by Haley Brinker, IMHM graduate intern from the Public History Department at IUPUI

In the Bacteriology Laboratory of the Indiana Medical History Museum, you’ll find a photograph of Dr. John Hurty, hard at work at his desk. Next to this photograph, you’ll discover a large poster depicting a goblinesque typhoid germ, beckoning and inviting you to meet it at the town pump. This poster, commissioned by the ever public health-conscious Dr. Hurty and created by cartoonist Garr Williams, is a reflection of the very serious typhoid problem threatening the health of Indiana’s citizens at that time. In order to combat this problem, Dr. Hurty recognized that commissioning memorable posters that left little room for confusion of their messages would make it easier for the public at large to understand the public health issues facing them.

Another of these posters (above) depicts a Creature from the Black Lagoon lookalike, rising from a bottle of milk, while a helpless, diapered child looks on, his rattle his only defense. Looking at this poster today, one can’t help but wonder what on earth could be so deadly about drinking something so seemingly harmless as milk.

To put it simply, milk, prior to pasteurization and federal regulation, was absolutely disgusting. One analysis showed that a sample of milk in New Jersey had so many bacterial colonies that the scientists just stopped counting. Dairymen at the time often used cost-saving and morally questionable tricks in order to ensure that they could milk (sorry) the most profit out of their product. One such trick was thinning the milk with water. In one case, a family reported that their milk appeared to be “wriggling.” Upon investigation, it was discovered that the milkman had used “stagnant” water nearby, which was apparently full of tiny, insect eggs that grew into tiny, insect larva, causing the “wriggling” the family had noticed. Aside from being a scene out of one of your elementary school lunchtime nightmares, it further illustrated the need to regulate the industry. After the thinning process, the milk would sometimes be discolored. In order to solve this problem, the dairymen simply added things like chalk or plaster to turn it back to the crisp, white color their customers expected. Then, it gets nauseating. In order to make doctored dairy look “richer” and more cream colored, a puree of calf brains would sometimes be added to the mixture.

Samples of milk tested during that time often had “sticks, hairs, insects, blood, and pus,” but it gets worse. There was also a lot of manure present. There was so much manure in Indianapolis’s milk in 1900 that “it was estimated that the citizens of Indianapolis consumed more than 2000 pounds of manure in a given year.” How could the powers that be possibly fight against all the rampant bacteria and the illness it caused? With formaldehyde of course! What better way to cure society’s ills than with embalming fluid in the food we eat and the milk we drink. Even our illustrious Dr. Hurty was on board at the beginning. However, he soon realized that it was doing more harm than good. Often, formaldehyde-related outbreaks of illness would occur, and could even be deadly, especially in children. In 1901, Hurty stated that over 400 children had died from milk tainted with either the chemical, dirt, or bacteria.

When the federal government finally got around to passing the Federal Pure Foods and Drugs Act in 1906, the practice of putting formaldehyde in food was finally banned. While government-mandated pasteurization of dairy was still a long way off, the tireless efforts of Dr. Hurty to remove formaldehyde from milk helped pave the way for legal change to better protect the public from those that would profit at the expense of their health.

TO SEE MORE OF HURTY'S COMMISSIONED CARTOONS AND LEARN MORE ABOUT INDIANA's 1899 PURE FOOD & DRUGS ACT, VISIT THE ONLINE EXHIBIT "FOOD FIGHT!"

                                   

References:

Blum, D. (2018). The 19^th-century fight against bacteria-ridden milk preserved with embalming fluid. Retrieved from https://www.smithsonianmag.com/science-nature/19th-century-fight-bacteria-ridden-milk-embalming-fluid-180970473/#:~:text=In%20late%201900%2C%20Hurty's%20health,was%20%E2%80%9Cwriggling.%E2%80%9D%20It%20turnedAugust 6, 2020.

Thurman B. Rice, MD. “Dr. Thaddeus M. Stevens- Pioneer in Public Health [Chapter XIV].” In The Hoosier Health Officer: A Biography of Dr. John N. Hurty, 57–60, n.d.

by Norma Erickson

It’s sometimes difficult to grasp why racial health disparities still exist in the twenty-first century. There are many aspects to the problem. One that is very relatable to everyone today is …money. How is healthcare paid for and who pays for it?

In the late 1800s and early 1900s, there were few choices. Starting with the most expensive, the very rich were cared for in their homes. Their physician made house calls and private duty nurses provided round-the-clock care. If one had the means, a private sanitarium (a for-profit hospital typically owned by one doctor, sometimes a group of them) cared for patients in need of surgery or other higher level care. If you had a little money, the public or municipal hospital offered affordable care for paying patients and the patient’s own doctor could still have charge of their case.

The public hospital also admitted the poor, whose care fell to the hospital staff physicians. In the case of a municipal hospitals with connections to medical colleges, interns and student nurses gave care under the guidance of professional staff (Indianapolis City Hospital for instance). For minor care and medications, the very poor could access publically funded dispensaries; again, these often doubled as teaching sites.

At the end of the Civil War, most of the nation’s African American population lived in the South, existing in an agriculture-based economy that placed no expectations on education. Eventually, many would leave to find better opportunities in the North’s large cities. Indianapolis was a very interesting northern city because, unlike some the larger metropolitan areas, its African American population grew at a relatively slow pace. This allowed the white population to become more familiar with their new neighbors and the establishment of businesses and occupations that crossed over the color line, a line of social segregation between the races that stood solidly until the latter years of the twentieth century.

The Black community developed class strata, just as did the white side. There were well-to do folks, a hardworking middling group, laborers, and the indigent on both sides. On the Black side of the line, no matter the group, an underlying missing element—that most of the white side enjoyed as a given—was respect.  African Americans could find that respect within their own environment, but truly adequate healthcare existed only on the other side of the line, where respect was hard to gain. For many in the middle group (small business owners, craftspeople, high-level service workers like train porters), the public hospital was the only option, and they knew that even if they paid, they would be admitted to the worst section of an aging building without access to their own doctor and at the mercy of a staff that might not respect them.

The leaders in the Black community understood that the providing and receiving healthcare was an economic issue. The community was missing out on opportunities for employment (nurses and developing technology specialists) and higher level physician skills with required modern surgical equipment and support.

Except for the Alpha Home for Women that cared for aged black women, no institutional medical facilities for Blacks existed in the city until the 1896 when a new physician, Fernando Beamouth, opened a sanitarium at 651 North Senate Avenue. The Freeman, a major Black newspaper, noted that this was the first sanitarium in the state for Black patients and only the second in the nation to be started by doctor of color. Beamouth died in 1897. In August 1903, several prominent men in the Black community, including Dr. Sumner Furniss, tried to purchase a building in the 900 block of North Meridian to start a clinic, but abandoned the project when white neighbors objected.

Later, Dr. Joseph H. Ward opened his sanitarium on Indiana Avenue around 1906 (the actual date is unclear).  This first viable effort mostly served the portion of the population able to pay for private care.  For the first few years, Ward did not advertise his sanitarium in the newspapers, but the society pages occasionally announced hospitalizations there, naming patients known as elite members of the black community.  Later, he was Madame C.J. Walker’s personal physician. It is likely he also cared for a few charity patients, too.

Beamouth, Ward, and Furniss were also members of the Black business league. Ward acted on the fuller economic function of health care as a source of good-paying jobs by starting a nurse training program. His sanitarium filled a gap for the elite, but the middle class needed an alternative to the City Hospital. In 1909, Furniss and several other Black doctors formed the Lincoln Hospital that would function as a public hospital for the African American community with the ability to pay for care. The Lincoln Hospital and its physicians will be the subject of the blog post next month in The Struggle for Adequate Healthcare for African Americans in Indianapolis-1906-1925 Part III.

Photo: Officers of the National Negro Business League, at Indianapolis in 1904 from the collection of the Schomburg Center for Research in Black Culture at the New York Public Library. Dr. Sumner Furniss is the first on the left in the second row. 

by Sarah Halter

Despite the ongoing pandemic and our temporary closure, these are exciting and productive times at the Indiana Medical History Museum.

This organization has come a long way in recent years. Among other things, we are making it a priority to better manage and care for all of our collections, and, as much as possible, make them accessible to the public. In late 2019, after successfully completing a large project to catalog the Museum’s library collection, we began a similar project to catalog, organize, and better protect our extensive archival collection. Our goals were to improve accessibility of the materials, identify holes in the collection, better track conditions, prioritize materials for digitization, and better manage and track use of the materials.

We currently don't know the full extent of our archival collection precisely, but we estimate that the collection contains approximately 5,500 documents (personal papers, research notes, pamphlets, charts, instruction sheets, loose records, photographs, sketches, advertisements, class photos, etc.), including many oversized or rolled documents, plus hundreds of pieces of framed artwork, ledger books, and 16mm film reels and about 11,000 (!) glass plate negatives.

As was the case with the library collection before we completed Phase I of this project, we just don't know everything we have. We can't always locate materials that we know we have, because storage locations in many cases have changed numerous times over the years. Our archival collections have been disorganized and inadequately protected on shelves that are sometimes unstable and frequently inefficient and unsecured. To protect and make better use of these materials, we must organize and store them using archival quality materials and secure, and in some cases fire and water resistant, shelves and cabinets. Last month we were awarded a $15,000 Heritage Support Grant provided by the Indiana Historical Society and made possible by Lilly Endowment, Inc. to help us accomplish this.

This is such important work. It’s critical, in fact, to our mission to preserve and present Indiana’s rich medical history. We are stewards of a wonderful collection that contains a wealth of knowledge and many rare and very historically significant materials. When this project is completed, these materials will be much more useful for our internal research, publications, and exhibits. And most will be available to patrons, as well, when we reopen to the public and establish our Reading Room hours.

We miss seeing you all here in the Old Pathology Building for tours and programs. But we’re making good use of this time to improve our digital and virtual offerings and to improve your experience and your access to our collections when it’s safe to have you back. Thanks for your patience and your continued support! It means so much to us.

PHOTOS

Top: The IMHM collection includes many pieces of artwork, including works created by patients. The works of the transient artist John Zwara are among the most exceptional. We have 22 of his paintings, 21 of which were done while he was a patient at Central State Hospital in the spring and summer of 1938. Most depict the grounds of the hospital as they were at that time. He painted several of the hospital’s large buildings, like this one of the Pathological Department that now houses the IMHM, as well as areas of the grounds.

Bottom: Our collection consists of many ledgers of autopsy records from Central State Hospital as well as admissions, bookkeeping, and other types of records from a number of other hospitals. Here is a ledger from Long Hospital in Indianapolis.

by Erin Powers of Ball State University's Applied Anthropology Laboratories

Before the pandemic, I loved that my job involved being outdoors; now in the midst of the pandemic, I ’m grateful that my job involves being outdoors! I am an archaeologist in the Applied Anthropology Laboratories (AAL) at Ball State University and while we are braving these unprecedented times as best we can, we have been fortunate to be able to continue doing student-centered research in the past months. This means that we are now able to set a date to conduct a geophysical survey in an unmarked cemetery used during the early years of Central State Hospital. Originally, we scheduled this project for June 2020, but the pandemic had other plans. This project targets the oldest and first cemetery associated with the Central State Hospital that was used from 1848 to 1905.

Currently, we do not know how many individuals are buried there and the extent of the cemetery. Sometime in the mid-twentieth century, the grave markers were removed. These individuals deserve to be acknowledged and represented, which is what we hope to address with this project through geophysical survey. Along with the Indiana Medical History Museum (IMHM), Indianapolis Metropolitan Police Department Mounted Horse Patrol and Canine Unit, and the Caroline Scott Chapter of the Daughters of the American Revolution, we intend to find the extent of the cemetery and how many individuals are buried there using non-invasive ground penetrating radar (GPR).

This project is using GPR as opposed to traditional archaeological excavation because it is non-invasive and it will not destroy the cemetery or property. GPR projects requires fewer archaeologists and is much faster than traditional archaeological projects. Normally when you think of archaeology, you imagine a big square trench where everyone is troweling the soil, exposing artifacts, and removing dirt. Since cemeteries are incredibly sensitive historic spaces, traditional archaeology cannot be applied here. Instead, archaeologists have started to use geophysical equipment, like GPR, that read or send electromagnetic waves into the earth and collect information. This information is analyzed in the laboratory and it lets archaeologists see into the ground without removing any earth.

While we analyze the data, we are looking for disturbances in horizontal soil strata, which indicate that the soil was disturbed. In cemeteries, we are typically looking for patterns of disturbance that resemble grave shafts and metal artifacts that could be associated with the burials. For example, coffin hardware or metal jewelry buried with an individual will typically show up in the GPR data. In an ideal situation, once the GPR data is processed, an AAL staff member can clearly demarcate each grave shaft and the boundary of the cemetery. In most cases, there are many disturbances that the GPR picks up and some of them are associated to animal activity, various construction phases, and metal fences or poles nearby. GPR can tell us the extent of the cemetery, the number of grave shafts, and the minimum number of individuals.

Back in March 2020, Sarah Halter (Executive Director, IMHM) and I created a crowdfunding campaign at Ball State University in order to raise the funds needed to fund this project at Central State Hospital. Thanks to all of our donors and supporters, we exceeded our goal of $5500 and raised over $5800. This money will go to the AAL staff members conduct the GPR survey and processing the data. The AAL team is going to resume fieldwork very soon in a socially distant, safe, and healthy way. We will keep the public updated about the fieldwork, data processing, and results of this project. We are looking forward to getting this project underway and bringing to light the marginalized individuals buried at Central State Hospital. 

by Rhea Cain and Allison Linn

“Does public opinion indorse [sic] sterilization? The following report of a nationwide poll gives the answer.” 

The Indianapolis Star, Sun, May 23^rd, 1937

It sounds a bit like a line from a dystopian novel by Margaret Atwell, but alas, it is from Indiana’s own not-so-distant past. Most folks may not realize that Indiana has a lot of “firsts” under its belt: The first city illuminated by electric light? Wabash, Indiana. The first gas pump?  Ft. Wayne, thanks to the forward thinking (what a name!) Sylavanus Freelove Bowser. The first compulsory sterilization laws used against the mentally ill? Indiana again.  

This law, enacted in Indiana with overwhelming support from the eugenics community in, was simply referred to as The Indiana Plan. Its justification can be traced back to theories of eugenics. Eugenics as a branch of science developed in the late 1800’s, which sprouted from Gregor Mendel’s cross breeding of plants in the mid-19^th century. Mendel, is commonly referred to as the father of genetics, but it was his research and his theories on inherited traits that provided the foundation to the eugenics movement.

By the beginning of the twentieth century the adapted theories of Eugenics had established a firm following. The Eugenics Movement became popularized because it was believed that by installing some form of control over human reproduction, society would form a healthier and stronger human population in later generations. By the time Indiana passed its sterilization law, eugenics was a serious scientific study which held powerful advocates within the state and across the country. Indiana was a state known at this time for its reform in welfare and charity, therefore eugenics was a response to the state’s concern with its impoverished and mentally disabled citizens. Looking back, was the movement’s goal to improve the human race by assisting evolution (a slow process) or simply remove troublesome inherited characteristics from reaching the next generation (quick and brutal)? 

So how did Indiana become the first state culpable in designing such a destructive law to begin with? There are three key Hoosiers who were major proponents for the passing and implementation of the Indiana Plan, the first being Dr. Harry Sharp. Sharp was the prison physician at Jeffersonville reformatory. Starting in 1899 Dr. Sharp, with written consent from the convicted, began conducting routine vasectomies on his male prisoners. Between the years of 1899-1909, Dr. Sharp had performed four hundred and sixty-five of these surgeries. Three hundred and eighty-four surgeries were done before the passage of Indiana’s sterilization law. Dr. Sharp and his clinical studies on the surgeries itself, as well as the impact on male prisoners following the surgery, were published in clinical magazines all throughout the country.  They were then used as a scientific legitimization that sterilization can be deemed beneficial physically and mentally to those operated on. Dr. Sharp often argued in his publications that crime and degeneracy were hereditary in nature, and therefore sterilization is necessary in order to eliminate most crime within a community.

The next two individuals were G. Henri Bogart and John Hurty, both physicians highly revered within the medical community, who advocated for the sterilization of those deemed “unfit” by licensed professionals. Their opinions were published in a plethora of medical journals as well as influential national papers during the early twentieth century. Dr. Bogart alone published thirty articles on human sterilization between 1908 and 1910. Dr. Hurty not only promoted the use of sterilization but also the enactment of marriage restrictions (who was restricted?), public vaccination and public sanitation. All subjects he bundled together and used as his platform during his involvement with The United States Health Movement.

There were some legal hiccups along the way; the law was overturned in 1921 by the Indiana Supreme Court due to perceived violations of the 14^th Amendment.  but diligent legislators put forth a new more stringent law in 1927 once the United States Supreme Court sided with Virginia in the now landmark case, Buck v. Bell. As a result of the Buck case, states felt emboldened to move forward with their crusades to combat poverty and disease via eugenics.

 Ultimately, the real reason became quite clear. Indiana legislators worked to enact laws that would sterilize citizens that they deemed undesirable: criminals, the mentally ill, the rural poor, orphans, county home residents, unwed mothers, etc. Why? To save the State of Indiana as much money as possible. “Many of these shiftless, feebleminded folks can barely eke out a living for themselves, but that does not deter them from marrying and propagating their kind, thus adding to the burden of the state.” CITATION Ass96 \l 1033  (Associated Press 1996) If “weak minded” and “morally corrupt” people were prohibited from reproducing, there would be less need for institutions of all kinds (because clearly all behavior must be hereditary, right?).

So how did this process work in an institutional setting? It was up to the superintendent of the institution to “nominate” patients for sterilization and present them to the institution’s governing board. Then a hearing was held for the patient and potentially a family member to take part in that would determine of the patient was a candidate for sterilization. IF the patient or their family was unhappy with the outcome of this hearing? They could fight the governing board in the courts. In 1931, it was decided to allow county judges (as long as they had the approval of two licensed physicians), to order the sterilization of a patient during their commitment procedure, circumventing the institutions’ boards altogether. In 1935, Representative Dr. Horace Willan went even further when he proposed that any patient that could potentially become a parent be sterilized within 30 days of admission to a state hospital if physicians deemed it “necessary”.  CITATION Uni35 \l 1033 (United Press 1935). (And 80% of those polled in the cited article were most definitely in favor of mandatory sterilization in 1937.)

Except for the gap between 1921 and enactment of 1927, the sterilization laws remained in effect in Indiana until 1974. CITATION Sta74 \l 1033  (State of Indiana 1974)  In the period the law was enacted, roughly 2500 Indiana residents were sterilized in order to protect the tax payers of Indiana. And while state mandated sterilizations all but stopped in the 1960’s due to cost, there will still other ways of thwarting “undesirables” from having children. One of the most enforced was simply making it unlawful for certain populations of Indiana residents to get married. Indiana Law 111 passed in 1905 prohibited a marriage license from being issued to anyone under guardianship as a person of unsound mind, and specifically prohibited men who had spent any time in the past five years in a county asylum or home for indigent persons. The Indiana marriage laws remained on the books in some capacity until 1977. CITATION Sta77 \l 1033  (State of Indiana 1977)

Public approval of eugenic theory began to wane after clear examples from Nazi Germany showed what could happen in a society when its people began placing value on certain members within a group and denigrating members of others. Science was also starting to reveal that earlier data on biological heredity was not as accurate as once believed. New information revealed that a multitude of mental disabilities are not inherited at all, while human behaviors are shaped more by environment than by heredity. Near the end of the war, the world learned of the atrocities committed at the hands of Nazis and their concentration camps, this only strengthened western culture’s opposition to sterilization and eugenics. America would instead place higher emphasis on individual and personal rights, and finally in 1974, Indiana’s sterilization laws were repealed.

In reviewing the history of Indiana’s compulsory sterilization laws, it becomes all too clear that sometimes, history does repeat itself—and not for the better. Overwhelmingly the victims of this program were the under-educated, the poor, and people of color. We owe it to those victims to not only know about our state’s part in this chapter of American medical history, but to work diligently to ensure it never happens again. We also need to acknowledge that systemic racism and classism, direct mechanisms behind Indiana’s eugenics movement, still negatively impact our communities today.

Further Learning:

Imbeciles: The Supreme Court, American Eugenics, and the Sterilization of Carrie Buck by Adam Cohen

Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America by Alexandra Stern

A Century of Eugenics in America: From the Indiana Experiment to the Human Genome Era edited by Paul Lombardo

The Eugenics Crusade. WGBH Boston https://www.pbs.org/wgbh/americanexperience/films/eugenics-crusade/

by Norma Erickson

Imagine for a moment that you are in desperate need of a complicated surgical operation, one that cannot be performed as an outpatient. It is such a serious surgery that you could die, if it is not successful. Some of the success of the operation depends on good nursing care during your recovery. 

Now imagine you are in Indianapolis in 1904 and you are a Black patient in need of surgery in a hospital at a time when your personal physician, also Black, is not allowed to practice in City Hospital (now Sidney & Lois Eskenazi Hospital)—the only hospital that will admit you. You don’t know how your white surgeon feels about operating on an African American. You also don’t know—when you are finally anesthetized—if an intern will be holding the scalpel that will be slicing into your abdomen, practicing his newly-learned surgical skills. The nurse who will be taking care of you will also be white and may not like going to the dank and dark basement Colored Ward to care for you.

Is it little wonder that you waited so long to see a doctor and relied on home remedies or even resorted to magical charms to evade the possibility of mistreatment that folks in your neighborhood warned you about? They described the hospital as a “terror” many times. Your Black doctor may not know the feelings of the white doctor, because the normal way of getting to know other physicians, the local medical society, does not allow him membership.

This scenario shows just one of the reasons the African American community experienced a disparity in healthcare in the early twentieth century.  But what could be done? Racial segregation was a fact of life, and it appeared that nothing would change. To gain some control over the situation, there had to be healthcare that the community could trust, and there had to be adequate places to deliver such care. For this reason, individuals and groups decided to “yield to the inevitable” and began an effort in the city to alleviate this problem by establishing hospitals and private sanitariums to provide good medical care and nurse training programs to uplift the Black citizens of Indianapolis both economically and socially.

Subsequent blog posts will tell a bit of the story of three such institutions that existed in Indianapolis between the years 1906 and 1925—Ward’s Sanitarium, Lincoln Hospital, and the Sisters of Charity Hospital. As you read these stories, keep in mind that although they disappeared in the first quarter of the century, the problems they sought to cure did not, reaching even until the present day.

by Mary Mauer

With the outbreak of COVID-19, we’re reminded now more than ever of the importance of good hygiene. Trench Warfare during the First World War is an excellent example of what can happen if hygiene is not well understood. Trenches were dug for numerous reasons-- to protect from heavy artillery, gas, and bullets, to name a few. But with trenches came unexpected consequences, one being trench foot. (Photo:  © IWM Q 10622 from the Ministry of Information First World War Official Collection of Imperial War Museums)

Trench foot, also known as “immersion foot,” is a condition brought on when feet are exposed to wet and cold conditions for long periods of time, although it can even manifest during warmer weather as high as 60 degrees if the feet are constantly wet. Humans loose heat in our wet feet 25 times faster than we do when they are dry. To prevent heat loss, the body inadvertently acts against us- constricting blood vessels to shut down circulation in the feet. [i] If left like this long enough, the outcome can be disastrous. Symptoms include tingling and or itching, pain, swelling, cold and blotchy skin, numbness, and a heavy feeling in the foot. The feet may become red, dry, and painful when warmed. In severe cases, blisters will form and, if left untreated, the skin and other tissue can break down. [ii] This can lead to gangrene and can require amputation. [iii] Over the course of the war, it is predicted there were up to 2,000 American and 75,000 British casualties from the condition, alone.[iv]

Because of frequent rainfall in Europe, trenches would flood or flow with rivers of mud. Winters could become horrifically cold, and before preventative measures, soldiers’ feet and boots were persistently wet and cold. Filthy conditions in the trenches certainly didn’t help the matter. Below are personal recollections of life in trenches. As seen, the two primary factors that induced trench foot were frequently mentioned miseries for soldiers both in and outside the trenches.

The Man in the Trench

(Written after the great Battle of Ypres)

From here I watch you, through the driving sleet,

Under the evening sky,

Hurrying Home. [v]

James Bernard Fagan,

The Daily Telegram, Nov., 1914

 _____

 

Fight of the Last Battalion

All day long we pushed them back,

By night we’d their second line trench,
Then we “dug in,” and waited for him,

By morn, with rain we were drenched

…

Did you ever lay out in the cold all night,

When the frost just creeps through the air,

When death and misery stalks the night,

Like a giant bat of despair? [vi]

“Buck Private” McCollum

 ____

“Thank the powers it has stopped raining and we’ll be able to get dry. I came in plastered from head to foot while lying in the rain on my tummy and peering over the top of a trench.” [vii] Coningsby Dawson

                                 Letter to his mother, September 19, 1916

_____ 

“The winter of 1916-17 was notoriously a very, very cold winter. And for my part, I think I almost in my own mind then tasted the depths of misery really, what with the cold.” [viii]

Victor Fagence

_____ 

 

Once it became clear that trench foot was a serious ailment, doctors began to look for the cause and preventative measures. Prevention was simple. By keeping the feet warm, dry, and clean, trench foot could be avoided. Soldiers were given a spare set of socks in the trenches and, when circumstances permitted, instructed to dry and rub their feet, and put on dry socks. [ix] Soldiers were also provided with whale oil to coat their feet as a means of waterproofing them.[x] Additionally, feet were often inspected for signs of the condition. [xi] Attempts were also made to improve the trenches with the installation of Duckboards, as theoretically the raised edges on the boards would protect the men’s feet from standing water. [xii]

An unexpected and hard lesson was learned over the 4 years of the war; there are dire consequences to poor hygiene. Your life and the life of others around you can be saved by something as simple as pair of clean and dry socks, or hands that have been washed with soap for at least 20 seconds.

[i] “Cold Stress- Cold related Illnesses Types of Cold- related illnesses,” CDC and NIOSH, (updated: 6 June 2018), accessed 27 May 2020 https://www.cdc.gov/niosh/topics/coldstress/coldrelatedillnesses.html

[ii] “Trench Foot or Immersion Foot. Disaster Recovery Fact Sheet” (last reviewed 8 September 2005), accessed 26 March 2020 https://www.cdc.gov/disasters/trenchfoot.html

[iii] Canadian War Museum. Canada and the First World War, Rats, Lice, and Exhaustion, (created 20, June 2008. Last Updated 16, October, 2018), accessed 27 May 2020 https://www.warmuseum.ca/firstworldwar/history/life-at-the-front/trench-conditions/rats-lice-and-exhaustion/

[iv] RL Atenstaedt, 2006. “Trench foot: the medical response in the first World War 1914-1918”, Wilderness and Environmental Medicine Journal. Volune 17, Issue 4, Pages 282-289, 2006. I used page 282 https://www.wemjournal.org/article/S1080-6032(06)70334-9/pdf

[v] Carrie Ellen Holman (selected by). In the Day of the Battle. Poems of the Great War (Toronto: Anness Publishing, 1918) p. 42

[vi] L.C. McCollum History and Rhymes of the Lost Battalion (1922) p. 48, p.51

[vii] Coningsby Dawson. Carry On (New York: John Lane Company, 1917) p. 48

[viii] Imperial War Museum. Voices of the First World War: Winter 1916, (created 5 June 2018), accessed 26 May 2020 https://www.iwm.org.uk/history/voices-of-the-first-world-war-winter-1916

[ix] Library and Archives Canada, RG9 111-B-2, vol. 3615, file 25/7/1-25/7/6: Name of file. General Routine Order Regarding the Prevention of Chilled Feet in Soldiers, October 11, 1915 http://data2.collectionscanada.gc.ca/e/e001/e000000266.jpg

https://www.bac-lac.gc.ca/eng/discover/military-heritage/first-world-war/canada-first-world-war/Pages/felix-cullen.aspx?wbdisable=true

[x] Imperial War Museum, Why Whales Were Vital in the First World War, (crated 14 June 2018), accessed 26 May 2020, https://www.iwm.org.uk/history/why-whales-were-vital-in-the-first-world-war

[xi] Amanda Mason, Imperial War Museum, How to Keep Clean and Healthy in the Trenches, (created 11 January 2018), accessed 27 May 2020 https://www.iwm.org.uk/history/how-to-keep-clean-and-healthy-in-the-trenches#entry5

[xii] Imperial War Museum, Our collections: Duckboard, British, First World War, accessed 26 May 2020    https://www.iwm.org.uk/collections/item/object/30028121

 

by Norma Erickson

If that exclamation is unfamiliar to you, then you are probably an American who has not been streaming a lot of British telly during the recent months. In the UK, bollocks are a vulgar term for testicles. The word is frequently used as an expletive when something is deemed ‘utter nonsense’ or fraudulently exaggerated. Americans use the word ‘bull!’ in the same capacity. It seems somewhat paradoxical that prim and proper Brits would use a more earthy description than the free-wheeling Americans. But, of course, a bull isn’t a bull without the bollocks, right?

Image: Cells from a testicular specimen.

All this talk of testicles reminds us that June is Men’s Health month and concern over testicular cancer (TC) rightly brings out advocates for men’s self-checks and frank conversations with their physicians. While TC remains a rare form of cancer, as cancers go, it is still the leading form of malignancy for men between the ages of 20-40. The good news—it is a highly treatable disease. There is a 95% survival rate after five years.  The American Society of Clinical Oncologists estimates 1 out of 250 men and boys will be diagnosed in their lifetime. The bad news—half of men with it don’t seek treatment until it has spread to other parts of the body. Guys---you really need to get on this.

The reason for the good news of the successful recovery rate is actually a bit of Indiana’s medical history, thanks to the dedicated work of two outstanding physicians at Indiana University School of Medicine—the oncologist Lawence H. Einhorn and the urologic surgeon John Donohue. Together, their efforts rocketed the survival rate from 5% in the early 1970s to 95%. Dr. Thomas Ulbright, of the IU School of Medicine’s Department of Pathology and Laboratory Medicine, is a world-renowned pathologist in the area of diagnosis of testicular cancer. He says that even with good treatment, there are still patients who die of the disease, mainly because they present with advanced stage disease—tumors the size of a baseball or softball that have metastasized to other organs. Guys, you have to do your part—early detection, right?  Early detection begins with self-examinations.

How can men be motivated to do better in this regard? Currently, there is a “Three Fs” approach:

1) Fear— Although 95% overall survivability is great, not letting it get out of hand is better. Besides the effects that might include gynecomastia (breast enlargement) and sexual problems, did you know it can affect the brain? There’s a serious related disease that affects some with TC called "testicular cancer-associated paraneoplastic encephalitis”.  These patients experience progressive loss of control of their limbs, eye movements, and sometimes, even their speech. So the earlier detected the better. Often these neurological issues regress with simple excision of the tumor-bearing testis, but again time is of the essence.

2) Fun- Catchy slogans to take away the squeamish idea of self-checks. There’s the Australian Movember website with its ‘know thy nuts’ campaign. The BaggyTrouserUK charity in England and Wales that challenges to “have the guts to check your nuts”. In Brazil, there is the mascot Mr. Testicle that seems to be what is under those square pants of SpongeBob’s.

3) Fandom—Celebrity spokespersons help the cause. Often, sports personalities draw attention. Before his doping confession, Tour de France champion Lance Armstrong, a former patient of Dr. Einhorn’s, was front and center as THE success story of beating the disease.  The #FafChallenge features the Springbok Rugby team posing in Speedos sporting the South African flag, in an effort to remove the stigma of self-examination. Note: the website has a strange video testimonial made by “John’s left testicle”. From the entertainment world, Cahonas Scotland has received the support of the Starz Outlander TV series star Sam Heughan (a.k.a. Jamie Fraser—King of Men). Based on the romantic historical novels of Diana Gabaldon, the show’s viewer base is comprised of 50% men.  Besides his charitable donations through his My Peak Challenge fitness organization, he has also provided the voice-over for a testicular tutorial.

The procedure is outlined on many TC websites like https://testicularcancer.org/. Learn it for health, guys. And that’s no bull.

References:

https://www.cancer.net/cancer-types/testicular-cancer/statistics

https://newsnetwork.mayoclinic.org/discussion/scientists-discover-autoimmune-disease-associated-with-testicular-cancer/

by Sarah Halter

If you don't love history, it's because you haven't been properly introduced to it. Sometimes the stories that on the surface sound the most boring and the most relevant, turn out to be exactly the opposite.

Case in point: the establishment of the Indiana State Board of Health

Dr. Thaddeus Merrill Stevens was the fabulously awkward first Secretary of the Indiana State Board of Health. He's not a very well-known figure in Indiana's history, which is really a shame. You may be thinking, "Thaddeus Stevens, eh? I've heard that name...” Well, you probably have if you’re a big history nerd like me, but it's not the same guy. I'm talking about the Other Thaddeus Stevens…our Thaddeus Stevens. The Thaddeus Stevens you may remember was a US Representative from Pennsylvania and a leader of the Radical Republican faction of the Republican party in the 1860s. He was difficult to get along with for many, but he was also pretty interesting and progressive for his time-- an advocate for free public education, an opponent of slavery and of discrimination against African Americans, and later an advocate for African American rights during the Reconstruction period.

OUR Thaddeus Stevens was that guy's nephew.

Before the Indiana State Board of Health was established, there were a handful of local health departments in the Indiana. But there were no state-led efforts to promote or track the health of Hoosiers. We did have a state-wide medical society, and in 1855 that society formally proposed that a committee of members from all over the state should be established and meet regularly to collect vital statistics, address issues of epidemics, and make recommendations, etc. The State Legislature at the time had little interest in creating such a committee, so the idea was tabled. But in the 1870s, a new push was made to form a State Board of Health. Our Thaddeus Stevens, Thaddeus M. Stevens, MD, professor of toxicology, medical jurisprudence, and chemistry at Indiana Medical College, was very actively involved in these efforts. He delivered addresses stressing the importance of collecting and analyzing data, informing local boards of health and the public about health issues, and addressing the factors that lead to epidemics so they could be stopped before they began.

After years of pleas and prodding by the medical field and years of indifference from the State government, what is now called the Indiana State Medical Association, grew impatient and took it upon themselves to create such a board on its own with Thaddeus Stevens as its chair. This committee didn't have much real power to execute health ordinances or force counties to collect, report, and track information. But they did force the State to take notice and recognize the value of such action.

In 1881, a former Civil War surgeon-turned family doctor-turned State Senator from Marion County, the delightfully named Flavius Josephus Van Vorhis, proposed Senate Bill 93, which established the Indiana State Board of Health, now the Indiana State Health Department. SB93 passed the Senate in March, 39 to 3, and on the last day of session, it passed the House 56 to 20 and was signed by Governor Albert Porter. This new act of legislation provided a system of registration and reporting of vital statistics and sanitary statistics for most counties, townships, and cities, and it imposed penalties on violations. This Board consisted of five members, four of whom would be appointed by the Governor and did not have to be physicians. The fifth member, to be elected by the other members of the Board, was required to be a doctor. This was the Secretary of the Board, who would be known as the Health Officer of the State. The splendidly coifed Thaddeus Stevens (See for yourself above!), was the Board's first Secretary. He was considered by many to be the Father of Public Health in Indiana. He was considered by others to be a dreamer, rather peculiar, and even "a strange man."

I think to understand what happened next, a little background information is helpful. There aren't a lot of surviving records of our Thaddeus Stevens’ early life. A later Public Health Officer, Thurman Rice, who was a bit of a controversial figure for reasons that we won't dive into here today, gave an account of Thaddeus Stevens' life and family in a book he published in 1946.* It goes something like this: Thaddeus Stevens' grandfather was a shoemaker in Vermont. He was also a champion wrestler and a "right merry fellow." He may or may not have been killed in the War of 1812, but he definitely disappeared. There were rumors he had just walked away. The family lore, again according to Rice who had been in contact with Stevens' descendants, was that he'd lost interest in shoes...grew tired of his family...and ran off to join a circus as a bear wrestler. His children suffered terribly because of their father's reputation and abandonment. They were bullied in school and grew up to be rather bitter, sensitive, somewhat childish adults. At least one of his sons passed these personality flaws on to his own children. The shoemaker's oldest son was that first Thaddeus Stevens, and another, Joshua Stevens, became the father of our Thaddeus Stevens.

Thurman Rice's account of Thaddeus Steven's early life paints him as a reserved, abstracted, and overly-sensitive young man who lacked people skills, was incredibly stubborn and relentless, and often seemed detached and in his own world. Based on events from his later life...things we know with more certainty...this seems like a reasonably accurate depiction.

Joshua Stevens was an early settler in the Indianapolis area, and in 1829 he purchased land near what is now the intersection of Delaware and Washington Streets. He got married, had three children, became a widower, got married again, got divorced, and then died in 1858. Like his father before him, Joshua was...a bit strange. He was strongly-disliked and to some was a physically disturbing presence- enormous and club-footed. He was generally considered to be mentally deranged. When he died, his somewhat meager estate went to Thaddeus, who being "a very impractical man in his personal affairs," promptly squandered it.

Young Thaddeus grew up, became a doctor, taught in medical school, and had a remarkably successful career...at first. He was married twice, and both wives died leaving him with small children that he was emotionally ill-equipped and possibly too busy to care for. He married a third time, though, and things worked out better. Not only did she outlive him by decades, she was also very supportive of his work and lived with his sons long after his death.

Stevens graduated from the Indiana Medical College in about 1852. As early as 1856 he was a very active member of the Indiana Medical Society. He served on numerous committees and gave many papers at their meetings. He was an Indiana delegate at several American Medical Association annual meetings. And his papers were on a wide and interesting variety of topics including legal medicine, insanity, crime, toxicology, and public health. He was an active advocate not only for the establishment of the Indiana State Board of Health but also for asylum and prison reform, public hospitals, improved medical education, and so on. He was highly praised and respected, but at the same time was not well-liked personally by many and was pitied by some.

In 1881, Thaddeus Stevens was elected Secretary of the new Indiana State Board of Health. This was a brand-new board governing a brand-new state agency, and no one really knew what to do or how to begin. Indiana was knee-deep in a smallpox epidemic. And county and town leaders were slow to implement the new reporting rules. In many places, the new rules and procedures were simply ignored. It was chaotic and confusing, and Stevens, as the administrating officer of the board, had a lot of trouble making anything happen. He became frustrated with the situation, but in trying to remedy it, he made things much worse. He was brilliant. He was a good doctor. He understood what was needed. But he lacked the leadership skills needed to bring others on board and to get things done. He lacked the communication skills needed to convey his ideas clearly and coherently. He was better at nagging and agitating than taking action. He'd always preferred theory to practice. So, you won't be surprised to learn that from the very beginning, there were clashes between him and the other Board members.

Within a year, the Board decided they couldn't bear it any longer. They charged that Stevens was incapable of doing his job and determined to replace him. On March 15, 1883, after a secret meeting held without Stevens' presence or even knowledge, a report was filed removing Thaddeus Stevens as Secretary of the Board due to his "mismanagement and ...incompetency" and replacing him. Effective immediately Stevens was "ordered to deliver forthwith all books, papers and furniture, and all other property of the Board in his possession, to his successor" as soon as he'd been formally notified of his own removal. And the Board, God love 'em, decided that Steven's own replacement should deliver the bad news. The shock of all of this understandably angered Stevens, but his handling of the situation merely increased the tension.

And this is where the story really gets interesting….stay tuned for Part Two.

*Thurman B. Rice, MD. “Dr. Thaddeus M. Stevens- Pioneer in Public Health [Chapter XIV].” In The Hoosier Health Officer: A Biography of Dr. John N. Hurty, 57–60, n.d.

by Hannah Smith, IMHM Graduate Intern

Image: Section I of Central State Hospital's Cemetery, 2020

Around noon on November 21, 1848, Rev. Dr. Dowling asked a crowd of two thousand people in Long Island, New York, “Who would not prefer, rather than the crowded city burial place, to fix upon some spot amidst the solitudes of this Cypress Grove?” The people gathered for the new Cypress Hills cemetery’s dedication ceremony, which concluded with the voices of the American Musical Institute’s choir as benediction. Cypress Hills was one of the nation’s first rural, or garden, cemeteries.        

In the 19^th century, as the amount of space in church graveyards significantly decreased, city planners built rural cemeteries based on the idea of romantic art and sentimentalism. This came to be known as the Rural Cemetery Movement. A decade and a half before the establishment of Cypress Hills, the Massachusetts Horticultural Society laid plans for the opening of Mount Auburn Cemetery, the first garden cemetery in the U.S., just outside of Boston. At a meeting in September of 1832, the Horticultural Society declared that they wanted in a burial ground “whatever there was in nature which could give satisfaction to the mind,” “everything in the arts which could gratify a refined taste” and “lessons of the most exalted philosophy … and of the soundest morals.” Not only did rural cemeteries offer a solution to the need for more burial space, they also allowed for the “opportunity to experiment with landscaping” before the establishment of public parks. Planners like the Massachusetts Horticultural Society could channel Victorian and Romantic ideas into the art of landscaping through the creation of rural cemeteries.

Communities benefited the most from the creation of rural cemeteries. Cemeteries like Mount Auburn and Cypress Hills, “nestled among the smiling landscapes and beautiful gardens” on the outskirts of cities appealed to visitors’ “sense of beauty.” In the garden cemetery, people could take walks or carriage rides and have picnics – it was a public place for anyone to enjoy the scenery. The cemetery parks not only allowed people a space to enjoy nature, but a more sentimental place to mourn the dead. Before the advent of the rural cemetery, people generally avoided the “old-style graveyards” and thus often “neglected or ignored” the “remains of the deceased.” Turning cemeteries into beautifully landscaped parks allowed people to spend time memorializing their loved ones, creating a relationship between the living and the dead.

As the Indiana Medical History Museum (IMHM) works to identify the lost dead in Section I of Central State Hospital’s cemetery, we keep this notion in mind. Museum Director Sarah Halter said this about the IMHM’s cemetery project:

We have always told the story of Central State Hospital and its role in the State, the development of psychiatry, the technology of the Old Pathology Building, and the research done there. But in recent years, we have worked hard to recognize the patients themselves and their experiences at the hospital with programs and exhibits that include their perspectives. Last year, we unveiled a new interpretation of the specimens in our anatomical collection to rehumanize them and give them back their identity and their voice.

There is another group of long-forgotten patients whose humanity and significance we need to acknowledge – those buried unmarked plots in the oldest section of the hospital’s cemetery.

We want to properly memorialize the patients buried there by marking each grave, but we also want to create a beautiful green space where the Indianapolis community can feel a sense of beauty and reflect on the lives of the people buried there, as well as those of living people affected by mental illness.

  

Images: Central State Hospital patient choir (left); Group of patients on the grounds (right)

Bibliography

Dearborn, H.A.S. “Horticultural: Massachusetts Horticultural Society.” The New England Farmer, and Horticultural Register (1822-1890) 11, no. 9 (September 1832): 65-69.

Doerner, Paige. “Romanticism and Ruralism: Changing Nineteenth Century American Perceptions of the Natural World.” The Spectrum: A Scholarly Day Journal 3, no. 2 (January 2015).

“Dr. Dowling’s Address: At the Dedication of the Cypress Grove Cemetery.” Christian Advocate and Journal (1833-1865) 23, no. 50 (December 1848): 1-200.

Giguere, Joy M. “Localism and Nationalism in the City of the Dead: The Rural Cemetery Movement in the Antebellum South.” Journal of Southern History 84, no. 4 (November 2018): 845-882.

“Mount Auburn Cemetery.” Zion’s Herald and Wesleyan Journal (1842-1863) 34, no. 51 (December 1863): 1.

Quakenbos, George Payn, ed. “City Chronicle: For the week ending November 28^th, 1848.” The Literary American 1, A.J. Townsend, publisher (December 1848): 1-496.

Williams, Tate. “In the Garden Cemetery: The Revival of America’s First Urban Parks.” American Forests (Spring/Summer 2014). Accessed 18 March 2020, americanforests.org/magazine/article/in-the-garden-cemetery-the-revival-of-americas-first-ubran-parks/.