Item of the Month, March 2012: 'How the Department of Health of the city of New York is fighting tuberculosis'

To mark World TB Day 2012, we're travelling back to the United States at the turn of the 20th century to look at tuberculosis prevention in New York.

In 1882 Robert Koch announced his discovery of the tuberculosis bacillus, formally placing pulmonary tuberculosis (or consumption) among other communicable but preventable diseases. Responses to this varied. In New York the sanitary authorities didn’t make any major steps towards sanitary regulation and prevention using Koch’s work until 1894.

Hermann Michael Biggs (1859-1923), M.D. and from 1902, New York General Medical Officer, had initiated concerns and started a campaign to change the local approach to stopping the disease as early as 1887 when he was a consulting pathologist, urging notification, registration and surveillance of the disease as well as education of the public involving leaflets, press, exhibitions and lectures.  

These measures were all brought in eventually and disinfection was additionally suggested as a vital part of the campaign as well as free sputum analysis tests offered by the Dept. of Health’s bacteriological laboratory. Epidemiological cluster studies recorded on maps showed where local concentrations of the disease were, enabling targeting of available health resources.

This new approach caused angry controversy within the medical profession, but continued. In 1896 land for a tuberculosis sanatorium was bought at Otisville, 75 miles away in the Shawangunk mountains, offering free treatment for New York City residents. Special tuberculosis wards were set up in one of the New York Hospitals in 1903. Specialised clinics were opened with trained staff between 1904 and 1907. 

A scrapbook of 134 pages with 116 items of assorted stationery pasted into a continuous narrative about the city’s battle to prevent and control tuberculosis was compiled specially for the 1908 conference on tuberculosis in Washington, D.C. A footnote on the title page would appear to indicate that “250 sets” were produced. The Wellcome Library has one of these scrap books in its printed medical ephemera collection.

The scrapbook includes ‘A brief history of the campaign against tuberculosis in New York City’ by Biggs and preserves a very comprehensive range of campaign publications which includes simple forms, cards, envelopes, letterheads as well as samples of the pamphlets and leaflets that were distributed to people. The material is primarily in English, but with certain items translated into other languages reflecting the diverse ethnic population of New York City in 1908.

Four small maps also show detailed epidemiology of the disease, building by building in Lower New York in 1894-1898 and 1899-1908. Procedures for sanitary supervision and registration are given in detail with the relevant forms pasted in situ. Leaflets used in the campaign are here in a variety of languages explaining what the disease is, how it is spread (spitting is given as the chief cause), the importance of hygiene (disinfection and fumigation), what hospital and other health services were available to people and the need to report cases to the authorities. Information for health professionals is also included. The work of the bacteriological diagnosis laboratory is outlined as are the procedures for the collection of sputum samples.

The book documents a turning point in how tuberculosis was treated in New York and also the efforts of Hermann Biggs, fighting against the authorities to get them to change their approach in the light of Koch’s recent discoveries.

Tuberculosis features throughout the Wellcome Library’s collections. A general search in the online catalogue will yield much more in the way of books, journals, pictures and ephemera: this sources guide outlines our manuscripts and archive collections pertaining to the disease. [2] 

Images:
- Hemrnan Biggs, (From 'Plagues and People' website University of California, Irvine)
- Images from 'How the Department of Health of the city of New York is fighting tuberculosis' scrapbook

Author: Stephen Lowther

[1] It had previously been in the Medical Department Library of the British Local Government Board, responsible for overseeing administration, public health, sanitation etc. at a local level in England and Wales between 1871 and 1919 when it was abolished by the Ministry of Health Act.

[2] The Ephemera Collection in particular has numerous examples of colourful Christmas fund-raising stamps or seals from around the world which were sold every year to raise money for charities working with people suffering from TB. They had no postal value but made Christmas card envelopes look brighter and more cheerful. Many countries funded services and help for people with tuberculosis by placing a small surcharge on their actual postage stamps once a year. The money raised by this went specifically to help organisations and charities. We have many of these and they can be found within the Wellcome Library's stamp collections.

Global Handwashing Day

It is Global Hand Washing Day today and we've chosen to mark the date by highlighting material from a recent library acquisition of African health posters, a number of which remind us all of the importance of hand washing and basic sanitation.

For instance, the simple act of washing hands with soap (752738i) and segregation of toilet facilities (756161i) can prevent common ailments in children like diarrhoea associated with cholera (755196i), eye infections (755601i) and since 2000, avian flu (755530i).



Personal hygiene was key to the 2000 Sara Campaign, an initiative aimed at adolescent girls developed in 10 countries of Eastern and Southern Africa with UNICEF assistance. Originally a radio series, the programme branched out into animated films, comic books, storybooks, audiocassettes, guides and posters. (Source: www.unicef.org/lifeskills/index).

Hand washing with soap is said to be the most effective and cheapest way to prevent diarrhoea (associated with cholera and typhoid fever) and acute respiratory infections (like TB and pneumonia). Such infections take the lives of millions of children in developing countries each year, according to the Global Public-Private Partnership for Hand Washing who initiated Global Handwashing Day (GHD) in 2008. Posters are an essential way of promoting the routine which, it appears, is seldom practiced in some areas yet could save more lives than any single vaccine or medical intervention. (Source: http://globalhandwashingday.org/).


Apart from basic hygiene issues, the majority of posters from this collection highlight family planning issues (birth control, family size, contraception etc) but, not surprisingly, many other problems are revealed: malaria (755536i), polio (755539i ), TB (752340i), typhoid (755617i) avian flu (752086i), trachoma and blindness (752498i ), diabetes (755362i) and hypoglyemia (755464i).







Less commonly depicted are issues concerning female circumcision (755185i and 755386i ), genital mutilation (752291i), and in 2001, the ‘flying toilet’ problem in Kibera slums (755701i, and 755711i).

Details of our collection of African health posters can be seen in the Wellcome Library catalogue.

Images:

A girl washing her hands in a bowl above a tap in a washing cubicle; health education in Ethiopia. Colour lithograph by Health Education Centre (?), ca. 2000, Wellcome Library ref. 752738i

School children visiting a segregated corrugated toilet and washing their hands: hygiene in Kenya. Colour lithograph by Ministry of Health, Kenya, ca. 2000, Wellcome Library ref. 756161i

Women preparing a chicken and washing their hands: preventing avian flu in Kenya. Colour lithograph by Ministry of Health, ca. 2006, Wellcome Library ref. 755530i

A girl holds a chicken on a plate as a man washes his hands: protecting against avian flu in Kenya. Colour lithograph by UNICEF and Maskew Miller Longman, ca. 2000, Wellcome Library ref. 755918i

Campaign against female genital mutilation in Djibouti. Colour lithograph by A. Rachid and A. Djama for Ministère de la Santé MGF project, ca. 2010, Wellcome Library ref. 752291i

Three toilets in the form of ducks in flight: appeal to improve sanitation in the slums of Kibera. Colour lithograph by AMREF, 2001, Wellcome Library ref. 755701i

Robert Louis Stevenson

"For fourteen years I have not had a day's real health; I have wakened sick and gone to bed weary; and I have done my work unflinchingly. I have written in bed, and written out of it, written in hemorrhages [sic], written in sickness, written torn by coughing, written when my head swam for weakness; and for so long, it seems to me I have won my wager and recovered my glove" [1]

The quote comes from a letter written in September 1893 by the Scottish author Robert Louis Stevenson, born on this day 160 years ago. It summarises the dedication Stevenson had to his life as a writer, which he maintained despite his long-standing ill-health. And whilst we would not aim to reduce Stevenson's career to one purely shaped by illness, the anniversary of his birth affords us an opportunity to mention a number of instances - represented in the collections of the Wellcome Library - where medicine is reflected in his work.

Take The Strange Case of Dr Jekyll and Mr Hyde: the first commercial success of Stevenson's career and arguably his most famous work. Conceived by Stevenson as tale in the Gothic tradition, the story is now interpreted as a discussion on personality and primitivism, a work influenced by the evolutionary theories of Darwin and prefiguring the work of Freud on the unconscious. But consider too the nature of the transformative agent Jekyll takes - this has been interpreted as an underlying comment on nineteenth century attitudes to drugs and cocaine in particular. Others have seen the spatial arrangement of Jekyll's home as being influenced by the eighteenth century surgeon John Hunter and his property in London's Leicester Square, which served as both his residence and teaching museum.

A clearer medical influence comes from Stevenson's birthplace. Growing up in mid-nineteenth century Edinburgh, the murders carried out by William Burke and William Hare - committed in order to procure bodies for the anatomy lecturer Dr Robert Knox - were still very recent to Stevenson and formed the basis for his early story The Body-Snatcher.

Stevenson's health - contemporary opinion was that he suffered from a tubercular complaint - necessitated a great deal of travel to seek warmer climates for his health. It's ultimately this need which led to Stevenson's life of almost constant upheaval and how he and his family eventually settled in Samoa. But as our quote above indicates - and his astonishingly wide-ranging output shows - Stevenson was not a writer whose illness restricted his creative sensibilities.

Image: Execution of William Burke, from The Sack-'em-up-Men by J.M. Ball


[1] Robert Louis Stevenson to George Meredith, 5 September 1893. Quoted in Selected Letters of Robert Louis Stevenson (ed. Ernest Mehew), Yale University Press (1997)

The 'Captain of all these men of death‘ is back - if he was ever away

Tuberculosis remains a global killer, but it is often supposed to be a disease of only historical interest within the UK in the present. However, it was recently reported, Experts urge TB vaccine for all London children, that the incidence of childhood infections with tuberculosis in London has now passed the level at which routine immunisation should be introduced, according to public health experts. Even in the mid-1980s, when figures were at an all-time low, numbers of cases were in the thousands.


The extent to which this illness was a major cause of concern for centuries is reflected in Archives and Manuscripts in the Wellcome Library, and a new resources guide, Tuberculosis, draws attention to our substantial holdings. Recipe books from the seventeenth century (now digitised and available online) reveal numerous remedies for consumption (pulmonary TB) and ‘The King’s Evil’ – scrofula, tuberculosis of the lymph nodes in the neck, historically largely caused by drinking milk from infected cows.

Moving forward in time, archives and manuscripts from the nineteenth century onwards delineate changing clinical understandings of tuberculosis in its numerous forms and the rise of public health education and awareness initiatives, including mass radiography and BCG vaccination, as well as the development of effective treatment with the rise of antibiotics.

The collections also contain a few personal accounts by sufferers, including a consultation in Paris, 1723 by the 1st Viscount Palmerston for his pain in the chest and spitting of blood (MS.4764), Mrs Phyllis Tarn’s letters to her husband, while convalescing from TB in 1922 at the Royal National Hospital for Consumption and Diseases of the Chest, Ventnor, Isle of Wight (MS.8211), Captain Andrew Haggards’s diary detailing his experiences suffering from tuberculosis of the scrotum, 1950-3 (MS.7885), and an oral history interview with a doctor whose medical training was interrupted by having to spend time in a sanatorium for TB (GP/58/2).

Information on the whereabouts of historical records of TB hospitals and sanatoria can be found in the Wellcome/National Archives Hospital Records Database.

A Weekend with Wells

The weekend 9th to 11th July saw a fascinating conference celebrating the 50th anniversary of the H. G. Wells Society, ‘H. G. Wells: From Kent to Cosmopolis’, held in the appropriate setting of the Darwin College Conference Suite at the University of Kent at Canterbury.

While the conference dealt predominantly with Wells as writer and social visionary, there were a number of papers and elements of interest to the medical historian. The planned opening speaker, the distinguished author Brian Aldiss, was unable to attend, but sent a brief note to be read to the conference referencing a group of novels written by Wells in the 1920s dealing with the topic of mental disturbance, and raising the question of how far these were rooted in personal experience.


A paper by Marc Arnold on ‘H. G. Wells: Tuberculosis, Class and the Fear of Racial Degeneration’ revealed contrasting attitudes - strongly based on social class - to sufferers from TB in the nineteenth century, either ethereally delicate and frail or brutish and animalistic. Although Wells had himself been diagnosed as tubercular as a young man (but had recovered), he lent his weight to the campaign in Sandgate mounted by respectable residents objecting to the presence of numerous pauper consumptives in the town brought there by a local sanatorium entrepreneur. Arnold also made the intriguing suggestion that the depiction of the Eloi and the Morlocks in The Time Machine (1895) owes something to these contrasting images of consumption.



Themes of notions of racial degeneration and Wells’ interest in eugenics cropped up in a number of other papers. John Partington, for example, explored Wells’ relationship to the developing birth control movement, indicating that his interests lay in the wider issues of racial improvement that he saw birth control as enabling. Although most of Wells’ correspondence with Marie Stopes is in the British Library Department of Manuscripts, there is one furious note to her among the Stopes correspondence here in the Wellcome, concerning his resignation from the Society for Constructive Birth Control in 1922, and carbon copies of her letters to him some years later trying to woo him back as a supporter (PP/MCS/A.242). Her endeavours failed, although he later became a Vice President of the rival National Birth Control Association, renamed the Family Planning Association in 1938, from its inception in 1930 until shortly before his death in 1945 (SA/FPA/A14/173)

There was a fascinating plenary lecture by the science fiction novelist and children’s author Gwyneth Jones (Ann Halam) about The Island of Dr Moreau (1896) and writing her own novel Dr Franklin’s Island (2001) influenced by it, deploying modern techniques of stem cells and genetic engineering rather than surgery as the means by which the sinister scientist creates human-animal hybrids. The discussion raised issues of the context for Wells’ depiction of vivisection. The Brown Dog furore about animal experimentation at University College took place from 1903 to 1910 (on which there is some documentation in Archives and Manuscripts) and had vivisection much in the news took place after the publication of the novel, but the topic had been a cause for concern and agitation throughout the later decades of the nineteenth century. The archives of the Lister Institute, formerly British Institute for Preventive Medicine, include material on the protests by local residents against its establishment on the Chelsea Embankment on the grounds of resistance to experimentation on animals.

This was an excellent conference, and I may also add that my own paper, ‘An Ambiguous Idol: H. G. Wells inspiring and infuriating women’, based on research in the Wells papers in the Rare Book and Manuscript Library of the University of Illinois at Urbana-Champaign, was well-received.

Archives and Manuscripts cataloguing - June 2010

We mentioned in the last round up of new archives and manuscripts cataloguing that there is considerable overlap between May's work and June's: data released to the public in early June included a large amount of material created in May. Those collections were described in the May posting so we ask indulgence for any duplication in this month's digest.

As mentioned in May’s posting, two collections catalogued during May by archive students on a placement at the Library from UCL were released in June following a little fine-tuning of the data and some work on rehousing the papers. The archive of Professor Emmanuel Ciprian Amoroso CBE, FRCP, FRS (1901-1982), veterinary embryologist and endocrinologist, includes personal papers, correspondence, academic writing, Royal Society material, Manatee research and information on the International Centre for Research on Manatees, papers on mariculture and the Cayman Turtle Farm, and documentation on the Trinidad and Tobago Medical Task Force. The overlap between animal and human biology is illustrated vividly by a set of photographs documenting lactation in various mammals, homo sapiens among them (PP/AMO/C/4/7). The collection as a whole can be seen under the reference PP/AMO.

The other collection catalogued by our archive students documented the long and productive life of Dr Philip D'Arcy Hart (1900-2006), specialist in tuberculosis, socialist and peace campaigner. It includes personal papers, material on University College Hospital, the Medical Research Council - where Hart was still working at the time of his 100th birthday - international visits, Societies, Committees and Fellowships, and so forth. Hart was initially recruited by the MRC to supervise an investigation of chronic pulmonary disease among coal miners. In the 1930s, mine workers who excavated the shafts and who developed silicosis were compensated: however those who worked at the coal face and who developed a range of lung diseases widely termed pneumoconiosis were not eligible for compensation. Between 1937-1948, as part of the Pneumoconiosis Research Unit, Hart travelled the valleys of South Wales with a portable x-ray van. The Unit's work demonstrated that the disease was occupational, that industrial compensation for pneumoconiosis was warranted, and as a result compensation was subsequently extended. After what some would feel was a full career in the MRC Tuberculosis Unit, Hart embarked on a new career as a cell biologist, looking at the cellular interactions of tubercle bacilli within the defence macrophage cells, from 1965 until 2002. His papers may be seen in the catalogue under the reference PP/PDH.

We mentioned in a recent blog post that June saw something of a milestone in the retroconversion of our remaining hard copy archive catalogues: the papers of Sir Ernst Boris Chain (1906-1979), biochemist and Nobel Laureate for his work in the development of penicillin, were made visible in the database, at a stroke becoming one of the largest of our personal papers collections to be searchable. The papers can be seen under the reference PP/EBC. Also mentioned last month was the arrival in the first days of June of the papers of Henry McIlwain (1912-1992), biochemist and founding figure in neurochemistry, the majority of which was converted in May. The papers include biographical material, correspondence, material on lectures, visits, publications, and papers on his work with the Institute of Psychiatry. The 500+ new database entries can be found under the reference PP/MCI.

The last days of June, of course, fell into the Library's closed week, during which - as has been reported recently - work took place to make producible various collections of papers received from the British Psychological Society. We hope to bring further information about this material in the next round-up of archives cataloguing, to appear in early August.

The image at the head of this blog post shows the cataloguers' interface to the archives database, the collection-level record for the papers of Philip D'Arcy Hart on the screen.

Archives and Manuscripts cataloguing - April 2010

Three new collections of twentieth century archives dominate this month's cataloguing highlights.

As described in a recent blog post, the papers of the various organisations that combined in 1982 to form the British Thoracic Society have now been catalogued. They include minutes, printed material and some administrative records; correspondence and other papers relating to the training and examination of tuberculosis nurses; a small amount of material relating to the formation and early activities of the British Thoracic Society; and a 1932 London County Council post-mortem examination book of unknown provenance. The catalogue can be viewed in our online database under the reference SA/BRT.

Another, small, collection relating to tuberculosis was released at the same time as SA/BRT (as related in the same blog post): the papers of Alexander Stephenson Hall (1904-1995). Hall was a Tuberculosis Officer in Middlesex in the 1930s and consultant chest physician for a group of hospitals in Buckinghamshire from the 1940s to the 1960s; he was heavily involved in the activities of the British Tuberculosis Association and gathered material for a history of the organisation (never published). His papers include this historical documentation as well as various writings by on the social impact of tuberculosis. The catalogue can be found under the reference PP/HAL.

Thirdly, as noted in last month's bulletin, the papers of the International Epidemiological Association (IEA) have now been catalogued. The collection includes minutes and other organisational and business records; corporate records; membership directories and some photographs; general and Officer's correspondence; printed books, conference programmes, proceedings and abstracts. All this new material can be found in the database under reference SA/IEA.

Finally, as an illustration of the work that goes on behind the scenes in the archive catalogue, it is worth noting that the entire database was modified at the end of the month, to keep pace with recent changes in Library copying procedures (the introduction of self-service scanning and the consequent lifting of the 100 exposures-per-year limit for archive material) and access arrangements. This work involved the modification of over 140,000 archive records; an indication of how fast the database has grown in the 9 years that we have been populating it with catalogue information.

New archive sources for the study of tuberculosis

Two new sources for the study of tuberculosis are now available in the Library's Archives and Manuscripts department.

The Library has recently acquired the records of the British Thoracic Society: they have now been catalogued and made available for research (SA/BRT). The Society was founded in 1982 as an amalgamation of the British Thoracic Association and the Thoracic Society but it can trace its family tree back to 1910. The Society’s archive thus contains records of predecessor organisations dating back to the 1920s including the Society of Superintendents of Tuberculosis Institutions (f.1920); The Tuberculosis Association (f.1928 and later known as the British Tuberculosis Association, the British Thoracic and Tuberculosis Association and the British Thoracic Association); the Joint Tuberculosis Council (f.1924) and the Thoracic Society (f.1944).

Over the years, and in its various incarnations, the Society has brought together respiratory physicians, surgeons, anaesthetists, radiologists, pathologists and others working in the field. Its records provide a wide-ranging professional perspective on tuberculosis and lung disease which complements the story told in other collections already held by the Library, such as the records of the lay body the National Association for the Prevention of Consumption and other forms of Tuberculosis (SA/NPT).

In addition to the shifts and changes within thoracic medicine during the 20th century, other themes emerge in the records. Those researching women in medicine, for example, may be interested in Dr. Jane Walker’s involvement as a founder member and first President of the Society of Superintendents, and the career paths for women doctors in tuberculosis work more generally. For nursing historians there is material on the organisation's interest in nurse training, which dates back to 1924 when it first issued certificates in tuberculosis nursing. It made repeated, but unsuccessful, attempts to secure recognition of the qualification by the General Nursing Council, and also took an interest in related issues such as the recruitment, health and welfare of nurses, and the needs of those who developed tuberculosis during nurse-training.

Alongside the British Thoracic Society archive, the catalogue of a small set of related personal papers is also being launched. Alexander Stephenson Hall (1904-1995) was a Tuberculosis Officer in Middlesex in the 1930s and from 1947-1969 he was a consultant chest physician for a group of hospitals in Aylesbury, Buckinghamshire. Hall was heavily involved in the activities of the British Tuberculosis Association, serving as both Honorary Secretary and Vice-President. During the 1940s he was also Editor of the Association's journal Tubercle. In the 1950s Hall gathered material for a history of the Association, but this was never published. His papers (PP/HAL) include lectures and unpublished writings by on the social impact of tuberculosis and material on the foundation and development of the British Tuberculosis Association which complements the official archive.

Author: Jennifer Haynes

Re-edit medical history film

A new addition to the Wellcome Film project has been made: downloadable videos to keep, edit and watch as you wish from your own computer. The videos are H.264 (MPEG4) format and broadband resolution (2Mbps), easily playable by both Mac and PC users. To download, simply find the title you want in the catalogue searching the Wellcome Film homepage, and click on the 'Download entire title' link in the catalogue record.

All videos on the Wellcome Film website are made available under a Creative Commons Attribution-Non-Commerial 2.0 UK licence, so go ahead and edit away! If you do use any of our videos in one of your projects, please let us know by leaving a comment on our blog or on our YouTube channel - we'd love to see them!

In other Wellcome Film news, our YouTube channel was featured on Wired's website bringing a new audience to these medical films. The most popular video as a result of this is now Prefrontal Tuberculoma, a 1933 surgical film showing the removal of a brain tumour caused by tuberculosis (not for the faint of heart - see below).

Author: Lucy Smee