good evening. i'm gavin. please be with the director of programs exhibitions and community partnerships for the massachusetts historical society, and i'm happy to welcome you to our program this evening. we'll hear from tea and keto we'll speak on her new book exploring american health care through 50 historic treasures. this book presents a history of health and medicine in the united states tracing paradigm shifts such as the introduction of anesthesia the adoptional germ theory and advances in public health the book showcases little known objects and illustrate are complex relationship with health and highlights objects related to famous moment and medicine ranging from vitamin d beer to the discovery of penicillin each artifact illuminates some case of the social cultural and technical influences on how people fundamental questions about health. program we'll look at a selection of these artifacts with an emphasis on massachusetts stories. health. we'll look at a section of these artifacts with an emphasis on massachusetts stories. miss kehoe is a public historian, museum curator and writer. she specializes in history and health care with social history, social history angle. her main research interest includes material culture and history -- interpretation history of medicine in the body. she works as the exhibition in his occasion specialists at the paul s russell museum of medical history and innovation at the massachusetts general hospital in boston. before we get started, i just want to offer a special welcome to anyone who may be joining us for the first time, if you're unfamiliar with mass historical society. we are an independent nonprofit organization, maintains vast research library and host a wide variety of programs and topics relate to massachusetts in american history. we have some great programs plan for the next couple of months just to give you a sample of a we have coming up the next couple of weeks on next wednesday we will host seth -- who will discuss his book loss the freedom trail the national park service and urban renewal and pose for boston. he'll be joined by michael casey, general superintendent of national parks of boston in susan feinstein from the harvard graduate school design. on tuesday, february 8th, will host nancy stewart to discuss her new book, -- debra reed franklin and the other women behind the founding father. in wednesday, february 9th, we will host a panel discussion titled challenging assumptions in telling underrepresented history. this will feature for museum professionals from four different organizations in massachusetts. who will discuss creative approaches they've taken to conduct research and document history of disempowered people who have not left traditional records and historians often rely on. and finally, on thursday, february 10th, we will host our second installment of the movie club -- this i will discuss the film almost odd and we will be joined by both the current editor and chief of the adams papers projects and mass assortments is heidi. share a modern and james taylor. this is just a sample of the white variety of programs we host, we're only able to produce these programs because the support of our members so we hope that if you are enjoying our programs, supporter of nhs, you will either join mh us or contributed supporter work so without further ado unhappy to have tegan to come up and start the presentation. >> thank, you gavin. and thank you to matt historical society for having me. and for all of you for being here this evening. my book exploring american health care through 50 historic treasures is in many ways of sampler of health care history as well as a sampler of artifacts. museums and historic sites around the country. today, i'll be sharing a small sample of the stories from my book. and while the mass historical society has not featured in my book, i will be mentioning several plans in connection with the societies collections because there are plenty to choose from and it's quite interesting. when i started writing my book, i remarks on how the inherent disallowed-y of medical history makes a tangible and something we can -- even when discussing discoveries from centuries ago. by the time i finish the book, we were in a pandemic and i didn't need to worry about whether people connect to the subject. i do think they're looking at the path can be a source of a lot of hope. but the hopeful stories aren't always clear cut. it's often that seeing the ways people for the past have struggled with ups and downs. can better help us better understand what's going on in the president. in that light, the first couple of stories from my book that i would like to share our about vaccines. the first of these to have a vaccine will smallpox and much later, it also became the first disease to be fully eradicated. smallpox was recognized both by the foul smelling potentials that cover person's body but it killed by causing internal bleeding and damaging to heart, lungs and liver. indifferent outbreaks, the disease killed from ten to 50% of this victims. the earliest known prevention prices began on the 12th century. people in asia, africa, and the mediterranean protect themselves by deliberately catching a mild case of the disease that left immune. they inhaled powdered material from smallpox patients cabs, or inoculated themselves by inserting the scam material under their skin. smallpox invaded this continent the first europeans and it contributed to severe or the population of native peoples. inoculation against smallpox has been known in boston since the 17 teens when an african man whom the reverend cotton matter was holding slavery explain it to matter. the enslaved man's real name and birthplace aren't recorded. but ma they're called him onassis and that's how we know him today. the spread of inoculation in the west is often attributed to lady mary worley montagu who learned the practice while traveling with her husband in turkey. when she arrived home in england, she told her doctor about it. and it became a common practice. but by no means a universal. one inoculating people with smallpox itself is called very elation after the name of the smallpox virus, very ola. it's not safe by modern standards. patients to get a case of smallpox. but it was usually milder than if they had caught the wider, while -- in the death rate was lower. patients had to be quarantined while they recovered. or they risk passing the virus on. and if you caught the virus from someone who had been inoculated, you weren't guaranteed that milder case. it was actually never guaranteed but it was likely that he will get that milder case it was just like you got it from anyone else. so debates raged over whether this practice was safe and whether it was natural. this trade-off was hotly debated during the epidemic that swept north america during the revolutionary war. individuals and families waved their options and military strategist discuss the risks of inoculation the troops. patients had to recover for about two weeks after inoculation. and they were contagious during that time so macedonian men leaving armies vulnerable to enemy attacks. in 1796, english doctor edfwarde jenner began a new era when he inoculated eight year old james phipps. now with smallpox, but with a mild or related disease called cowpox. after a few months, he knocked away the boy with smallpox to try to produce a mild case. but he didn't get sick. he tried again several times but phipps never develop smallpox. jenner began testing more people and writing up his results. he called his process vaccination. after the cowpox vaccine. doctor benjamin waterhouse a founding faculty member of harvard medical school, registers report. he wrote to jenner, and asked for cowpox material to do his own experiments with. one of waterhouse four study subjects his own five-year-old son. experiments related to vaccination were often done in children because they hadn't had smallpox yet. so while to modern viewers that can be a little alarming, they were the population that had made the most centuries experiments on. three more of his children and two household servants followed. water house became the first proponent vaccinations in the united states. the artifact related to smallpox that i featured my book and that we have up on the screen is in the collection of the countway library of medicine at harvard medical school. because it is not endemic in the united states, water house regularly purchased cowpox material from england, typically shipped in poultry for the cause. in the shipment in 1802, jen impact of the cost inside a gift from water house. this small, finally made silver snuff box, with a gold in lay. and if i could have the next slide, please? thank you! the massachusetts historical society and countless primary sources related smallpox and many of them have been digitized and are available online. they include newspaper clippings that both sides as well as numerous letters between individuals. referencing losing loved ones to smallpox, the decision to get inoculated when the only option was the pre-vaccine variation, the epidemic during the siege in boston in 1775 to 1776, and hopes and fears about the cowpox based vaccine. i'd like to read a least shorter acts of drama lesser-known document, which is what's on the spin. this is a broadside or flyer from around 1810 in providence, rhode island, describing what to expect from a vaccine in rhyming couplets. a date needs no deviation from that before inoculation. a little silicon paper patch may soon be from the arm detached. duluth sleeves are best and i'm skeptical, children need not be kept from school. and so on. thank you, you can take the slides down for the time being. after vaccination caught on, in 1855, massachusetts became the first state in the u.s. to require schools children to be vaccinated. to the 19th century, vaccination in adults was often carried out in response to a current or a potential outbreak. smallpox continued to spread over the continent through trade, warfare and migration. representatives of the u.s. government offered vaccination to a number of native groups, but withheld it from native groups who didn't cooperate in the forced removal from their land. rates of vaccination out of their disease varied by race and socioeconomic status. in the civil war for, example, case rates of smallpox where more than six times higher among black soldiers than among whites to white soldiers. meanwhile, changing methods of preparing and administering vaccines were starting to make vaccines safer, but there was really no regulatory insight or -- excuse -- me oversight into vaccination until several decades into the 20th century. from 1898 to 1903, a wave of smallpox epidemics spread across the continent. it was the worst outbreak in at least a generation. in 1905, u.s. supreme court case that originated in cambridge, mass, set the legal precedent for how far reaching a vaccine mandates could be. henning jacobson, a local pastor, remember to having had a bad reaction to the vaccine when you was a child in sweden and refused to be vaccinated again. he didn't need it again, since the vaccine available at the time conferred immunity for about seven years. since jacobson didn't comply with cambridge's vaccine order, he was charged a five dollar fine. the supreme court concluded that the mandate was constitutional and the government could limit personal choice for the sake of public health if the mandate meant certain standards, including being necessary for public health, being proportional to the risks of the situation, and minimizing harm to the individual. of course, this was not the end of debates over vaccines. in the middle of the 20th century, there was a swell of support for vaccines because of a period of trust in science, the importance of vaccines in ending the polio academics, and a range of new vaccines that protected against common but deadly childhood illnesses. in the past 40 years or so, despite more regulations and more safety testing than ever, there has been a vocal minority against a number of common vaccines, as many of you well know. rather than going into depth on the modern anti-vaccination movement, though, i'd like to zoom out, and discussed what different attitudes towards health interventions mean in their historical context. i'd like to read an excerpt from the indirect introduction to my book. a popular impression is that medical history is a tidy story about progress in the march of science, in which one discovery built on another while incorrect ideas get discounted and forgotten. in samantha telling's, science veered off of the path of what humans mean and now progresses further away. at the same time, the popular imagination hints paints medical history as a gruesome spectacle, filled with and mccarver and not for the faint of heart. the artifacts in this book show that both the navigable march forward and the mccarver templates are partially true, and both have flaws. behind the ghastly reality of searches operating without cleaning their bone cells between patients, there were people doing the best with what they knew. the same is true for patients my nostrum, and the same is true for doctors and public health officials debating the safety of raw milk in the 1880s, or of ddt in the 1960s. rather than solely looking at advances in health care is useful to examine turns in how people have answered some fundamental questions with what they knew. each artifact tells some piece of the story of how it uses approached or answered one or more of these questions. perhaps the most basic of these questions is this -- what causes sickness and what causes? health mainstream scientific understanding has not only changed overtime but has gone through periods of expansion and contraction, supporting either one underlying cause of disease, such as unbalanced humorous, or invading micro organisms, or diverse causes, including vitamin deficiency and pollutants. meanwhile, cultural and religious practices, home remedies and sales pitch as provided alternative series, many of which appear to their a adherents to counterbalance the flaws of mainstream science related question is this -- how do we solve health problems that have been identified when knowing what causes them isn't enough? often it becomes an engineering problem, literally in the sense of creating new technologies, or figuratively, in creating new surgical techniques to address a new unknown issue? the field of health care has developed clearer, more healthful helpful, and more accurate answers to these questions over time. and yet there's still much to learn broadening the scope from how to treat diseases to how to treat patients, another fundamental question is how terry should be organized? within care facilities and within professions. something as simple as a nurses uniform is actually part of the complex evolution of the role of the nurse from an informal, untrained caregiver to a member of an emerging trade with closing resembling that of a made, to a trained professional. organizing carry involves challenges when money, physical space, and practitioners time are all finite. these questions become urgent when conditions like war or epidemics created it for decisions that affect who lives or dies. and we are the core question is this -- to what extent can anyone know what other principles of health, and to what extent to people determine lauren outside authorities? relatedly, how can a patient determine whether to provide to truly wants to help or only wants to exert control or make money? the tickets on the late 19th and early 20th century's are well represented in this book, because of a large number of developments in scientific medicine. the drum theory revolution, x-rays, antibiotics, and other developments greatly increased many people's willingness to trust science. however, with alternative health trends and unscrupulous practitioners persisted, creating the need for a turn towards greater accountability in the 20th century, including fda regulations, and in the requirement that research [inaudible] by institutional resume boards. where not everyone agrees who has authority and health, how much short doctors and governments provide for the health of the populace? when there is a risk benefit judgment to be made, who makes it? people often care about factors that science ignores. such as whether treatment is affordable, whether it's in line with their understanding of their wealth, and their attitude toward outside authority and systems of power. this is clear in the diverse public attitudes towards masks and vaccines and the coronavirus pandemic, which is an evolving story, and this book is being written. these questions may be cerebral, but health care is inherently visceral. think of the core feel of [inaudible] love, the kobe [inaudible] strep throat mechanisms medicine utica child, or the closeness of must. in any moment of the past, the physicality of health care might be the soft, one inches of the toys the visiting nurse brought with her, the grasp of the metric metal caliber measuring your head, or the tar stink of carbonic acid, a precursor to today's much gentler antisemitic hospital smell. the physical stuff of health care makes abstract can conserve like trust, and persuade them tangible. historian and museum curator, general danya meth, has [inaudible] given to us on both weapons of the american revolution, and medicine of the american revolution at the same museum. visitors were excited by visceral, gory content on the weapons tour. a barnett make so triangular win that feels poorly. but very fearful are disgusted by similar content on the medical history tour. it soon became clear that this news imagined and themselves inflicting the damage when taking the weapons tour, but imagine themselves as the victim or patient when taking the medicine tour. the history of health care can inspire deep empathy. i invite you to look for and opportunities for empathy with the patients, caretakers, researchers, and victims and survivors of the complex stories that these historic treasures tell. the remainder of the story from my book that i like to share with you this evening go in roughly chronological order but several of them, like the smallpox story, take place over long periods of time. for example, alternative medicine movements. many of which might sound to modern ears like they were invented by 1960s flower children, first blossomed around the 1830s. at the same time, mass produced name brand drugs begin to proliferate across the country. both of these trends were partially and reaction to it was often called, , regular medicine. today regular mission is called mainstream, biomedical or scientific medicine. but it wasn't very scientific in the early 19th century. while individual doctors did experiments with varying levels of scientific rigor, it would be nearly a century before randomized controlled trials for standard. in applying we consider -- analysis to disease outbreaks was a pretty new idea. doctors relied on women that have been handed down through medical schools. the theory of the four humors, which comes to us from the ancient greeks and has similarities to ancient indian medical tradition still influenced positions in the 19th century's. new moral theory states of the body and temperament are governed by four forces that can cause harm without a balance. bleeding and purging were often used to try to rectify that balance. in the late 18th and early 19th centuries, some leading doctors essentially streamlined moral theory to focus on large doses of treatments that produces dramatic effect. this was sometimes called heroic medicine. doctors raise blisters, use bloodletting and gave laxatives and medics. and heroic didn't always mean helpful. the popular drug khalil or blue mass often given for a host of different complaints could cause mercury poisoning for example. the various schools of thought that we might call turn a divorce complimentary medicine today were often lumped under the name irregular medicine in the 19th century. often -- excuse me. often stressing preventative care, irregular doctors position themselves in opposition to the authoritative medical celebrant and harsh treatments like blue math. they appeal to people who wanted to be self-reliant or wanted medicine to seem gentle and natural. a number of a regular medical philosophies preached the health of the body and the spirit could be obtained by abstaining from alcohol, eating a specific diet, for example vegetarian, or following similar rules. other 19th century irregular trends included -- the power of positive thinking, chiropractic and mesmerizing. the founders and most enthusiastic adherence of these trends consider them holistic approaches to health. if you had this, you didn't need anything else, was there thinking. could i have the screen share back on the next slide? >> the other alternative to going to the doctor for bleeding and mercury was to treat yourself with patent medicines. this term referred to almost any tonic, pill, or powder with a proprietary formula and a name brand. the example on the screen and in my book is a bottle of hosteler's celebrated stomach bitters. and yes celebrated is part of the name. advertisements claim that hosteler's cure prevented nearly infinite ills from gastrointestinal distress to nervous prosecution, mental bloom and general lack of vigor. this was a hallmark of patent medicine adds. most of these medicines did nothing except make the consumer feel good briefly with alcohol, morphine, other things like that. hostages was mainly alcohol and was even some who sold by the glass in solutions many patant medicine makers claim they could cure anything and replace doctors. the people also use patent medicines in addition to regular medicine. the way one might buy over-the-counter cough syrup today. there were no laws limiting some drugs to prescription only until the 20th century. so all of the options were over the counter at the time. the specific bother of hostetter's in my book is in the museum of the rockies in montana. while the company started in pittsburgh, hostetter's was often marketed travelers and people moving to territory unknown to them during the u.s. congress of the people and lands to the west. advertisements highlighted the likelihood of gastrointestinal distress on these journeys. at the time, both regular medicine and popular understanding believe that putrid air could cause disease. traveling would make it hard to see a doctor if indeed a doctor could be helpful. whoa to him who encounters the malaria of the tropical seaboard or the me asthma of a western swamp with his stomach on tone and nerves and braced. this morning was an essay in 1868 addition of hostetter's almanac which the company published annually from 1861 to 1909. the proposed solution, naturally, was hostetter's bidders as a daily preventative. next slide, please. thank you. a patent medicine i mentioned only briefly in the book but i want to discuss here because of a local connection is lydia hostetter's -- in part because the advertisement featured a real woman who was its founder. also intended to be specifically for women's health. in this era, women were seen as the guardians of their family's health, particularly their children's. but their own health was often an afterthought. for much of the 19th century, women were very literally consider the weaker. sex and many women's health issues were dismissed as being inevitable parts of the condition of womanhood. we see echoes of this today even though the science behind these ideas has been discredited. lydia pinkham's vegetable compound was marketed for female complaints. the list of ailments it purported to cure include difficult or painful menstruation, menopausal issues and uterine tumors. but also depression, sleeplessness, general debility and again nervous prosecution. in a sense, it played into popular understandings of human health. but the company didn't assume that fema complaints were women's cross to bear. instead it offer the option of treating them. even better, it promised treatment without an invasive gynecological exam by a male doctor. at a time when women physicians were a few and far between. and their idea of professionalism, doctors at the time idea of professionalism, was very paternalistic. so a different bedside manner than would hope for today. patent medicines loved women take their health into their own hands. the company lore was that lidia pinkham's who was born in massachusetts in 1819 made herbal tonics in her kitchen at first she only sold them because other women ask for two but after the panic of 1873 put her family in her financial straits, she reluctantly went commercial. whether or not her original aspirations were so modest, her pen medicine became wildly popular. versions are actually still soul today. this isn't necessarily to say that it works, it's classified as an herbal supplements of the makers aren't required to demonstrate its efficacy. but it clearly had an impact on the market. mass historical has a few biographies of pink him from the first half the 20th century and they remember her as an early woman entrepreneur. while madison didn't see great number of advances in the 19th century and the last few decades the phil surgery did make a number of great strides in the mid 19th century. many of these were due to new techniques, new instruments or increasing specialization by surgeons. but in the 1840s, several practitioners hit upon an answer to the problem of pain as it was often called. this story is in many ways one of the engineering problem, but there's also a component of a story in which the practitioners themselves disagreed about whose authority could really be trusted. on an autumn day in 1846, a group of doctors gathered in the surgical amphitheater at massachusetts general hospital to see an operation in progress. watching an operation they were involved in wasn't remarkable. the room was designed with seeding for about 100. just as in many of the operating theaters in europe. and a few major other hospitals in the united states. however, in this case, the hospitals cofounder, and eminent surgeon, john collins warren, had allowed a dentist to offer a public demonstration of a drug that promised to conquer pain. the patient was a young man named gilbert abbott who had a painful growth on his neck. as you might imagine, before anesthesia, the operation to address the sensitive area was typically very painful. some doctors gave patients opium or alcohol to try to dull the pain. next slide, please. the dentist william moran was actually rather late to the operation. he brought with him a hollow glass globe, very much like the one pictured. he had this inhaler custom-made and it said that he was late because he was having a last-minute adjustments made to. it inside the globe was a natural sponge soaked with a chemical. morton called it leaked the on and said it was a chemical of his own creation. but it was really -- a synthetic solvent with known applications in science. plus some orange oil to mask ethers distinctive stick seat -- morton was determined to get a patent for infusion which is why he was making a last-minute adjustments to the inhaler and saying this chemical was his own creation. he later did get a patent, but it was rendered unenforceable very quickly. in later uses of the ether, people sometimes administer it on a prosaic unpalatable piece of cloth rather than a complicated inhaler. once he was in place, more unhealthy inhaler up to the patients nose and mouth and had him breathe in the sweet favors for several minutes. the patient fell unconscious and the doctors looked on a nervous anticipation. it was clearly having an effect but they weren't sure it would really conquer pain. one reason for doubt was that morton was an outsider. doctors at the time the nazi dentist as fellow medical professionals at all. a year earlier, dentists horse wells use nitrous oxide to anesthetize a patient in front of a word -- harvard medical school students. also called laughing gas, the gas was already known for causing a high. it's used as a mild anesthetic to this day but in this demonstration, the patient groaned and appeared to be in considerable pain. the students cheered and called wells's demonstration a humbug. the operation to address the tumor on abbott's neck went according to plan. no complications. but then of course the question was, will the patient wake up? the doctors looking on worry that he would be in a coma, that he would die, or that he wouldn't recover all of his senses. but he did wake up and he said that he remembered a scraping sensation but no pain. doctor warren turn to the crown and pronounced, gentlemen, this is no humbug. within the next few weeks and certainly the next few months, word spread in newspapers and medical journals throughout the country and throughout the world. a year later, dr. james sense of admiral tested a number of chemicals with similar chemical properties to ether and discover that chloroform could be used and is as an anesthetic as well. william warren believe that the discovery of anesthesia was his in his alone. but not everyone agreed. horse wells felt that he had an earlier plan. in athens georgia, surgeon crawford long had to use ether to induce anesthesia in 1842. but he didn't publicize his results until 1849. once morton's demonstration had become famous. in addition, physician charles thomas jackson announced that he had discovered ether anesthesia first. morton had not only been studying medicine under him, although the arrangement was a loose one, jackson made a reasonably well supported claim that he had suggested to mourn that either might work as an aesthetic. and a hotly contested claim that he should get the credit above morton for its discovery. next slide, please. thank you. mass general has quite a bit of information on -- as well as the perception of anesthesia in the years following in our archives. people researching the history of the story and depth also often can dulled the massive historical society because they hold the paper of dr. john collins worth, the paper of a descendant of gilbert abbott who did some research on him and the metal that william morgan received from the national institute of france in 1850 for the discovery of anesthesia. and that's what's on the screen. he was actually quite chagrin because he was given this prestigious -- jointly with charles jackson. historical debates about who should get the credit for solving a problem in health care tell us something about what was most important to the people involved. but the debate over ethers discovery didn't directly affect patients. they had access to anesthesia regardless of who invented it. debates over how to organize care, on the other hand, almost always directly affect patients. in the late 19th and early 20th century, state and federal governments looked at hansen's disease, then known as leprosy, as a major challenge in organizing care. the question was not just how to quarantine people who had a disease that was believed to be extremely contagious, but how to do so for people who would then be there for life. for years, hansen's disease was said to be a spread by association with sin, being figuratively dirty. but it had been known science to since 1873 it was actually caused by a bacterium. this didn't change the stigma against the disease, and the fact that it was also believed to be associated with tropical countries was an avenue for racist attitudes to be mixed in with the rest of the stigma. one public health official in the late 19th century wrote, leopards shown people instinctively but remain human for a long time. this cruelty dehumanization is not uncommon in descriptions of people with deformities and disability but it is particularly blatant in descriptions of people with hansen's. several states tried to fund quarantine hospitals for patients with hansen's disease. but they often met with ire from the communities that the hospitals would be in or near. in recent years, scientists have discovered the disease is only transmissible with prolonged contact. and around 95% of humans are naturally immune because susceptibility is linked with a fairly roll gene. so hands is actually quite hard to transmit. but at the turn of the last century, scientists as well as the general public still thought it was wildly contagious. next slide, please. in 1904, the state of massachusetts purchased hanna keys island, a 75 acre island in buzzards bay to use as a quarantine hospital or leper colony in the parlance of the day. the state had already chosen to other sites on the mainland, but never built there because of opposition from local communities. in addition to being separated from their families and friends by water, many of the patients were immigrants who didn't share a common language with one another or with their doctors making this quarantine hospital extremely isolating experience similarly the state of louisiana founded leper home in carville in 1894 following a state law calling for people with the disease to be quarantined. the law banned hansen's disease patients from public transit so the hospitals first residents arrived on a cool barge. louisiana also had t turned carville into the national leprosaurium. massachusetts closed the quarantine hospital on panickies island and response and sent its 13 patients to carville. massachusetts closed the quarantine hospital on penikese island in response and said it's 13 patients to carville. the only physical remains of that hospital are a few stonethe other hand was active up until only about 20 years ago and almost all of the buildings still stand and it is a historic site that could be visited and it's one of the sites in my book. over the course of the century that carville was an operation the question of how to best care for the residents was not just discussed by doctors and by bureaucrats it became an area for both collaboration and fierce debate and sometimes power struggles between hospital leadership and the residents themselves. especially in the early years residents were often barred from seeing their families and generally treated like inmates. the institution sometimes punished leaving against medical advice whether for a night away or as an attempt to leave permanently where to stay in the on-site jail and against medical advice really meant anyone with the disease was not allowed to leave at the time. that changed over the course of the years that the hospital was open. next slide please. thank you. many residents expected to be at carville for life and they did their best to create community recreation and independence for themselves with or without the institutions approval. married couples some of whom met at carville often build their own small cottages as they weren't initially allowed to live together in the dorm like residences. this image shows new dorms under construction in the 1940s, and they did have housing for for couples. it's an example of one of the changes over time. over the decades the site had movie theaters chapels sports teams and an annual mardi gras celebration. there were two of almost everything one for patients one for staff. after antibiotics created effective treatments in the middle of the 20th century. some people recovered and were discharged. numerous former carville residents challenged the stigma of their disease when they're writing and they're speaking describing their diverse experiences. many of them began this work around the same time as the emerging disability rights movement in the 1960s and 1970s. many residents did advocacy work from within carville as well, especially through writing for the residents newspaper the star. it was carville residence in the star who first advocated for changing the name from the medieval sounding leprosy to hansen's disease after the scientist who had identified the bacteria. after decades of advocacy people with hansen's no longer expect their families to disown them after diagnosis. however, the history of this disease and phrases such as treat someone like a leper are a reminder of the fact that value judgments and even judgments about who's human have a powerful influence on health decisions in our society. everyone has a reason for the healthcare choices that they make whether that's for themselves and their families or whether they're making healthcare policy. and whether or not the choices end up being good ones. the reasons aren't just about the science. they're influenced by politics. faith in various belief systems trust and distrust of certain authorities prejudice affordability comfort and myriad other factors. this way of examining the stories in my book focusing on the questions the people tried to answer and how they frame those questions can lead itself to a fairly individualistic lens through which to view history. but it doesn't have to. major historical events and movements ranging from the civil war and world war two to the industrial revolution and the social reforms of the progressive era. to attitudes about race and gender. we're all important driving forces for many of decisions that people made around healthcare in the stories in my book. however, studying history through questions like how to organize care how to balance risks and who gets to have a voice in their own or others treatment. helps us see what we have in common with people who are operating from very different historical and scientific contexts. and with that i'll close and i'm happy to take questions or comments whether about there about the stories that i shared tonight or anything else about the book. all right. well, thank you very much for a very informative talk. we do have some questions from the audience. so just to have a person to ask the questions. i would point out that ron ron said hi tegan. he was looking forward to the talk. yeah your question but worth mentioning. he also followed up with an actual question where he said did olivia pinkett was medicine actually have a desirable and useful effect because it contained iron that's a very good question. i don't know whether there are studies on that. um, there are anecdotal reports. i think the fact that it's still on the market suggests that there are definitely believers, but i have not come across in my reading about lydia pinkham whether whether it's been studied and one of the things that scientists look for in determining whether something might work is whether there's a known mechanism not all mechanisms are known we still don't fully understand how anesthesia works, although we're getting closer, but the fact that something contains iron and iron can be helpful for you know certain -- or regularities that sort of thing. there's a possible mechanism. so it's plausible, but i haven't come across whether there's a yet known answer to that great question. tony asks, um, i was surprised to learn that 19th century doctors considers dentists to be outsiders. when did the doctors recognized dentist as equals in healthcare? and maybe not quite yet. that's a great question and the the exact year of this event is escaping me, but sometimes in the first half of the 19th century, there was an event that dentists or at least dentists with an interest in history refer to as the historic rebuff, which was when a pair of dentists approached a prestigious medical school about founding and dental program there and the medical school basically said, what are you doing? we're a medical school where we're not going to admit potential dentists. and so that was the historic rebuff and by some people's account medicine and dentists dentistry were on separate paths from there on out. however, a number of medical schools do have dental programs. a dental degree is a doctor a doctor of dental medicine degree. it is a medical degree. so in terms of when that rift started to heal, it was really a gradual process. i think that one of the things that was transformative if not the only thing is in world war one there were a lot of advances in oral and maxillofacial surgery, especially reconstructive surgery for soldiers who had had damage to their face in either from shrapnel or gunshots or various other things and so that oral surgeons becoming really important and respected surgeons was one of the things that helped people understand help people within other medical professions understand how important dentistry is the fact that dental insurance is often a separate add-on component to health insurance is often cited as one of the pieces of evidence that we still don't understand or really appreciate even if we do understand how much dental health is linked to the rest of physical health. actually, i have to say just reminds me of one point when i had oral surgery. i was never because i didn't have dental care. they were like oh, but that's surgery. so that is correct. it was like oh, but you won't pay to clean my teeth. um, well janet asked did the way vaccines or administered change of the centuries when did doctors start using needles? great question. i don't know off the top of my head when doctors started using needles, but the hypodermic needle that we know today is a fairly recent historical invention. so you know by the mid 20th century, that would be the standard is administering a vaccine through a needle unless you have something like the oral vaccine for polio, which was actually you would put it in a little dixie cup full of water or on a sugar cube and the patient would just drink it but if you're getting a shot it would be through hypodermic needle. the method that was used in in dr. waterhouse's day was essentially a braiding the skin or making one or more cuts in the skin and then inserting the material. onto and into the skin the the insertion was because you would already made the cut that that was possible. and so that was if you if you've seen in a medical history collection, or maybe another museum either a lancet, which is just one knife. sometimes folding or a fleam which is several different blades often kind of lever activated from a little box. it's kind of horrifying looking if you think about it and if you think about possibly opening it wrong and cutting yourself, but either of those would create that basically opportunity for the outside material to get in the skin even though you're not giving the person a shot as we know it today. right, so there's actually two people had questions about ether monument and the boston common susan said, can you relay the story of how the ether monument in boston's public garden reflected the controversy over invented ether and peter said, can you say something about the public monument ether anesthesia in the public garden a very large object, but i think there's interest in both and some of the controversy around the ether monument. sure, so that was erected. i believe about 40 years after the initial demonstration. well, i say initial demonstration. i'm referring to the one that happened at mass general hospital. that wasn't the only initial demonstration. but at that time it was still really hotly debated and i think there's an argument that it that debate continues to this day. of which individual and which institution should really get the credit for anesthesia. and some of those key players morton and jackson and wells in particular. really they were part of that controversy. they were trying to get the credit for themselves as far as i know crawford long was much less a part of that controversy. he wasn't local which has a contributing factor. um, but there were also people who you know took sides essentially and so it wasn't just these individuals who had this controversy. it was really you know who gets the credit? and there are some sort of philosophy of science questions inherent in that it's not just about who was first but which thing makes the discovery? is it a successful demonstration? is it a mostly successful demonstration of a successful technology, but the thing that actually or the things that actually prove that it works come later. is it hitting upon the idea because jackson never claimed to have experimented with this before morton. did he claimed that he thought of it before morton did and told morton about it. so there is that kind of ideological component to the controversy. and so when this monument was erected in the boston public garden they ended up deciding to have the allegorical biblical story of the good samaritan as the prominent visual in the monument. so this is the idea of we're conquering pain. we're allowing doctors and people in the medical field to be more humane than they've ever had the technology to be and that's the part that's going to be celebrated on the monument. however, the monument does reference mass general hospital. so i think that some mass general folks feel like you know they won in that sense with this monument. yeah, i know that the metal that you showed from the mhs collection only the core part of it was actually the metal presented, but then the rest was added on to make it more grandiose to further the claim of discovery if i remember correctly from what i read. received both the metal and prizing and he used that prize money to have that decorative metal collar created for the metal to make it bigger. and if you see it in person, it is like gigantic largest metal that i've seen in a long time. it's certainly conveys, you know importance. so cat said have you noticed any regional differences and attitudes approaches or questions in the history of medicine? that's a great question. and to be honest, it's not one that i've given. a lot of thought to i think that certainly at different times there have been regional differences in. and how people approach questions how people approach these healthcare questions because there have been different different influences. so in you know early 19th century new england was there were a lot of people who were really really invested in being self-reliant. that was kind of the idea of what being a yankee was. it was this self-reliance and so when we talk about national trends like jacksonian democracy and these ideas of you know every man for himself and their ideas about self-reliance did tend to privilege white middle-class able-bodied men. they were they were the person who were the people in this society. they if you have that. regionally as well as nationally then you're more likely to become interested in something like i don't need a fancy medical degree to start. practicing medicine i can found my own business and sell people herbal tonics and you know write poems to help them remember which tonic to use which a couple different companies in that era used as a strategy but none of these things are universal none are you don't have you know the the south wasn't against self-reliance, but it wasn't necessarily part of a particular cultural ethos in a given decade. so i hope that example helps even though it was a little nebulous as compared to sort of the breadth of the initial question. so yeah, an anonymous attendee or anonymous question who says does your book include barbara polls and the tales of how barbers were frequently searches? um, that's a good question. it references that but doesn't go into depth. so the tradition of barber surgeons is quite a bit older than the united states and my books starts really with the united states as a political entity. just just a little bit before so while there have been european settlers on this continent for much longer than that and there have been people on this continent for much much longer than that. that's sort of where i started this history. and so the this idea of barber surgeons, which were let me back up for a little bit before surgery was a trained part of you know branch of medicine. it was a trade and it was not considered a high status trade. although it was very much an essential one and the people who might you know cut a tumor off your neck rather than john collins warren or the people who might pull your tooth. we're also the same people who would shave you so these barber surgeons that was that was part of their trade. this could be something self-taught but in parts of europe it was also there were guilds and it was treated like other trades and that tradition was waning but not over at the time that my book starts so i do have a bleeding cup in the book or a couple of bleeding cups, which were for bloodletting. that's a, you know, kind of a holdover from that medieval era although those particular cups are from the civil war. but that's definitely a fascinating part of history. that doesn't get as much attention in my book as some of the other subjects. and so i think we just have time for about one one more question or so, but do you have an object in your book that really surprised you that you'd really like people to know that if there's something that just sort of like really stands out as the thing that you you didn't expect. that's a good question and it's kind of like when people ask me my favorite artifact in the book or my favorite artifact in the museum where i work where i have answers, but they change frequently, but i think one that i expect to surprise others, and so i often include it in descriptions of my book and blurbs and that sort of thing is vitamin d beer and that was from the early 20th century during the first vitamin craze. so anyone who's maybe eight years old or older has lived through at least one vitamin craze because they happen often where you know the cover of every health magazine and that sort of thing and every you know, kombucha bottle in the store is saying this particular vitamin or sometimes these days it's micronutrient which typically means vitamin or mineral is the thing that will will carry you or that will make you healthy that will ensure vitality those crazes started basically as soon as we understood that vitamins exist, and that was early 20th century when that research really started to get going. and so a couple of scientists in wisconsin figured out both what vitamin d is the fact that it was the connecting factor between things like rickets, which is a vitamin d deficiency and various other things in health and uv light and certain fats and certain fats that had been exposed to uv light. so they started putting all these pieces together and because they were putting those pieces together it became possible to fortify things with vitamin d. um, wisconsin has a big dairy industry. so one of the first things get fortified was milk, but there was also a lager that was being sold as sunshined vitamin d beer and the idea was that you were capturing the health rays of the sun in your bottle of beer and it didn't really catch on and i have some theories about why that don't i don't have enough evidence to fully support them, but i think that at the time ideas about things like vitamins were even more heavily gendered than they have been in more recent years and this idea of you know a woman taking care of her home was was really important in how vitamins were often marketed and so something that was closer to like an athleisure energy drink would be the today equivalent, you know, the advertisements were showing people drinking beer on the the deck of a sailboat. you know, it's that kind of athleticism and leisure and recreation all in one in your beer advertising that it was just it was a little too soon for this idea as my personal theory. so that's vitamin d beer. it surprised me at first and it's one that i expect to surprise others, although maybe you've already heard of it and and this is old but it's a fun one. i think there is one final thing which is john asked where can he get a signed copy of the book and we'll let people know where to order a book from but an assigned copy might be different. yes great question. so the book is sold in many different places. you can get it right from the publisher roman and littlefield. you can get it on amazon. i have a bookshop.org site, which is just my name tegan kehoe or you can order it from your local bookstore through bookshop.org or just straight from your bookstore. um, sir currently, there are not a lot of signed copies out there in the world and because of i've been starting through how to make that possible, but i do make it i try to make it so that if you can spell my name, you can contact me. it's my twitter handle. it's my website. it's my email and so on and so if there's anyone who's interested in assigned bookplate, i'm happy to pop one of those in the mail if you get in touch with me and signed copies might exist in the future, but they don't quite yet. great. well, thank you very much, and i'd like to thank everyone for joining us and here is among other things the link to bookshelf.org, but i think this was a fascinating talk and a great program and i hope everybody i enjoyed it and i hope you all order copies of the books that they'll be available as soon as there should be. so thank you. do you and have a great evening to everyone? thank you gavin and thank you everyone for being herewell nowv we're going to talk about historic preservation. want to introduce you to jordan tannenbaum. he is the vice chair of the advisory council on historic preservation. mr. tan about what is that? yeah organization the advisory councilman historic preservation is an independent federal agency part of the executive branch. it was it is was created by the national stark act o19

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