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  • September 26, 2022 9:09 AM | Anonymous member (Administrator)

    by Luke Skulski, IMHM Graduate Intern

    Poliomyelitis, or polio for short, is perhaps the most well-known disease of the early 20th century and was certainly one of the most feared. Poliomyelitis is a disease caused by the poliovirus, which is highly contagious and can spread easily from person to person, especially through contaminated hands and body fluids. Those infected with the virus often do not become sick, but for those who do become sick, the effects can be devastating. Patients experience severe cold and flu-like symptoms and may feel extraordinary pain in the limbs. Often, they recover with some form of paralysis. Polio can be traced back thousands of years, even being documented in ancient Egypt, but the disease did not reach epidemic levels until the late 19th century. It is during the 19th and 20th century, that polio captured the public’s attention as it terrorized the world.

    (Image: unknown artist; Stele of Roma the Doorkeeper,1403-1365 BCE; limestone, paint; from the collection of the Ny Carlsberg Glyptotek Museum; https://www.tuftsmedicalcenter.org/neurology-illustrated/spinal-cord/ancient-illness) 

    Polio struck without warning and did not discriminate between rich or poor. During its peak in the 40s and 50s, polio paralyzed or killed about half a million people each year. For this reason, it became greatly feared by Americans in the 19th and 20th centuries when it began to reach epidemic levels. Polio confounded doctors at the time who had few options to treat polio and no cure available to them. More terrifyingly, polio disproportionately affected children, leading to its alternative name “infantile paralysis”. Because of this, parents often lived in fear of their children becoming infected, often haunted by the imagery of the disease such as leg braces, wheelchairs, and iron lungs. 

    Iron Lung 

    The dreaded iron lung is perhaps one of the most famous symbols of polio in the 20th century. Invented by Phillip Drinker and Louise Shaw in 1927, iron lungs are a type of respirator that uses air pressure and vacuum chambers to force the lungs to breathe. Polio can cause paralysis of the diaphragm, which prevents the chest from rising and the lungs from inflating. Iron lungs were designed to assist people with such paralysis by using vacuums and air pressure to force air in and out of the lungs. The amount of time an individual had to spend in an iron lung depended completely on the severity of the case. Some people had to spend hours each day in an iron lung, while some individuals remained trapped in them for the rest of their lives. It was finally thanks to the polio vaccine in the 1950s that iron lungs began to fall out of use, eventually being replaced entirely by respirators. 

    (Image: Pediatric Iron Lung, circa 1950; from the collection of the Indiana Medical History Museum; www.imhm.org) 

    Polio Vaccine 

    It was only thanks to the research of scientists such as Dr Jonas E. Salk, Dr. Albert Sabin, and countless others that the polio vaccine was able to be developed. Research into polio was funded by the combined efforts of government agencies, philanthropists, and through organizations such as The March of Dimes. Teams all around the world raced around the clock, trying to be the first to develop a polio vaccine. At long last, in 1955, Salk released his polio vaccine made with killed polio virus to the public. The 1960s would also see several other polio vaccines introduced, such as Sabin’s polio vaccine, made with a weakened or attenuated polio virus, released in 1961.The development of polio vaccines had a tremendous effect in helping combat the disease around the world. As vaccinations rose, cases began to drop drastically, being virtually eradicated in the US and in many developed countries. 

    Polio Today 

    There is currently an ongoing effort to eradicate the poliovirus completely. There are obstacles to overcome, even in countries where polio had previously been eliminated. Despite having been previously eradicated almost completely within much of the world, polio is beginning to make a small comeback in the United States and other developed countries. Vaccination numbers have been going down in some states, which has left a larger percentage of people now vulnerable. This vulnerability was  made evident when poliovirus was recently found within New York’s water and sewage. This indicates that polio is spreading among the unvaccinated population in New York. Of course, paralysis resulting from contracting the polio virus is extremely rare, but that too is also now starting to happen as well, with one unvaccinated New Yorker in 2022 unfortunately becoming the first polio victim to suffer paralysis caused by polio in the US since 2013. While the threat to vaccinated individuals is very low, polio returning in the US poses a potentially deadly threat to those in the US who have not received the polio vaccine. Thankfully, there is hope. The World Health Organization continues the effort to make the vaccination available globally and doctors and health professionals within the US continue to advocate for vaccination. Through vaccination and through the work of organizations such as WHO, polio has the potential to be eradicated completely within our lifetime

    Sources https://web.archive.org/web/20070929090612/http://www.immunize.cpha.ca/english/consumer/consrese/pdf/Polio.pdf

    https://www.tuftsmedicalcenter.org/neurology-illustrated/spinal-cord/ancient-illness 

    https://www.mayoclinic.org/coronavirus-covid-19/history-disease-outbreaks-vaccine-timeline/polio 

    https://polioeradication.org/who-we-are/our-mission/ 

    https://polioeradication.org/polio-today/history-of-polio/ 

    https://www.cdc.gov/polio/what-is-polio/faq/index.htm 

    https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-polio-vaccination 

    https://medicine.yale.edu/news-article/is-polio-making-a-comeback/ 

    https://www.nydailynews.com/news/ny-polio-new-york-explainer-20220812-7hauuth5rneuljlgdchsnh2d7u-story.html

  • June 10, 2022 10:02 AM | Anonymous member (Administrator)

    by Allison Reardon, Public History Graduate Student at the Indiana Medical History Museum

    The COVID-19 pandemic has contributed to feelings of isolation and uncertainty for many people, so it is evident that it could have a significant impact on mental well-being. According to the World Health Organization, the pandemic has negatively impacted mental health worldwide, with cases of anxiety and depression increasing by 25% in just one year [1]. While it is extremely important to acknowledge the impact on general mental health, this post will focus on the pandemic’s effect on one specific mental illness: obsessive-compulsive disorder (OCD). The unique characteristics of this disorder can make life in the face of a global pandemic more challenging, in terms of both symptom presentation and treatment.

    Although not all people diagnosed with OCD suffer from obsessions and compulsions related to germs and contamination, this form is the most common, or, at least, “the most frequently reported” [2]. Many of these contamination-related compulsions, such as hand washing and avoiding places that may be contaminated, share similarities with the behaviors encouraged during the pandemic [3]. These similarities have allowed for the perpetuation of misconceptions about OCD in a new context. Near the beginning of the pandemic, for example, OCD-UK responded to a March 2020 article from the Wall Street Journal entitled “We All Need OCD Now.” As evident from their response, the article provides an example of someone recognizing the similarities between COVID-19 precautions and some OCD compulsions without understanding or acknowledging the anxiety and thought patterns that contribute to the disorder [4]. [Photo: Santa Clara County public health graphic showing ways to reduce the risk of COVID-19, including hand washing and social distancing. These precautions, on the surface, share similarities with some OCD compulsions.]

    Contamination-related OCD is not an advantage during a pandemic. In fact, the specific conditions of a disease outbreak can exacerbate the anxiety around this form of the disorder. One specific article describes a case of one woman in Europe who experienced intensifying OCD symptoms from the start of the pandemic - before any cases were reported outside of China [2]. Another article describes a similar case in which a woman experienced debilitating symptoms at the very beginning of the pandemic. This article, published in late 2021, additionally mentions that “[a]necdotally, some authors have reported increased numbers of patients with obsessive-compulsive disorder (OCD) or personality difficulties seeking psychiatric help in recent months” [3].

    These reports show that life in a pandemic can exacerbate certain OCD symptoms, but what actually leads to this escalation? It can be explained through two main parts: assessment of obsessive thoughts and access to treatment.

    Starting with assessment of obsessive thoughts, the previously-mentioned overlap between contamination-related OCD and COVID-19 precautions has certainly posed unique issues. One woman showed that although she “exhibited good insight into the nature of her OCD symptoms,” she had “difficulty in cognitively re-appraising her intrusive thoughts in light of the public discourse surrounding COVID-19” [2]. When public health authorities encourage thorough cleaning and other precautions that align with certain compulsions, it can be challenging to separate these behaviors from obsessive thoughts about contamination and to break the compulsions. In other words, it can be difficult for those struggling with contamination-related OCD to effectively distinguish between adaptive behaviors that prevent the spread of disease and maladaptive behaviors that simply reinforce anxiety and obsessive thoughts [3].

    The exacerbation of OCD symptoms is also more likely during a pandemic due to treatment issues. Similar to patients, clinicians can have difficulties distinguishing between adaptive and maladaptive behaviors [2]. They can also struggle to find practical strategies for treatment. One of the most effective treatments for OCD is exposure and response prevention, which involves exposure to anxiety-inducing situations. The actual dangers associated with exposure in certain situations due to the pandemic makes this treatment more challenging to attempt [3].

    It can be more difficult for patients to receive any treatment at all due to the effects of the pandemic, such as social distancing guidelines. One article suggests that telemedicine is a possible solution for some of these issues [2]. It is important to note, however, that these new challenges pile onto existing disparities in mental health care that create obstacles to treatment. One report from 2017 explains that “[m]ental disorders are among the top most costly health conditions for adults 18 to 64 in the U.S.,” and there are also racial and ethnic disparities that can contribute to poor mental health care [5]. Recognizing these disparities is the first step in working toward mental health equity, which is an essential consideration when discussing treatment solutions. [Photo: Sign in the window of a coffee shop explaining that they are closing due to COVID-19. Many places, including those dedicated to mental health treatment, were forced to find new solutions for operation due to the pandemic.]

    Several aspects of the COVID-19 pandemic, such as the encouraged precautions of hand washing and social distancing, can contribute to the worsening of some OCD symptoms. These intensified symptoms are not unique to this pandemic, though; previous outbreaks of diseases like MERS and influenza have had similar impacts. Although these effects have been observed before, one study from 2020 reports that little attention went to care for people struggling with contamination-related OCD during the COVID-19 pandemic [2]. The evidence suggests that more specific attention should be paid to those suffering from these symptoms.

    Clinicians are not the only ones who should be aware of the issue, though. As evident from OCD-UK’s response to the Wall Street Journal article, misunderstandings still exist around OCD, and these incorrect views can contribute to the stigma that prevents people from seeking help. The goal of this blog post series is to bring awareness to the real diagnosis of obsessive-compulsive disorder and play a part in the reduction of this stigma. Although it is especially relevant now during the COVID-19 pandemic, it is important to continue this awareness and learning to support those affected by the disorder.

    References

    [1] “COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide.” World Health Organization. March 2, 2022. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide.

    [2] French, I., and J. Lyne. “Acute exacerbation of OCD symptoms precipitated by media reports of COVID-19.” Irish Journal of Psychological Medicine 37, no. 4 (2020): 291-294, https://doi.org/10.1017/ipm.2020.61.

    [3] Costa, Ana, Sabrina Jesus, Luís Simões, Mónica Almeida, and João Alcafache. “A Case of Obsessive-Compulsive Disorder Triggered by the Pandemic.” Psych 3, no. 4 (2021): 890-896. https://doi.org/10.3390/psych3040055.

    [4] Fulwood, Ashley, and Zoe Wilson. “Response to Wall Street Journal article.” OCD-UK, April 2, 2020, https://www.ocduk.org/response-to-wall-street-journal/.

    [5] American Psychiatric Association. “Mental Health Disparities: Diverse Populations,” 2017. https://www.psychiatry.org/File%20Library/Psychiatrists/Cultural-Competency/Mental-Health-Disparities/Mental-Health-Facts-for-Diverse-Populations.pdf.

    Image Credits

    Image 1: Santa Clara County Public Health. “3 W’s to Reduce Risk of COVID-19.” Wikimedia Commons. August 2020, https://commons.wikimedia.org/wiki/File:%223_Ws_to_Reduce_RIsk_of_COVID-19%22,_Santa_Clara_County_Public_Health.jpg.

    Image 2: Webster, Tony. “COVID-19 - Coffee Shop Forced to Close.” Wikimedia Commons. March 17, 2020, https://commons.wikimedia.org/wiki/File:COVID-19_-_Coffee_Shop_Forced_to_Close_(49670878693).jpg. (To view the license for this image, visit https://creativecommons.org/licenses/by/2.0/deed.en)


  • May 28, 2022 10:43 AM | Anonymous member (Administrator)

    by Guest Blogger, Heidi Bitsoli from Sunshine Behavioral Health

    Although addiction treatment has garnered media attention and public interest over the past few decades, humans have been dealing with substance use since as early as 12,000 B.C. Historians believe that these early civilizations discovered that certain plants would produce a pleasant smell and interesting effects if ground into a powder.

    We’ve been picking up mind-altering substances ever since, but the treatment of addiction is a relatively new concept.

    The earliest American addiction treatment efforts date around the 18th and 19th centuries. As they say, the rest is history.

    Humble Beginnings of Addiction Treatment

    Since the colonists first came to America, alcohol was an integral part of their culture. In the 1800s, distilleries abundantly furnished the early settlers with alcoholic beverages. Still, the colonists frowned upon public drunkenness. Much like today, alcohol was commonly available and easy to access, but overindulging earned the judgment of those who could control their drinking. Since alcohol was the first common drug in this land, it was also the first form of addiction early practitioners attempted to treat.

    Between the 18th century and the 19th century, institutions and similar facilities began making space for alcoholics. Although the public held drunks in contempt, they housed them in designated spaces – including incarcerating alcoholics in jails. It doesn’t seem like reform or recovery happened very often in these cases because alcohol was served in jails at the time.

    Almshouses (facilities that housed the destitute), hospitals, and asylums sometimes took in alcoholics. But even these places had limited space, which left many alcoholics to die of their disease socially stigmatized and ill.

    Prohibition

    While many people think of the “Roaring Twenties” of the 20th century as a raucous, decade-long party, it was during this time – 1920-1933 – that alcohol was also banned.

    Prohibition was a nationwide effort to curb alcohol usage by outlawing it. Unfortunately, these laws seemed to have the opposite effect. Although the thinking at the time considered alcohol usage to be a moral failing, it is an illness and a maladaptive coping skill. Since prohibition only banned drinking, it did not address the root issues that cause excessive drinking.

    When alcohol became illegal, it became even more popular as groups and individuals began going “underground” to purchase and drink alcohol. This failed experiment in ending alcohol use was not entirely fruitless. It showed later generations that banning a substance alone will not treat it. We have since discovered that making a substance legal and widely available can decrease usage while banning it can do the opposite, and lead to abuse.

    Alcoholics Anonymous

    What started as a meeting between two men (one who was having his last drink as they spoke) has become the gold standard for peer-facilitated group therapy in addiction recovery. When Bill W. and Dr. Bob S. met in 1935, it’s hard to say whether they envisioned the scope of people that their program Alcoholics Anonymous and subsequent 12-step programs would help.

    Bill W. published the Alcoholics Anonymous Big Book in 1939.Since then, the principles and steps have remained largely the same. Individuals gather, work the steps, support each other in recovery, and welcome back those who have relapsed, so they can start recovering again.

    Over time, a handful of meetings offered to workmen turned into countless meetings across the country that help people of all backgrounds.

    National Committee for Education on Alcoholism (and Drug Dependence)

    Right around the time when Alcoholics Anonymous meetings were spreading through the nation, another forerunner in addiction treatment history emerged. Marty Mann founded the National Committee for Education on Alcoholism(currently called the National Council on Alcoholism and Drug Dependence).

    Mann based this committee on several key propositions. First, he defined alcohol as a disease. He then dubbed the alcoholic a “sick person.” Because of this, we could assume the alcoholic can be helped and is worth helping. At the time, he argued that alcoholism was the fourth most prevalent public health problem and it was the responsibility of the public to resolve it.

    For local NCEA affiliates, Mann wanted to implement a five-point approach to tackle the problem. He believed in launching local public education campaigns about alcoholism, pushing local hospitals to hospitalize alcoholics for acute detox, creating alcohol information centers, establishing clinics for diagnostic and treatment purposes, and building what he called “rest centers” to house and care for alcoholics in the long-term.

    Mann’s treatment model resembles some of the avenues of treating and preventing addiction that professionals in the field still use in this century.

    Addiction Treatment Today

    From simply storing alcoholics away from the rest of society in asylums and alcohol-serving jail cells to ineffectively banning alcohol to the beginnings of 12-step meetings, a lot has changed in the past few centuries for addiction treatment.

    Today, addiction treatment consists of a variety of psychological and medical interventions in different outpatient and inpatient settings. For someone who is experiencing withdrawal symptoms, “medically managed withdrawal” can ease the process for those detoxing from opioids, benzodiazepines, alcohol, nicotine, barbiturates, and other sedatives.

    Once an individual safely comes to the other side of the detoxification process, therapeutic programs such as intensive outpatient or long-term residential treatment can help him or her deal with the underlying issues and behaviors that contributed to the substance use.

    Nowadays, we have a great deal of information about addiction as a disease, and researchers are continuing to increase their understanding of this complex illness.

    The Future of Addiction Treatment

    As our society gains a better understanding of how addiction affects the brain, body, and culture, we will be able to develop even more effective means of treating this disease. Like the early colonists who couldn’t imagine things like the AA meetings and medically assisted withdrawals of today, we can’t even begin to picture what addiction treatment could look like decades from now.

    Some experts suggest that those suffering from addiction today can expect decreased stigma around addiction, redefined success for treatment outcomes, increased recognition of co-occurring disorders such as anxiety and other mental health concerns, and evolving treatment strategies.

     

    Sources

    sunshinebehavioralhealth.com- Finding Drug Rehab Centers in Indiana

    sciencetimes.com - The History of Addiction Treatment

    researchgate.net - History of Substance Use Treatment

    williamwhitepapers.com - Significant Events in the History of Addiction Treatment and

    Recovery in America

    nida.nih.gov - Types of Treatment Programs

     


  • May 13, 2022 8:47 AM | Anonymous member (Administrator)

    by Allison Reardon, IMHM Public History Graduate Intern from the Indiana Medical History Museum

    From TV shows like Monk to movies like As Good As It Gets, we commonly see obsessive-compulsive disorder (OCD) portrayed in pop culture. However, it is not always portrayed accurately, and this can cause real harm to people living with the disorder. For some people, media representations may be the first way they learn about OCD and the people affected by it. If these portrayals are inaccurate and promote stereotypes, they can contribute to the stigma around mental illness that often stops people from seeking help or talking about their struggles [1]. Therefore, it is important to assess OCD in media and the ways in which people’s perceptions of the disorder may be influenced.

    OCD has not always been portrayed in the same way throughout history. In his article “What’s So Funny about Obsessive-Compulsive Disorder?,” Paul Cefalu explains that more recent characters suffering from OCD are “typically cast [...] as the protagonists in comedies,” but earlier depictions “often showed up in melodramas, tragedies, and gothic literature” [2]. As discussed in part two of this blog post series and mentioned by Cefalu, these earlier depictions were not clearly labeled as OCD and were, instead, viewed as diagnoses like monomania and scrupulosity [2]. Because of these differing diagnoses, it is sometimes difficult to clearly identify the characters as people dealing with OCD. However, obsessions and compulsions are common symptoms in many of these gothic stories.

    Many of Edgar Allan Poe’s stories involve monomania. However, several modern diagnoses would have fallen into the category of monomania, with one article describing paranoid schizophrenia in “The Tell-Tale Heart” and phobias in “The Premature Burial” [3]. OCD would have also fallen into this broad category. Although the characters in these monomania stories are often associated with different modern diagnoses, it is useful to discuss them in the context of OCD because they would have been perceived similarly at the time. [Photo: 1935 illustration by Arthur Rackman for Poe’s short story “The Imp of the Perverse.”]

    One thing that stands out in these gothic stories is the violence often carried out by characters with monomania. For example, one story by Poe that is often cited as an example of intrusive thoughts, which play a significant role in OCD, is “The Imp of the Perverse” [4]. In this story, the narrator’s intrusive thoughts lead him to kill another person. Violent representations like this example contribute to stigma and prejudice surrounding mental illness [1]. Also, it is an inaccurate representation of obsessive-compulsive disorder because according to OCD-UK, “people living with OCD are the least likely people to actually act on such thoughts” [5].

    In more recent times, media representations of OCD have moved away from these violent depictions to more comedic portrayals. However, these can still be harmful. As described by Paul Cefalu, “mainstream depictions tend to make us forget that, according to the DSM IV, OCD is fundamentally an anxiety disorder, hardly a laughing matter to most of its long-term victims” [2].

    A 2018 study delved into one particular comedic portrayal of the disorder: Monk. The title character, Adrian Monk, suffers from OCD, and the show has received a lot of praise and acclaim for this representation. However, this particular study, which focused on reception of the show from people dealing with OCD and other anxiety disorders, demonstrated that there were some negative reactions to it. For example, one person responded to the show by saying that it “minimizes the suffering of a person with severe OCD experiences [because it] tends to feed the stereotype that OCD is merely about fear of dirt and germs.” Another person responded by explaining that although “the humor on the show lightens up the topic of mental illness,” it also “makes light of being mentally ill in a society that already thinks we are dangerous/completely crazy/the butt end of all jokes and useless to society” [6]. [Photo: Monk Season 1 DVD cover, which describes the title character with the words “Obsessive. Compulsive. Detective.”]

    Although many pieces of media depict OCD in a comedic way that contributes to stigma and stereotyping, not all recent portrayals are harmful. In fact, one more accurate representation is found in a book that conveniently has a strong Indiana connection: Turtles All the Way Down by John Green. The main character of this Indianapolis-based book, Aza Holmes, suffers from OCD, and this portrayal is largely informed by Green’s own experiences with the disorder. Because of this basis in reality, the book gets a lot right about the disorder, those struggling with it, and people trying to support loved ones with OCD. In the article “How ‘Turtles All the Way Down’ Perfectly Explained My OCD,” Maia Kinney-Petrucha explains her connection to the story through this statement: “It felt like I experienced something more than empathy” [7]. Another article discusses the book’s portrayal of mental illness and ultimately praises it and recommends that it “be used in secondary English classrooms to create mental health allies” and to provide accurate representations for young adults struggling with OCD [8]. [Photo: Book cover for Turtles All the Way Down by John Green.]

    Overall, media representations of OCD have rarely been completely accurate. As one article explains, it is important to be aware of the impact of these portrayals, especially in “depictions of stigmatized groups that are tinged with humor, where there is a fine line between what can seem true and what can seem trivializing” [6]. Although there are positives associated with the depiction of OCD in pop culture, we still have a long way to go to accurately depict the disorder and reduce stigma around it. As mentioned by Rachel May in an article discussing OCD in Encanto, “[a]t a time when anxiety disorders (of which OCD is a part) and depression are skyrocketing among both children and adults due to the pandemic, it would be helpful to see OCD accurately represented, and to use a mentally ill character for something other than the punchline” [9]. The next part of this series will focus on COVID-19 and some of the unique challenges of OCD in the pandemic, demonstrating the need for more accurate media portrayals.

     

    References

    [1] “Stigma, Prejudice and Discrimination Against People with Mental Illness.” American Psychiatric Association. Accessed March 4, 2022. https://www.psychiatry.org/patients-families/stigma-and-discrimination.

    [2] Cefalu, Paul. “What’s So Funny about Obsessive-Compulsive Disorder?” PMLA 124, no. 1 (2009): 44-58. https://www.jstor.org/stable/25614247.

    [3] Zimmerman, Brett. “Poe as Amateur Psychologist: Flooding, Phobias, Psychosomatics, and ‘The Premature Burial.’” Edgar Allan Poe Review 10, no. 1 (2009): 7-19. https://www.jstor.org/stable/41507855.

    [4] Mahoney, Donna M., and Deborah L. Wilke. “The Self Psychological View of Obsessive-Compulsive Disorder: Treating the Tormented Self.” Annals of Psychotherapy & Integrative Health (Spring 2012): 26-34.

    [5] “What are obsessions?” OCD-UK. Accessed January 29, 2022. https://www.ocduk.org/ocd/obsessions/.

    [6] Hoffner, Cynthia A., and Elizabeth L. Cohen. “A Comedic Entertainment Portrayal of Obsessive-Compulsive Disorder: Responses by Individuals With Anxiety Disorders.” Stigma and Health 3, no. 2 (2018): 159-169. http://dx.doi.org.proxy.ulib.uits.iu.edu/10.1037/sah0000083.

    [7] Kinney-Petrucha, Maia. “How ‘Turtles All the Way Down’ Perfectly Explained My OCD.” The Mighty, November 26, 2017, https://themighty.com/2017/11/turtles-all-the-way-down-john-green-explain-obsessive-compulsive-disorder-ocd/.

    [8] Hall, Michael. “Bibliotherapy and OCD: The Case of Turtles All the Way Down by John Green (2017).” New Horizons in English Studies 5, no. 1 (2020): 74-87. doi: 10.17951/nh.2020.5.74-87.

    [9] May, Rachel. “Let’s Talk About Bruno: In Encanto’s OCD Allegory, the Weird Brother Deserves Better.” Literary Hub, January 26, 2022, https://lithub.com/lets-talk-about-bruno-in-encantos-ocd-allegory-the-weird-brother-deserves-better/#top.

     

    Image Credits

    Image 1: Rackman, Arthur. Illustration for “The Imp of the Perverse.” In Poe’s Tales of Mystery and Imagination. 1935. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:09_rackham_poe_impoftheperverse.jpg.

    Image 2: “Monk Season One DVD.” Wikimedia Commons. https://en.wikipedia.org/wiki/File:Monk_Season_One_DVD.jpg.

    Image 3: “John Green Turtles All the Way Down Book Cover.” Wikimedia Commons. https://en.wikipedia.


  • May 06, 2022 9:46 AM | Anonymous member (Administrator)

    by Allison Reardon, Public History Graduate Student at the Indiana Medical History Museum

    The history of obsessive-compulsive disorder (OCD) is extensive. In fact, it can be traced back to at least the Middle Ages [1]. Early descriptions of OCD-like symptoms are often connected to the idea of “scruples” [2]. According to Joanna Bourke in her article about religious scruples, people who suffered from it were in “a serious state of existence that included fanatical performance of religious devotion combined with an overwhelming burden of spiritual doubt” [3]. Several mentions of religious scruples can be found in sources from the 17th century, including a 1691 sermon from John Moore in which he labels scruples as “religious melancholy” [2]. This quote from Moore’s sermon is a perfect example:

    “Because it is not in the power of those disconsolate Christians, whom these bad Thoughts so vex and torment, with all their endeavors to stifle and suppress them. Nay often the more they struggle with them, the more they encrease [sic]” [4].

    Along with these more general examples, there is evidence suggesting that some early religious figures suffered from scruples. One major figure, Martin Luther, who lived in the late 15th and early 16th centuries, is often cited as one of these “famous sufferers” [3]. An example of this scrupulous behavior is cited in a 2004 biography: “And yet my conscience would not give me any certainty, but I always doubted and said, ‘You didn’t do that right. You weren’t contrite enough. You left that out of your confession’” [5]. Although these religious obsessions would now be viewed as OCD-like symptoms, they were not always discussed in a psychiatric context. The shift to more psychiatric discussions occurred in the 20th century [3]. [Photo: Drawing based on a photograph of a person suffering from religious melancholy, printed in 1858.]

    Moving past the narrow descriptions of scruples, the concept of OCD changed several times before eventually reaching our current definition of obsessions and compulsions. Even within the 19th century, psychiatrists differed in their definitions and understandings of the disorder. As mentioned on the Stanford Medicine website, “psychiatrists [mainly from France and Germany] disagreed about whether the source of OCD lay in disorders of the will, the emotions or the intellect” [2]. In the early 19th century, some psychiatrists, especially the French psychiatrist Esquirol, categorized the disorder under monomania, but by the end of the century, it was largely accepted as part of the broad category of neurasthenia [2]. (For more information about this diagnosis, check out this other blog post.)

    According to Stanford Medicine, OCD was more clearly distinguished from neurasthenia at the beginning of the 20th century by both Pierre Janel and Sigmund Freud [2]. In his 1920 book, A General Introduction to Psychoanalysis, Freud discusses “obsessional neurosis,” and he additionally credits both Janet and Josef Breuer with the discovery of “[t]he meaning of neurotic symptoms,” although he does express some disagreement with many of Janet’s views [6]. Janet proposed the isolation of “psychasthenia” from neurasthenia in Les Obsessions et la Psychasthenie (1903) [2]. Some other doctors of the time questioned his argument because they felt there was no reason to separate it from the already accepted diagnoses of neurasthenia and hysteria [7]. Despite this resistance, the term “psychasthenia” was used by some in early 20th century medical journals. [Photo: Part of a 1922 newspaper article describing symptoms of psychasthenia that are similar to possible symptoms of OCD]

    Psychasthenia was also an accepted diagnosis at Central State Hospital. The first mention of this specific diagnosis for a patient at Central State seems to have been in 1927, and between 1927 and 1946, 21 people were diagnosed with psychasthenia at their first admission to the hospital. Some of the diagnoses were listed as “psychasthenia or compulsive states,” which seems more closely related to the current name of the disorder [8]. It is difficult to tell how many people admitted to the hospital may have suffered with OCD before the name psychasthenia was used, but there are some broader diagnoses into which the disorder may have fallen. For example, “monomania,” “neurasthenia,” and general “psychoneuroses” were diagnoses that were used at the hospital before 1927 [9]. Although it is possible that people who received these diagnoses suffered with OCD, it is not possible to say that with certainty. Also, “religious excitement” is often listed as a cause for mental illness (as opposed to a form), even at the opening of the hospital, and it is possible that there is a connection to the idea of religious scruples [10]. Again, however, there is no way to prove this connection.

    Eventually, people adopted the name “obsessive-compulsive disorder.” This label can be traced back to the German psychiatrist Westphal and the term “Zwangvorstellung” [2]. This term was translated into English in two different ways: “obsession” was used in Great Britain and “compulsion” in the United States [2]. A footnote in a 1952 printing of Freud’s A General Introduction to Psychoanalysis notes this difference. In this book, Freud describes “obsessional neurosis,” and the footnote explains that “Zwangneurose [is] sometimes called in English compulsion-neurosis” [6].

    Although the name “obsessive-compulsive disorder” did not appear until well into the 20th century, the history makes it clear that it is not a new disorder. Examples of OCD-like symptoms have been present since at least the 17th century, and some are even cited before that time [2]. This history also illuminates the fact that there is always more to learn. In fact, part one of this series discussed the ongoing conversation among researchers about differences between OCPD and OCD [11]. Some recent research has also focused on the effects of trauma in OCD [12] (Interestingly, an article written during World War I discussed connections between psychasthenia and shell shock [13]). Overall, the history of OCD has been long and winding, and it is still a subject of learning and debate. The next part will focus on another aspect of this history: media representations.

    References

    [1] Baldridge, Iona C., and Nancy A. Piotrowski. “Obsessive-Compulsive Disorder.” In Magill’s Medical Guide, edited by Bryan C. Auday, Michael A. Buratovich, Geraldine F. Marrocco, and Paul Moglia, 1631-1634. 7th ed. 5 vols. Ipswich, MA: Salem Press, 2014.

    [2] “History.” Stanford Medicine. Accessed February 23, 2022. https://med.stanford.edu/ocd/treatment/history.html.

    [3] Bourke, Joanna. “Divine Madness: The Dilemma of Religious Scruples in Twentieth-Century America and Britain.” Journal of Social History 42, no. 3 (2009): 581-603. https://www.jstor.org/stable/27696480.

    [4] Moore, John. Of religious melancholy a sermon preach’d before the Queen at White-Hall March the 6th, 1691/2 / by the Right Reverend Father in God John, Lord Bishop of Norwich. London: Printed for William Rogers, 1692; Ann Arbor: Text Creation Partnership. http://name.umdl.umich.edu/A51223.0001.001.

    [5] Mullett, Michael A. Martin Luther. London: Routledge, 2004.

    [6] Freud, Sigmund. A General Introduction to Psychoanalysis. Garden City, NY: Garden City Books, 1952.

    [7] Schwab, Sidney I. “Psychasthenia: Its Clinical Entity Illustrated by a Case.” Journal of Nervous & Mental Disease 32, no. 11 (1905): 721-728, https://oce-ovid-com.proxy.ulib.uits.iu.edu/article/00005053-190511000-00003/HTML.

    [8] Central State Hospital. (1927-1946). Annual Report of the Board of Trustees and Superintendent of the Central State Hospital at Indianapolis, Indiana.

    [9] Indiana Hospital for the Insane. (1888). Annual Report of the Trustees and Superintendent of the Indiana Hospital for the Insane. https://babel.hathitrust.org/cgi/pt?id=nyp.33433004139758&view=1up&seq=9&skin=2021.

    Central Indiana Hospital for the Insane. (1904). Annual Report of the Board of Trustees and Superintendent of the Central Indiana Hospital for Insane. https://babel.hathitrust.org/cgi/pt?id=nyp.33433004139766&view=1up&seq=9&skin=2021.

    Central Indiana Hospital for the Insane. (1924). Annual Report for the Board of Trustees and Superintendent of Central Indiana Hospital for the Insane at Indianapolis, Indiana.

    [10] Indiana Hospital for the Insane. (1849). Annual Report of the Commissioners and Medical Superintendent of the Hospital for the Insane, to the General Assembly, of the State of Indiana.

    [11] Thamby, Abel, and Sumant Khanna. “The role of personality disorders in obsessive-compulsive disorder.” Indian Journal of Psychiatry 61, Suppl 1 (2019): S114-S118. doi: 10.4103/psychiatry.IndianJPsychiatry_526_18.

    [12] Dykshoorn, Kristy L. “Trauma-related obsessive-compulsive disorder: a review.” Health Psychology and Behavioral Medicine 2, no. 1 (2014): 517-528. https://doi.org/10.1080/21642850.2014.905207.

    [13] Williamson, R. T. “Remarks on the Treatment of Neurasthenia and Psychasthenia Following Shell Shock.” British Medical Journal 2, no. 2970 (1917): 713-715. https://www.jstor.org/stable/20308835.

    Image Credits

    Image 1: Bagg, W. ‘Religious melancholy’ after a photograph by H. W. Diamond. Drawing. Wellcome Collection. January 2, 1858. https://wellcomecollection.org/works/hu8xh2qs.

    Image 2: “Peculiar Moods.” South Bend News-Times (South Bend, IN) 39, no. 194, July 13, 1922. https://newspapers.library.in.gov/?a=d&d=SBNT19220713.1.6&srpos=1&e=-------en-20--1---txIN-------.


  • April 29, 2022 12:52 PM | Anonymous member (Administrator)

    by Allison Reardon, Public History Graduate Student at the Indiana Medical History Museum

    “I’m a bit OCD.” This is a common phrase that you have likely heard at some point in your life. People often use it as a joke to explain their desire to keep their spaces tidy or their projects organized, and it can go unquestioned because it is so common. However, the ubiquitous nature of the phrase can obscure the real diagnosis of obsessive-compulsive disorder (OCD) behind a layer of jokes and misunderstandings. Advocates for those suffering with OCD often fight against these misunderstandings. For example, the charity OCD-UK shared facts to bust OCD myths in 2019. Some of these myths included “People with OCD love to clean” and the familiar “Everybody has a bit of OCD” [1]. [Photo: OCD myth, busted by OCD-UK, that “Everybody has a bit of OCD.”]

    The first step in the process of busting the myths of OCD is learning about the disorder, which, according to Magill’s Medical Guide, “affects 1 to 2 percent of the population” [2]. There are two main concepts to understand, and they are conveniently listed in the name: obsessions and compulsions.

    Obsessions are defined as “persistent and uncontrollable thoughts, […] images, impulses, worries, fears or doubts [that] interfere with the sufferers [sic] ability to function on a day-to-day basis” [3]. These obsessions can vary widely from person to person. OCD-UK lists several common obsessions, such as “Worrying that you or something/someone/somewhere is contaminated,” “Worrying that everything must look and feel arranged at a specific position,” “Unwanted and unpleasant sexual thoughts,” “Fear of something bad happening unless checked,” and “Worrying that you have caused an accident whilst driving” [3]. Not everyone who struggles with OCD suffers from all of these obsessions, and this list is by no means exhaustive.

    OCD-UK defines compulsions, the other part of OCD, “as repetitious, purposeful physical or mental actions that the individual feels compelled to engage in according to their own strict rules or in a stereotyped manner” [4]. Compulsions, like obsessions, can vary widely from person to person. Examples include more visible acts like “Excessive washing of one’s hands or body,” “Hoarding,” and “Checking that items are arranged ‘just right’” as well as mental acts like seeking the “reassurance of trying to remember a particular incident or event” and “Avoiding particular places, people or situations to avoid an OCD thought” [4]. Compulsions occur as a response to obsessions [1]. [Photo: OCD myth, busted by OCD-UK, that “All OCD compulsions are visible.”]

    One of the easiest obsession/compulsion combinations to describe is related to germs and contamination because this idea is what many people associate with OCD. For someone with obsessions related to germs, one obsessive thought may be a fear that touching a doorknob will contaminate it and harm other people who touch it later. This thought could then lead to a compulsion of washing their hands. Although this compulsion may decrease anxiety, it will not suppress it permanently. In one article, Rachel May explains that although people who suffer from OCD are aware that their thoughts are irrational, they cannot “take the risk” of not carrying out compulsions in response because the disorder is like a series of “What ifs” [5]. It is also important to mention that, as explained by OCD-UK, these obsessive thoughts are involuntary, and in regards to more upsetting thoughts people experience, “people living with OCD are the least likely people to actually act on such thoughts” [3].

                Many aspects of OCD can be found in people without the disorder. However, they are not seen to the same extent. People often experience intrusive thoughts, but it is not always an indication that they have OCD [3]. The disorder is associated with more intense and disruptive thoughts, and it is known as a disorder because it “critically impacts on a person’s ability to function” [2,1]. OCD can also be confused with a similar but separate disorder: obsessive-compulsive personality disorder (OCPD). This disorder is associated with “a maladaptive pattern of excessive preoccupation with detail and orderliness, excessive perfectionism, and need for control over one’s environment” [6]. Although there has been less research conducted into OCPD, there is evidence that it is a separate diagnosis to OCD, and some studies estimate that it affects around 7% of the population [6].

                Learning the definitions behind obsessive-compulsive disorder is the first step in breaking the misunderstandings that can harm those struggling with it. Saying “I’m a bit OCD,” in some ways, disregards the diagnosis as a “personality quirk” [7]. However, it is a real disorder that can be debilitating. In some cases, it can have drastic impacts on a person’s quality of life [7]. Although it is not always severe and is manageable, it is important to recognize the devastating effect it can have on those affected. This post is the first in a series on the blog that will seek to build an understanding of OCD. The series will explore the history of the diagnosis, the ways in which it is portrayed in media, and the unique challenges that arise with life in a pandemic.

     

    References

    [1] “OCD Awareness Handouts.” OCD-UK. Accessed January 29, 2022. https://www.ocduk.org/category/ocdhandouts/.

    [2] Baldridge, Iona C., and Nancy A. Piotrowski. “Obsessive-Compulsive Disorder.” In Magill’s Medical Guide, edited by Bryan C. Auday, Michael A. Buratovich, Geraldine F. Marrocco, and Paul Moglia, 1631-1634. 7th ed. 5 vols. Ipswich, MA: Salem Press, 2014.

    [3] “What are obsessions?” OCD-UK. Accessed January 29, 2022. https://www.ocduk.org/ocd/obsessions/.

    [4] “What are compulsions?” OCD-UK. Accessed January 29, 2022. https://www.ocduk.org/ocd/compulsions/.

    [5] May, Rachel. “Let’s Talk About Bruno: In Encanto’s OCD Allegory, the Weird Brother Deserves Better.” Literary Hub, January 26, 2022, https://lithub.com/lets-talk-about-bruno-in-encantos-ocd-allegory-the-weird-brother-deserves-better/.

     [6] Thamby, Abel, and Sumant Khanna. “The role of personality disorders in obsessive-compulsive disorder.” Indian Journal of Psychiatry 61, Suppl 1 (2019): S114-S118. doi: 10.4103/psychiatry.IndianJPsychiatry_526_18.

    [7] “The Impact of OCD.” OCD-UK. Accessed February 2, 2022. https://www.ocduk.org/ocd/impact-of-ocd.

    Image Credits

    “OCD Awareness Handouts.” OCD-UK. Accessed January 29, 2022. https://www.ocduk.org/category/ocdhandouts/.


  • March 27, 2022 4:38 PM | Anonymous member (Administrator)

    by Norma Erickson

    Henry Watson Furniss’s life could have been one more example of a brilliant Black physician who could not reach his full potential because of the barriers imposed by 19th and 20th century racial segregation. His story can be summed up not as career opportunities denied, but rather his was marked with achievements driven by ability, ambition, and being in the right place at the right time.

    Furniss was born in Brooklyn, New York, in 1868 to a highly educated African American couple, whose ancestors also included relatives of European origin.*  Not long after his birth, his father William Henry Furniss was appointed the Assistant Secretary of State of Mississippi. He moved his wife, Caroline Williams Furniss, and young Henry to the capital city of Jackson, where little brother Sumner was born in 1874. In just a few years, Reconstruction would end in 1877 and the Federal troops that provided protection for Blacks trying to advance politically and economically in the South were withdrawn.  The family remained in Mississippi until around 1880, then settled in Indianapolis, where the Furniss men thrived in the community. The boys attended high school at Indianapolis High School, and ultimately both went on to study medicine in local medical colleges. Their father scored the highest grade on the postal clerk exam and was placed in charge of a post office department. Their mother also had a teaching career, and the entire family became part of the elite of the African American community of Indianapolis. 

    Rather than immediately establishing a medical practice in Indianapolis after graduation, Henry went east for further study at Howard Medical School, the Harvard Medical School master’s program, the New York Post Graduate School, and the PhD in Pharmacology program at NYU. His medical experience began with a surgical internship at Freedman’s Hospital in Washington, DC, in 1895. When he returned to Indianapolis in 1896, he was likely one of the most highly-trained physicians in the city at that time—Black or White. 


    Besides his academic medical achievements, he also returned to Indianapolis with connections made in Washington that would lead to a career in diplomatic service for the US. In 1897, he was appointed by President William McKinley to be Consul to the Brazilian state of Bahia, one of the few diplomatic positions open to Blacks at the time. His mission there was to provide information to the US State Department and American companies who might have an interest in establishing businesses in Brazil. He learned Portuguese, traveled the countryside widely, and wrote detailed reports back to the States. His experience as a physician resulted in extensive information about public health issues in the locale being sent back to the States.

    Late in 1905, Furniss was appointed US Minister to Haiti by President Theodore Roosevelt, a post traditionally given to Blacks since 1862. Connections with Roosevelt’s Vice President, Hoosier Charles M. Fairbanks, might also have pushed his appointment forward.  He left Bahia with years of valuable diplomatic experience that would carry him through the service ahead of him. He also landed in Haiti with a white German-born wife.  Both would impose barriers and produce advantages, depending on the time and place. His diplomatic service ended in 1913. 

    Henry wed Anna Wichmann in London, England, in October of 1903. She was the daughter of a wealthy German businessman and maintained ties with family in Hamburg. The Furnisses had three children in Haiti, but their firstborn died of tropical dysentery shortly after his first birthday.  His term in Haiti ended in 1913, but the family remained there until about 1917. Henry did not return to Indianapolis to practice medicine with his brother as he did in 1896. On one hand, Indiana had strict miscegenation laws; putting down roots with a white wife and two mulatto children in tow would be difficult. The situation promised no improvement, as Indiana was beginning to enter its active Ku Klux Klan decade. On the other, the Black community was not especially pleased that one of their most successful sons had married outside of its circle.

    The family returned to the US, settling in the West Hartford, Connecticut area, where Dr. Furness set up a urology practice. The barriers he might encounter because of his Blackness held less importance in his life there.  In some respects, a more liberal northeastern community may have made the family’s acceptance better. Also around this time, he was received differently for one very important reason—he ultimately began to identify as white. His son, William, who was listed as Black when he attended Tufts University Medical School, also assumed a different life—passing as a white man when enlisting in the army and serving as a flight surgeon in WWII.

    Fluent in English, German, and Portuguese, Furniss was a 33rd degree Mason, a member of the American Society of International Law, the American Microscopical Society, and the American Medical Association. Furniss passed away in 1955, aged 87. His death certificate identified him as White.

     (Furniss's parents were sometimes described with the ethnic designation commonly used at the time--mulatto. This is considered a derogatory term today and rightly so because of its origin in slavery culture).

    Sources:

    Happy, Richard and Diane Furniss Happy, Under the Radar: The Little Known Story of Dr. Henry Watson Furniss, An African-American Pioneer. (Middletown, DE, 2020)

    Transactions of the Indiana State Medical Association, Issue 48, p. 291

    Who’s Who of the Colored Race, Vol.1, 1915

    Indiana Medical Journal: A Monthly Journal of Medicine and Surgery, Vol.14, p.453

    Fredrick Douglass and American Empire in Haiti, https://reparationscomm.org/reparations-news/editors-choice/frederick-douglass-and-american-empire-in-haiti/#:~:text=At%20the%20age%20of%20seventy,reward%20for%20the%20elderly%20abolitionist, accessed 2/14/2022

    Photos:

    1) Henry  W. Furniss, MD (Photo from cover of Under the Radar: The Little Known Story of Dr. Henry Watson Furniss, An African-American Pioneer)

    2)Caption: Furniss was the first Black physician to deliver a paper at an Indiana State Medical Association annual meeting.    (Transactions of The Indiana State Medical Association, Issue 48, p. 291,Forty-eighth Annual Session, 1897, Terre Haute, Indiana.)

    3) Henry W. Furniss, Envoy to Haiti, courtesy of the New York 


  • January 28, 2022 2:07 PM | Anonymous member (Administrator)

    by Allison Reardon

    The collections of a museum often stretch much further than what could ever be displayed to the public, and even the artifacts that are exhibited can fall by the wayside due to the time restraints of a guided tour. Although these artifacts are sometimes overlooked in favor of other interesting objects on the tour, that doesn’t mean that they don’t also have important and interesting stories of their own. One such example is found in the clinical laboratory at the Indiana Medical History Museum. On the lab bench, surrounded by various other pieces of equipment, lies a small box with a velvet lining holding several small pieces of a medical device. (The lining of the device currently on display has faded to a tan color; a look at another version in the museum’s collection shows the beautiful original green velvet.) The box itself reveals the device’s identity: “The Dare Hemoglobinometer.” [Photo: Dare Hemoglobinometer on display at IMHM]

    The Dare hemoglobinometer is a device that was patented in 1922, and 100 years later, hemoglobinometers are still in use. Although modern examples would be unrecognizable compared to this artifact, they serve the same purpose: to determine the amount of hemoglobin (Hb), a protein that carries oxygen, in a patient’s blood. To operate the Dare hemoglobinometer, a physician would place a pipet with a patient’s blood sample in a portion of the device that lined up with a color scale; they would then compare the blood to this scale, indicating the percentage of Hb in the blood [1]. Many methods are available today for the same test, but similar examples are often digital. Digital hemoglobinometers are similar to the Dare hemoglobinometer because they are able to be used outside of a laboratory and read quickly, but these digital devices have many advantages, such as the fact that there is “no or minimal subjectivity in the estimation of Hb” [2]. Digital hemoglobinometers like TrueHb Hemometer and HemoCue® work through photometry rather than estimation by a physician looking through a lens [2]. [Photo: Another Dare Hemoglobinometer in the IMHM collection]

    [Photo: Advertisement for the Dare Hemoglobinometer showing the device set-up]

    Although these disparate technologies are separated by a century, they serve similar purposes in the realm of healthcare. They are both examples of point-of-care tests, which are medical tests that do not need to be performed in a hospital laboratory. The unique qualities of point-of-care tests – including their small footprint and their speed of providing results – make them great candidates for use in low-income countries, and according to UNICEF, they “offer an unprecedented opportunity to reduce inequalities in health” [3]. Hemoglobinometers, including the artifact on display at the IMHM, can be held up as examples of point-of-care testing, and they are an essential part of solving the worldwide health issue of anemia. This medical condition, which occurs due to a low level of hemoglobin in the blood, affects “42% of children less than 5 years of age and 40% of pregnant women worldwide” and is most prevalent in low-income countries [4].

    Anemia is not the only serious global health issue that can benefit from point-of-care testing. A more recent issue that has been put at the forefront of scientific research and discussion is the COVID-19 pandemic. At the beginning of the pandemic, people brought point-of-care testing into the conversation because it can allow for faster testing, which in turn helps to slow the transmission of the disease [5]. A September 2021 New York Times article explained that the U.S. was falling behind other countries in regards to this type of testing, and this “shortage of testing in the U.S. may be contributing to the virus’s spread” [6]. Of course, there are disadvantages to point-of-care and at-home testing for COVID-19. However, this Times article argues that the advantages may outweigh the disadvantages. Rapid tests do not have the same level of sensitivity as PCR tests (most often used in the U.S.), but some experts explain that they “do not need to be so sensitive to be effective” [6]. Like with anemia, researchers have also thought of these tests as a way to reduce health inequalities. COVID-19 has “disproportionately impacted people of color and under-resourced regions,” and point-of-care testing is a viable option for making testing faster and more accessible [5]. [Photo: NHS rapid COVID-19 test]

    Point-of-care testing is an essential part of health care today that is actively discussed and improved in response to global health concerns – from anemia to COVID-19. As researchers look into point-of-care technology, a look back at some earlier examples of these tests can give us a more complete appreciation of their use and convenience. So, although the Dare hemoglobinometer in the clinical laboratory at the Indiana Medical History Museum may seem like a small, insignificant object in a room full of equipment, a closer look reveals that this point-of-care device foreshadows current healthcare solutions.

               

    References

    [1] “The Dare Hemoglobinometer.” Smithsonian’s National Zoo & Conservation Biology Institute. Accessed September 8, 2021. https://nationalzoo.si.edu/object/nmah_735248.

    [2] Yadav, Kapil, Shashi Kant, Gomathi Ramaswamy, Farhad Ahamed, and Kashish Vohra. “Digital Hemoglobinometers as Point-of-Care Testing Devices for Hemoglobin Estimation: A Validation Study from India.” Indian Journal of Community Medicine 45, no. 4 (2020): 506-510. doi: 10.4103/ijcm.IJCM_558_19.

    [3] Kirby, Rebecca, and Kara Palamountain. Target Product Profile: Hemoglobinometer – Point-of-Care Diagnostics. UNICEF, 2020. Accessed September 8, 2021. https://www.unicef.org/supply/media/2911/file/Hemoglobinometer-TPP-v1.pdf.

    [4] “Anaemia.” World Health Organization. Accessed September 9, 2021. https://www.who.int/health-topics/anaemia#tab=tab_1.

    [5] Valera, Enrique, Aaron Jankelow, Jongwon Lim, Victoria Kindratenko, Anurup Ganguli, Karen White, James Kumar, and Rashid Bashir. “COVID-19 Point-of-Care Diagnostics: Present and Future.” ACS Nano 15, no. 5 (2021): 7899-7906. https://doi.org/10.1021/acsnano.1c02981.

    [6] Leonhardt, David. “Where Are the Tests?” The New York Times. September 21, 2021. https://www.nytimes.com/2021/09/21/briefing/rapid-testing-covid-us.html.

    Image Credits

    Image 1: Dare hemoglobinometer found in IMHM clinical laboratory, photo provided by author.

    Image 2: Another version of Dare hemoglobinometer in IMHM collection, photo provided by author.

    Image 3: Hemoglobinometer – Originated and Perfected by Dr Arthur Dare. Wikimedia Commons. 1920, https://commons.wikimedia.org/wiki/File:Hemoglobinometer_-_Originated_and_Perfected_by_Dr_Arthur_Dare.jpg.

    Image 4: Jwslubbock. NHS Covid test pack and contents 2. Photograph. Wikimedia Commons.August 18, 2021, https://commons.wikimedia.org/wiki/File:NHS_Covid_test_pack_and_contents_2.jpg. (To view the license for this image, visit https://creativecommons.org/licenses/by-sa/4.0/deed.en)


  • January 06, 2022 10:19 AM | Anonymous member (Administrator)

    by guest blogger, David Zauner

    Sir Arthur Conan Doyle is most famous for his accounts of the cases of that great consulting detective, Sherlock Holmes of 221B, Baker Street, London, perhaps the best-known literary character in the world.  However, Conan Doyle was also a trained physician and well versed in both detective fiction and real-life criminal cases.  This background gave him a body of knowledge and experience that not only informed his writing and shaped Holmes as a detective quite different than his fictional predecessors, but also made him an advocate for improvements in investigative procedures and led him to conduct his own inquiries into a number of cases, including several in which he saw gross miscarriages of justice.  On this 6th of January – recognized by many in the Sherlockian world as the birthday of Holmes – we delve deeper into Conan Doyle’s own story and how he not only changed detective fiction, but likely also had a significant impact on the development of modern investigative methods.

    (Image: Sidney Paget illustration of Sherlock Holmes engaged in a chemical experiment in Arthur Conan Doyle's short story "The Adventure of the Naval Treaty.")

    Edinburgh University, where Conan Doyle studied medicine from 1876 to 1881, had several notable figures in medical jurisprudence, as forensic medicine was then known, on the faculty or teaching in extramural schools loosely associated with the University.  Sir Robert Christison taught materia medica and therapeutics during Conan Doyle’s time at the University, and had authored several standard texts on medical jurisprudence.  His successor and former research assistant, Professor Thomas Fraser, taught one of Conan Doyle’s classes.  Dr. Henry Littlejohn had a forensic medicine practice and was a popular extramural lecturer; one of his former students, Dr. Joseph Bell, had an uncanny ability to diagnose medical conditions simply by observing patients.  Conan Doyle worked closely with Dr. Bell as outpatient clerk in the Royal Infirmary, and Dr. Bell is widely credited as the inspiration for Sherlock Holmes’ powers of observation.

    Besides being a student of medicine, Conan Doyle was also a student of crime, reading the Newgate Calendars – accounts of notable crimes and trials from the 1770s – and the memoirs of Eugène Vidocq of the Paris Sûreté, plus the fictional tales of Edgar Allan Poe and Èmile Gaboriau.  He corresponded with Francis Galton, one of the pioneers of fingerprint identification; knew about Alphonse Bertillon’s method of identification through the use of body measurements, known as anthropometry; and visited the London Metropolitan Police “Black Museum” to research police procedures.  Conan Doyle was acquainted with Bernard Spilsbury, who became perhaps the most renowned forensic pathologist in Great Britain.  Through his reading and contacts, Conan Doyle gained practical information on the methods and procedures of criminal investigation.

    Although Conan Doyle started writing as a student, it was his Sherlock Holmes stories that made his literary mark.  By creating a detective who used information gleaned from close observation and scientific analysis of minute clues to make deductions to solve his cases, Conan Doyle not only found the niche that gave him a lasting place on the list of great authors, he also seized the opportunity to use his writing ability to advocate for a systematic and scientific approach to criminal investigation, along the lines of that taken in the realm of medical diagnosis and jurisprudence with which he was so familiar.  The cases of Sherlock Holmes, following his axiom that “detection is, or ought to be, an exact science and should be treated in the same cold and unemotional manner,” introduced the reading public to these possibilities as well, and started a fascination with crime detection and forensic science that continues to this day.  Conan Doyle’s stories had an impact on professionals as well:  Edmond Locard, a pioneer in forensic science who established the world’s first police laboratory in Lyon, France, in 1912 and wrote an encyclopedia of criminalistics still referenced today, acknowledged Holmes as one of his inspirations, and even referenced him in the introduction to one of his books.  The official police were finally starting to catch up to the methods of Holmes.

    As Sherlock Holmes grew in popularity, Conan Doyle became well known around the world, and with that fame came an increasing number of letters.  Some were simply “fan mail”, but a number of others – addressed either to Holmes or to Conan Doyle himself – were pleas to look into cases that the authorities were unable to solve.  At first, he simply dismissed these, but later he did look into several matters, applying the same methods of reason and rational deduction used by the character he created.  Two of his inquiries stand out in particular; in both, Conan Doyle was able to exonerate individuals unjustly accused of serious crimes and convicted on flimsy evidence.  George Edalji was convicted of horse-maiming in Staffordshire in 1903, and was suspected in a number of other animal mutilation cases, mainly due to a vicious campaign of anonymous letters against him and his family.  Conan Doyle’s investigation revealed that the police case against Edalji was based on flawed – and perhaps fabricated – evidence, as well as rampant racial prejudice in the rural district; Edalji was the son of an Indian father and British mother.  Conan Doyle’s work on Edalji’s behalf resulted in him being granted a full pardon.  Oscar Slater was convicted of murdering a woman in Glasgow in 1908 and sentenced to life imprisonment, but Conan Doyle found inconsistencies in witness statements, unexplored leads, and evidence of judicial misconduct in the case. Slater was pardoned in 1927 and compensated by the British government for his unjust conviction and imprisonment.  Conan Doyle took on a number of other cases in his lifetime; not all ended as successfully as these two, but he approached each in the manner of his Great Detective.

    Arthur Conan Doyle, through his literary offspring Sherlock Holmes, offered a new approach to crime detection, one that used observation, science, and reason to solve cases and bring miscreants to justice.  He sparked a lasting public interest in police procedures and forensic science, and served as an inspiration to some who were working to incorporate these principles into real-life police investigations.  Conan Doyle himself embodied many of the same qualities and abilities he ascribed to Holmes, and deserves recognition for his exploits as a “consulting detective” as well as for his masterful storytelling.

    Many biographies of Sir Arthur Conan Doyle have been written, but two of the better ones (in this author’s humble opinion) are Andrew Lycett’s 2007 work, Conan Doyle: The Man Who Created Sherlock Holmes; and Peter Costello’s 2006 account, Conan Doyle, Detective: True Crimes Investigated by the Creator of Sherlock Holmes.


    David Zauner, the author of this “trifling monograph”, serves as a docent, collections assistant, and member of the board of the Indiana Medical History Museum.  He is a retired forensic scientist, and a member of The Illustrious Clients of Indianapolis, a Sherlock Holmes literary society.


  • November 03, 2021 7:00 PM | Anonymous member (Administrator)

    by Marissa Hamm, IMHM Intern

    [a] One of the many popular “medicines” for neurasthenia. Indianapolis Times April 15, 1927.In Charlotte Perkins Gilman's The Yellow Wallpaper, readers follow the downward spiral of the female protagonist as she suffers from “temporary nervous depression.” To cure her issues of fatigue and irritability, her physician husband, John, whisks her away to a house in the country where she is confined to an attic room and ordered to stay in bed. John provides his wife with “cod liver oil, tonics, ale, wine, and rare meat” and prevents her from having any “excitement” that would further drain her nervous energy. By the end of the story, the protagonist’s condition has worsened and she  imagines that she is now part of the yellow wallpaper that lines the attic room.[1]

    This short story often lives on in the minds of those who read it in their high school literature classes. However, many do not know about the real condition underlying the protagonist’s troubles: Neurasthenia. In 1869, George Beard coined the term neurasthenia. Beard posited that the human body was a machine powered by nervous energy -- a compelling metaphor for Americans embroiled in the industrial revolution. When people expended too much nervous energy, they became fatigued and sick with neurasthenia.[2]

    Symptoms of neurasthenia included depression, irritability, insomnia, lethargy, indigestion, a lack of ambition, an inability to concentrate, anxiety, headaches, muscle and joint pain, weight loss, impotence, amenorrhea, and mental and physical collapse. As this laundry list of symptoms shows, neurasthenia was a catch-all diagnosis for many issues. So what exactly caused this illness? 

    Physicians like Beard believed that modernity and society’s progress took a toll on one’s nervous energy and led to neurasthenia. It was thought that modern conventions such as steam power, the periodical press, telegraphs, overpopulated cities, and “the mental activity of women” placed demands on citizens that were sometimes too much to handle.[2] Neurasthenia quickly became known by a secondary name, “Americanitis,” and those with the condition were said to be an “active mind, a competitive character, a lover of liberty -- in short, the quintessential American.”[2,3] Some patients begged their physicians to diagnosis them with neurasthenia because of the condition’s positive perception, and many doctors were eager to make the diagnosis. [b] Some drugs used the colloquial name “Americanitis” in their advertisements. Greencastle Harold May 11, 1911

    An important distinction to keep in mind is that neurasthenia was an illness of the privileged, particularly white, Northern, and Protestant Americans. In order to get the diagnosis, one had to be able to afford to see a physician and then pay for the recommended treatments. Further, the illness became a tool of oppression used against Catholics, Southern whites, Native Americans, immigrants, and African Americans. Beard theorized that these groups of people were immune to neurasthenia because they lived in various states of “ignorance” therefore their brains were not at risk of being overworked.[2]

    The primary treatments for neurasthenia were total rest for women, as seen in “The Yellow Wallpaper”, or an “escape” to the Western U.S. for men so that they could participate in “manly” work – an actual treatment prescribed to Theodore Roosevelt before his presidency.[3] In Indianapolis, wealthy citizens could check into a facility such as “Norways”, Dr. Albert E. Sterne’s sanatorium for nervous diseases. In 1912, Norways cost patients $35 to $90 a week and promised a luxurious experience (as one would expect for that price tag!).[4] Yet Central State Hospital also cared for neurasthenic patients, although on a much smaller scale. Between 1889 to 1916, Central State admitted four cases of neurasthenia, 75% of which were female.[5] 

    The Hospital also admitted patients for “nervous prostration” and “overwork.” There were only two cases of nervous prostration (a type of nervous exhaustion), one male and one female, between 1889 and 1896. Significantly more popular was the diagnosis overwork. Between 1889 and 1916, 36 males and 25 females were admitted to the Hospital for overwork.[5,6] Overwork was very similar to neurasthenia. As Horatio C. Wood explained it in his 1885 book Brain-Work and Overwork, when people are engaged in “emotional excitement” for extended periods of time, such as stockbrokers, they forget to check in with their body and rest, which leads to nervous exhaustion known as overwork.[7] 


    [c] Advertisement for “Norways,” the sanatorium for the wealthy. Indianapolis Medical Journal, January 1912

    Despite its earlier popularity, neurasthenia eventually fell out of favor as the psychology field grew. By 1920, neurasthenia was largely out of use and in 1980, the DSM III officially removed the diagnosis. However the legacy of neurasthenia lingers. Not only do scholars agree that conditions such as chronic fatigue syndrome, fibromyalgia, anxiety, and depression are modern day equivalents of neurasthenia, the illness also transformed the way that Western nations view health. There is a societal belief that happiness, comfort, and emotional wellbeing lead to good physical health.[2]

    In many ways, people around the world still struggle with neurasthenia today, but instead we call it things like “stress” or “burnout.” We long to take relaxing vacations, spend time in nature, and discover our “inner peace” as ways to manage the daily stressors of modern life. We may have more ways to discuss and understand how our mental and physical health are connected, but at the end of the day, we are still trying to achieve the ideal “happiness” that promises long-term health, just like the neurasthenics did over a century prior. 


    Sources:

    [1] Gilman, Charlotte Perkins. The Yellow Wallpaper. Auckland: The Floating Press, 2009. 

    [2] Schuster, David G. Neurasthenic Nation: America’s Search for Health, Happiness, and Comfort, 1869-1920. New Brunswick: Rutgers University Press, 2011. 

    [3] Beck, Julie. “‘Americanitis’: The Disease of Living Too Fast.” The Atlantic. March 11, 2016. https://www.theatlantic.com/health/archive/2016/03/the-history-of-neurasthenia-or-americanitis-health-happiness-and-culture/473253/ 

    [4] Hostetler, Joan. “Then and Now: Clifford Place and Norways Sanatorium.” Historic Indianapolis. May 12, 2011. https://historicindianapolis.com/then-and-now-clifford-place-and-norways-sanatorium/

    [5] Annual Report of the Central Indiana Hospital for the Insane, Volumes 40-49. http://hdl.handle.net/2027/nyp.33433004139758

    [6] Annual Report of the Board of Trustees and Superintendent of the Central Indiana Hospital for Insane, Issues 54-67. http://hdl.handle.net/2027/mdp.39015069712100

    [7] Wood, H.C., M.D. Brain-Work and Overwork. Philadelphia: P. Blakiston, Son & Co., 1885. https://hdl.handle.net/2027/umn.31951000955961b


    Images: 

    [a] “Dr. Miles Nervine Advertisement.” Indianapolis Times (Indianapolis, IN), April 15, 1927. https://newspapers.library.in.gov/?a=d&d=IPT19270415.1.9&srpos=92&e=-------en-20--81--txt-txIN------- 

    [b] “Americanitis Elixir Advertisement.” Greencastle Harold (Greencastle, IN), May 11, 1911. https://newspapers.library.in.gov/?a=d&d=GH19110511-01.1.4&srpos=2&e=-------en-20--1--txt-txIN------- 

    [c] “‘Norways’ Sanatorium Inc. – for Nervous Diseases Advertisement.” Indianapolis Medical Journal 15, no. 1 (1912): 18a. 

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