p>[<em>Get the best of The Conversation’s politics, science or religion articles each week.</em><a href="https://memberservices.theconversation.com/newsletters/?source=inline-best">Sign up today</a>.]</p><img src="https://counter.theconversation.com/content/177696/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Borland does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
This illustrated health manual dating back to the 13th century provides a glimpse of daily life in aristocratic households during the Middle Ages.
Jennifer Borland, Professor of Art History, Oklahoma State University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/178463
2022-03-11T13:19:52Z
2022-03-11T13:19:52Z
Guns, not roses – here’s the true story of penicillin’s first patient
<figure><img src="https://images.theconversation.com/files/451134/original/file-20220309-25-206ycs.jpg?ixlib=rb-1.1.0&rect=62%2C209%2C3357%2C2439&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Penicillin ushered in the antibiotics revolution, with amazing results during war and peace.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/in-1928-alexander-fleming-a-scottish-researcher-discovered-news-photo/90736822">Science & Society Picture Library/SSPL via Getty Images</a></span></figcaption></figure><p>Albert Alexander was dying. World War II was raging, and this police officer of the county of Oxford, England, had developed a severe case of sepsis after a cut on his face became badly infected. His blood was now teeming with deadly bacteria. </p>
<p><a href="https://doi.org/10.1136/bmj.289.6460.1721">According to his physician</a>, Charles Fletcher, Alexander was in tremendous pain, “desperately and pathetically ill.” The bacterial infection was eating him alive: He’d already lost one eye and had oozing abscesses all over his face and in his lungs.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man in 1940s police uniform" src="https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=829&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=829&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=829&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1041&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1041&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451124/original/file-20220309-28-1p5rh2n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1041&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Albert Alexander in uniform.</span>
<span class="attribution"><span class="source">Courtesy of Linda Willason</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Since all known treatment options were exhausted and death appeared imminent, Fletcher decided that Alexander was the perfect candidate to try a new, experimental therapy. On Feb. 12, 1941, Alexander became the first known person to be treated with penicillin. Within days he began to make a stunning recovery.</p>
<p>I am a <a href="https://medicine.iu.edu/faculty/13502/sullivan-william">professor of pharmacology</a>, and Alexander’s story is the prelude to my yearly lecture on antibiotics. Like many other microbiology instructors, I’d always told students that Alexander’s septicemia arose after he scratched his cheek on a thorn while pruning rosebushes. This popular account dominates the scientific literature as well as recent articles and books.</p>
<p>The problem is, while descriptions of the miraculous effect of penicillin in this case are accurate, the details of Alexander’s injury were muddled, likely by wartime propaganda.</p>
<h2>Breaking the mold</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man looking into microscope" src="https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=672&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=672&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=672&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=845&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=845&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451136/original/file-20220309-13-5iedmw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=845&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Bacteriologist Alexander Fleming discovered antibiotic penicillin in 1928.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/alexander-fleming-scottish-bacteriologist-18-december-1943-news-photo/102730610">Daily Herald Archive/SSPL via Getty Images</a></span>
</figcaption>
</figure>
<p>The promise of penicillin as an antibiotic was first noted in 1928, when microbiologist Alexander Fleming noticed something funny in his petri dishes at St. Mary’s Hospital in London. Fleming’s cultures of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048009/">staphylococcal bacteria did not grow well</a> on plates contaminated with a penicillium mold. Fleming discovered that the mold’s “juice” was lethal to some types of bacteria. </p>
<p>A decade later, a team of scientists led by Howard Florey at Oxford University began the arduous task of purifying the active substance from the “mold juice” and formally testing its antimicrobial properties. In August 1940, Florey and his colleagues published their striking findings that <a href="https://doi.org/10.1016/S0140-6736(01)08728-1">purified penicillin safely wiped out numerous bacterial infections</a> in mice.</p>
<p>Florey then sought Fletcher’s help to try penicillin in a human patient. That patient would be Alexander, whose death seemed inevitable otherwise. As Fletcher stated, “There was all to gain for him in a trial of penicillin and <a href="https://doi.org/10.1136/bmj.289.6460.1721">nothing to lose</a>.”</p>
<p>At the time, purified penicillin was extremely scarce, since the mold was slow to grow and yielded precious little of the drug. Despite recycling unprocessed penicillin from Alexander’s urine, there just wasn’t enough available to finish off the infection once and for all. After 10 days of improvement, Alexander gradually relapsed. <a href="https://doi.org/10.1136/bmj.289.6460.1721">He died on March 15, 1941</a>, at the age of 43.</p>
<p>Despite the tragic outcome, Alexander’s case turbocharged interest in penicillin research. As Fletcher observed, “There was <a href="https://doi.org/10.1136/bmj.289.6460.1721">no doubt about the temporary clinical improvement</a>, and, most importantly, there had been no sort of toxic effect during the five days of continuous administration of penicillin.”</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/451131/original/file-20220309-20-mcpueg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="magazine ad with drawing of wounded soldier" src="https://images.theconversation.com/files/451131/original/file-20220309-20-mcpueg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451131/original/file-20220309-20-mcpueg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=789&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451131/original/file-20220309-20-mcpueg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=789&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451131/original/file-20220309-20-mcpueg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=789&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451131/original/file-20220309-20-mcpueg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=992&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451131/original/file-20220309-20-mcpueg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=992&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451131/original/file-20220309-20-mcpueg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=992&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An ad promoting penicillin and its role in the war effort.</span>
<span class="attribution"><a class="source" href="https://www.nlm.nih.gov/exhibition/fromdnatobeer/exhibition-making-yellow-magic.html">Schenley Laboratories, Inc. advertisement, 1944</a></span>
</figcaption>
</figure>
<p>Almost exactly a year later, on March 14, 1942, doctors in Connecticut administered the antibiotic to a woman named <a href="https://www.nytimes.com/1999/06/09/us/anne-miller-90-first-patient-who-was-saved-by-penicillin.html">Anne Miller</a> who was deathly ill with streptococcal septicemia. She made a full recovery and became the first patient cured with penicillin. <a href="https://www.washingtonpost.com/history/2020/07/11/penicillin-coronavirus-florey-wwii-infection/">Mass production of penicillin</a> became a top priority of the U.S. War Department, second only to the Manhattan Project. It is widely believed that <a href="https://us.macmillan.com/books/9780805077780/the-mold-in-dr-floreys-coat">penicillin helped the Allies during World War II</a>, preventing wound infections and helping soldiers diagnosed with gonorrhea to return to the battlefield.</p>
<h2>The rosebush tale has been a thorn in their sides</h2>
<p>Albert Alexander has earned a place in history as the first known person to be treated with penicillin for a clinical condition. Almost as famous as his name is the purported cause of death: sepsis due to a scratch from rosebushes.</p>
<p>However, an alternative explanation was revealed in a <a href="https://www.ox.ac.uk/news/science-blog/penicillin-oxford-story">2010 interview with Eric Sidebottom</a>, a historian and author of “<a href="http://www.offoxpress.com/oxford-medicine-a-walk-through-nine-centuries.html">Oxford Medicine: A Walk Through Nine Centuries</a>.” He claimed that Alexander was injured when his police station was hit during a German bombing raid on Nov. 30, 1940. Shrapnel from this attack caused the facial lacerations that led to Alexander’s fatal blood poisoning, he said.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="elderly woman holds up a black and white photo" src="https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=538&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=538&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=538&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=676&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=676&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451127/original/file-20220309-1729-ehbqqf.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=676&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sheila LeBlanc holding photo of her father, Albert Alexander, in 2012.</span>
<span class="attribution"><span class="source">Courtesy of Linda Willason</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Alexander’s daughter, Sheila LeBlanc, who moved to California and became an artist, confirmed Sidebottom’s account in a <a href="https://www.pe.com/2012/11/02/redlands-local-artists-share-childhood-bond/">2012 interview</a> with a local newspaper. She also revealed the grim consequences Alexander’s death had on his family. Since they’d lived in a house provided by the village, for the village constable, his death forced them to move out. LeBlanc, who was seven at the time, and her older brother were sent to an orphanage, since their mother had to find work.</p>
<p>Michael Barrett, a professor of biochemical parasitology at the University of Glasgow, also spoke to LeBlanc about the cause of Alexander’s injury. <a href="https://mosaicscience.com/story/penicillin-first-patient-history-albert-alexander-AMR-DRI/">Writing in 2018, Barrett stated</a> that while LeBlanc recalled that the constable’s house did have a beautiful rose garden, <a href="http://www.fnrcnewbury.org.uk/biography.asp?BiogID=225&PersonID=2467">her father’s fatal cut</a> was sustained during the German blitz.</p>
<p>In February 2022, I contacted Alexander’s granddaughter, Linda Willason, who is also an artist in California, to help set the record straight. Willason validated the shrapnel account and suggested that the rosebush story was “a bit of wartime propaganda.” By downplaying bombing injuries, the government likely hoped to maintain the public’s stiff upper lip.</p>
<p>While the nature of Alexander’s injury may seem a trivial detail, correcting the historical record is important. Alexander died in the line of duty, and the apocryphal rosebush story obscures his honorable actions. His descendants are hopeful the true account of his injury will now eclipse the false one.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="blue plaque with white text on brick wall" src="https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=413&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=413&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=413&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=519&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=519&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450839/original/file-20220309-27-pxnrfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=519&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A plaque dedicated in 2021 shares the real story of Alexander’s injury.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Albert_Alexander_plaque.jpg">Newbury Town Council/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>In 2021, <a href="https://www.bbc.com/news/uk-england-berkshire-57208267">a plaque commemorating Alexander</a> was installed in Newbury that reads: “On war support duty in Southampton on 30th November 1940, Albert was injured in an air raid. Contracting staphylococcal and streptococcal septicaemia, he was transferred to the Radcliffe Infirmary in Oxford, where he was selected for the first clinical application of penicillin. … His place in the history of antibiotics is secure.”</p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-youresmart">You can read us daily by subscribing to our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/178463/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Sullivan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Albert Alexander was the first known person treated with penicillin. While his ultimately fatal case is well known in medical histories, the cause of his illness has been misattributed for decades.
Bill Sullivan, Professor of Pharmacology & Toxicology, Indiana University School of Medicine
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/178473
2022-03-04T13:21:44Z
2022-03-04T13:21:44Z
Women’s History Month: 5 groundbreaking researchers who mapped the ocean floor, tested atomic theories, vanquished malaria and more
<figure><img src="https://images.theconversation.com/files/449925/original/file-20220303-8225-r5fm6i.jpg?ixlib=rb-1.1.0&rect=281%2C74%2C3403%2C2477&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tu Youyou shared the Nobel Prize in Physiology or Medicine in 2015.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/nobel-medicine-prize-2015-co-winner-chinese-youyou-tu-news-photo/500814006">Claudio Bresciani/AFP via Getty Images</a></span></figcaption></figure><p>Behind some of the most fascinating scientific discoveries and innovations are women whose names might not be familiar but whose stories are worth knowing.</p>
<p>Of course, there are far too many to all fit on one list.</p>
<p>But here are five profiles from The Conversation’s archive that highlight the brilliance, grit and unique perspectives of five women who worked in geosciences, math, ornithology, pharmacology and physics during the 20th century.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/349770/original/file-20200727-35-1udrgwj.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C1198%2C883&q=45&auto=format&w=1000&fit=clip"><img alt="Marie Tharp at work drafting a map at her desk" src="https://images.theconversation.com/files/349770/original/file-20200727-35-1udrgwj.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C1198%2C883&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/349770/original/file-20200727-35-1udrgwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=468&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349770/original/file-20200727-35-1udrgwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=468&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349770/original/file-20200727-35-1udrgwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=468&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349770/original/file-20200727-35-1udrgwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=588&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349770/original/file-20200727-35-1udrgwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=588&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349770/original/file-20200727-35-1udrgwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=588&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Marie Tharp with an undersea map at her desk. Rolled sonar profiles of the ocean floor are on the shelf behind her.</span>
<span class="attribution"><a class="source" href="https://www.ldeo.columbia.edu/news-events/join-us-celebrating-marietharp100">Lamont-Doherty Earth Observatory and the estate of Marie Tharp</a></span>
</figcaption>
</figure>
<h2>1. Revealing and mapping the ocean floor</h2>
<p>As late as the 1950s, wrote Wesleyan University <a href="https://scholar.google.com/citations?user=ruUF3z4AAAAJ&hl=en&oi=ao">geoscientist Suzanne OConnell</a>, “many scientists assumed the seabed was featureless.”</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/349741/original/file-20200727-15-69lzu4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="sketches of undersea features based on sonar" src="https://images.theconversation.com/files/349741/original/file-20200727-15-69lzu4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/349741/original/file-20200727-15-69lzu4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=967&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349741/original/file-20200727-15-69lzu4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=967&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349741/original/file-20200727-15-69lzu4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=967&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349741/original/file-20200727-15-69lzu4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1216&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349741/original/file-20200727-15-69lzu4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1216&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349741/original/file-20200727-15-69lzu4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1216&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An illustration of Marie Tharp’s mapping process. (a) Shows the position of two ship tracks (A, B) moving across the surface. (b) Plots depth recordings as profiles. (c) Sketches features shown on the profiles.</span>
<span class="attribution"><a class="source" href="http://mirrorservice.org/sites/gutenberg.org/4/9/0/6/49069/49069-h/49069-h.htm">The Floors of the Ocean, 1959, Fig. 1</a></span>
</figcaption>
</figure>
<p><a href="https://theconversation.com/marie-tharp-pioneered-mapping-the-bottom-of-the-ocean-6-decades-ago-scientists-are-still-learning-about-earths-last-frontier-142451">Enter Marie Tharp</a>. In 1957, she and her research partner started publishing detailed hand-drawn maps of the ocean floor, complete with rugged mountains, valleys and deep trenches. </p>
<p>Tharp was a geologist and oceanographer. Aboard research ships, she would carefully record the depth of the ocean, point by point, using sonar. One of her innovations was to translate this data into topographical sketches of what the seafloor looked like.</p>
<p>Her discovery of a rift valley in the North Atlantic shook the world of geology – her supervisor on the ship dismissed her idea as “girl talk,” and Jacques Cousteau was determined to prove her wrong. But she was right, and her insight was a key contribution to plate tectonic theory. That’s part of why, OConnell writes, “I believe Tharp should be as famous as Jane Goodall or Neil Armstrong.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/marie-tharp-pioneered-mapping-the-bottom-of-the-ocean-6-decades-ago-scientists-are-still-learning-about-earths-last-frontier-142451">Marie Tharp pioneered mapping the bottom of the ocean 6 decades ago – scientists are still learning about Earth's last frontier</a>
</strong>
</em>
</p>
<hr>
<h2>2. Sympathetic observation of bird behavior</h2>
<p>Margaret Morse Nice was a field biologist who <a href="https://theconversation.com/margaret-morse-nice-thought-like-a-song-sparrow-and-changed-how-scientists-understand-animal-behavior-123734">got into the minds of her study subjects</a> to garner new insights into animal behavior. Most famously she observed song sparrows in the 1920s and ‘30s.</p>
<p>Rochester Institute of Technology professor of science, technology and society <a href="https://www.rit.edu/directory/kjwgla-kristoffer-whitney">Kristoffer Whitney</a> recounted what Nice called her “phenomenological method,” acknowledging the obvious “affection and anthropomorphism” you can see in her descriptions. </p>
<p>“When I first studied the Song Sparrows,” Nice wrote, “I had looked upon Song Sparrow 4M as a truculent, meddlesome neighbor; but … I discovered him to be a delightful bird, spirited, an accomplished songster and a devoted father.”</p>
<p>Despite earning no advanced degrees and being considered an amateur, Nice promoted innovations like the “use of colored leg bands to distinguish individual birds,” gained the respect of her better-known peers and enjoyed a long, successful career.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/margaret-morse-nice-thought-like-a-song-sparrow-and-changed-how-scientists-understand-animal-behavior-123734">Margaret Morse Nice thought like a song sparrow and changed how scientists understand animal behavior</a>
</strong>
</em>
</p>
<hr>
<h2>3. A medical researcher in Maoist China</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/449932/original/file-20220303-25-wxv1nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man and woman working at lab bench" src="https://images.theconversation.com/files/449932/original/file-20220303-25-wxv1nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/449932/original/file-20220303-25-wxv1nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=598&fit=crop&dpr=1 600w, https://images.theconversation.com/files/449932/original/file-20220303-25-wxv1nj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=598&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/449932/original/file-20220303-25-wxv1nj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=598&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/449932/original/file-20220303-25-wxv1nj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=751&fit=crop&dpr=1 754w, https://images.theconversation.com/files/449932/original/file-20220303-25-wxv1nj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=751&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/449932/original/file-20220303-25-wxv1nj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=751&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tu Youyou in a pharmacology lab with a colleague in the 1950s.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/oct-5-2015-undated-file-photo-shows-tu-youyou-right-front-a-news-photo/491452698">Xinhua News Agency via Getty Images</a></span>
</figcaption>
</figure>
<p>At the height of China’s Cultural Revolution, a young scientist named Tu Youyou headed a covert operation called Project 523 under military supervision. One of her team’s goals was to identify and systematically test substances used in traditional Chinese medicine in an effort to vanquish chloroquine-resistant malaria. </p>
<p>Emory University <a href="https://scholar.google.com/citations?user=hLDgM4QAAAAJ&hl=en&oi=ao">historian Jia-Chen Fu</a> described how “contrary to popular assumptions that Maoist China was summarily against science and scientists, the <a href="https://theconversation.com/the-secret-maoist-chinese-operation-that-conquered-malaria-and-won-a-nobel-48644">Communist party-state needed the scientific elite</a> for certain political and practical purposes.”</p>
<p>Tu followed a hunch about how to extract an antimalarial compound from the qinghao or artemisia plant. By 1971, her team had successfully “obtained a nontoxic and neutral extract that was called qinghaosu or artemisinin.” In 2015, she was honored with a Nobel Prize.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-secret-maoist-chinese-operation-that-conquered-malaria-and-won-a-nobel-48644">The secret Maoist Chinese operation that conquered malaria – and won a Nobel</a>
</strong>
</em>
</p>
<hr>
<h2>4. A mathematician who wouldn’t be diverted</h2>
<p>Not everyone gets called a “creative mathematical genius” by Albert Einstein. But Emmy Noether did.</p>
<p>Rutgers University <a href="https://sites.math.rutgers.edu/%7Etl548/">mathematician Tamar Lichter Blanks</a> wrote about the <a href="https://theconversation.com/emmy-noether-faced-sexism-and-nazism-100-years-later-her-contributions-to-ring-theory-still-influence-modern-math-163245">roadblocks Noether faced as a Jewish woman</a> who wanted to pursue a math career in early 1900s Germany. For a while, Noether supervised doctoral students without pay and taught university courses listed under the name of a male colleague.</p>
<p>All the while, she conducted her own research in theoretical physics, contributing to Einstein’s theory of relativity. Her most revolutionary work was in ring theory and is still pondered by mathematicians today.</p>
<p>Noether died less than two years after emigrating to the U.S. to escape the Nazis.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/emmy-noether-faced-sexism-and-nazism-over-100-years-later-her-contributions-to-ring-theory-still-influence-modern-math-163245">Emmy Noether faced sexism and Nazism – over 100 years later her contributions to ring theory still influence modern math</a>
</strong>
</em>
</p>
<hr>
<h2>5. Testing nuclear theories one by one</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/383299/original/file-20210209-23-13scq0b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Forever stamp with portrait of Chien-Shiung Wu." src="https://images.theconversation.com/files/383299/original/file-20210209-23-13scq0b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/383299/original/file-20210209-23-13scq0b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=944&fit=crop&dpr=1 600w, https://images.theconversation.com/files/383299/original/file-20210209-23-13scq0b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=944&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/383299/original/file-20210209-23-13scq0b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=944&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/383299/original/file-20210209-23-13scq0b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1187&fit=crop&dpr=1 754w, https://images.theconversation.com/files/383299/original/file-20210209-23-13scq0b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1187&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/383299/original/file-20210209-23-13scq0b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1187&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A 2021 U.S. postage stamp featuring Chien-Shiung Wu.</span>
<span class="attribution"><a class="source" href="https://about.usps.com/newsroom/national-releases/2021/0201ma-nuclear-physicist-chien-shiung-wu-to-be-honored-on-forever-stamp.htm">U.S. Postal Service</a></span>
</figcaption>
</figure>
<p>While sometimes called the “Chinese Marie Curie” in her home country, nuclear physicist Chien-Shiung Wu is less well-known in the U.S., where she did the bulk of her work. Rutgers University-Newark <a href="https://scholar.google.com/citations?user=-x2wJigAAAAJ&hl=en&oi=ao">physicist Xuejian Wu</a> considered Chien-Shiung Wu (no relation) “an icon” who inspired his own career path.</p>
<p>As a grad student, Wu traveled by steamship to California in 1936, where she <a href="https://theconversation.com/new-postage-stamp-honors-chien-shiung-wu-trailblazing-nuclear-physicist-154687">fell in love with atomic nuclei research</a> at UC Berkeley, home of a brand new cyclotron. She worked on the Manhattan Project during World War II.</p>
<p>Among her many accomplishments, Wu’s careful experimental work discovered what’s called parity nonconservation – that is, that a physical process and its mirror reflection are not necessarily identical. Her colleagues who focused on the theoretical side of this breakthrough won the 1957 Nobel Prize in physics, but Wu was overlooked.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-postage-stamp-honors-chien-shiung-wu-trailblazing-nuclear-physicist-154687">New postage stamp honors Chien-Shiung Wu, trailblazing nuclear physicist</a>
</strong>
</em>
</p>
<hr>
<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/178473/count.gif" alt="The Conversation" width="1" height="1" />
Discover the stories of five trailblazing women – Tharp, Nice, Tu, Noether and Wu – who worked in STEM during the 20th century.
Maggie Villiger, Senior Science + Technology Editor
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/175587
2022-01-26T13:26:24Z
2022-01-26T13:26:24Z
When will the COVID-19 pandemic end? 4 essential reads on past pandemics and what the future could bring
<figure><img src="https://images.theconversation.com/files/442590/original/file-20220125-21-10zigar.jpg?ixlib=rb-1.1.0&rect=650%2C42%2C4116%2C3030&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Wishing won't be enough to make the pandemic history.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/woman-wearing-a-face-mask-walks-past-digital-displays-news-photo/1212048671">David Cliff/NurPhoto via Getty Images</a></span></figcaption></figure><p>More than two years after the first cases of COVID-19 were diagnosed, people are exhausted by the coronavirus pandemic, ready for all this to end. When – if ever – is it realistic to expect SARS-CoV-2 will recede from the headlines and daily life?</p>
<p>That’s the unspoken question beneath the surface of many of The Conversation’s articles about COVID-19. None of our authors can see the future, but many do have expertise that offers insights about what’s reasonable to expect. Here are four such stories from our archive. Written by historians and scientists, they each suggest a way to think about what’s at the end of the pandemic tunnel – and paths to get there.</p>
<h2>1. Past pandemics are not a perfect prediction</h2>
<p>Almost as soon as it hit, people were trying to figure out how the COVID-19 pandemic would proceed. It was tempting to look for clues in the course of the 1918 flu pandemic that killed as many as 50 million people worldwide. Could the waves of disease seen in the 1900s provide a road map for what could be expected a century later?</p>
<p>Daily deaths from COVID-19 were declining in the U.S. when historian <a href="https://scholar.google.com/citations?user=41RCe6UAAAAJ&hl=en&oi=ao">Mari Webel</a> and virologist <a href="https://scholar.google.com/citations?user=ubfhdQwAAAAJ&hl=en&oi=ao">Megan Culler Freeman</a> from University of Pittsburgh Health Sciences cautioned against reading too much into how things had gone for people generations ago. </p>
<p>It was so tempting to superimpose a timeline of flu surges on the modern calendar to get even a blurry forecast of what the coronavirus might have in store for us. “Scanning the historical record is one way to draw our own lives into focus and perspective,” wrote Webel and Culler Freeman. “Unfortunately, the end of influenza in summer 1919 <a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">does not portend the end of COVID-19 in the summer of 2020</a>.”</p>
<p>And for reasons ranging from biology to demographics to politics, that is one prediction that most certainly came true.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">Compare the flu pandemic of 1918 and COVID-19 with caution – the past is not a prediction</a>
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</em>
</p>
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<h2>2. Calling it over before it’s really over</h2>
<p>While the 1918 flu pandemic wasn’t an exact template for how the coronavirus would sweep the world, the earlier pandemic provided plenty of parallels when it came to human behavior.</p>
<p>University of Michigan historian <a href="https://scholar.google.com/citations?user=gzhca9MAAAAJ&hl=en&oi=sra">J. Alexander Navarro</a> described how in the early 20th century Americans essentially <a href="https://theconversation.com/people-gave-up-on-flu-pandemic-measures-a-century-ago-when-they-tired-of-them-and-paid-a-price-156551">quit on effective social distancing precautions</a> when they got fed up with living constrained lives. Sound familiar?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="masked clerks at desks in early 20th century" src="https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=451&fit=crop&dpr=1 600w, https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=451&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=451&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=567&fit=crop&dpr=1 754w, https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=567&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=567&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">During the 1918-1920 influenza pandemic, many people eventually tired of taking precautions, like wearing masks.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/women-wear-cloth-surgical-style-masks-to-protect-against-news-photo/515181868">Bettman via Getty Images</a></span>
</figcaption>
</figure>
<p>As case numbers declined, “People clamored to return to their normal lives. Businesses pressed officials to be allowed to reopen,” Navarro wrote. “Believing the pandemic was over, state and local authorities began rescinding public health edicts.”</p>
<p>With the burden of public health resting on individual choices, additional waves of flu crashed over the population. Some amount of wishful thinking, along with a premature return to “normal,” was likely to blame. People’s choices can affect whether an infectious disease outbreak ends or drags on.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/people-gave-up-on-flu-pandemic-measures-a-century-ago-when-they-tired-of-them-and-paid-a-price-156551">People gave up on flu pandemic measures a century ago when they tired of them – and paid a price</a>
</strong>
</em>
</p>
<hr>
<h2>3. Once a virus comes, it never really leaves</h2>
<p>Infectious diseases are as old as humanity. Pointing to examples such as malaria, tuberculosis, leprosy and measles, Rutgers University – Newark historian <a href="https://scholar.google.com/citations?user=dKrEwMkAAAAJ&hl=en&oi=ao">Nükhet Varlik</a> wrote, “Once added to the repertoire of pathogens that affect human societies, <a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066">most infectious diseases are here to stay</a>.” Only smallpox has been completely eradicated, thanks to an intense global vaccination campaign.</p>
<p>Varlik’s own research has focused on plague, a bacterial disease that’s caused at least three pandemics in the past 5,000 years – including the 14th century’s Black Death – along with many more localized outbreaks over the years. Outbreaks wound down based on factors like “changes in temperature, humidity and the availability of hosts, vectors and a sufficient number of susceptible individuals,” Varlik wrote. “Some societies recovered relatively quickly from their losses caused by the Black Death. Others never did.” </p>
<p>The responsible bacterium, <em>Yersinia pestis,</em> is still with us today.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066">How do pandemics end? History suggests diseases fade but are almost never truly gone</a>
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</em>
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<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="socially distanced line waiting at testing site" src="https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=438&fit=crop&dpr=1 754w, https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=438&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=438&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Someday mass testing sites won’t be necessary.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/free-covid-19-testing-site-was-hosted-by-reliant-nhealth-news-photo/1365460079">Brittany Murray/MediaNews Group/Long Beach Press-Telegram via Getty Images</a></span>
</figcaption>
</figure>
<h2>4. The endemic endgame</h2>
<p>A post-pandemic world may still have COVID-19 in it. Many researchers suspect that the SARS-CoV-2 coronavirus will become endemic, meaning it’s always around, with some level of constant ongoing transmission. The viruses that cause the flu and the common cold, for instance, are endemic.</p>
<p><a href="https://scholar.google.com/citations?user=XY7DNtgAAAAJ&hl=en&oi=ao">Sara Sawyer</a>, <a href="https://www.colorado.edu/pac/arturo-barbachano-guerrero">Arturo Barbachano-Guerrero</a> and <a href="https://scholar.google.com/citations?user=l2lpnYkAAAAJ&hl=en&oi=ao">Cody Warren</a>, a team of virologists and immunologists from the University of Colorado Boulder, wrote that SARS-CoV-2 might hit the sweet spot for a virus to become endemic by being just the right degree of transmissible: “Generally speaking, viruses that are highly contagious, meaning that they spread really well from one person to the next, <a href="https://theconversation.com/is-covid-19-here-to-stay-a-team-of-biologists-explains-what-it-means-for-a-virus-to-become-endemic-168462">may never die out on their own</a> because they are so good at finding new people to infect.”</p>
<p>[<em>More than 140,000 readers get one of The Conversation’s informative newsletters.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140K">Join the list today</a>.]</p>
<p>SARS-CoV-2 spreads easily through the air. Even people who aren’t experiencing any symptoms can pass the coronavirus to others. These factors, along with today’s heavily interconnected global society, make it unlikely COVID-19 is going away completely anytime soon.</p>
<p>For now, these scholars write, the best we can likely hope for is stabilized rates of SARS-CoV-2 that settle down into predictable patterns, like flu season. If you want to help hurry things along toward this end stage, do what you can to make yourself an inhospitable host for the coronavirus – most notably, <a href="https://theconversation.com/alpha-then-delta-and-now-omicron-6-questions-answered-as-covid-19-cases-once-again-surge-across-the-globe-174703">keep up to date with recommended COVID-19 vaccinations</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-covid-19-here-to-stay-a-team-of-biologists-explains-what-it-means-for-a-virus-to-become-endemic-168462">Is COVID-19 here to stay? A team of biologists explains what it means for a virus to become endemic</a>
</strong>
</em>
</p>
<hr>
<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/175587/count.gif" alt="The Conversation" width="1" height="1" />
None of our authors can see the future, but many do have expertise that offers insights about what’s reasonable to expect.
Maggie Villiger, Senior Science + Technology Editor
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/168899
2021-10-22T12:39:13Z
2021-10-22T12:39:13Z
Parents were fine with sweeping school vaccination mandates five decades ago – but COVID-19 may be a different story
<figure><img src="https://images.theconversation.com/files/427788/original/file-20211021-14-cn140n.jpg?ixlib=rb-1.1.0&rect=197%2C8%2C2645%2C1814&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children and parents lined up for polio vaccines outside a Syracuse, New York school in 1961.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/LinedUpForPolioVaccine1961/4da7b3b42ecd4a68a089a5985f951f32/photo?Query=school%20vaccine&mediaType=photo&sortBy=arrivaldatetime:asc&dateRange=Anytime&totalCount=1077&currentItemNo=9">AP Photo</a></span></figcaption></figure><p>The ongoing battles over COVID-19 vaccination in the U.S. are likely to get more heated when the Food and Drug Administration authorizes emergency use of a vaccine for children ages 5 to 11, expected later this fall.</p>
<p>California <a href="https://www.gov.ca.gov/2021/10/01/california-becomes-first-state-in-nation-to-announce-covid-19-vaccine-requirements-for-schools/">has announced</a> it will require the vaccine for elementary school attendance once it receives full FDA approval after emergency use authorization, and other states may follow suit. COVID-19 vaccination mandates in workplaces and colleges have sparked controversy, and the possibility that a mandate might extend to younger children is <a href="https://www.kff.org/coronavirus-covid-19/press-release/most-parents-dont-want-their-schools-to-require-covid-19-vaccination-but-most-favor-requiring-masks-for-unvaccinated-children-and-staff/">even more contentious</a>.</p>
<p>Kids are already required to get a host of other vaccines to attend school. School vaccination mandates have been around since the 19th century, and they became a fixture in all 50 states in the 1970s. Vaccine requirements are among the <a href="https://pubmed.ncbi.nlm.nih.gov/12508514/">most effective means of controlling infectious diseases</a>, but they’re currently under attack by small but vocal minorities of parents who consider them unacceptable intrusions on parental rights.</p>
<p>As a public health historian who studies the <a href="https://www.ucpress.edu/book/9780520247499/state-of-immunity">evolution of vaccination policies</a>, I see stark differences between the current debates over COVID-19 vaccination and the public response to previous mandates.</p>
<h2>Compulsory vaccination in the past</h2>
<p>The <a href="https://doi.org/10.1353/bhm.2004.0062">first legal requirements for vaccination</a> date to the early 1800s, when gruesome and deadly diseases routinely terrorized communities. A loose patchwork of local and state laws were enacted to stop epidemics of smallpox, the era’s only vaccine-preventable disease. </p>
<p>Vaccine mandates initially applied to the general population. But in the 1850s, as universal public education became more common, people recognized that schoolhouses were likely sites for the spread of disease. Some states and localities began enacting <a href="https://doi.org/10.1093/jhmas/XXXIII.3.344">laws tying school attendance to vaccination</a>. The smallpox vaccine was crude by today’s standards, and concerns about its safety led to numerous lawsuits over mandates.</p>
<p>The U.S. Supreme Court upheld compulsory vaccination in two decisions. The first, in 1905, <a href="https://supreme.justia.com/cases/federal/us/197/11/">affirmed that mandates are constitutional</a>. The second, in 1922, <a href="https://supreme.justia.com/cases/federal/us/260/174/">specifically upheld school-based requirements</a>. In spite of these rulings, many states lacked a smallpox vaccination law, and some states that did have one failed to enforce it consistently. Few states updated their laws as new vaccines became available.</p>
<p>School vaccination laws underwent a major overhaul beginning in the 1960s, when health officials grew frustrated that <a href="https://doi.org/10.1177/0033354919826558">outbreaks of measles were continuing to occur in schools</a> even though a safe and effective vaccine had recently been licensed.</p>
<p>Many parents mistakenly believed that measles was an annoying but mild disease from which most kids quickly recovered. In fact, it often caused <a href="https://www.cdc.gov/measles/symptoms/complications.html">serious complications</a>, including potentially fatal pneumonia and swelling of the brain.</p>
<p>With encouragement from the Centers for Disease Control and Prevention, all states updated old laws or enacted new ones, which generally covered all seven childhood vaccines that had been developed by that time: diphtheria, pertussis, tetanus, polio, measles, mumps and rubella. In 1968, just half the states <a href="https://www.ucpress.edu/book/9780520247499/state-of-immunity">had school vaccination requirements; by 1981, all states did</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Smiling boy rolls up his sleeve to get a shot from a nurse" src="https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sometimes, students even received vaccinations from nurses at school.</span>
<span class="attribution"><a class="source" href="http://resource.nlm.nih.gov/101447463">NIH U.S. National Library of Medicine</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<h2>Expanding requirements, mid-20th century</h2>
<p>What is most surprising about this major expansion of vaccination mandates is how little controversy it provoked.</p>
<p>The laws did draw scattered court challenges, usually over the question of exemptions – which children, if any, should be allowed to opt out. These lawsuits were often brought by chiropractors and other adherents of alternative medicine. <a href="https://pubmed.ncbi.nlm.nih.gov/15868682/">In most instances, courts turned away these challenges</a>.</p>
<p>There was scant public protest. In contrast to today’s vocal and well-networked anti-vaccination activists, organized resistance to vaccination remained on the fringes in the 1970s, the period when these school vaccine mandates were largely passed. Unlike today, when <a href="https://www.cdc.gov/vaccinesafety/concerns/index.html">fraudulent theories of vaccine-related harm</a> – such as the discredited notion that vaccines cause autism – <a href="https://theconversation.com/anti-vaccination-mothers-have-outsized-voice-on-social-media-pro-vaccination-parents-could-make-a-difference-120572">circulate endlessly on social media</a>, public discussion of the alleged or actual risks of vaccines was largely absent.</p>
<p>Through most of the 20th century, <a href="https://doi.org/10.1353/bhm.2013.0047">parents were less likely to question</a> pediatricians’ recommendations than they are today. In contrast to the empowered “patient/consumer” of today, an attitude of “doctor knows best” prevailed. All these factors contributed to overwhelmingly positive views of vaccination, with more than 90% of parents in a 1978 poll reporting that <a href="https://www.ucpress.edu/book/9780520247499/state-of-immunity">they would vaccinate their children even if</a> there were no law requiring them to do so.</p>
<p>Widespread public support for vaccination enabled the laws to be passed easily – but it took more than placing a law on the books to control disease. Vaccination rates <a href="https://doi.org/10.1177/0033354919826558">continued to lag in the 1970s</a>, not because of opposition, but because of complacency.</p>
<p>Thanks to the success of earlier vaccination programs, most parents of young children lacked firsthand experience with the suffering and death that diseases like polio or whooping cough had caused in previous eras. But public health officials recognized that those diseases were far from eradicated and would continue to threaten children unless higher rates of vaccination were reached. Vaccines were already becoming a victim of their success. The better they worked, the more people thought they were no longer needed.</p>
<p>In response to this lack of urgency, <a href="https://press.uchicago.edu/ucp/books/book/chicago/V/bo14237741.html">the CDC launched a nationwide push in 1977</a> to help states enforce the laws they had recently enacted. Around the country, health officials partnered with school districts to audit student records and provide on-site vaccination programs. When push came to shove, they would exclude unvaccinated children from school until they completed the necessary shots.</p>
<p>The lesson learned was that making a law successful requires ongoing effort and commitment – and continually reminding parents about the value of vaccines in keeping schools and entire communities healthy.</p>
<h2>Add COVID-19 to vaccine list for school?</h2>
<p>Five decades after school mandates became universal in the U.S., <a href="https://www.pewresearch.org/science/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks/">support for them remains strong overall</a>. But misinformation spread over the internet and social media has weakened the public consensus about the value of vaccination that allowed these laws to be enacted.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="adults and kids with signs protesting COVID-19 vaccines" src="https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some anti-vaccination activists are vocal opponents of vaccine mandates for kids.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/with-her-daughter-ella-baindourov-nara-varderesyan-leads-news-photo/1235967787?adppopup=true">Sarah Reingewirtz/MediaNews Group/Los Angeles Daily News via Getty Images</a></span>
</figcaption>
</figure>
<p>COVID-19 vaccination has become politicized in a way that is unprecedented, with sharp partisan divides over whether <a href="https://www.pewresearch.org/fact-tank/2020/07/22/republicans-remain-far-less-likely-than-democrats-to-view-covid-19-as-a-major-threat-to-public-health/">COVID-19 is really a threat</a>, and whether the <a href="https://news.gallup.com/poll/352397/democratic-republican-confidence-science-diverges.aspx">guidance of scientific experts can be trusted</a>. The attention focused on COVID-19 vaccines has given new opportunities for anti-vaccination conspiracy theories to reach wide audiences. </p>
<p>[<em>Over 115,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.] </p>
<p>Fierce opposition to COVID-19 vaccination, powered by <a href="https://www.npr.org/2021/10/17/1046598351/the-political-fight-over-vaccine-mandates-deepens-despite-their-effectiveness">anti-government sentiment and misguided notions of freedom</a>, could undermine support for time-tested school requirements that have protected communities for decades. Although vaccinating school-aged children will be critical to controlling COVID-19, lawmakers will need to proceed with caution.</p><img src="https://counter.theconversation.com/content/168899/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Colgrove has received funding from the National Library of Medicine, the Greenwall Foundation, the Milbank Memorial Fund, and the William T. Grant Foundation. </span></em></p>
Public health experts know that schools are likely sites for the spread of disease, and laws tying school attendance to vaccination go back to the 1800s.
James Colgrove, Professor of Sociomedical Sciences, Mailman School of Public Health; Dean of the Postbaccalaureate Premedical Program, Columbia School of General Studies, Columbia University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/149907
2021-09-30T12:29:56Z
2021-09-30T12:29:56Z
50 years ago, the first CT scan let doctors see inside a living skull – thanks to an eccentric engineer at the Beatles’ record company
<figure><img src="https://images.theconversation.com/files/423940/original/file-20210929-26-mhu7qn.jpg?ixlib=rb-1.1.0&rect=55%2C0%2C4034%2C2996&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Godfrey Hounsfield stands beside the EMI-Scanner in 1972.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-25-000-macrobert-award-and-gold-medal-were-presented-by-news-photo/828266748"> PA Images via Getty Images</a></span></figcaption></figure><p>The possibility of precious objects hidden in secret chambers can really ignite the imagination. In the mid-1960s, <a href="https://doi.org/10.4103/0972-2327.194414">British engineer Godfrey Hounsfield</a> pondered whether one could detect hidden areas in Egyptian pyramids by capturing cosmic rays that passed through unseen voids.</p>
<p>He held onto this idea over the years, which can be paraphrased as “<a href="https://birorgukportal.force.com/CPBase__item?id=a0j20000006wvWqAAI">looking inside a box without opening it</a>.” Ultimately he did figure how to use high-energy rays to reveal what’s invisible to the naked eye. He invented a way to see inside the hard skull and get a picture of the soft brain inside.</p>
<p>The first computed tomography image – a CT scan – of the human brain was made 50 years ago, on Oct. 1, 1971. Hounsfield never made it to Egypt, but his invention did take him to Stockholm and Buckingham Palace.</p>
<h2>An engineer’s innovation</h2>
<p>Godfrey Hounsfield’s early life did not suggest that he would accomplish much at all. He was not a particularly good student. As a young boy his teachers <a href="https://www.worldcat.org/title/godfrey-hounsfield-intuitive-genius-of-ct/oclc/823708300&referer=brief_results">described him as “thick</a>.”</p>
<p>He joined the British Royal Air Force at the start of the Second World War, but he wasn’t much of a soldier. He was, however, a wizard with electrical machinery – especially the <a href="https://www.iwm.org.uk/history/how-radar-changed-the-second-world-war">newly invented radar</a> that he would jury-rig to help pilots better find their way home on dark, cloudy nights.</p>
<p>After the war, Hounsfield followed his commander’s advice and got a degree in engineering. He practiced his trade at EMI – the company would become <a href="https://doi.org/10.1097/RCT.0b013e318249416f">better known for selling Beatles albums</a>, but started out as Electric and Music Industries, with a focus on electronics and electrical engineering.</p>
<p>Hounsfield’s natural talents propelled him to lead the team building the most advanced mainframe computer available in Britain. But by the ‘60s, EMI wanted out of the competitive computer market and wasn’t sure what to do with the brilliant, eccentric engineer.</p>
<p>While on a forced holiday to ponder his future and what he might do for the company, Hounsfield met a physician who complained about the poor quality of X-rays of the brain. <a href="https://www.medmuseum.siemens-healthineers.com/en/stories-from-the-museum/our-brain?">Plain X-rays show marvelous details of bones</a>, but the brain is an amorphous blob of tissue – on an X-ray it all looks like fog. This got Hounsfield thinking about his old idea of finding hidden structures without opening the box.</p>
<h2>A new approach reveals the previously unseen</h2>
<p>Hounsfield formulated a new way to approach the problem of imaging what’s inside the skull.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="schematic of three X-ray beams through one 'slice' of brain" src="https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=567&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=567&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=567&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=712&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=712&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423821/original/file-20210929-18-8ywyce.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=712&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">X-rays beam through each ‘slice’ of brain, oriented at each degree from 1 to 180 in a semicircle.</span>
<span class="attribution"><span class="source">Edmund S. Higgins</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>First, he would conceptually <a href="https://doi.org/10.1259/0007-1285-46-552-1016">divide the brain into consecutive slices</a> – like a loaf of bread. Then he planned to beam a series of X-rays through each layer, repeating this for each degree of a half-circle. The strength of each beam would be captured on the opposite side of the brain – with stronger beams indicating they’d traveled through less dense material.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="simplified illustration of more X-rays making it through softer material" src="https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=458&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=458&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423822/original/file-20210929-24-lb50bz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=458&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Calculating the strength of each X-ray once it’s passed through the object, and working backward with an impressive algorithm, it is possible to construct an image.</span>
<span class="attribution"><span class="source">Edmund S. Higgins</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Finally, in possibly his most ingenious invention, Hounsfield created an algorithm to reconstruct an image of the brain based on all these layers. By working backward and using one of the era’s fastest new computers, he could calculate the value for each little box of each brain layer. Eureka!</p>
<p>But there was a problem: EMI wasn’t involved in the medical market and had no desire to jump in. The company allowed Hounsfield to work on his product, but with scant funding. He was forced to scrounge through the scrap bin of the research facilities and cobbled together a primitive scanning machine - small enough to rest atop a dining table.</p>
<p>Even with <a href="https://doi.org/10.1259/0007-1285-49-583-604">successful scans of inanimate objects</a> and, later, <a href="https://www.jweekly.com/1997/04/25/kosher-cow-brains-help-pioneer-ct-scan-technology/">kosher cow brains</a>, the powers that be at EMI remained underwhelmed. Hounsfield needed to find outside funding if he wanted to proceed with a human scanner. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="line drawing of CT scanner" src="https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=786&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=786&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=786&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=988&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=988&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423636/original/file-20210928-14-96ensy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=988&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Schematic diagram of the CT scanner included in Hounsfield’s U.S. patent.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:CT_US4115698_Fig1.jpg">Godfrey Newbold Hounsfield</a></span>
</figcaption>
</figure>
<p>Hounsfield was a brilliant, intuitive inventor, but not an effective communicator. Luckily he had a sympathetic boss, Bill Ingham, who saw the value in Hounsfield’s proposal and struggled with EMI to keep the project afloat. </p>
<p>He knew there were no grants they could obtain quickly, but reasoned the U.K. Department of Health and Social Security could purchase equipment for hospitals. Miraculously, Ingham sold them four scanners before they were even built. So, Hounsfield organized a team, and they raced to build a safe and effective human scanner. </p>
<p>Meanwhile, Hounsfield needed patients to try out his machine on. He found a somewhat reluctant neurologist who agreed to help. The team installed a full-sized scanner at the <a href="http://www.impactscan.org/CThistory.htm?">Atkinson Morley Hospital in London</a>, and on Oct. 1, 1971, they scanned their first patient: a middle-aged woman who showed signs of a brain tumor.</p>
<p><a href="https://doi.org/10.1259/bjr/29444122">It was not a fast process</a> – 30 minutes for the scan, a drive across town with the magnetic tapes, 2.5 hours processing the data on an EMI mainframe computer and capturing the image with a Polaroid camera before racing back to the hospital.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="pixelated image of a brain" src="https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=530&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=530&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=530&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=665&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=665&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423942/original/file-20210929-64926-b3svf8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=665&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The first clinical CT scan, with brain tumor visible as darker blob.</span>
<span class="attribution"><a class="source" href="https://www.ncbi.nlm.nih.gov/books/NBK546157/figure/ch8.fig2/">'Medical Imaging Systems: An Introductory Guide,' Maier A, Steidl S, Christlein V, et al., editors.</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>And there it was – in her left frontal lobe – a cystic mass about the size of a plum. With that, every other method of imaging the brain was obsolete.</p>
<h2>Millions of CT scans every year</h2>
<p>EMI, with no experience in the medical market, suddenly held a monopoly for a machine in high demand. It jumped into production and was initially very successful at selling the scanners. But within five years, bigger, more experienced companies with more research capacity such as GE and Siemens were producing better scanners and gobbling up sales. EMI eventually exited the medical market – and <a href="https://www.blackwellpublishing.com/content/GrantContemporaryStrategyAnalysis/docs/Grant_Cases_Guide_Chapter_10.pdf">became a case study</a> in why it can be better to partner with one of the big guys instead of trying to go it alone.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hounsfield in tuxedo shaking hands with King facing away from camera" src="https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=641&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=641&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=641&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=805&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=805&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423941/original/file-20210929-66198-1pskqvw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=805&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">King Carl Gustaf awards the Nobel Prize to Hounsfield in Stockholm on Dec. 11, 1979.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/british-scientist-sir-godfrey-hounsfield-joint-nobel-news-photo/51867039">Keystone/Hulton Archive via Getty Images</a></span>
</figcaption>
</figure>
<p>Hounsfield’s innovation transformed medicine. He <a href="https://www.nobelprize.org/prizes/medicine/1979/press-release/">shared the Nobel Prize</a> for Physiology or Medicine in 1979 and was knighted by the Queen in 1981. He continued to putter around with inventions until his final days in 2004, when he died at 84. </p>
<p>In 1973, American <a href="https://doi.org/10.1197/jamia.M2127">Robert Ledley</a> developed <a href="https://doi.org/10.1126/science.186.4160.207">a whole-body scanner</a> that could image other organs, blood vessels and, of course, bones. Modern scanners are faster, provide better resolution, and most important, do it with less radiation exposure. There are even mobile scanners.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423640/original/file-20210928-26-3rul6h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Modern CT scans provide much higher resolution images of the ‘slices’ of the brain than Hounsfield’s original scan did in 1971.</span>
</figcaption>
</figure>
<p>By 2020, technicians were performing <a href="https://www.sciencedaily.com/releases/2020/07/200723115909.htm">more than 80 million scans annually in the U.S.</a>. Some physicians argue that number is excessive and maybe a third are unnecessary. While that may be true, the CT scan has <a href="https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/computed-tomography-ct">benefited the health</a> of many patients around the world, helping identify tumors and determine if surgery is needed. They’re particularly useful for a quick search for internal injuries after accidents in the ER.</p>
<p>And remember Hounsfield’s idea about the pyramids? In 1970 scientists placed <a href="https://en.wikipedia.org/wiki/Cosmic-ray_observatory">cosmic ray detectors</a> in the lowest chamber in the Pyramid of Khafre. They concluded that <a href="https://doi.org/10.1126/science.167.3919.832">no hidden chamber was present within the pyramid</a>. In 2017, another team placed cosmic ray detectors in the Great Pyramid of Giza and <a href="https://doi.org/10.1038/nature.2017.22939">found a hidden, but inaccessible, chamber</a>. It’s unlikely it will be explored anytime soon. </p>
<p><em>This article has been updated to correct the spelling of the name of Hounsfield’s boss at EMI, Bill Ingham.</em></p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/149907/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edmund S. Higgins does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
On Oct. 1, 1971, Godfrey Hounsfield’s invention took its first pictures of a human brain, using X-rays and an ingenious algorithm to identify a woman’s tumor from outside of her skull.
Edmund S. Higgins, Affiliate Associate Professor of Psychiatry & Family Medicine, Medical University of South Carolina
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/162743
2021-07-21T12:16:19Z
2021-07-21T12:16:19Z
Insulin was discovered 100 years ago – but it took a lot more than one scientific breakthrough to get a diabetes treatment to patients
<figure><img src="https://images.theconversation.com/files/412304/original/file-20210720-15-sb91vs.jpg?ixlib=rb-1.1.0&rect=0%2C91%2C2902%2C2241&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A single brilliant insight is only part of the story of how diabetes became a manageable disease.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/diabetic-girl-injecting-her-arm-with-insulin-news-photo/3324678">Douglas Grundy/Three Lions via Getty Images</a></span></figcaption></figure><p>Diabetes was a fatal disease before insulin was discovered on July 27, 1921. A century ago, people diagnosed with this <a href="https://www.niddk.nih.gov/-/media/Files/Strategic-Plans/Diabetes-in-America-2nd-Edition/chapter10.pdf">metabolic disorder usually survived only a few years</a>. Physicians had no way to treat their diabetic patients’ dangerously high blood sugar levels, which were due to a lack of the hormone insulin. Today, though, nearly <a href="https://www.diabetes.org/resources/statistics/statistics-about-diabetes">1.6 million</a> Americans are living normal lives with Type 1 diabetes thanks to the discovery of insulin.</p>
<p>This medical breakthrough is usually attributed to one person, Frederick Banting, who was searching for a cure for diabetes. But getting a reliable diabetes treatment depended on the research of two other scientists, Oskar Minkowski and Søren Sørensen, who had done earlier research on seemingly unrelated topics. </p>
<p><a href="https://scholar.google.com/citations?user=Itgu0QwAAAAJ&hl=en&oi=ao">I’m a biomedical engineer</a>, and I teach a course on the history of the treatment of diabetes. With my students, I emphasize the importance of unrelated basic research in the development of medical treatments. The story of insulin illustrates the point that medical innovations build on a foundation of basic science and then require skilled engineers to get a treatment out of the lab and to the people who need it.</p>
<h2>Basic research pointed to the pancreas</h2>
<p><a href="https://doi.org/10.4239/wjd.v7.i1.1">Diabetes had been known since antiquity</a>. The first symptoms were often a prodigious thirst and urination. Within weeks the patient would be losing weight. Within months, the patient would enter a coma, then die. For centuries, no one had any clue about what caused diabetes.</p>
<p>People had, though, been aware of the pancreas for centuries. The <a href="https://doi.org/10.1016/0002-9610(83)90286-6">Greek anatomist Herophilos</a> first described it around 300 B.C. Based on its anatomical location, people suspected it was involved in the digestive system. But no one knew whether the pancreas was an essential organ, like the stomach, or extraneous, like the appendix.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/412040/original/file-20210720-25-1i67eeo.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Portrait of a bearded man with glasses" src="https://images.theconversation.com/files/412040/original/file-20210720-25-1i67eeo.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/412040/original/file-20210720-25-1i67eeo.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=855&fit=crop&dpr=1 600w, https://images.theconversation.com/files/412040/original/file-20210720-25-1i67eeo.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=855&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/412040/original/file-20210720-25-1i67eeo.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=855&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/412040/original/file-20210720-25-1i67eeo.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1075&fit=crop&dpr=1 754w, https://images.theconversation.com/files/412040/original/file-20210720-25-1i67eeo.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1075&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/412040/original/file-20210720-25-1i67eeo.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1075&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Oskar Minkowski discovered the pancreatic origin of diabetes almost by accident.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Minkowski.JPG">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>In 1889, <a href="https://doi.org/10.1007/BF00271257">Oskar Minkowski</a>, a pathologist at the University of Strassburg, in what was then Germany, was one of the most talented surgeons of his time. As part of a study, he performed a surgical feat that was thought to be impossible: keeping an animal alive after totally removing its pancreas.</p>
<p>The dog he operated on survived the surgery, but to Minkowski’s surprise, it began exhibiting all the symptoms of diabetes. Minkowski had discovered that removing the pancreas caused diabetes. Today, this is known as an animal model of the disease. Once an animal model of a disease is established, researchers can experiment with different cures in the animal in hopes they’ll find something that will then work in people.</p>
<p>Can you grind up a pancreas and feed it to a diabetic animal to cure or alleviate the symptoms of diabetes? No, that didn’t work. The problem, understood in today’s terms, is that the pancreas has two functions: producing enzymes for the digestive system and producing insulin. Mixed together, the digestive enzymes destroyed the insulin.</p>
<h2>Isolating the insulin</h2>
<p>In 1920, Fred Banting, a small-town doctor in London, Ontario, had an idea. He thought that he could surgically tie off the ducts between the pancreas and the digestive system in an animal. Wait for a few weeks, while the part of the pancreas that produces those digestive enzymes decays, then remove the pancreas completely. This decayed pancreas, he thought, would contain the insulin, but not the destructive enzymes.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/412303/original/file-20210720-27-tr5jkz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="two men in early 20th C clothes standing with a dog between them" src="https://images.theconversation.com/files/412303/original/file-20210720-27-tr5jkz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/412303/original/file-20210720-27-tr5jkz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=816&fit=crop&dpr=1 600w, https://images.theconversation.com/files/412303/original/file-20210720-27-tr5jkz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=816&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/412303/original/file-20210720-27-tr5jkz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=816&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/412303/original/file-20210720-27-tr5jkz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1025&fit=crop&dpr=1 754w, https://images.theconversation.com/files/412303/original/file-20210720-27-tr5jkz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1025&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/412303/original/file-20210720-27-tr5jkz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1025&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Charles Best (left) and Frederick Banting with one of the first dogs to be kept alive with insulin.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/discoverers-of-insulin-charles-best-and-frederick-banting-news-photo/2667496">Hulton Archive via Getty Images</a></span>
</figcaption>
</figure>
<p>On July 27, 1921, he concluded this experiment <a href="https://insulin.library.utoronto.ca/">in the laboratory of J.J.R. Macleod</a> at the University of Toronto. Banting, working with a Toronto student named Charles Best, prepared an extract from the atrophied pancreas of a dog. Then he injected the extract into another dog that had induced diabetes, due to the removal of its pancreas. The animal’s diabetes symptoms began to disappear.</p>
<p>Although Banting’s experiment was successful, his method of insulin purification was impractical. J.J.R. Macleod assigned the biochemist James Collip the task of coming up with a practical method of purifying insulin from a pancreas.</p>
<p>Collip developed a method based on alcohol purification. The concept was simple: He’d mash up a fresh pig pancreas, readily available from butcher shops, and mix it into a solution of alcohol and water. Collip slowly increased the percentage of alcohol in the solution. He found that the insulin would stay dissolved in the solution until he reached a critical concentration of alcohol, then it would suddenly fall out of solution, no longer dissolved in the liquid. By collecting that solid precipitate at the bottom of a flask, he had a purified form of insulin.</p>
<p>Collip’s extraction of insulin allowed Banting and others at the University of Toronto Hospital to <a href="https://insulin100.utoronto.ca/">begin treating patients</a>. The first injections took place in January 1922. Within weeks, the results were miraculous. These injections of insulin helped dozens of patients who were close to dying regain normal activities. Word spread. Demand for insulin increased.</p>
<h2>Insight from a brewery</h2>
<p>But disaster struck when Collip failed to purify larger batches of insulin. He was puzzled why, following the exact same recipe as he’d used before, his preparations lacked insulin. J.J.R. Macleod now turned to Eli Lilly and Company, a commercial firm in Indiana that made medicinal capsules, for help.</p>
<p>At Eli Lilly, <a href="https://doi.org/10.1093/clinchem/48.12.2270">the purification problem fell to George Walden</a>, a 27-year-old chemist. Walden thought of a measure that Danish chemist <a href="https://doi.org/10.1038/143629a0">Søren Sørensen</a> had introduced a dozen years before. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/412305/original/file-20210720-19-ejtxrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="beer with analysis tools at a brewery" src="https://images.theconversation.com/files/412305/original/file-20210720-19-ejtxrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/412305/original/file-20210720-19-ejtxrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/412305/original/file-20210720-19-ejtxrh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/412305/original/file-20210720-19-ejtxrh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/412305/original/file-20210720-19-ejtxrh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/412305/original/file-20210720-19-ejtxrh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/412305/original/file-20210720-19-ejtxrh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The equipment has changed, but breweries still monitor the pH of their beers.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/still-life-analyze-still-life-beer-brewery-analysis-ph-news-photo/883613366">Stanzel\ullstein bild via Getty Images</a></span>
</figcaption>
</figure>
<p>Sørensen was the director in the early 1900s of the Carlsberg Laboratory, set up by the beer company to advance the science of brewing. He introduced the concept of pH as a way to quantify the acidity of a solution. A higher pH during the brewing stage leads to a more bitter-tasting beer.</p>
<p>When Walden measured the pH of the pancreas solution, he discovered that the acidity was far more important to the solubility of insulin than the alcohol concentration. He set up a purification procedure like Collip’s but based on pH rather than alcohol concentration. Collip’s failure to scale up purification of insulin was probably because he neglected to control the pH of the solution carefully.</p>
<p>This insight allowed for mass production of insulin.</p>
<h2>Vanquishing a human disease</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/412306/original/file-20210720-23-181jgrc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="ampules of commercial insulin from the 1920s" src="https://images.theconversation.com/files/412306/original/file-20210720-23-181jgrc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/412306/original/file-20210720-23-181jgrc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=652&fit=crop&dpr=1 600w, https://images.theconversation.com/files/412306/original/file-20210720-23-181jgrc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=652&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/412306/original/file-20210720-23-181jgrc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=652&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/412306/original/file-20210720-23-181jgrc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=820&fit=crop&dpr=1 754w, https://images.theconversation.com/files/412306/original/file-20210720-23-181jgrc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=820&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/412306/original/file-20210720-23-181jgrc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=820&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Insulin samples from the 1920s.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/still-life-analyze-still-life-beer-brewery-analysis-ph-news-photo/883613366">Science & Society Picture Library via Getty Images</a></span>
</figcaption>
</figure>
<p>By May 1924, diabetes was no longer a fatal disease. Physician Joseph Collins, writing in The New York Times, described it this way: “One by one the implacable enemies of man, the diseases which seek his destruction, are overcome by Science. <a href="https://www.nytimes.com/1923/05/06/archives/diabetes-dreaded-disease-yields-to-new-gland-cure-previous-claims.html">Diabetes, one of the most dreaded, is the latest to succumb</a>.”</p>
<p>Today, the implacable enemies of man include cancer, Alzheimer’s disease and schizophrenia. The cures for each will likely be built from advances made by basic research.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>]</p><img src="https://counter.theconversation.com/content/162743/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James P. Brody has in the past received funding from the National Science Foundation, the National Institutes of Health and the US Department of Defense.</span></em></p>
A biomedical engineer explains the basic research that led to the discovery of insulin and its transformation into a lifesaving treatment for millions of people with diabetes.
James P. Brody, Professor of Biomedical Engineering, University of California, Irvine
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/161569
2021-07-01T12:15:51Z
2021-07-01T12:15:51Z
Benjamin Franklin’s fight against a deadly virus: Colonial America was divided over smallpox inoculation, but he championed science to skeptics
<figure><img src="https://images.theconversation.com/files/409191/original/file-20210630-21-sgosjo.jpg?ixlib=rb-1.1.0&rect=0%2C551%2C4653%2C3592&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As a printer's apprentice in 1721, Franklin had a front-row seat to the controversy around a new prevention technique.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/1700s-1721-benjamin-franklin-age-15-in-his-brothers-news-photo/658540811">ClassicStock/Archive Photos via Getty Images</a></span></figcaption></figure><p>Exactly 300 years ago, in 1721, Benjamin Franklin and his fellow American colonists <a href="https://sitn.hms.harvard.edu/flash/special-edition-on-infectious-disease/2014/the-fight-over-inoculation-during-the-1721-boston-smallpox-epidemic/">faced a deadly smallpox outbreak</a>. Their varying responses constitute an eerily prescient object lesson for today’s world, similarly devastated by a virus and divided over vaccination three centuries later.</p>
<p>As <a href="https://scholar.google.com/citations?user=Xy_EasYAAAAJ&hl=en&oi=ao">a microbiologist</a> and <a href="https://scholar.google.com/citations?user=QrpiSzEAAAAJ&hl=en">a Franklin scholar</a>, we see some parallels between then and now that could help governments, journalists and the rest of us cope with the coronavirus pandemic and future threats.</p>
<h2>Smallpox strikes Boston</h2>
<p>Smallpox was nothing new in 1721. Known to have affected people for <a href="https://www.cdc.gov/smallpox/history/history.html">at least 3,000 years</a>, it ran rampant in Boston, eventually striking <a href="https://sitn.hms.harvard.edu/flash/special-edition-on-infectious-disease/2014/the-fight-over-inoculation-during-the-1721-boston-smallpox-epidemic/">more than half the city’s population</a>. The virus killed about <a href="https://doi.org/10.1056/NEJM192108251850802">1 in 13 residents</a> – but the death toll was probably more, since the lack of sophisticated epidemiology made it impossible to identify the cause of all deaths.</p>
<p>What was new, at least to Boston, was a simple procedure that could protect people from the disease. It was known as “variolation” or “inoculation,” and involved deliberately exposing someone to the smallpox “matter” from a victim’s scabs or pus, injecting the material into the skin using a needle. This approach typically caused a mild disease and induced a state of “immunity” against smallpox.</p>
<p>Even today, the exact mechanism is <a href="https://apps.who.int/iris/handle/10665/39485">poorly understood</a> and not much research on variolation has been done. Inoculation through the skin seems to activate an immune response that leads to milder symptoms and less transmission, possibly because of the route of infection and the lower dose. Since it relies on activating the immune response with live smallpox variola virus, inoculation is different from the modern vaccination that <a href="https://theconversation.com/a-massive-public-health-effort-eradicated-smallpox-but-scientists-are-still-studying-the-deadly-virus-139468">eradicated smallpox</a> using the much less harmful but related vaccinia virus.</p>
<p>The inoculation treatment, which originated in Asia and Africa, came to be known in Boston <a href="https://doi.org/10.1258/jrsm.2012.12k044">thanks to a man named Onesimus</a>. By 1721, <a href="https://www.americanantiquarian.org/proceedings/48057585.pdf">Onesimus was enslaved</a>, owned by the most influential man in all of Boston, the Rev. Cotton Mather.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/409192/original/file-20210630-21-ix8xvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="etching of an 18th century man in white wig" src="https://images.theconversation.com/files/409192/original/file-20210630-21-ix8xvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/409192/original/file-20210630-21-ix8xvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=770&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409192/original/file-20210630-21-ix8xvo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=770&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409192/original/file-20210630-21-ix8xvo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=770&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409192/original/file-20210630-21-ix8xvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=968&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409192/original/file-20210630-21-ix8xvo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=968&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409192/original/file-20210630-21-ix8xvo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=968&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cotton Mather heard about variolation from an enslaved West African man in his household named Onesimus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-engraved-portrait-of-cotton-mather-a-boston-news-photo/517387846?adppopup=true">Bettman via Getty Images</a></span>
</figcaption>
</figure>
<p>Known primarily as a Congregational minister, <a href="https://www.britannica.com/biography/Cotton-Mather">Mather was also a scientist</a> with a special interest in biology. He paid attention when <a href="https://doi.org/10.1258/jrsm.2012.12k044">Onesimus told him</a> “he had undergone an operation, which had given him something of the smallpox and would forever preserve him from it; adding that it was often used” in West Africa, where he was from.</p>
<p>Inspired by this information from Onesimus, Mather teamed up with a Boston physician, <a href="https://www.britannica.com/biography/Zabdiel-Boylston">Zabdiel Boylston</a>, to conduct a scientific study of inoculation’s effectiveness worthy of 21st-century praise. They found that of the approximately 300 people Boylston had inoculated, <a href="http://dx.doi.org/10.1136/qshc.2003.008797">2% had died</a>, compared with almost 15% of those who contracted smallpox from nature.</p>
<p>The findings seemed clear: Inoculation could help in the fight against smallpox. Science won out in this clergyman’s mind. But others were not convinced.</p>
<h2>Stirring up controversy</h2>
<p>A local newspaper editor named James Franklin had his own affliction – namely an insatiable hunger for controversy. Franklin, who was no fan of Mather, set about attacking inoculation in his newspaper, The New-England Courant.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/409174/original/file-20210630-21151-1xbbyj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="frontpage of a 1721 newspaper" src="https://images.theconversation.com/files/409174/original/file-20210630-21151-1xbbyj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/409174/original/file-20210630-21151-1xbbyj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=863&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409174/original/file-20210630-21151-1xbbyj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=863&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409174/original/file-20210630-21151-1xbbyj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=863&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409174/original/file-20210630-21151-1xbbyj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1085&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409174/original/file-20210630-21151-1xbbyj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1085&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409174/original/file-20210630-21151-1xbbyj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1085&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">From its first edition, The New-England Courant covered inoculation.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:NewEnglandCourant_00001.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>One article from August 1721 tried to guilt readers into resisting inoculation. If someone gets inoculated and then spreads the disease to someone else, who in turn dies of it, <a href="https://nationalhumanitiescenter.org/pds/becomingamer/ideas/text7/smallpoxinoculation.pdf">the article asked</a>, “at whose hands shall their Blood be required?” The same article went on to say that “Epidemeal Distempers” such as smallpox come “as Judgments from an angry and displeased God.”</p>
<p>In contrast to Mather and Boylston’s research, the Courant’s articles were designed not to discover, but to sow doubt and distrust. The argument that inoculation might help to spread the disease posits something that was theoretically possible – at least if simple precautions were not taken – but it seems beside the point. If inoculation worked, wouldn’t it be worth this small risk, especially since widespread inoculations would dramatically decrease the likelihood that one person would infect another?</p>
<p>Franklin, the Courant’s editor, had a kid brother apprenticed to him at the time – a teenager by the name of Benjamin.</p>
<p>Historians don’t know which side the younger Franklin took in 1721 – or whether he took a side at all – but his subsequent approach to inoculation years later has lessons for the world’s current encounter with a deadly virus and a divided response to a vaccine.</p>
<h2>Independent thought</h2>
<p>You might expect that James’ little brother would have been inclined to oppose inoculation as well. After all, <a href="https://doi.org/10.1080/10463280701592070">thinking like family members and others you identify with</a> is a common human tendency.</p>
<p>That he was capable of overcoming this inclination shows <a href="https://theconversation.com/talking-politics-in-2021-lessons-on-humility-and-truth-seeking-from-benjamin-franklin-153924">Benjamin Franklin’s capacity for independent thought</a>, an asset that would serve him well throughout his life as a writer, scientist and statesman. While sticking with social expectations confers certain advantages in certain settings, being able to shake off these norms when they are dangerous is also valuable. We believe the most successful people are the ones who, like Franklin, have the intellectual flexibility to choose between adherence and independence.</p>
<h2>Truth, not victory</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/409194/original/file-20210630-20925-1fg34y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="etching of Franklin standing at a table in a lab" src="https://images.theconversation.com/files/409194/original/file-20210630-20925-1fg34y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/409194/original/file-20210630-20925-1fg34y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=744&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409194/original/file-20210630-20925-1fg34y6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=744&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409194/original/file-20210630-20925-1fg34y6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=744&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409194/original/file-20210630-20925-1fg34y6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=935&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409194/original/file-20210630-20925-1fg34y6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=935&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409194/original/file-20210630-20925-1fg34y6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=935&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Franklin matured into a well-known scientist and statesman, with many successes aided by his open mind.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-engraving-depicting-benjamin-franklin-in-his-laboratory-news-photo/1130664685?adppopup=true">Universal History Archive/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<p>What happened next shows that Franklin, unlike his brother – and plenty of pundits and politicians in the 21st century – was <a href="https://theconversation.com/talking-politics-in-2021-lessons-on-humility-and-truth-seeking-from-benjamin-franklin-153924">more interested in discovering the truth</a> than in <a href="https://www.psychologytoday.com/us/blog/shift-mind/201103/why-is-it-so-important-be-right">proving he was right</a>.</p>
<p>Perhaps the inoculation controversy of 1721 had helped him to understand an unfortunate phenomenon that continues to plague the U.S. in 2021: When people take sides, progress suffers. <a href="https://doi.org/10.1126/science.1197754">Tribes</a>, whether long-standing or newly formed around an issue, can devote their energies to <a href="https://blogs.cardiff.ac.uk/openfordebate/2019/05/30/what-polarization-does-to-us/">demonizing the other side</a> and rallying their own. Instead of attacking the problem, they attack each other.</p>
<p>Franklin, in fact, became convinced that inoculation was a sound approach to preventing smallpox. Years later he intended to have his son Francis inoculated after recovering from a case of diarrhea. But before inoculation took place, the 4-year-old boy contracted smallpox and died in 1736. Citing a rumor that Francis had died because of inoculation and noting that such a rumor might deter parents from exposing their children to this procedure, Franklin made a point of setting the record straight, explaining that the child had “<a href="https://founders.archives.gov/documents/Franklin/01-02-02-0025">receiv’d the Distemper in the common Way of Infection</a>.”</p>
<p>Writing his autobiography in 1771, Franklin reflected on the tragedy and used it to advocate for inoculation. He explained that he “<a href="https://www.gutenberg.org/files/20203/20203-h/20203-h.htm">regretted bitterly and still regret</a>” not inoculating the boy, adding, “This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.”</p>
<h2>A scientific perspective</h2>
<p>A final lesson from 1721 has to do with the importance of a truly scientific perspective, one that embraces science, facts and objectivity.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/409195/original/file-20210630-21327-fftq4q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="19th-century photo of a smallpox patient" src="https://images.theconversation.com/files/409195/original/file-20210630-21327-fftq4q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/409195/original/file-20210630-21327-fftq4q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=439&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409195/original/file-20210630-21327-fftq4q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=439&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409195/original/file-20210630-21327-fftq4q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=439&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409195/original/file-20210630-21327-fftq4q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=552&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409195/original/file-20210630-21327-fftq4q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=552&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409195/original/file-20210630-21327-fftq4q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=552&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Smallpox was characterized by fever and aches and pustules all over the body. Before eradication, the virus killed about 30% of those it infected, according to the U.S. Centers for Disease Control and Prevention.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/smallpox-1898-middle-east-news-photo/1139698133">Sepia Times/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<p>Inoculation was a relatively new procedure for Bostonians in 1721, and this lifesaving method was not without deadly risks. To address this paradox, several physicians meticulously collected data and compared the number of those who died because of natural smallpox with deaths after smallpox inoculation. Boylston essentially carried out what today’s researchers would call a clinical study on the efficacy of inoculation. Knowing he needed to demonstrate the usefulness of inoculation in a diverse population, he <a href="http://resource.nlm.nih.gov/2544007R">reported in a short book</a> how he inoculated nearly 300 individuals and carefully noted their symptoms and conditions over days and weeks.</p>
<p>The recent emergency-use authorization of <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mRNA.html">mRNA-based</a> and <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/viralvector.html">viral-vector vaccines</a> for COVID-19 has produced a vast array of <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html">hoaxes, false claims and conspiracy theories</a>, especially in various social media. Like 18th-century inoculations, these vaccines represent new scientific approaches to vaccination, but ones that are based on decades of scientific research and clinical studies. </p>
<p>We suspect that if he were alive today, Benjamin Franklin would want his example to guide modern scientists, politicians, journalists and everyone else making personal health decisions. Like Mather and Boylston, Franklin was a scientist with a respect for evidence and ultimately for truth. </p>
<p>When it comes to a deadly virus and a divided response to a preventive treatment, Franklin was clear what he would do. It doesn’t take a visionary like Franklin to accept the evidence of medical science today.</p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p><img src="https://counter.theconversation.com/content/161569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I have written and recorded an Audible Original about Benjamin Franklin (due to be released on July 20, 2021).</span></em></p><p class="fine-print"><em><span>Christian Chauret does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
When Bostonians in 1721 faced a deadly smallpox outbreak, a new procedure called inoculation was found to help fend off the disease. Not everyone was won over, and newspapers fed the controversy.
Mark Canada, Executive Vice Chancellor for Academic Affairs, Indiana University Kokomo
Christian Chauret, Dean of School of Sciences, Professor of Microbiology, Indiana University Kokomo
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/158177
2021-04-06T12:27:48Z
2021-04-06T12:27:48Z
The 17th-century cloth merchant who discovered the vast realm of tiny microbes – an appreciation of Antonie van Leeuwenhoek
<figure><img src="https://images.theconversation.com/files/392870/original/file-20210331-13-1k3l5mc.jpg?ixlib=rb-1.1.0&rect=46%2C7%2C5068%2C3396&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Leeuwenhoek refined the magnifying glass, creating the world's first microscope.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/model-of-leeuwenhoek-microscope-on-book-royalty-free-image/75650913">Tetra Images via Getty Images</a></span></figcaption></figure><p>Imagine trying to cope with a pandemic like COVID-19 in a world where microscopic life was unknown. Prior to the 17th century, people were limited by what they could see with their own two eyes. But then a Dutch cloth merchant changed everything. </p>
<p>His name was Antonie van Leeuwenhoek, and he lived from 1632 to 1723. Although untrained in science, van Leeuwenhoek became the greatest lens-maker of his day, discovered microscopic life forms and is <a href="https://makingscience.royalsociety.org/s/rs/people/fst00039851">known today as the “father of microbiology.”</a></p>
<h2>Visualizing ‘animalcules’ with a ‘small see-er’</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/392877/original/file-20210331-19-kncz3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An oil painting of man with long curly hair holding a pair of tweezers posed next to a globe." src="https://images.theconversation.com/files/392877/original/file-20210331-19-kncz3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/392877/original/file-20210331-19-kncz3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=699&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392877/original/file-20210331-19-kncz3z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=699&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392877/original/file-20210331-19-kncz3z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=699&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392877/original/file-20210331-19-kncz3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=878&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392877/original/file-20210331-19-kncz3z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=878&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392877/original/file-20210331-19-kncz3z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=878&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Van Leeuwenhoek opened the door to a vast, previously unseen world.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/ft6mf62b">J. Verolje/Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Van Leeuwenhoek didn’t set out to identify microbes. Instead, he was trying to assess the quality of thread. He developed <a href="https://micro.magnet.fsu.edu/primer/museum/leeuwenhoek.html">a method for making lenses</a> by heating thin filaments of glass to make tiny spheres. His lenses were of such high quality he saw things no one else could.</p>
<p>This enabled him to train his microscope – literally, “small see-er” – on a new and largely unexpected realm: objects, including organisms, far too small to be seen by the naked eye. He was the <a href="https://ucmp.berkeley.edu/history/leeuwenhoek.html">first to visualize red blood cells, blood flow in capillaries and sperm</a>.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/392848/original/file-20210331-21-1gy6f72.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pen and ink drawings of four different rod shaped bacteria." src="https://images.theconversation.com/files/392848/original/file-20210331-21-1gy6f72.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/392848/original/file-20210331-21-1gy6f72.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=539&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392848/original/file-20210331-21-1gy6f72.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=539&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392848/original/file-20210331-21-1gy6f72.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=539&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392848/original/file-20210331-21-1gy6f72.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=677&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392848/original/file-20210331-21-1gy6f72.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=677&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392848/original/file-20210331-21-1gy6f72.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=677&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drawings from a van Leeuwenhoek letter in 1683 illustrating human mouth bacteria.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Leuwenhoek_picture_of_animacules.png">Huydang2910</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Van Leeuwenhoek was also the <a href="https://www.aaas.org/discovery-bacteria">first human being to see a bacterium</a> – and the importance of this discovery for microbiology and medicine can hardly be overstated. Yet he was reluctant to publish his findings, due to his lack of formal education. Eventually, friends prevailed upon him to do so.</p>
<p>He wrote, “Whenever I found out anything remarkable, I thought it <a href="https://ucmp.berkeley.edu/history/leeuwenhoek.html">my duty to put down my discovery on paper</a>, so that all ingenious people might be informed thereof.” He was guided by his curiosity and joy in discovery, asserting “I’ve taken no notice of those who have said <a href="https://laurieximenez.files.wordpress.com/2016/03/2-microbe-hunters-paul-de-kruif.pdf">why take so much trouble and what good is it</a>?”</p>
<p>When he reported visualizing “animalcules” (tiny animals) swimming in a drop of pond water, members of the scientific community questioned his reliability. After his findings were <a href="https://doi.org/10.1098/rsnr.2004.0055">corroborated by reliable religious and scientific authorities</a>, they were published, and in 1680 he was invited to join the Royal Society in London, then the world’s premier scientific body.</p>
<p>Van Leeuwenhoek was not the world’s only microscopist. In England, his contemporary <a href="https://theconversation.com/robert-hooke-the-english-leonardo-who-was-a-17th-century-scientific-superstar-119497">Robert Hooke coined the term “cell”</a> to describe the basic unit of life and published his “Micrographia,” featuring incredibly detailed images of insects and the like, which became the first scientific best-seller. Hooke, however, did not identify bacteria.</p>
<p>Despite van Leuwenhoek’s prowess as a lens-maker, even he could not see viruses. They are about 1/100th the size of bacteria, much too small to be visualized by light microscopes, which because of the physics of light <a href="http://www.auburn.edu/academic/classes/biol/4101/estridge2/tutorial1a.pdf">can magnify only thousands of times</a>. Viruses weren’t visualized until 1931 with the <a href="http://www.auburn.edu/academic/classes/biol/4101/estridge2/tutorial1a.pdf">invention of electron microscopes</a>, which could magnify by the millions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/393164/original/file-20210401-17-bvjvvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white microscopic image showing a cluster of dots." src="https://images.theconversation.com/files/393164/original/file-20210401-17-bvjvvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393164/original/file-20210401-17-bvjvvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=495&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393164/original/file-20210401-17-bvjvvo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=495&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393164/original/file-20210401-17-bvjvvo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=495&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393164/original/file-20210401-17-bvjvvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=622&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393164/original/file-20210401-17-bvjvvo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=622&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393164/original/file-20210401-17-bvjvvo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=622&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An image of the hepatitis virus courtesy of the electron microscope.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/Hepatitis/20c83d41c4ef41a593761c96f6565697">E.H. Cook, Jr./CDC via Associated Press</a></span>
</figcaption>
</figure>
<h2>A vast, previously unseen world</h2>
<p>Van Leeuwenhoek and his successors opened up, by far, the largest realm of life. For example, all the bacteria on Earth <a href="https://www.vox.com/science-and-health/2018/5/29/17386112/all-life-on-earth-chart-weight-plants-animals-pnas">outweigh humans by more than 1,100 times</a> and outnumber us by an unimaginable margin. There is fossil evidence that <a href="https://ucmp.berkeley.edu/bacteria/bacteriafr.html">bacteria were among the first life forms on Earth</a>, dating back over 3 billion years, and today it is thought the planet houses about <a href="http://news.bbc.co.uk/2/hi/science/nature/158203.stm">5 nonillion (1 followed by 30 zeroes) bacteria</a>.</p>
<p>Some species of <a href="https://sphweb.bumc.bu.edu/otlt/mph-modules/ph/ph709_infectiousagents/PH709_InfectiousAgents4.html">bacteria cause diseases</a>, such as cholera, syphilis and strep throat; while <a href="https://doi.org/10.3389/fmicb.2019.00780">others, known as extremophiles</a>, can survive at temperatures beyond the boiling and freezing points of water, from the upper reaches of the atmosphere to the deepest points of the oceans. Also, the number of harmless bacterial cells on and in our bodies <a href="https://www.nature.com/news/scientists-bust-myth-that-our-bodies-have-more-bacteria-than-human-cells-1.19136">likely outnumber the human ones</a>.</p>
<p>Viruses, which include the coronavirus SARS-CoV-2 that causes COVID-19, outnumber bacteria by a factor of 100, meaning there are <a href="https://www.nationalgeographic.com/science/article/factors-allow-viruses-infect-humans-coronavirus">more of them on Earth than stars in the universe</a>. They, too, are found everywhere, from the upper atmosphere to the ocean depths.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/392874/original/file-20210331-21-1jfdfea.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A black and white image showing a segmented sphere shaped item." src="https://images.theconversation.com/files/392874/original/file-20210331-21-1jfdfea.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/392874/original/file-20210331-21-1jfdfea.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=580&fit=crop&dpr=1 600w, https://images.theconversation.com/files/392874/original/file-20210331-21-1jfdfea.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=580&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/392874/original/file-20210331-21-1jfdfea.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=580&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/392874/original/file-20210331-21-1jfdfea.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=728&fit=crop&dpr=1 754w, https://images.theconversation.com/files/392874/original/file-20210331-21-1jfdfea.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=728&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/392874/original/file-20210331-21-1jfdfea.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=728&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A visualization of the human rhinovirus 14, one of many viruses that cause the common cold. Protein spikes are colored white for clarity.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Rhinovirus_isosurface.png">Thomas Splettstoesser</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Strangely, <a href="https://www.scientificamerican.com/article/are-viruses-alive-2004/">viruses probably do not qualify as living organisms</a>. They can replicate only by infecting other organisms’ cells, where they hijack cellular systems to make copies of themselves, sometimes causing the death of the infected cell.</p>
<p>It is important to remember that microbes such as bacteria and viruses do far more than cause disease, and many are vital to life. For example, <a href="https://doi.org/10.1177/1535370217746612">bacteria synthesize vitamin B12</a>, without which most living organisms would not be able to make DNA.</p>
<p>Likewise, viruses cause diseases such as the common cold, influenza and COVID-19, but they also play a vital role in transferring genes between species, which <a href="https://www.sciencedaily.com/releases/2016/07/160713100911.htm">helps to increase genetic diversity and propel evolution</a>. Today <a href="https://www.cancer.gov/news-events/cancer-currents-blog/2018/oncolytic-viruses-to-treat-cancer">researchers use viruses to treat diseases such as cancer</a>.</p>
<p>Scientists’ understanding of microbes has progressed a long way since van Leeuwenhoek, including the development of antibiotics against bacteria and vaccines against viruses including SARS-CoV-2. </p>
<p>But it was van Leeuwenhoek who first opened people’s eyes to life’s vast microscopic realm, a discovery that continues to transform the world.</p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/158177/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Gunderman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Van Leeuwenhoek, who discovered bacteria, is one of the most important figures in the history of medicine, laying the groundwork for today’s understanding of infectious disease.
Richard Gunderman, Chancellor's Professor of Medicine, Liberal Arts, and Philanthropy, Indiana University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/156774
2021-03-26T14:51:39Z
2021-03-26T14:51:39Z
This 400-year-old botched nose job shows how little our feelings about transplants have changed
<figure><img src="https://images.theconversation.com/files/391110/original/file-20210323-20-sl0gpf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://wellcomecollection.org/works/hgq8rjwm/images?id=eyc5jpag">© Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>In 1624, a physician called Jean-Baptiste van Helmont told a strange story in his book of “magnetic cures” about a man from Brussels who had lost his nose. Having had his nose cut off “in combat”, the man went to a famous Italian surgeon, Gaspare Tagliacozzi, who promised to make him a new one “resembling nature’s pattern”. The problem was that Tagliacozzi wanted to use some of the man’s own skin to recreate the nose. Not keen on this idea, the noseless man decided to buy his way to a new face. He hired a local porter to donate some of his skin and had the surgeon fashion a new nose out of this foreign tissue.</p>
<p>All seemed well, recounted Van Helmont, until just over a year later, the man found that his new nose suddenly grew “frigid and cadaverous”. Over the next few days, it began to putrefy on his face, and within a week it had dropped off entirely. </p>
<p>Investigating the cause of the sudden misfortune, the man’s friends found out that the porter who supplied the flesh had died at just the same time that the nose first turned cold. Though Van Helmont admitted that the story seemed fantastical, he insisted that there were men “of good repute, that were eyewitnesses of these occurrences”. This, he insisted, was not superstition, but evidence of a powerful “affinity” between the borrowed tissue and its original owner.</p>
<hr>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
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<p><strong><em>This article is part of Conversation Insights</em></strong>
<br><em>The Insights team generates <a href="https://theconversation.com/uk/topics/insights-series-71218">long-form journalism</a> derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.</em> </p>
<hr>
<p>When I read Helmont’s extraordinary story, almost four centuries later, it led me down a rabbit hole of 17th-century medical and philosophical writings, and eventually to writing a <a href="https://www.cambridge.org/gb/academic/subjects/literature/renaissance-and-early-modern-literature/surgery-and-selfhood-early-modern-england-altered-bodies-and-contexts-identity?format=HB">book</a> on early modern surgery and embodiment. In the process, it emerged that the phenomenon Van Helmont described was based on philosophical and scientific speculation about the existence of a “sympathetic” connection between disembodied flesh and its original owner. This in turn reflected deep-seated belief in the importance of one’s body to identity, which led to anxious debates about the resurrection of the body after death.</p>
<p>I also found that though the concerns of Renaissance patients and physicians about “borrowed flesh” might seem outlandish and out of date, they are surprisingly relevant to the modern surgical landscape. Both commonplace cosmetic surgeries and more radical procedures, such as hand and face transplants, centre on the belief that how we look is a central part of our identity, at the same time that they offer us the chance to be our “real” selves by changing our appearance.</p>
<p>Like the early rhinoplasty described by Helmont, most elective <a href="https://baaps.org.uk/about/news/1708/cosmetic_surgery_stats_number_of_surgeries_remains_stable_amid_calls_for_greater_regulation_of_quick_fix_solutions/">cosmetic surgery</a> is still undertaken for aesthetic reasons. The popularity of these “plastic” surgeries has remained steady for several years; 2019 saw 28,000 aesthetic surgeries performed in the UK, of which nearly 3,000 were rhinoplasties (nose jobs). </p>
<p>At the experimental edges of surgical endeavour, however, ever more ambitious attempts are being made to restore and transform patients with facial differences. In 2020, for instance, New Yorker <a href="https://www.bbc.co.uk/news/world-us-canada-55933848">Joe DiMeo</a> became the recipient of the world’s first double hand and face transplant. DiMeo had suffered 80% burns in a car accident, and his reconstructive surgery was hailed as a medical breakthrough. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/x0nAI5buVKM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Though often life saving, these radical surgeries can raise issues of identity not dissimilar to those of the Renaissance nose job. The recipient of the world’s first hand transplant, an Australian named <a href="https://www.theguardian.com/uk/2001/feb/04/robinmckie.nickpatonwalsh">Clint Hallam</a>, neglected the physical therapy and close medical supervision his doctors advised, on the grounds that he didn’t identify with his new hand. He then stopped taking his immunosuppressant drugs in order to force surgeons to remove the limb. “As it began to be rejected,” explained Hallam, “I realised that it wasn’t my hand after all.” </p>
<h2>Borrowed faces</h2>
<p>In the Renaissance, complete limb and face replacements like those performed on DiMeo or Hallam belonged in the realm of fantasy. Nonetheless, this period too had its surgical pioneers, and Tagliacozzi’s famous nose reconstruction was at the cutting edge of medical science. The operation was first described by Tagliacozzi in 1596; he had probably learned it from an Italian family called the Brancas. </p>
<p>In painstaking detail, Tagliacozzi outlined how a portion of the skin of the patient’s arm first had to be lifted with forceps and cut on two sides, before lint was placed underneath to prevent the skin reuniting with the flesh. When the swelling from this wound had died down, the surgeon was to cut the third edge of the skin flap, fold it back and bandage it, keeping the skin attached to the arm to maintain its blood supply. </p>
<p>After two weeks or so, the surgeon could consider suturing the flap – still attached at one end to the arm – to the mutilated nose, binding the area with specially made bandages. For the first week, it was essential that the patient avoided any movement, even talking, if the skin was to have a chance of adhering. Three weeks later, one might fully detach the skin from the arm and continue shaping the nose. But it would be a further six to nine weeks before the nose could be finished, complete with nostrils.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/389915/original/file-20210316-21-cdwbpf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white illustration of a man in bed with his arm attached to his head." src="https://images.theconversation.com/files/389915/original/file-20210316-21-cdwbpf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389915/original/file-20210316-21-cdwbpf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=904&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389915/original/file-20210316-21-cdwbpf.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=904&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389915/original/file-20210316-21-cdwbpf.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=904&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389915/original/file-20210316-21-cdwbpf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1135&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389915/original/file-20210316-21-cdwbpf.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1135&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389915/original/file-20210316-21-cdwbpf.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1135&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An illustration of Tagliacozzi’s operation.</span>
<span class="attribution"><a class="source" href="https://iiif.wellcomecollection.org/image/M0013854/full/full/0/default.jpg">© Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In an era before antibiotics or anaesthesia, the operation was dangerous and painful. Indeed, it’s unclear if anyone other than Tagliacozzi ever attempted this procedure. Nonetheless, it captured the public imagination, partly because it was so timely. </p>
<p>The 16th and 17th centuries saw an unprecedented need for facial surgery, driven by decades of war and rampant infectious disease. Syphilis, or the “French pox”, as it was known, was both the most commonplace and the most shameful way to lose your nose, as serious infections caused the nasal cartilage to disintegrate. Typically, men picked up the venereal disease in brothels and took it home to their wives, and children might inherit it from their parents.</p>
<p>There was also a social toll from syphilis, with vicious judgements passed on those with visible symptoms. In 1704, for example, the diarist Sarah Cowper was told by her friend about a mutual acquaintance whose husband had given her the pox. Hearing that the afflicted woman was “airy, brisk, and a great Dancer”, Cowper retorted that “by no means shou’d any Woman dance without a nose, tho’ never so innocently lost”.</p>
<p>For many years, people had attempted to hide their shame with false noses, often made of silver and enamelled to look like real flesh. But <a href="https://hekint.org/2020/05/28/the-times-of-gaspare-tagliacozzi-founder-of-plastic-surgery/">Tagliacozzi’s</a> operation offered the chance of a real nose. No records exist to indicate how many nose operations Tagliacozzi performed, perhaps because he died aged 49 just two years after publishing his famous work on the topic. Nonetheless, he claimed to be able to make noses “so perfect” that some patients found them “better than the original ones which they had received from nature”. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/389916/original/file-20210316-20-1n0emw2.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Silver coloured artificial nose on grey background." src="https://images.theconversation.com/files/389916/original/file-20210316-20-1n0emw2.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389916/original/file-20210316-20-1n0emw2.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=902&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389916/original/file-20210316-20-1n0emw2.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=902&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389916/original/file-20210316-20-1n0emw2.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=902&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389916/original/file-20210316-20-1n0emw2.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1133&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389916/original/file-20210316-20-1n0emw2.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1133&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389916/original/file-20210316-20-1n0emw2.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1133&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Artificial nose, Europe, 1601-1800.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/vwkeypvj/items?langCode=false&canvas=1">© Science Museum, London</a></span>
</figcaption>
</figure>
<p>Of course, this wasn’t easy to achieve. Even in modern hand transplants, the new limb is never a perfect match for the recipient body. The skin will differ in colour or texture, and the point of attachment is clearly visible. In the case of the 17th-century nose job, Tagliacozzi admitted that by using skin from another part of the body, the grafted nose would differ in colour and texture from the recipient’s facial skin, and might grow hair “so luxuriant that it must be shaved”. </p>
<p>These differences led to allegations such as the one made by Van Helmont that, contrary to Tagliacozzi’s original instructions, rich patients were buying flesh from other people to make their new noses. Though there was no evidence for this, it was soon treated as fact, both by other physicians such as Van Helmont and by contemporary satirists. The English poet <a href="http://pulterproject.northwestern.edu/poems/vm/to-sir-william-davenant-upon-the-unspeakable-loss-of-the-most-conspicuous-and-chief-ornament-of-his-frontispiece/">Hester Pulter</a> wrote a jesting poem to her fellow royalist Sir William Davenant, offering to donate a piece of her leg to repair his missing nose, while the satirist Samuel Butler claimed that:</p>
<blockquote>
<p>… learned Talicotius from<br>
The brawny part of Porter’s bum<br>
Cut supplemental noses, which<br>
Lasted as long as parent breech:<br>
But when the date of nock was out,<br>
Off drop’d the sympathetic snout.</p>
</blockquote>
<p>In part, this idea of exchanging flesh between one person and another was fuelled by real scientific experiments. At the <a href="https://royalsociety.org/about-us/history/">Royal Society</a>, a coalition of scientists and physicians, men such as Robert Boyle were trialling blood transfusions and skin grafts between animals. They hoped to discover whether qualities such as aggressiveness or friendliness were innate in the blood of the animals they experimented on, though they were hindered by the tendency of their test subjects to run away at the earliest opportunity. In France, meanwhile, there was a bold but ill-fated attempt to transfuse the blood of a calf into a madman. The theory was that the meek nature of the calf would be transferred in its blood, and allay the madness, but instead the man died, and the Parisian medical authorities banned any more human infusions. </p>
<p>Rumours about “borrowed” noses also reflected growing public unease about the potential for cosmetics, prostheses and clothing to deceive onlookers. In the image-obsessed 1600s, fashion-conscious consumers could benefit from padding to fatten the cheeks and hips, corsets to whittle the waist, lead washes to whiten the complexion, rouge to redden the cheeks, and drops to brighten the eyes. More serious customers could even pay to have new teeth inserted, sometimes drawn from the mouths of corpses or servants. The <a href="https://www.pepysdiary.com/diary/1664/10/10.">diarist</a> Samuel Pepys made it clear that he considered this to be deceitful:</p>
<blockquote>
<p>Sir William Batten doth rail still against Mr. Turner and his wife (telling me he is a false fellow, and his wife a false woman and hath rotten teeth and false, set in with wire) and as I know they are so, I am glad he finds it so.</p>
</blockquote>
<p>Pepys was peeved to find that he couldn’t discern natural good looks from ones that had been paid for, but the stakes for nose operations were much higher. When a person’s face could be repaired in such a radical way, how could one tell the genuinely healthy apart from the merely wealthy?</p>
<figure class="align-center ">
<img alt="Set of ivory teeth and wooden tools on grey background." src="https://images.theconversation.com/files/389917/original/file-20210316-22-134znu8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389917/original/file-20210316-22-134znu8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389917/original/file-20210316-22-134znu8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389917/original/file-20210316-22-134znu8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389917/original/file-20210316-22-134znu8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389917/original/file-20210316-22-134znu8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389917/original/file-20210316-22-134znu8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Carving instrument used to make ivory dentures, Europe, 1701.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/kwh5qve8">© Science Museum, London</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Flesh, spirit and sympathy</h2>
<p>As the story of the Brussels man who lost his nose reveals, there was another, more serious problem with the nose operation. Several sources alleged that if a patient had their new nose made from the flesh of another person, that nose could drop off when the donor died. </p>
<p>In 1658, for instance, the scientist and courtier Sir Kenelm Digby asserted that:</p>
<blockquote>
<p>Artificiall noses that are made of the flesh of other men … do putrifie as soon as those persons out of whose substance they were taken come to die, as if that small parcell of flesh ingrafted upon the face did live by the spirits it drew from its first root, and source.</p>
</blockquote>
<p>He was probably thinking back to a story told by the physician-astrologer Robert Fludd, who in 1631 relayed the story of a lord who had a new nose made from the flesh of a slave. All seemed well with the new nose, said Fludd, until “it happened, that the slave fell sicke and dyed, at which instant, the Lords nose did gangrenate and rot”.</p>
<p>What was the cause of this misfortune? Fludd and Digby claimed that the death of the grafted-on noses was proof of a quasi-scientific idea known as the doctrine of <a href="https://www.google.co.uk/books/edition/The_Virtue_of_Sympathy/9mfwBQAAQBAJ?hl=en&gbpv=0">sympathy</a>. This theory, which was esoteric even for its own time, held that atoms – a term used in this period to describe small, indivisible particles – had an identity. That is, they were blood atoms, nose atoms, or so on. Each atom had an in-built affinity with others of its own type, meaning that given the chance, atoms would travel through the air to where they were most plentiful (say, transplanted nose atoms travelling back to their original owner). </p>
<p>Proponents of sympathy claimed that using this principle, they could cure wounds at a great distance. For instance, by applying a special “wound-powder” to blood that had dried on a knife, they could cure the wound which the knife had inflicted, even if they had never seen the patient. The atoms of wound-powder would travel with the blood atoms from the knife to the patient’s body. The same principle also applied in reverse; as one anonymous text asserted, grafted-on noses were “nevertheless still animated with the Vitality of [the donor], of whom it was yet truly a part”.</p>
<p>The doctrine of sympathy never gained much credence among the medical establishment, who saw it as at best foolish and at worst evidence of witchcraft. But the idea that noses always “belonged” to their original owner tapped into deeper worries about what “belonged” to any individual body. Most early modern Christians believed that on the day of resurrection, those who were destined for heaven would be raised out of the grave in the same bodies which they had in life. The <a href="https://www.biblegateway.com/passage/?search=1%20Corinthians%2015%3A42-43&version=KJV">book of Corinthians</a> reads:</p>
<blockquote>
<p>So also is the resurrection of the dead. It is sown in corruption; it is raised in incorruption:<br>
It is sown in dishonour; it is raised in glory: it is sown in weakness; it is raised in power </p>
</blockquote>
<p>This was taken to mean that people who died old, sick or disabled would be resurrected strong and healthy, free from the sufferings they had endured on earth. </p>
<figure class="align-center ">
<img alt="Jesus, Mary and St. John preside over the dead, some of which are admitted to the Kingdom of Heaven, others to eternal punishment." src="https://images.theconversation.com/files/389925/original/file-20210316-21-o0psum.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389925/original/file-20210316-21-o0psum.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=436&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389925/original/file-20210316-21-o0psum.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=436&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389925/original/file-20210316-21-o0psum.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=436&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389925/original/file-20210316-21-o0psum.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=548&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389925/original/file-20210316-21-o0psum.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=548&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389925/original/file-20210316-21-o0psum.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=548&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Stefan Lochner’s depiction of the Last Judgement, c. 1435.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Last_Judgment#/media/File:Stefan_Lochner_-_Last_Judgement_-_circa_1435.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>It was a comforting thought, but in practice, it raised many questions. Even in peacetime, the fate of amputated limbs was uncertain. For instance, in 1720, the London Journal newspaper reported:</p>
<blockquote>
<p>On Monday last part of the right Leg of a man was found in a Cellar Window in Bartholomew Close, which probably may have belonged to some Patient in the neighbouring Hospital, that has undergone an Amputation. </p>
</blockquote>
<p>The 17th century was far from peaceful, with decades of war at sea and on land, and many soldiers maimed far from home. What happened, then, if one lost a leg in the Atlantic sea and later had one’s nose disintegrate from syphilis? How were those parts to be restored at the resurrection? This wasn’t only a question of finding the missing parts. What happened if the leg lost at sea was eaten by a fish, which was then eaten by a person? The atoms which had made up the leg were now making up that other person, and they couldn’t be restored to both parties at the Last Judgement.</p>
<p>Philosophers and poets agonised over these issues. <a href="https://quod.lib.umich.edu/e/eebo2/A29027.0001.001?view=toc">Some</a> suggested that perhaps not all of the matter that had made up the body needed to be resurrected, and instead it would be enough if just the bones and the major organs were made of the same stuff as in life. <a href="https://books.google.co.uk/books?id=He9bAAAAQAAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false">Others</a> pointed out that the body produced a lot more matter over the course of a lifetime than it needed, in the form of fingernails, hair and shed skin. Perhaps this superfluous material could make up any shortfall? </p>
<p>For the most part, however, writers on this subject followed the lead of poet and clergyman John Donne, who insisted (though a little too fervently) that God would sort everything out in His own mysterious way. God, preached Donne, “sits in heaven, and spans all this world, and reunites in an instant armes, and legs, bloud, and bones, in what corners so ever they be scattered”. It might seem to mere mortals that resurrection was fraught with problems, but good Christians should have faith that even their “scattered body” would be repaired and recompacted.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/390442/original/file-20210318-19-t95nlr.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sketch depicting revitalised skeletons and amputees searching for their missing limbs." src="https://images.theconversation.com/files/390442/original/file-20210318-19-t95nlr.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390442/original/file-20210318-19-t95nlr.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390442/original/file-20210318-19-t95nlr.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390442/original/file-20210318-19-t95nlr.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390442/original/file-20210318-19-t95nlr.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390442/original/file-20210318-19-t95nlr.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390442/original/file-20210318-19-t95nlr.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">1782 engraving depicting bodies in an anatomy lab who have got their arms and legs mixed up at resurrection.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/cf9afhqx/images?id=bs7rg4pq">© Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>While Donne’s advice reflected the religious orthodoxy of the time, the actions of everyday people show that they still worried about these issues. Criminal punishments involving being cut up and one’s parts scattered about struck fear into audiences precisely because they feared that these parts might not be gathered up at the resurrection. </p>
<p>Some law-abiding citizens made efforts to make sure that their bodies stayed intact as much as possible by specifying in their wills that they didn’t want to share a tomb, even with members of their own family. People who had amputations might even bury their lost limbs, ready to be reunited at a later date. At a graveyard in west Wales, there is an 18th-century tombstone with the inscription:</p>
<blockquote>
<p>Here lies the Leg of Master Conder:<br>
But he’s alive, and that’s a Wonder.<br>
It was cut off by Dr. Johnson,<br>
The famousest Surgeon of the Nation.</p>
</blockquote>
<p>All these controversies centred on the belief that a person’s identity could not be separated from their body. Grafted flesh would always “belong” to its original owner, and keeping one’s body together was important even after death. </p>
<p>To my surprise, a little research into modern transplantation showed that similar impulses still inform amputations and transplant surgeries, and especially hand and face transplants. While most amputated body parts are disposed of as medical waste, both the UK and <a href="https://www.jfas.org/article/S1067-2516(20)30060-0/fulltext">US</a> now offer patients the chance to preserve their limbs for burial. What is more, the donors of both hands and faces may now receive prostheses that restore them to bodily “wholeness” before they are buried. </p>
<p>Of course, these aren’t driven primarily by religious considerations, but by concern for the families and doctors involved. One 2007 <a href="https://pubmed.ncbi.nlm.nih.gov/17645723/">article</a> proposing use of silicone facial prostheses for face donors found that this intervention was welcomed by doctors involved in transplantation. In <a href="https://indianexpress.com/article/cities/pune/artificial-limbs-to-be-attached-to-donors-bodies-expert-panel-chalks-out-new-guidelines-for-hand-transplant-5821765/">India</a>, it’s now recommended practice to attach artificial hands to the bodies of deceased hand transplant donors, a <a href="https://indianexpress.com/article/cities/pune/artificial-limbs-to-be-attached-to-donors-bodies-expert-panel-chalks-out-new-guidelines-for-hand-transplant-5821765/">step</a> that’s undertaken more patchily in other parts of the world.</p>
<p>The donor of Joe DiMeo’s new face and hands received “replica parts” supplied by New York University’s LaGuardia 3D printing studio. Explaining the decision, DiMeo’s doctor Eduardo Rodriguez told the <a href="https://nypost.com/2021/02/03/face-and-hand-transplant-recipient-steps-out-for-the-first-time/">New York Post</a>: “Despite the fact that they’re now declared deceased […] we still respect the dignity of the donor. It’s important for us to continue to care for the donor because that patient is still our patient.” </p>
<p>DiMeo has gradually regained physical function, but the immunosuppressants he has to take for the rest of his life are a reminder that in one sense at least, his transplants are still “borrowed” flesh. Like Van Helmont’s nose-buying nobleman, 21st-century transplant doctors and patients continue to grapple with the ethics and practicalities of altering the body.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>For you: more from our <a href="https://theconversation.com/uk/topics/insights-series-71218?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Insights series</a>:</em></p>
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<li><p><em><a href="https://theconversation.com/durex-condoms-how-their-teenage-immigrant-inventor-was-forgotten-by-history-152497?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK">Durex condoms: how their teenage immigrant inventor was forgotten by history</a></em></p></li>
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<p><em>To hear about new Insights articles, join the hundreds of thousands of people who value The Conversation’s evidence-based news. <a href="https://theconversation.com/uk/newsletters/the-daily-newsletter-2?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKengagement&utm_content=InsightsUK"><strong>Subscribe to our newsletter</strong></a>.</em></p><img src="https://counter.theconversation.com/content/156774/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alanna Skuse receives funding from The Wellcome Trust, ref 218099/Z/19/Z.</span></em></p>
Though Renaissance concerns about ‘borrowed flesh’ might seem outlandish and out of date, they are surprisingly relevant to the modern surgical landscape.
Alanna Skuse, Lecturer in English Literature, University of Reading
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/156773
2021-03-25T16:59:34Z
2021-03-25T16:59:34Z
Doctors only started measuring body temperature 200 years ago – here’s why
<figure><img src="https://images.theconversation.com/files/389818/original/file-20210316-20-19zgb9o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/04HE-456KIg">Dony Wardhana/Unsplash</a>, <a class="license" href="http://artlibre.org/licence/lal/en">FAL</a></span></figcaption></figure><p>Over the past year, fever thermometers have become omnipresent. Body temperature is taken in front of shops, at airports, even before visiting a museum – often with ultra-modern devices. So-called fever cameras or fever scanners can determine the body temperature even without contact. It might now seem obvious that fevers are connected to a high body temperature – in many cultures, the question “do you have a temperature?” is clear evidence of that – but this hasn’t always been the case. </p>
<figure class="align-left ">
<img alt="Black and white historic portrait of a bearded man." src="https://images.theconversation.com/files/389820/original/file-20210316-14-6xvzx4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/389820/original/file-20210316-14-6xvzx4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=889&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389820/original/file-20210316-14-6xvzx4.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=889&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389820/original/file-20210316-14-6xvzx4.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=889&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389820/original/file-20210316-14-6xvzx4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1117&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389820/original/file-20210316-14-6xvzx4.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1117&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389820/original/file-20210316-14-6xvzx4.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1117&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sanctorio Sanctorius, 1609.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/File:Sanctorius.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>The beginnings of measuring fever go back more than 400 years. At the turn of the 17th century, several scholars dealt with the development of thermometers. In London, Robert Fludd worked on an instrument to measure temperature. On the Italian peninsula, Galileo Galilei and his close friend Giovanni Francesco Sagredo were engaged in the same activity. So it cannot be clearly determined <a href="https://www.springer.com/de/book/9789048186440">who invented the thermometer</a>. </p>
<p><a href="https://www.jstor.org/stable/10.1086/667970?seq=1#metadata_info_tab_contents">But historians agree</a> that a particular member of Galileo’s Venetian circle of friends was the first to apply the instrument to medicine. This was the Venetian physician <a href="https://www.mpiwg-berlin.mpg.de/research/projects/emergence-iatromechanical-medicine">Sanctorio Sanctorius (1561 – 1636)</a>, who developed the first fever thermometers to determine his patients’ body heat. </p>
<p>This was a novelty. While today we trust in numbers and measurements, especially regarding medical issues, in Sanctorius’ times it was not thought that phenomena like health or disease could be recorded by numbers, let alone be measured. Rather, people relied on the experience of their physicians. Through regularly touching the foreheads of their patients, they gauged what kind and how bad the fever was.</p>
<h2>The first body thermometer</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/390438/original/file-20210318-23-1cb4hk.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white illustration of a historic thermometer." src="https://images.theconversation.com/files/390438/original/file-20210318-23-1cb4hk.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/390438/original/file-20210318-23-1cb4hk.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1463&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390438/original/file-20210318-23-1cb4hk.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1463&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390438/original/file-20210318-23-1cb4hk.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1463&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390438/original/file-20210318-23-1cb4hk.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1838&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390438/original/file-20210318-23-1cb4hk.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1838&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390438/original/file-20210318-23-1cb4hk.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1838&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An illustration of Sanctorius’ thermoscope (on the right), a thermometer without a scale, 1626.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/c8vwha2p/items?langCode=false&canvas=1">© Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Sanctorius’ measurement and notion of fever did not tally with modern understandings. The Venetian physician made use of the thermal expansion of air in his thermometers, rather than liquids, which is what tends to be used in today’s traditional fever thermometers. </p>
<p>Since air does not expand and contract only due to changes in temperature, but also in atmospheric pressure, Sanctorius’ unsealed thermometers were sensitive to both. Therefore, any measurement of body heat with an instrument of Sanctorius’ type would be distorted by the influence of atmospheric pressure. This was realised a short time later. To avoid its influence, in later thermometers, air was replaced with a liquid sealed in a glass tube.</p>
<p>Sanctorius seems to have used his non-sealed air thermometers anyway. Galileo and Sagredo, who worked with similar types of thermometers outside of a medical context, realised that there were irregularities, but the phenomenon of atmospheric pressure and its effect was still unknown to them. From today’s perspective, such thermometers might seem not very helpful, but at the time these were the first instruments that could be used to obtain information about degrees of hot and cold without appealing to the human senses.</p>
<p>And although Sanctorius used the Latin term <em>temperamentum</em>, <a href="https://brill.com/view/book/edcoll/9789047442318/Bej.9789004170506.i-582_005.xml">his concept of a “temperature”</a> was very different from today’s. He adhered to the medical theory of the four humours, which assumed that human health depended on a balanced proportion of the four humours: blood, phlegm, yellow, and black bile. These humours were assigned to so-called primary qualities: hot, cold, moist and dry. Here, too, balance was crucial: if one of the primary qualities was too strong or too weak, it could cause diseases.</p>
<figure class="align-left ">
<img alt="Diagram illustrating the associations of the four humours." src="https://images.theconversation.com/files/389822/original/file-20210316-17-1w5vryx.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/389822/original/file-20210316-17-1w5vryx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=601&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389822/original/file-20210316-17-1w5vryx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=601&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389822/original/file-20210316-17-1w5vryx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=601&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389822/original/file-20210316-17-1w5vryx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=756&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389822/original/file-20210316-17-1w5vryx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=756&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389822/original/file-20210316-17-1w5vryx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=756&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Diagram illustrating the four humours.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/File:Humorism.svg">Tom Lemmens</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>So when Sanctorius used his fever thermometers, what he was trying to measure was certain degrees of hot and cold in his patients’ complexions, which he believed would reveal their individual mixtures of the four humours. In doing so, he wanted to determine “the quantity of diseases”, by which he meant the deviation of the body from its balanced, healthy state.</p>
<p>For a long time, the “quantity” of heat was considered to be only <a href="https://jhupbooks.press.jhu.edu/title/more-hot">one of several parameters</a> that allowed the physician to differentiate between healthy body heat and <a href="https://www.cambridge.org/core/journals/medical-history/article/fever-pathology-in-the-sixteenth-century-tradition-and-innovation/652A82CDFDB5FAD191D5E0C969FCA632">febrile heat</a>. The latter was also characterised by qualitative aspects and could, for example, be “sharp” or “biting”. Not only the degree of heat was important but also its kind. What’s more, besides body heat, the pulse, respiration, the skin, and urine were all thought to indicate a fever’s character.</p>
<h2>Thermometers in use</h2>
<p>And so although the diagnosis and treatment of fever was a central preoccupation of the physicians of the Renaissance, Sanctorius’ thermometers did not find considerable application in daily medical practice because heightened temperature simply wasn’t considered the main determinant of a fever. To physicians at the time, the measurement of body heat was of secondary interest.</p>
<p>It was <a href="https://www.faz.net/aktuell/feuilleton/buecher/rezension-sachbuch-die-skala-des-fortschritts-11305207.html">only in the 19th century</a> that the fever thermometer came into general clinical use and found its way into the household. Today, fever is defined as elevated body temperature and seen as a symptom that can occur in different diseases.</p>
<figure class="align-center ">
<img alt="Thermometer with red liquid interior on a neutral background." src="https://images.theconversation.com/files/390358/original/file-20210318-13-b5wwks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390358/original/file-20210318-13-b5wwks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390358/original/file-20210318-13-b5wwks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390358/original/file-20210318-13-b5wwks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390358/original/file-20210318-13-b5wwks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390358/original/file-20210318-13-b5wwks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390358/original/file-20210318-13-b5wwks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A modern liquid thermometer, which works by the change in volume of a thermometric fluid, mostly coloured alcohol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/glass-alcohol-thermometer-degrees-celsius-measuring-1608223156">MZinchenko/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>As different as Sanctorius’ thermometers and his notions of fever are to our modern devices and our understanding of increased body temperature, they still give an important insight into the long path that preceded our modern fever measuring devices – devices that are icons of the current pandemic like hardly any others.</p><img src="https://counter.theconversation.com/content/156773/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Teresa Hollerbach does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
The beginnings of measuring fever go back more than 400 years.
Teresa Hollerbach, Research Scholar, Max Planck Institute for the History of Science
Licensed as Creative Commons – attribution, no derivatives.