Photo @ Archives of the Chicago Historical Society
Frances Willard Hospital, Chicago. First decade of the nineteenth century.
Doctor Jacob Bolotin was examining a young woman. Three other doctors had already visited her, declaring her healthy as a horse – the causes of her condition were definitely psychological.
Bolotin placed his ear on her chest. Suddenly, he thought he heard the typical sound generated by an obstructed heart valve. He lightly touched her skin: it was sticky with sweat. Pressing his ear against her rib cage again, the doctor focused and heard, more clearly this time, the laboured and muffled sound of a mitral stenosis.
He told the woman to put back on her clothes and rushed into his superior’s office, communicating his discovery. And that’s how she survived.
Nothing special about this story, except for a small detail.
Doctor Jacob Bolotin was totally blind from birth.
Born in 1888 in Chicago from Polish Jewish immigrants, Bolotin was the last of seven children and the third suffering from total congenital blindness. A particularly brilliant mind, since his adolescence Bolotin showed an unbreakable spirit. At the time, life for the blind was not rosy at all: they were considered disabled, unsuited for working, and were frequently destined to end up begging in the streets. Regardless of this, the young Jacob cherished the impossible dream that one day he would graduate in medicine and obtain the occupational licence.
After getting his high school diploma at 14, Jacob found a job as a door-to-door seller of paint brushes and typewriters. Every day he walked for hours on end, all by himself, finding his way with his cane through the traffic of Chicago. With his earnings, he started to pay college tuition fees.
His life has been an uphill struggle. He had to fight to be admitted to the medical programme. Even after graduating with honours at the age of 24, he encountered several obstacles: a blind person taking the licensing examination was simply inconceivable.
To say the truth, during his internship Bolotin’s expertise and excellent cardiopulmonary knowledge had been vastly recognised by both patients – who loved him – and doctors, who frequently asked for his consultation. But that was far from granting him a professional qualification.
After years of strenuous fights to achieve the well-deserved acknowledgements, finally, Jacob successfully became the first blind doctor in the whole world.
Let’s picture him while he opens the long-awaited medical practice, filled with pride. He sits in his leather chair, and waits. For months, not a single patient.
Then a couple of Chicago Tribune journalists came in, drawn by the chance of writing a pulp story about the decline of humanity: the patients now had to rely on the cares of a “poor blind man”.
And Bolotin answered with unexpected passion: “Well, what is so remarkable about it? Because a man has no eyes, does it mean he hasn’t any brains either? That is the trouble with the world and the blind man. All the blind man asks is fair play. Give him an equal chance without prejudice, and he generally manages to hold his own with his more fortunate colleagues”.
So, shall we overlook the moral strength he proved, something really “remarkable” stands out anyway: his words about equal opportunities pronounced almost a century before the rise of disability rights movements.
Thanks also to the press attention, Jacob Bolotin became a successful doctor. Specialised in cardiopulmonary diseases, he was a skilful public speaker as well, and a fighter for the rights, career opportunities and social inclusion for the blind and visually impaired. He died in 1924 at the young age of 36, probably due to the strenuous amount of work, as he was constantly torn between the medical practice and public speeches.
After all his fights, Jacob Bolotin’s greatest reward consisted in the love of his colleagues and patients: he was so well-liked that more than 5000 people attended his funeral.
Among the bibliographic curiosities I have been collecting for years, there is also a little book entitled L’amico discreto. It’s the 1862 Italian translation of The silent friend (1847) by R. e L. Perry; aside from 100 beautiful anatomical plates, the book also shows a priceless subtitle: Observations on Onanism and Its Baneful Results, Including Mental and Sexual Incapacity and Impotence.
Just by skimming through the table of contents, it’s clear how masturbation was indicated as the main cause for a wide array of conditions: from indigestion to “hypoconriac melancholy”, from deafness to “bending of the penis”, from emaciated complexion to the inability to walk, in a climax of ever more terrible symptoms preparing the way for the ultimate, inevitable outcome — death.
One page after the other, the reader learns why onanism is to be blamed for such illnesses, specifically because it provokes an
excitement of the nervous system [which] by stimulating the organs to transient vigour, brings, ere middle life succeeds the summer of manhood, all the sensible infirmities and foibles of age; producing in its impetuous current, such an assemblage of morbid irritation, that even on trivial occasions its excitement is of a high and inflammable character, and its endurance beyond the power of reason to sustain.
But this is just the beginning: the worst damage is on the mind and soul, because this state of constant nervous stimulation
places the individual in a state of anxiety and misery for the remainder of his existence, — a kind of contingency, which it is difficult for language adequately to describe; he vegetates, but lives not: […] leading the excited deviating mind into a fertile field of seductive error — into a gradual and fatal degradation of manhood — into a pernicious, disgraceful, and ultimately almost involuntary application of those inherent rights which nature wisely instituted for the preservation of her species […] in defiance of culture, moral feeling, moral obligation, and religious impressions: thus the man, who, at the advent of youth and genius was endowed with gaiety and sociality, becomes, ere twenty-five summers have shed their lustre on him, a misanthrope, and a nadir-point of discontent! What moral region does that man live in? […] Is it nothing to light the gloomy torch that guides, by slow and melancholy steps to the sepulchre of manhood, in the gay and fascinating spring-time of youth and ardent desire; when the brilliant fire of passion, genius, and sentiment, ought to electrify the whole frame?
This being a physiology and anatomy essay, today its embellishments, its evocative language (closer to second-rate poetry than to science) seem oddly out of place — and we can smile upon reading its absurd theories; yet The Silent Friend is just one of many Nineteeth Century texts demonizing masturbation, all pretty popular since 1712, when an anonymous priest published a volume called Onania, followed in 1760 by L’Onanisme by Swiss doctor Samuel-Auguste Tissot, which had rapidly become a best-seller of its time.
Now, if physicians reacted in such a harsh way against male masturbation, you can guess their stance on female auto-eroticism.
Here, the repulsion for an act which was already considered aberrant, was joined by all those ancestral fears regarding female sexuality. From the ancient vagina dentata (here is an old post about it) to Plato’s description of the uterus (hystera) as an aggressive animale roaming through the woman’s abdomen, going through theological precepts in Biblical-Christian tradition, medicine inherited a somber, essentially misogynistic vision: female sexuality, a true repressed collective unconscious, was perceived as dangerous and ungovernable.
Another text in my library is the female analogue of Tissot’s Onania: written by J.D.T. de Bienville, La Ninfomania ovvero il Furore Uterino (“Nymphomania, or The Uterine Fury”) was originally published in France in 1771.
I’m pasting here a couple of passages, which show a very similar style in respect to the previous quotes:
We see some perverted young girls, who have conducted a voluptuous life over a long period of time, suddenly fall prey to this disease; and this happens when forced retirement is keeping them from those occasions which facilitated their guilty and fatal inclination. […] All of them, after they are conquered by such malady, occupy themselves with the same force and energy with those objects which light in their passion the infernal flame of lewd pleasure […], they indulge in reading lewd Novels, that begin by bending their heart to soft feelings, and end up inspiring the most depraved and gross incontinence. […] Those women who, after taking a few steps in this horrible labyrinth, miss the strength to come back, are drawn almost imperceptibly to excesses, which after corrupting and damaging their good name, deprive them of their own life.
The book goes on to describe the hallucinatory state in which the nymphomaniacs fall, frantically hurling at men (by nature all chaste and pure, it seems), and barely leaving them “the time to escape their hands“.
Of course, this an Eighteenth Century text. But things did not improve in the following century: during the Nineteenth Century, actually, the ill-concealed desire to repress female sexuality found one of its cruelest incarnations, the so-called “extirpation”.
This euphemism was used to indicate the practice of clitoridectomy, the surgical removal of the clitoris.
Everybody kows that female genital mutilations continue to be a reality in many countries, and they have been the focus of several international campaigns to abandon the practice.
It seems hard to believe that, far from being solely a tribal tradition, it became widespread in Europe and in the United States within the frame of modern Western medicine.
Clitoridectomy, a simple yet brutal operation, was based on the idea that female masturbation led to hysteria, lesbianism and nymphomania. The perfect circular reasoning behind this theory was the following: in mental institutions, insane female patients were often caught masturbating, therefore masturbation had to be the cause of their lunacy.
One of the most fervent promoters of extirpation was Dr. Isaac Baker Brown, English gynaecologist and obstetrical surgeon.
In 1858 he opened a clinic on Notting Hill, ad his therapies became so successful that Baker Brown resigned from Guy’s Hospital to work privately full time. By means of clitoridectomy, he was able to cure (if we are to trust his own words) several kinds of madness, epilepsy, catalepsy and hysteria in his patients: in 1866 he published a nice little book on the subject, which was praised by the Times because Brown “brought insanity within the scope of surgical treatment“. In his book, Brown reported 48 cases of female masturbation, the heinous effects on the patients’ health, and the miraculous result of clitoridectomy in curing the symptoms.
We don’t know for sure how many women ended up under the enthusiastic doctor’s knife.
Brown would have probably carried on with his mutilation work, if he hadn’t made the mistake of setting up a publicity campaign to advertise his clinic. Even then, self-promotion was considered ethically wrong for a physician, so on April 29, 1866, the British Medical Journal published a heavy j’accuse against the doctor. The Lancet followed shortly after, then even the Times proved to have changed position and asked if the surgical treatment of illness was legal at all. Brown ended up being investigated by the Lunacy Commission, which dealt with the patients’ welfare in asylums, and in panic he denied he ever carried out clitoridectomies on his mentally ill patients.
But it was too late.
Even the Royal College of Surgeons turned away from him, and a meeting decided (with 194 approving votes against 38 opposite votes) his removal from the Obstetric Society of London.
R. Youngson and I. Schott, in A Brief History of Bad Medicine (Robinson, 2012), highlight the paradox of this story:
The extraordinary thing was that Baker Brown was disgraced, not because he practised clitoridectomy for ridiculuous indications, but because, out of greed, he had offended against professional ethics. No one ever suggested that there was anything wrong with clitoridectomy, as such. Many years were to pass before this operation was condemned by the medical profession.
And many more, until eventually masturbation could be freed from medical criminalization and moral prejudice: at the beginning of the Twentieth Century doctors still recommended the use of constrictive laces and gears, straight-jackets, up to shock treatments like cauterization or electroconvulsive therapy.
1903 patent to prevent erections and nocturnal pollutions through the use of spikes, electric shocks and an alarm bell.
Within this dreadful galaxy of old anti-masturbation devices, there’s one looking quite harmless and even healthy: corn flakes, which were invented by famous Dr. Kellogg as an adjuvant diet against the temptations of onanism. And yet, whenever cereals didn’t do the trick, Kellogg advised that young boys’ foreskins should be sewn with wire; as for young girls, he recommended burning the clitoris with phenol, which he considered
an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will-power has become so weakened that the patient is unable to exercise entire self-control.
The worse cases among young women are those in which the disease has advanced so far that erotic thoughts are attended by the same voluptuous sensations that accompany the practice. The author has met many cases of this sort in young women, who acknowledged that the sexual orgasm was thus produced, often several times daily. The application of carbolic acid in the manner described is also useful in these cases in allaying the abnormal excitement, which is a frequent provocation of the practice of this form of mental masturbation.
(J. H. Kellogg, Plain Facts for Old And Young, 1888)
It was not until the Kinsey Reports (1948-1953) that masturbation was eventually legitimized as a natural and healthy part of sexuality.
All in all, as Woody Allen put it, it’s just “sex with someone you love“.
Physician’s is a strange job: on one hand it is a profession, on the other an “absolute” vocation, which should not depend from personal gain and well-being. In fact, from the moment he takes the Hippocratic Oath, every doctor is required to provide first aid even outside the strictly professional sphere, and there are many doctors who put their own health in danger to cure, or even just understand, a disease.
Nicolae Minovici (1868-1941) was one of these men determined to get his hands dirty in order to help others.
Most of his life was spent giving assistance to the weak, the poor and the outcasts who in Romania at the beginning of the XX Centry received little or no support from authorities: he founded one of the first ambulance and emergency services, provided care and assistance to more than 13.000 homeless people giving them the opportunity of working for the emergency units. He also helped out single mothers, opening shelters where they could find assistance before and after giving birth. He was even appointed mayor of the Băneasa district, where he modernized the sewage system, the fountains, the night shelters.
His professional and academic career was just another variation of Minovici’s interest in social issues. Having worked as a coroner, he touched first hand the most dramatic realities of his time; his studies in forensics, pathological anatomy, psychiatry and anthropology led him to take interest in delinquency (after all, his father was Mina Minovici, Romanian founder of criminological disciplines). In 1899 Nicolae published an essay on the alleged relationship between tattoos and criminal personality, coming to the conclusion — atypical in those times — that this relationship does not exist. HE founded the Romanian Association of Legal Medicine, and the Romanian Journal of Legal Medicine.
But his name is above all remembered for another work, his Study on hanging (1904).
Minovici’s humanist sensibility led him to believe that the physician’s vocation had to be both scientific and moral, as we said in the beginning. After all, he was not the kind of man who backs up before danger.
When, at the beginning of his studies on strangulation, he realized that he could not understand the dynamics of hanging without first hanging himself, Minovici did not hesitate.
In his first experiment, Minovici tried to personally adjust the intensity of asphyxiation. He passed a rope through a pulley fixed on the ceiling, and attached a dynamometer to the (non contracting) noose: he then pulled as hard as he could on the other end of the rope. Immediately his face turned purple red, and Minovici heared a prolonged hiss in his ears, as his visual became blurred. After just six seconds, he lost consciousnees.
This system allowed him to discontinue the rope’s tension in the exact moment he was about to faint. After experimenting with this method several other positions, recording symptoms and timing his resistance, Minovici moved to a new phase of decidedly more dangerous tests. With the help of some assistants, he decided he would be lifted from his neck, once again using a non contracting knot.
A couple of assistants pulled on the rope, one of them counted loudly as the seconds went by, so that Minovici could hear them over the tinnitus. But the first time the professor was lifted from the ground, and his feet lost contact with the floor, an excruciating pain went through his throat, as his airways were strangled and his eyes involountarily shut. Minovici frantically signaled the assistants to bring him back down, after few seconds.
Not at all discouraged, Minovici decided he needed a little practice. “I let myself hang six to seven times for four to five seconds to get used to it“. After this training, the professor was able to resist up to 25 seconds as he was hanging with his feet a couple of meters from the floor: the reckoning for this experiment were two weeks of sharp pain in his neck and throat muscles.
Eventually, Minovici was ready for the most dangerous and extreme endeavour: being hanged with a slip knot.
As usual, his assistants began to pull the rope, but this time the noose tightened in a split second, squeezing his neck in a grip of burning pain. The shock was so intense that after just three seconds Minovici signaled to let go of the rope. His feet had never even left the floor: the professor nevertheless swallowed with great difficulty and pain during the following month.
Besides experimenting on himself, Minovici ran some tests — albeit less dramatic ones — on some volunteers, who were chocked by applying pressure on the carotid and jugular. In these cases, as the subject’s face turned purple, he recorded sight problems, paresthesia (tingling sensensation, or numb limbs), a sensation of heat in the head, and tinnitus.
Minovici’s research, published in Romania in 1904 and in France in 1906, was extensively quoted in successive studies on the topic. His essay, in fact, was not limited to these singular hanging experiments, but related clinical records, statistics, information on the knots most frequently used by suicide victims, anatomy notes and so on.
Nicolae Minovici, who was passionate about Romanian folklore, had been collecting folk art objects all of his life. When in 1941 he died a bachelor, he donated his estate and collection to his Country, and today his former villa in Bucarest houses an ethnological museum.
Once upon a time on the circus or carnival midway, among the smell of hot dogs and the barkers’ cries, spectators could witness some amazing side attractions, from fire-eaters to bearded ladies, from electric dancers to the most exotic monstrosities (see f.i. some previous posts here and here).
Beyond our fascination for a time of naive wonder, there is another less-known reason for which we should be grateful to old traveling fairs: among the readers who are looking at this page right now, almost one out of ten is alive thanks to the sideshows.
This is the strange story of how amusement parks, and a visionary doctor’s stubbornness, contributed to save millions of human lives.
Until the end of XIX Century, premature babies had little or no chance of survival. Hospitals did not have neonatal units to provide efficient solutions to the problem, so the preemies were given back to their parents to be taken home — practically, to die. In all evidence, God had decided that those babies were not destined to survive.
In 1878 a famous Parisian obstetrician, Dr. Étienne Stéphane Tarnier, visited an exhibition called Jardin d’Acclimatation which featured, among other displays, a new method for hatching poultry in a controlled, hydraulic heated environment, invented by a Paris Zoo keeper; immediately the doctor thought he could test that same system on premature babies and commissioned a similar box, which allowed control of the temperature of the newborn’s environment.
After the first positive experimentations at the Maternity Hospital in Paris, the incubator was soon equipped with a bell that rang whenever the temperature went too high.
The doctor’s assistant, Pierre Budin, further developed the Tarnier incubator, on one hand studying how to isolate and protect the frail newborn babies from infectious disease, and on the other the correct quantities and methods of alimentation.
Despite the encouraging results, the medical community still failed to recognize the usefulness of incubators. This skepticism mainly stemmed from a widespread mentality: as mentioned before, the common attitude towards premature babies was quite fatalist, and the death of weaker infants was considered inevitable since the most ancient times.
Thus Budin decided to send his collaborator, Dr. Martin Couney, to the 1896 World Exhibition in Berlin. Couney, our story’s true hero, was an uncommon character: besides his knowledge as an obstetrician, he had a strong charisma and true showmanship; these virtues would prove fundamental for the success of his mission, as we shall see.
Couney, with the intent of creating a bit of a fuss in order to better spread the news, had the idea of exhibiting live premature babies inside his incubators. He had the nerve to ask Empress Augusta Victoria herself for permission to use some infants from the Charity Hospital in Berlin. He was granted the favor, as the newborn babies were destined to a certain death anyway.
But none of the infants lodged inside the incubators died, and Couney’s exhibition, called Kinderbrutanstalt (“child hatchery”) immediately became the talk of the town.
This success was repeated the following year in London, at Earl’s Court Exhibition (scoring 3600 visitors each day), and in 1898 at the Trans-Mississippi Exhibition in Omaha, Nebraska. In 1900 he came back to Paris for the World Exhibition, and in 1901 he attended the Pan-American Exhibition in Buffalo, NY.
The incubators building in Buffalo.
The incubators at the Buffalo Exhibition.
But in the States Couney met an even stronger resistence to accept this innovation, let alone implementing it in hospitals.
It must be stressed that although he was exhibiting a medical device, inside the various fairs his incubator stand was invariably (and much to his disappointment) confined to the entertainment section rather than the scientific section.
Maybe this was the reason why in 1903 Couney took a courageous decision.
If Americans thought incubators were just some sort of sideshow stunt, well then, he would give them the entertainment they wanted. But they would have to pay for it.
Couney definitively moved to New York, and opened a new attraction at Coney Island amusement park. For the next 40 years, every summer, the doctor exhibited premature babies in his incubators, for a quarter dollar. Spectators flowed in to contemplate those extremely underweight babies, looking so vulnerable and delicate as they slept in their temperate glass boxes. “Oh my, look how tiny!“, you could hear the crowd uttering, as people rolled along the railing separating them from the aisle where the incubators were lined up.
In order to accentuate the minuscule size of his preemies, Couney began resorting to some tricks: if the baby wasn’t small enough, he would add more blankets around his little body, to make him look tinier. Madame Louise Recht, a nurse who had been by Couney’s side since the very first exhibitions in Paris, from time to time would slip her ring over the babies’ hands, to demonstrate how thin their wrists were: but in reality the ring was oversized even for the nurse’s fingers.
Madame Louise Recht with a newborn baby.
Preemie wearing on his wrist the nurse’s sparkler.
Couney’s enterprise, which soon grew into two separate incubation centers (one in Luna Park and the other in Dreamland), could seem quite cynical today. But it actually was not.
All the babies hosted in his attractions had been turned down by city hospitals, and given back to the parents who had no hope of saving them; the “Doctor Incubator” promised families that he would treat the babies without any expense on their part, as long as he could exhibit the preemies in public. The 25 cents people paid to see the newborn babies completely covered the high incubation and feeding expenses, even granting a modest profit to Couney and his collaborators. This way, parents had a chance to see their baby survive without paying a cent, and Couney could keep on raising awareness about the importance and effectiveness of his method.
Couney did not make any race distinction either, exhibiting colored babies along with white babies — an attitude that was quite rare at the beginning of the century in America. Among the “guests” displayed in his incubators, was at one point Couney’s own premature daughter, Hildegarde, who later became a nurse and worked with her father on the attraction.
Nurses with babies at Flushing World Fair, NY. At the center is Couney’s daughter, Hildegarde.
Besides his two establishments in Coney Island (one of which was destroyed during the 1911 terrible Dreamland fire), Couney continued touring the US with his incubators, from Chicago to St. Louis, to San Francisco.
In forty years, he treated around 8000 babies, and saved at least 6500; but his endless persistence in popularizing the incubator had much lager effects. His efforts, on the long run, contributed to the opening of the first neonatal intensive care units, which are now common in hospitals all around the world.
After a peak in popularity during the first decades of the XX Century, at the end of the 30s the success of Couney’s incubators began to decrease. It had become an old and trite attraction.
When the first premature infant station opened at Cornell’s New York Hospital in 1943, Couney told his nephew: “my work is done“. After 40 years of what he had always considered propaganda for a good cause, he definitively shut down his Coney Island enterprise.
Martin Arthur Couney (1870–1950).
The majority of information in this post comes from the most accurate study on the subject, by Dr. William A. Silverman (Incubator-Baby Side Shows, Pediatrics, 1979).