Transactions of the Twelfth Session of the AR State Medical Society (1887)

Notes, Primary Sources, Thesis Research

Transactions of the State Medical Society of Arkansas (Little Rock: Press Printing Company, 1887).

Annual Address of the President, James A. Dibrell, Sr. (Van Buren)

“What amazing wonders have not modern scientific investigations accomplished? What a grand display of dazzling brilliants have not been dug up hitherto dark, unfathomed recesses of nature, where Science sat gloomy and enshrouded in her lonely solitude? What a blazing light is chemistry! Old things are done away and the radiant new sheds its lustre over the world, bringing grand results from worlds of microscopic observations teeming with interest and benefit to mankind. True pathology follows in the wake of anatomic histology, and physiology determines with accuracy the therapeusis of medical agents in their different modes of actions on the different tissues. The study of the physiological effects of medicine is one of the great discoveries of the day. [Goes on about surgery for awhile] What has modern medicine not accomplished? It has in some countries, notably England, increased human longevity nearly five per cent. Thus the time is not far distant when man shall live to the period assigned by the Creator, or until the organisms wear out and fail by long work. The same spirit which led medical men to sacrifice their lives in services to the poor, has led them to study enthusiastically and publish the minutes of their study to the world in the interests of humanity. [Discusses diseases traced to sewer gas, dirty water, “educational over-pressure,” contact with disease, and vaccination]” (18-19)

Disease as Framework

Papers

Medical historians, medical anthropologists, and other scholars concerned with a plethora of topics have written works centered around specific diseases; what comprises their arguments, evidence, and conclusions, however, varies greatly and begs the question, what exactly is the history of a disease, and how have scholars employed disease as a schema through which they analyze other topics? This essay will attempt to provide specific examples of historians (and anthropologists and literary scholars) using illness as a framework, and it will elucidate the benefits, drawbacks, and consequences of such work.

Few medical historians would argue with the statement that a disease is a constructed entity. The biology of an illness constitutes only a part of its meaning to the society from which it emerged. Oftentimes, there are non-biological factors — “beliefs, economic relationships, societal institutions,”[1] to name a few — that also make up the concept that is a particular disease. Syphilis is a good case in point. The biology of the disease is fairly standard; it is a bacterial infection that, if left untreated, can become quite serious. Because of the way that it is transmitted, however, syphilis has garnered a scandalous reputation and has been associated with sin since its appearance in Europe in the late 1400s. The way the disease was handled institutionally (syphilitics were often banned from hospitals or placed in homes amongst one another) and the way that sufferers experienced it (often shunned from society, and when treated at all, given needlessly harsh “remedies”), shows that it was, at least in the eyes of the religious societies it ravaged, much more than what its biological attributes would suggest.[2]

Medieval University Medicine

Summaries & Reviews

“The Faculty of Medicine,” Nancy Siraisi

            In her summary of the medical faculties of medieval universities, author Nancy Siraisi begins by discussing the various reasons why a unified medical program emerged at universities, while at the same time stressing the fact that university-educated physicians were not the only medical healers, nor were they the only ones with access to the knowledge they held. The influx of Classical and Islamic knowledge in the eleventh century and the demographic growth of twelfth and thirteenth century Europe both proved to be important to the establishment and proliferation of medical faculties; the ancient texts gave them a theoretical backing and the population spike stimulated a propagation of schools and people willing (and able) to pay medical fees. It must be noted, however, that even during this time period and for a long time afterward, university-trained physicians were in the minority of the total practicing population. Often the different classes of physicians served a different caste of clientele, but most sects of practitioners had access to a similar literary repertoire and used many of the same techniques. What was unique to university medicine was its establishment of “institutional and intellectual characteristics that would continue to influence medical education well into the early modern period,” including most notably the establishment of a medical elite.[1]

There were relatively few major centers for medical education, and most of their differences lay not in their curriculum, but in the numbers of students they attracted and their reputations. Salerno was the earliest major center because its location in southern Italy provided it early access to translated ancient medical sources. In the twelfth and thirteenth century, medical authors at Salerno compiled articella, or “short treatises,” that included basic Hippocratic and Galenic tenants — these early textbooks served as an introduction to the study of medicine. Professors at Salerno were also the first to associate medicine closely with natural philosophy. As Salerno faded in prominence in the early thirteenth century, Montpellier was rising as another fashionable medical university, especially after 1220 when the school received papal recognition. The medical faculty at Paris and Bologna came into the picture around the same time, and smaller medical centers, notably Padua, began to pop up in northern Italy in the middle of the thirteenth century.

Siraisi, in her next section on social and economic considerations, begins by stating that university-educated doctors were viewed as the elites of their profession. They earned their living primarily from their practice, although some enjoyed court patronage or professorships (the latter two often found in conjunction). From their new positions of power, these men and the medical faculties in general were given novel responsibilities by the state, such as licensing power and advising the leaders and population on medical matters. Their student bodies were made up of pupils from a variety of locations, and many, as members of the secular clergy, funded their schooling through church institutions. After obtaining their degrees in four or five years of study, university-trained physicians found themselves quite employable, either as practitioners or professors for fledgling medical schools.

In its relation to other faculties at universities, medicine was most closely linked with the arts. Linked traditionally and practically — those studying medicine had to read Latin and have a grasp on logic, astrology, and natural philosophy — the arts and medicine were almost always studied in conjunction (although the arts normally came first). As far as what students of medicine actually studied, Galen and Hippocrates were prominent, but Islamic writings also made up a major component of the curricula. Their ideas were often taught out of articella, and the content was frequently polluted with commentary by later intellectuals. The daily routine, symptoms of disease, and remedies were the main subjects that most medical students studied during their varied years at university; the time required to complete a medical degree ranged from three to six years, most often followed by at least six months of actual practice. Students were also generally exposed to dissections for the purpose of familiarization with the internal structure of the human body. Surgery was a separate entity in medieval times, viewed as a lower form of art due to its lack of theoretical backing, but it nonetheless was taught at many universities (although sometimes not under the medical faculty). The reading and course requirements for surgeons were probably very similar to that of physicians.

Medicine was taught in much the same way as other academic disciplines, through lectio and disputatio. This tradition, according to Siraisi, had a hand in grounding medicine in the philosophical way of thinking. Questions were asked, disputes held, and conclusions were formed based upon the discourse. The linking of natural philosophy and medicine through these methodological similarities helped legitimize medical theory at a time when philosophy held a higher place in the echelons of university faculties.

After establishing medicine as closely linked with natural philosophy, Siraisi goes into a brief description of humoral theory and the theory of complexion. According to the theory, bodies contain four humors in equilibrium, but their natural balance can be disrupted by illness or trauma. It is the doctor’s duty to prescribe regimen/diet changes, surgery, or medicine to restore balance. Medicines were produced that contained elements that together might produce a shift in the balance of hot, dry, wet, and cold in the body. Additionally, it was taught that the movement of the heavens had direct impacts on the body’s equilibrium, and different doctors and medical schools either stressed or merely considered this notion when healing.

Siraisi closes her chapter on medieval medical universities by discussing the implications of the scholastic method of educating medical practitioners and how university- trained medical men differed from their more philosophically inclined colleagues at the universities. She asserts that the methods employed in teaching encouraged students to question ancient medical doctrine and note discrepancies between Classical and Islamic medical scholars. In their hands-on practices, Siraisi believes, doctors also were more likely to compare their experiences to the theories they were taught and modify their beliefs accordingly. Thus, medieval physicians employed empiricism in a more concrete way than those studying more metaphysical subjects. The institutions and teaching methods established in the middle of the thirteenth and early fourteenth century medical faculties had a lasting impact on the medical profession, producing elite medical men that engaged in a book-based, theoretical practice, and forming an educational tradition in the medical field that outlasted even the Black Death.

[1] Nancy Siraisi, “The Faculty of Medicine,” in A History of the University in Europe ed. Hilde de Ridder-Symoens (Cambridge: Cambridge University Press, 1992), 364.

Malignant

Summaries & Reviews

Malignant: How Cancer Becomes Us, S. Lochlann Jain

            Part memoir part cultural analysis, Malignant tries to untangle the complicated relationship between cancer, institutional America, and people within and without the disease’s enigmatic aura. Using evidence from popular culture (ad campaigns, cartoons, and artwork), Jain elucidates how cancer is (mis)understood; the way that American medical and governmental institutions have attempted to grapple with cancer, Jain argues, is fundamentally flawed in many ways due to the prevalence and long-term nature of the disease. In various chapters, she cites statistical analysis, trials, the survivor mentality, prognoses, fundraisers (like the pink ribbon campaign), prosthetics, tort law, carcinogen regulation, doctor-patient relations, screening, and the use of fear as aspects of a bigger problem — that the ways we try to understand and deal with cancer are problematic, and that we need a change. Jain argues that we should not see cancer as “a disease awaiting a cure,” but instead “as a constitutive aspect of American social life, economic and science.”[1]

I admittedly had a little trouble initially relating this to other readings because of the style’s unfamiliarity. I wonder if this book is indicative of how medical anthropologists write — by inserting themselves and their experiences into the narrative and argument. As someone trained in history, I recoiled at first, but the message of the book was made all the more powerful by the protagonist’s insight — insight that could only be garnered from having been a part of the system she critiques. The images she presents, and her analysis of them, reminded me of Dangerous Pregnancies. Both authors took posters produced by various institutions and analyzed their usage of disease and the sick body to promote different agendas. The images of the mentally handicapped child and of the supermodel dying of cancer were both presented in the service of warning the public against certain activities, lest they end up in a similar situation. I think analyses of these kinds of images are extremely valuable in determining a society’s understanding of disease and the kind of moral behavior seen as counter to the depravity of illness.

I found Jain’s linking of the doctor-patient relationship to a separation of knowledge, and, by extension, a separation of roles has great potential for analyzing the changing dynamics in doctor-patient relations in the medical field in the late nineteenth and early twentieth centuries. In my research for my undergraduate thesis, I found that up until the 1870s and 1880s, what Roy Porter called a “lively medical pluralism” dominated. Patients had the authority to choose between different types of practitioners in times before government-sponsored medical regulation was the norm. Contrasting that with the experiences of cancer patients in Jain’s narrative, it is evident that a major change took place with the rise of medical authority. Patients, it seems, have lost their voice in many ways now that they do not have access to the privileged knowledge of trained practitioners. This separation of expertise has wide-ranging effects, as elucidated in part by Jain’s presentation of the powerless, relatively uninformed cancer patient. I wonder if a research project has been undertaken to try and understand how this structure — the doctor-patient relationship in which all of the power lies with the former — emerged from the quite different doctor-patient dynamic characteristic of nineteenth-century medical practice.

[1] S. Lochlann Jain, Malignant, 4.

Dying in the City of Blues

Summaries & Reviews

Dying in the City of Blues: Sickle Cell Anemia and the Politics of Race and Health, Keith Wailoo

Through the lens of a controversial disease, sickle cell anemia, author Keith Wailoo traces important developments in mid-twentieth century American health, in race relations, and in state and federal politics. He shows how diseases can take on varied meanings in different political, cultural, and medical environments, and he analyzes how these meanings affect the people closest to the disease — the sufferers and their families. Especially prominently featured are the ways in which the disease influenced (and was influenced by) the turbulent racial politics of Memphis, Tennessee from 1940s through the 1990s — from a disease under the radar, overshadowed by malaria, to an embodiment of African American suffering and disadvantage, to a condition that evoked suspicion and anger, sickle cell anemia, like those it afflicted, was directly affected by the cultural and political environment in which it was situated.

Wailoo’s method — using a disease to elucidate the politics of a time period, and showing how diseases are active political players — is almost identical to that of Leslie J. Reagans’ in Dangerous Pregnancies. Both authors spend a lot of time discussing the political and cultural context in which their diseases arise, and they go on to explain how their chosen diseases stimulate conversations that end in major alterations in cultural values and, more concretely, in changes in medical law. Wailoo briefly discusses the commodification of the disease, which he defines as; “the process by which bodily experiences such as pain are assigned value (monetary and otherwise) by physicians, patients, insurance companies, and others.”[1] This method of analysis is reminiscent of Warwick Anderson’s in Collectors of Lost Souls, where brains are commodified in the international scientific community studying Kuru. Wailoo’s focus is more on domestic commodification in the form of sick bodies as “clinical material” for learning medical students, but both authors address the propensity for scientists to objectify the sick body and use it to their financial or reputational ends. Both studies focus on the twentieth century; I wonder if body commodification is a relatively new phenomenon, perhaps linked to the rise of the clinic in early nineteenth century Paris, or if it existed in different capacities much earlier (as objects of anatomical specimens, for example).

The conclusion, like that of Dangerous Pregnancies, offered up “lessons” that could be learned from the history of sickle cell anemia. I have noticed that some historical works’ final chapter (the conclusion, coda, etc.) often contain similar content. The historian takes what he or she has gathered from their study and applies it to more modern-day problems; sickle cell anemia, for instance, has taught us (hopefully) that eradication is not a simple process, and that when diseases take on cultural meaning, institutional methods of treatment/cure are not always viewed as beneficial by those afflicted by the illness. In the future, therefore, we should be careful when dealing with culturally-affected disease. I think this is a valuable lesson, but it led me to reflect on what exactly a historian’s job is. Is it within our realm of practice to take the arguments we make and extend them to encompass contemporary issues? Should it not be left up to our readers to decide how to apply our insights to their lives? I think this tendency to proselytize based on what an author felt he or she learned by conducting the research tends to bring in contemporary biases, and I feel including it takes away from a book’s merit.

[1] 18

The Collectors of Lost Souls

Summaries & Reviews

The Collectors of Lost Souls, Warwick Anderson

            Warwick Anderson uses the events surrounding the discovery of and subsequent medico-scientific investigation into kuru to highlight not only the complex frameworks of giving and receiving that were characteristic of mid-20th century science, but those coloring the interactions between the Fore and the medical scientists and anthropologists who descended upon them starting in the 1950s. Scientists and the Fore alike exchanged parts of bodies, expecting something in return, and establishing an identity and place in the social hierarchy of their colleagues and conquerors through these transactions. The diseased Fore body thus became commoditized in the scientific marketplace, a tool used by scientists like D. Carleton Gajdusek to establish themselves as “big men” in science. As the scientific dynamics changed in the 1980s into the “biotechnology industry” characteristic of today’s exchange of scientific information and specimens, where contracts delineate interchanges between scientists, the Fore and some older members of the scientific community like Gajdusek found themselves struggling to establish or reinforce their place in the global socio-scientific structure.

The author’s approach certainly shares Bruno Latour’s emphasis on the history of scientific objects, or non-human entities, as actors in social exchanges, and the importance of scientific networks in the creation and proliferation of certain methods and the kinds of knowledge produced. I think Collectors of Lost Souls also provids a nice example of Thomas Kuhn’s “paradigm shift” in the transition from the slow virus hypotheses to the acceptance of the prion theory. Scientists ascribing to the idea that kuru was a slow virus were quite reluctant to acknowledge Stanley Prusiner’s hypothesis of a protein as the disease-causing agent as a viable alternative. They held fast to their beliefs about how antigens operated; there could be no protein with the capability of self-replication, a requirement for infectious agents. It was not until Prusiner isolated the protein in question, described how the protein replicated (through turning host protein rogue), and proved through enzymatic testing that it was the cause that the scientific community, often reluctantly, admitted the hypothesis as a possibility. This resistance to anomaly elucidation via an alternative theory fits quite well into Kuhn’s structure for “scientific revolutions.” A conversation could be had, however, concerning the lack of mutual exclusivity in regards to the old paradigm and the new; most infectious agents do operate under the more traditional mechanism, and prions are a special case found only in a few diseases.

I came away from the book with a profound feeling of discontent with the scientific process, specifically the way that it tends to foster a tendency to be remarkably skeptical of novel matters of fact that disrupt the implications older matters of fact purportedly suggested. Biologists discovered the incredibly important mechanism of RNA translation from DNA, and the subsequent transcription from RNA of proteins, the “doers” of minute biological processes — this mechanism explained many aspects of cellular biology and genetics that had previously proven quite problematic. These discoveries, however, did not necessitate the assumption that DNA to RNA to protein was the exclusive pathway all organisms took to gene expression (and by extension infection in the case of viruses). Anderson described the scientific community’s reaction to Stanley Prusiner’s suggestion of infectious proteins as “farfetched, if not heretical.”[1] Why do scientists take a matter of fact and extrapolate upon so that it colors further research in a way that the matter of fact itself is silent about? Why can scientists not allow for ambiguity, or the potentiality of their “discoveries” being incomplete, or at the very least not all encompassing?

[1] Warwick Anderson, The Collectors of Lost Souls, 196.