CEPI Curiosities: Aesculapius/Asclepius

CEPI Curiosities: Tales from Medical History's Strange Side

Hello again, fellow historico-medico aficionados, and welcome to another installment of CEPI Curiosities, our monthly dive into the medically strange. This time around, I hand the medical history reigns to a guest speaker: Jorge Colon. Jorge is currently performing admirable work as a CEPI intern and is an alum of the Out4STEM Program. Past interns have examined such topics as Chang and Eng Bunker (the original “Siamese Twins”), Harry Eastlack and FOP (Fibrodisplasia Ossificans Progressiva), CPP Fellow Chevalier Jackson and his collection of swallowed objects, and the difference between venom and poison. Jorge’s topic today examines the history of an omnipresent figure here at the College of Physicians of Philadelphia: Aesculapius, a marble statue of whom stands at the top of the staircase in the College’s rotunda.

Marble statue of Aesculapius at the top of the main staircase at the College of Physicians of Philadelphia

 

Take it away, Jorge!

Different sources claimed Asclepius to be many things. Some claimed he was a mortal physician (such as in Homer’s Iliad) who was struck by Zeus with a lightning bolt and became god. In other accounts, Asclepius was the ancient Greek god of medicine, son of the god Apollo and Coronis. He was married to Epione, the goddess of soothing; together, they had nine children:their daughters were Panacea (goddess of medicines), Hygeia (goddess of health), Iaso (goddess of recuperation), Aceso (goddess of the healing process), Aglaea or Aegle (goddess of magnificence and splendor). They also had four sons: Machaon and Podalirius, legendary healers who fought in the Trojan War; Telesphorus, who accompanied his sister, Hygeia, and symbolised recuperation; and Aratus. In Roman mythology, he is known as Aesculapius.

Asclepius learned medicine and the healing arts from the centaur Chiron. According to legend, he once healed a snake, whom in turn taught him secret knowledge. The Greeks considered snakes divine beings that were wise and could heal mortals. This is why a single snake wrapped around a staff became the symbol of Asclepius; it later became the symbol of medicine. Asclepius became so skilled a healer he learned how to cheat death and bring people back from the underworld. As a result, Zeus killed him to maintain the balance of life and death and placed him on the night sky under the constellation of the Ophiuchus (the snake holder).

Asclepius developed a loyal following of mortals who traveled far and wide to one of many sanctuaries for healing, called Asclepions. The most famous sanctuary of Asclepius was the Epidaurus, which hosted athletic, dramatic, and even musical games in honor of Asclepius every four years. Today you may notice the staff of Asclepius adorned on things related to health and medicine, such as on medical professionals’ uniforms or on the sides of ambulances.

Logo of the American Medical Association

Logo of the American Medical Association, using the Rod of Asclepius

However, sometimes you may notice a different staff with two snakes wrapped around it and a pair of wings at the top. This symbol is the staff of Caduceus, which belongs to the Greek god Hermes. Hermes is considered the god of transitions and boundaries. He acted as herald of the gods and also escorted the souls of the dead when they transitioned from the mortal realm to the afterlife. The Caduceus was usually affiliated with public speakers and heralds. Printing companies also used the staff.

Image of the Staff of Caduceus

The Staff of Caduceus

However, because it looks similar to Asclepius’s staff, it is often misrepresented today as a symbol of medicine. This dates back to 1902 when the Medical Department of the United States Army used the staff of Caduceus. Today, professional medical organizations use the staff of Asclepius; however, many commercial medical firms make use of the Caduceus. Make sure you keep an eye out for both symbols and see if a commercial or professional group is using them.

Until next time, catch you on the strange side!

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CEPI Curiosities: The Public Afterlife of Vladimir Lenin

CEPI Curiosities: Tales from Medical History's Strange Side

Greetings, fellow historico-medico aficionados, and welcome to the latest installment of CEPI Curiosities, our monthly dive into the medically interesting or unusual.

There are a variety of notable objects and specimens on display here at the Mütter Museum, from wax specimens to human remains to even select parts of heads of state (including parts from the heads of heads of state). Today’s episode offers a blending of these topics as today we examine the medical science and history behind the preservation and display of world leaders.

Those of you who recall their world history classes may be able to identify Vladimir Lenin (aka Vladimir Ilyich Ulianov). Lenin (1870-1924) was the founder of the Russian Communist Party and was the first Premier of the Soviet Union; in 1917, following the abdication of Czar Nicholas II, Lenin and his Bolsheviks successfully wrested control of the Russian government during what is known as the “October Revolution.”

Portrait of Vladimir Lenin by Pavel Semyonovich Zhukov

Vladimir Lenin in 1920 Source: Wikimedia Commons

Following his death on January 21, 1924, there were no initial long-term plans to preserve Lenin’s remains, and he was embalmed so as to temporarily lie in state in Moscow prior to burial. These intentions are actually reflected in his body, as pathologist Alexei Ivanovich Abrikosov severed many of Lenin’s blood vessels and arteries after conducting his autopsy (embalming would be easier were the circulatory system intact).

Flocks of mourners gathered at Red Square in Moscow to send off the Bolshevik leader; the throngs combined with a characteristically cold Russian winter led officials to keep Lenin’s remains on display for two months. When a thaw risked accelerating Lenin’s decay, a commission of scientists gathered in March 1924 to discuss the ultimate fate of the deceased premier. They weighed the scientific and ideological pros and cons of keeping Lenin on display and solutions ranged from immersing Lenin in a vat of embalming chemicals, to storing him in a refrigerated coffin, to simply burying him. Ultimately Vladimir Vorobiev, professor of anatomy at Kharkov University, and Boris Zbarsky devised a method of preserving Lenin through periodic embalming and preservative treatments, a process that could theoretically allow him to be preserved indefinitely.

Image of Lenin's preserved remains

Image Source: sid (via Flickr Commons); Reproduced under CC BY-NC-DD 2.0, no alterations to original.

During the initial procedure, the pair removed Lenin’s organs and immersed his body in a vat of special chemicals. As an aside, they removed and preserved his brain, eventually allowing a German scientist named Oskar Vogt to examine it in order to understand the source of his genius (an act quite similar to what befell Albert Einstein, whose brain is on display at the Mütter Museum). After the initial preservation, this process is repeated roughly every eighteen months, during which time the body is removed from its mausoleum, bathed in chemicals, purged of embalming fluid, and re-embalmed. Typically, embalming fluid is introduced through the body via the circulatory system; however, since much of Lenin’s was severed during his autopsy, scientists administer the preservatives through a series of localized injections. Most surprising (to this author), Lenin’s joints are left articulated, making his body easy to pose or useful in the unlikely event of him rising from the grave to crush capitalism.

However, despite their best efforts, the process is not a perfect system and over the last ninety-three years even this method has not completely arrested decomposition. Not long after Vorobiev and Zbarsky first performed the procedure, Lenin’s eyelashes disintegrated and had to be replaced. In 1945, Lenin’s team of conservators discovered to their horror that a section of skin from Lenin’s foot detached from the body and was never seen again. As his body shifts and changes, parts of him have to be occasionally reformed or replaced to maintain its original shape. One person involved with the process has described Lenin’s corpse as a “living sculpture,” a blending of human tissue and artificial parts designed to resemble Lenin as he looked in life, a grim tribute to the fallen communist leader made out of his own remains. While his presence in Moscow has been a subject of debate in the decades following the fall of communism, Lenin (pardon the bad pun) remains on public display in his mausoleum in Red Square to this day.

Lenin's Mausoleum in Red Square

Lenin’s Mausoleum in Red Square; Image Source: American_Rugbier (via Flickr Commons) Reproduced under CC BY-SA 2.0

While Lenin is perhaps the most famous example of a preserved head of state on permanent display, he is far from the only one. Other preserved world leaders include Vietnamese leader Ho Chi Minh, Chinese ruler Mao Zedong, and North Korean dictators Kim Il Song and Kim Jong Il. Initial reports following the death of Venezuelan president Hugo Chavez in 2013 suggested his preserved remains would be displayed in a glass case at the Revolution Museum; however, these plans were scrapped soon after his funeral as his body became too decomposed.

If you are looking for more stories on the handling (and in some cases, mishandling) of human remains, be sure to check out our articles on whether Joseph Hyrtl had Mozart’s skull among his collection, the case of a body made to impersonate a Persian princess, and the story of John Scott Harrison, a man who was the son and father of Presidents who also had his remains stolen by body snatchers.

Until next time, catch you on the strange side!

CEPI Curiosities: “It is a Bad Looking Tenant” – Grover Cleveland’s Secret Tumor

CEPI Curiosities: Tales from Medical History's Strange Side

Greetings, once again, fellow historico-medico aficionados, and welcome to another installment of CEPI Curiosities, our monthly journey into the realm of the medically unusual.

Observant regular readers will notice this publication appears on the twentieth of every month. It just so happens that February 20th is Presidents Day, our yearly celebration of America’s highest elected office; in honor of the day, it seems fitting that we do another issue on Presidential medical history. We’ve done more than a few of those here, from whether Zachary Taylor was murdered by arsenic poisoning, to the questionable mental state of Presidential candidate William Jennings Bryan, to whether a long inaugural address or the White House itself killed William Henry Harrison. Perhaps a more timely topic than I had initially planned, this issue examines the clandestine efforts of a select group to seek out and remove a dangerous foreign invader with very close connections to the President of the United States himself! Of course I’m talking about President Grover Cleveland’s tumor and the secret surgeries to remove it (what did you think I was talking about?).

Portrait of Grover Cleveland, 22nd and 24th President of the United States

Grover Cleveland; Image Credit: NARA

Grover Cleveland is another one of those Presidents who to modern audiences falls in that historical void between more famous Presidents such as Abraham Lincoln and Theodore Roosevelt. Born in New York in 1837, he served as Mayor of Buffalo and Governor of New York and was elected President in 1884 and again in 1892, making him technically the 22nd and 24th US Presidents. Cleveland holds the distinction of the only US President to serve two non-consecutive terms.

In June 1893, a few months into the start of his second term, Cleveland visited his personal dentist, Dr. Kasson C. Gibson, complaining of discomfort in his upper jaw. Dismayed by what he saw, Gibson arranged for Robert Maitland O’Reilly, the US Army’s attending surgeon and later US Surgeon General, to examine Cleveland’s mouth whereupon he discovered what he described as “an ulcerative surface nearly as large as a quarter, with cauliflower granulations, and crater edges with at least one sinus extending to the bone, which is apparently roughened” on the roof of the President’s mouth (R.M. O’Reilly to Joseph Bryant, June 19, 1893, William Williams Keen’s Material Related to the Operation of President Cleveland, 1893, 1915-1918, MSS2/0076-07, box 1, folder 1, Historical Medical Library of the College of Physicians of Philadelphia). In other words: Grover Cleveland had a tumor growing in his upper jaw. Understandably concerned, the President consulted with his personal physician, a doctor by the name of Joseph Decatur Bryant. When asked whether Cleveland should have the tumor removed, Bryant frankly replied, “It is a bad looking tenant. Were it in my mouth I would have it removed at once” (Joseph D. Bryant to Col. Daniel Lamont, May 9, William Williams Keen’s Material Related to the Operation of President Cleveland, 1893, 1915-1918, MSS2/0076-07, box 1, folder 4). A small collection of doctors along with Daniel Lamont, Cleveland’s Secretary of War, arranged to evict the President’s “bad looking tenant.”

However, secrecy was to be maintained at all costs. The American economy was in a tumultuous state in 1893. Speculation, especially over railroads, had been responsible for a series of severe recessions dating back to the infamous Panic of 1873. The 1870s and 1880s were characterized by high unemployment, inflation, and labor unrest. Another economic meltdown plunged the country back into recession in early 1893 (again brought upon part by railroad speculation), known now as the Panic of 1893. A year later, Cleveland himself would send federal troops to Chicago to put down a strike involving Pullman railroad workers. Cleveland feared news of his ill health would place greater strain on an already strained economy. As a result, he was emphatic that his tumor remain a secret.

A portrait of College of Physicians Fellow William Williams Keen

William W. Keen; Image Credit: NIH

Lamont, Bryant, and O’Reilly organized with a small group of medically-minded confederates to arrange for Cleveland to have his surgery on the Oneida, a yacht owned by a friend of the President named E.C. Benedict. Among the doctors involved was William Williams Keen. Keen was an extremely accomplished surgeon and a Fellow of the College of the Physicians of Philadelphia. Born in Philadelphia in 1837, Keen studied at Jefferson Medical College, served as an Army surgeon during the Civil War, and penned a paper with Silas Weir Mitchell (also a Fellow) on the treatment of gunshot wounds. After the war he became a pioneer in the study of brain surgery and was reportedly the first American to successfully remove a brain tumor. Along with Bryant, O’Reilly, and Keen, E.G. Janeway, John F. Erdmann, and Fred Hasbrook rounded out the rest of the team charged with removing President Cleveland’s tumor.

On June 30, 1893, Cleveland arrived in Jersey City, NJ, and from there boarded the Oneida where the surgical team awaited him. Bryant successfully removed the tumor, along with five teeth and part of his jaw, the following day. The President was by all accounts in good spirits given the situation, and he remained on the Oneida until July 5, when he returned to Gray Gables, his Cape Cod estate. By all outward appearances, he had just returned from a long Fourth of July vacation. When a second tumor was discovered several days later, Cleveland returned to the Oneida on July 17th to have the second growth removed.

Discretion was to be maintained at all times. Bryant removed the tumor using specialized tools that would allow him to remove it through Cleveland’s mouth. Rumors hold this was because he didn’t want to lose his trademark mustache, but it is just as likely Cleveland wanted there to be no physical evidence of his procedure. Gibson designed a hard rubber prosthetic to replace the excised section of Cleveland’s jaw, allowing the President to speak unimpeded. He also cast a mold of his jaw, followed by a second one several years later to monitor’s Cleveland’s healing progress. As for Keen, Bryant wrote to him on July 6, praising his efforts and re-affirming the need for confidentiality.

A July 6, 1893, letter from James D. Bryant to William W. Keen praising him for his work in Grover Cleveland's surgery and asking for his discretion

J.D. Bryant to W.W. Keen, July 6, 1893; used by the kind permission of the College of Physicians of Philadelphia, photograph by Kevin D. Impellizeri, Copyright 2017, The College of Physicians of Philadelphia

However, even the best-kept secrets, especially when they involve the Commander in Chief, can be found out. On August 29, 1893, Elisha Jay Edwards of the Philadelphia Press broke the story in an article bearing the provocative title “The President is a Very Sick Man” (journalist Matthew Algeo later used this as the title for his 2011 book covering Cleveland’s secret surgery). White House officials flatly denied the affair until September 22, 1917, when Keen published an article explaining the whole affair followed by a book later that year.

A jar containing parts of a tumor removed from US President Grover Cleveland

Today you can view both Cleveland’s tumor as well as a “cheek retractor,” one of the tools used in the procedure, at the Mütter Museum (Keen and Gibson donated the tumor to the College of Physicians of Philadelphia on October 5, 1917). The jar containing the Presidential mass offers a fitting reminder of the secretive circumstances that led it its removal. The jar’s label bears the warning, “Not to be photographed for newspaper or other similar public use.”

Until next time, catch you on the strange side!

CEPI Curiosities: What Killed William Henry Harrison?

CEPI Curiosities: Tales from Medical History's Strange Side

Hello, fellow historio-medico aficionados, and welcome again to another installment of CEPI Curiosities, a monthly foray into the interesting and unusual of medical history. This time around, we are celebrating two milestones. For one thing, it is the first CEPI Curiosities of 2017. It also happens to be the one-year anniversary of this now staple of the CEPI Blog. Over the course of twelve months, it has been my pleasure to let you in on the inside stories of such topics as measuring faces for moral character, electrocuting faces for scientific research, stealing bodies for research, manufacturing bodies for profit, reanimating the dead using root vegetables, and the whereabouts of the skull of one of history’s greatest musicians. This is to say nothing of guest articles from our Karabots Junior Fellows on the difference between venom and poison, the unfortunate life of Harry Eastlack, Chevalier Jackson’s swallowed objects, and the exploits of Chang and Eng Bunker.

For our one-year anniversary, I felt it necessary and proper to go back to our roots: Presidential weirdness. If you recall our first episode, we covered the controversy surrounding the death of Zachary Taylor, which led to his body being exhumed in 1991 and tested for arsenic poisoning. Since today is inauguration day, allow me to shed light on what has to be one of the most unusual inauguration stories: the death of William Henry Harrison.

James Reid Lambdin's Presidential portrait of William Henry Harrison

Harrison is mostly known as a historical footnote these days, known primarily for holding the shortest tenure as president (32 days). Born on February 9, 1773, to a wealthy Virginia family, he went on to serve for twelve years as Governor of Indiana Territory where he gained popular distinction with an armed clash with Native American confederations at the Battle of Tippecanoe (November 7, 1811). He went on to serve in the US House of Representatives and the US Senate and earned the 1836 Whig nomination for president, losing to Democrat Martin Van Buren (electoral count 170-73).

He faced Van Buren again in a Presidential rematch four years later, this time defeating the incumbent (electoral college count 234-60) thanks in no small part to the Whig’s campaign strategies. Advocates for Harrison painted him as a war hero under the catchy slogan of “Tippecanoe and Tyler, Too.” Democrats criticized Harrison’s advanced age (67) and argued he should be put to pasture, not given America’s highest office; Democratic writer John de Ziska commented about Harrison, “Give him a barrel of hard cider, and settle a pension on him…he will sit the remainder of his days in his log cabin by the side of the fire and study moral philosophy!” The Whigs, in a move that should be familiar to modern audiences, spun the attack into a focal point of their campaign, casting Harrison, despite his aristocratic background, as a common salt-of-the-earth man who could connect to lower class and rural white voters (the campaign came to be known as the “Log Cabin Campaign”).

Harrison was sworn in as America’s ninth President on March 4, 1841 (US Presidents originally received the oath of office on March 4, until the passage of the Twentieth Amendment in 1933, which moved it to the current day of January 20). He proceeded to deliver a verbose, rambling, two-hour (8445 word) inaugural address, a speech that remains to this day as the longest inaugural address in Presidential history. Despite it being a cold, rainy day in March, Harrison refused to dress for the weather, foregoing hat, coat, and gloves, as he dispensed long paragraph after paragraph on the historic evolution of representative democracy and the basic duties of the government.

Lithograph depicting the inuaguration of William Henry Harrison

Source: Library of Congress

Roughly three weeks after his inauguration, Harrison began to feel unwell. On March 26, he called upon Dr. Thomas Miller, his personal physician, complaining of fatigue and dyspepsia. Initially, Miller prescribed rest; however, Harrison’s symptoms persisted and he began to experience chills, constipation, and severe pain followed by a heavy cough. Miller prescribed numerous remedies, including laxatives, enemas, and applications of mustard plaster to his stomach (a common 19th century treatment for numerous ailments, including pneumonia); he later blistered the President’s skin (to balance out his humours) and gave Harrison laudanum to relieve pain (a brief report of Miller’s treatment can be read here). Despite initial signs of improvement, his conditioned worsened over the course of the week; on April 3, 1841, at 8:45 PM, President Harrison succumbed to his illness, dying a mere thirty-two days after taking the oath of office. His death gave him the dubious distinction as the first US President to die in office (his death triggered a Constitutional crisis over how succession would work in the event of a President’s death, but that’s for another article).

Most historical accounts cite pneumonia as Harrison’s cause of death, laying the blame on Harrison’s advanced age and long inaugural speech in the cold without proper winter wear as the instruments of his demise.

However, recent scholarship has placed the pneumonia diagnosis into question. To understand why, you need to briefly understand how pneumonia affects the body. According to the American Lung Association, pneumonia is a respiratory disease caused by numerous factors (viruses, bacteria, fungal infection, complications from another respiratory illness such as influenza); whatever variety of the disease, when it infects the lungs, pneumonia causes air sacks called alveoli to fill up with fluid. This fluid buildup can restrict the amount of oxygen the lungs take in when a person breathes; that lack of oxygen can cause cell damage that can eventually be fatal. People of any age can contract pneumonia but it is especially serious when the patient is very young or very old. Symptoms include a heavy cough, fatigue, fever, chills, and difficulty breathing.

Some of Harrison’s symptoms, namely the chills, pain, and heavy cough may point to pneumonia. His advanced age would have made him more susceptible to infection and complications. Pneumonia’s incubation period (the period between infection and when symptoms begin to manifest) is between 1-4 weeks depending on the strain, so it is plausible he could have contracted it during his speech; remember, he reported symptoms to Dr. Miller on March 26 and it isn’t clear how long he was ill before that. However, pneumonia is a respiratory illness (affecting only the lungs) and would not adequately explain his gastrointestinal distress. Recent scientific studies have suggested cold weather may help contribute to illness; however, a person ultimately catches pneumonia from exposure to an infected person, and Harrison’s choice to forego gloves and coat might make him more susceptible to hypothermia (depending on how cold it actually was, and there is some debate over the actual weather conditions in DC on March 4, 1841) rather than pneumonia. Even Dr. Miller himself was reticent to conclude that pneumonia was ultimately what did in President Harrison. In a report in the 1841 edition of Medical Examiner, Miller expressed his doubts with his own diagnosis:

“The disease was not viewed as a case of pure pneumonia; but as this was the most palpable affection, the term pneumonia afforded a succinct and intelligible answer to the innumerable questions as to the nature of the attack.” (Thomas Miller, The Case of the Late William Henry Harrison, President of the United States, Medical Examiner, Vol. 4 (1841), pp 309-12.)

So if it wasn’t pneumonia, what killed William Henry Harrison? A pair of recent scholars have offered an alternative cause of death. Jane McHugh and Philip A. Mackowiak examined Miller’s report and conducted a differential diagnosis based on Harrison’s reported symptoms. In their 2014 report published in Clinical Infectious Diseases, they concluded Harrison’s constipation and abdominal pain pointed toward “enteric fever,” a gastrointestinal illness caused by either salmonella typhi  or salmonella paratyphi, better known as typhoid fever and paratyphoid fever, respectively. Both are spread through contact with contaminated food or water and cause high fever, cough, malaise, rash, and diarrhea or constipation.

Possible presidential assassin? Image Credit: Sanofi Pasteur, Used under CC BY-NC-ND 2.0

Possible presidential assassin? Image Credit: Sanofi Pasteur, Used under CC BY-NC-ND 2.0

As to where he contracted it, while Harrison’s speech may not have killed him, his living in the White House very well may have. McHugh and Mackowiak pointed to Washington DC’s lack of an adequate sewer system and the White House’s proximity to a marsh where much of the Nation’s Capital’s human waste accumulated. These conditions combined with general poor sanitation and cleanliness practices in the 1840s created breeding grounds for such diseases as cholera, dysentery, and enteric fever. They further offered these conditions as an explanation for two other Presidential deaths within ten years of Harrison: James K. Polk (cholera, 1849) and our friend Zachary Taylor (cholera morbis, 1850). According to their report:

There is ample reason to conclude that Harrison’s move into the White House placed him at particular risk of contracting enteric fever. In 1841, the nation’s capital had no sewer system (nor, for that matter, did any other American city). Until 1850 sewage from nearby buildings simply flowed into public grounds at a short distance from the White House, where it stagnated and formed a marsh. The White House water supply, which came from springs in the square bounded by 13th, 14th, I, and K streets NW [now known as Franklin Square], was situated below a depository for night soil that was hauled there each day from the city at government expense. This might explain why 3 antebellum US presidents, Harrison, James Polk, and Zachary Taylor, each developed severe gastroenteritis while residing at the White House. (Jane McHugh and Philip A. Mackowiak, “Death in the White House: President William Henry Harrison’s Atypical Pneumonia,” Clinical Infectious Diseases, Vol. 59 (October 1, 2014), 993-994.)

Following Harrison’s death, Vice President John Tyler ascended to the Presidency, where he was nearly killed in a cannon explosion in 1844. As we’ve already covered, Harrison’s son–John Scott Harrison–was stolen by resurrectionists and sold to an Ohio medical college after his death.

Until next time, catch you on the strange side!

CEPI Curiosities: Duchenne’s Smiles

CEPI Curiosities: Tales from Medical History's Strange Side

Greetings and salutations, medico-historico enthusiasts and welcome to the latest installment of CEPI Curiosities, our regular look back at the thought-provoking and downright strange from the history of medicine. Past forays into the medically weird have included 1990s anti-drug PSAs, the famous Siamese Twins (Chang and Eng Bunker), and a physician who collected thousands of swallowed objects.

This month’s iteration is a continuation of our look from last month at physiognomy, the pseudoscience of divining evidence of one’s character by examining the physical dimensions of their face. As I enumerated upon last month, physiognomy, as with phrenology, was next to impossible to measure scientifically and, again as with phrenology, gradually fell out of favor. This time around we are going to take the science of faces from a different direction and examine some interesting, dare I say shocking, facial research. Today, it is my pleasure to introduce you to renowned faceologist (well, technically, French neurologist) Guillaume-Benjamin-Amand Duchenne de Boulogne.

Duchenne was a pioneer in neurology. He was one of the first in his field to use electricity to study muscular anatomy, also known as myology, and was an early adopter of photography, using the new medium to record his experiments. Among his contributions to the field was his extensive research on the myology of the face, which he first published in his 1862 treatise The Mechanism of Human Facial Expression (TMHFE). One of the legacies of his research is a genuine smile (one where the sides of the mouth curl upward, the cheeks raise, and the eyes form crow’s feet) is known today as a Duchenne smile. A contemporary of the physiognomy movement, Duchenne was politely dismissive of Lavater’s conclusions, in part calling out the Swiss theologian for his silence on facial movement to say nothing of his lack of scientific credentials, writing:

Lavater devoted himself to the study of facial expression at rest, of physiognomy as such. His research was concerned with the difference between the combinations of contours and lines, the profiles and silhouettes that make up the static face. He certainly would not have neglected as much as he did of the study of facial expression in movement, which should serve as the basis for the examination of the physiognomy at rest, had he been either an anatomist or a physiologist or a doctor or even a naturalist. Duchenne The Mechanism of Human Facial Expression 4.

Rather than study the face to measure the temperament of the human soul, Duchenne focused on mapping the functions of human facial muscles to determine what specific muscles a person used to convey different expressions. This is where the mention of Duchenne’s dual interest in electricity and photography become important, because Duchenne drew his conclusions by shocking patients’ faces with electricity and photographing the results. Even Duchenne himself was aware his methodology might come as…er…shocking to his contemporaries, musing in the early pages of TMHFE: “No one thought that the study of myology could benefit from gross experiments by a physician who provoked convulsions on the faces of his tortured subjects using electrical currents” (Duchenne 10).

Between 1852 and 1856, Duchenne conducted his experiments on a series of live human subjects, including a young man, a nine-year-old girl, and an elderly woman. However, he performed the bulk of his tests on an elderly man with localized facial paralysis that left him with an inability to feel pain. Duchenne described him as an ideal candidate for this sort of experiment because “I could stimulate his individual muscles with as much precision, and accuracy as if I were working with a still irritable [responsive to stimuli] cadaver” (43). He had each subject convey a facial expression displaying one of several emotions, which he listed as attention, reflection, aggression, pain, joy, kindness, scorn, lasciviousness, sadness, crying, sniveling, surprise, and astonishment. Duchenne then recreated the expressions by subjecting parts of the patients’ faces to localized electric shocks. In both cases he photographed their visages, publishing 73 photographic plates in TMHFE.

What I find especially interesting about Duchenne’s work, aside from the whole zapping people’s faces part, is his photographs provide a contrast to what one typically expects from historic photography. Long exposure times and the novelty and highly specialized nature of photographic technology led many 19th century portraits to take on a serious, or downright somber, tone. The Civil War photography of Mathew Brady offers an example of the gravity of 19th century portraits and provides the glimpse most modern observers think about when they think of the 1800s.

1864 Portrait of Abraham Lincoln by Matthew Brady; Source: National Archives and Records Administration

1864 Portrait of Abraham Lincoln by Matthew Brady; Source: National Archives and Records Administration

By contrast, in Duchenne’s imagery, we see people in various stages of joy, fright, sarcasm, and downright silliness; something people tend to associate with more modern images.

To bring Duchenne into the present day, his work recently gained some popular attention during the 2016 US Presidential Election.  Richard E. Cytowic, a professor of neurology at George Washington University, observed during the Republican primaries that Texas Senator and Presidential hopeful Ted Cruz stood at a disadvantage among voters because he lacked a Duchenne smile.

Now, while physiognomy has been disproven, there is a natural response to attempt to ascertain a person’s character by looking at them. It is a practice frequently seen in visual-based fiction, such as movies, comic books, and cartoons, where facial characteristics are used as a visual shorthand for viewers (think about the last TV show or film you watched; were you able to tell who were the “good guys” and “bad guys” by simply looking at them). The same, in this particular case, goes for politics.

And that wraps up our look at physiognomy and the science of faces. Until next time, catch you on the strange side!

CEPI Curiosities: Physiognomy

CEPI Curiosities: Tales from Medical History's Strange Side

Greetings and salutations once again to all you enthusiasts of the medically weird. This is Kevin, back for another installment of CEPI Curiosities, our monthly journey down the rabbit hole of medical curiosities. Past installments have examined such varied topics as anti-drug cartoon specials, the differences between venom and poison, medical experiments on inmates, and health-related video games.

Regular readers will perhaps recall from my article way back in March on the stealing of Shakespeare’s and Mozart’s skulls that I briefly touched upon phrenology, the since-discredited practice of measuring character based on the shape and contours of the skull. If you recall, the impetus behind anatomist Joseph Hyrtl’s famous skull collection (located at the Mütter Museum for your perusal) was to disprove phrenology. However, phrenology was not the only attempt by scientists of the time to find a direct correlation between personality and physical appearance. Allow me to introduce you to physiognomy.

Where phrenology examines the entire skull, physiognomy is the act of using the physical characteristics of the face as a measure of personal character. Conceptually, the practice dates back to ancient Greece, and one of the oldest mentions of it comes from the Physiognomonica, a text attributed to Aristotle although his authorship of the treatise has been highly disputed. Aristotle or not, the author argued in favor of a direct quantifiable connection between the body and the soul. According to the author:

MENTAL character is not independent of and unaffected by bodily processes, but is conditioned by the state of the body; and contrariwise the body is sympathetically influenced by affections of the soul.

While the concept is an old one, the height of its popularity came in the late 18th and early 19th century (roughly around the same time of phrenology’s popularity). This time around the most influential name in the practice was a Swiss theologian by the name of Johann Kaspar Lavater (1741-1801). His signature work on the subject was Physiognomische Fragmente zur Beförderung der Menschenkenntnis und Menschenliebe, a sprawling, four-volume tome published between 1775 and 1778. An English translation with the less word-intensive title Essays in Physiognomy appeared in the 1790s and went through multiple editions through the 19th century.

Image of Johann Kasper Lavater, 17th century advocate of physiognomy

Source: Wikimedia Commons

As with its skull-fixated, pseudoscientific cousin, observations related to physiognomy originated by examining animals. Advocates of physiognomy believed each species held certain innate qualities (the lion as noble, the fox as crafty, the sloth as lazy, etc.) and that these qualities manifested themselves in some facial characteristic. The goal of the human physiognomist (that is the physiognomist examining humans, not a physiognomist who was also a human, although they would be that as well) was to look for manifestations of those physical traits in their human subjects. Lavater’s analyses were exhaustive, complete with images of various faces and the characteristics they represented. My favorite of which, from a condensed version of his work from 1832 titled The Pocket Lavateris recreated below:

An image of a face depicted in the physiognomy book titled The Pocket Lavater. The face was to represent cruelty and deception.

Watch out for this fellow!

So what to look for in a person, aside from the nefarious scoundrel above? First and foremost, Lavater argued there was a direct correlation between a person’s physical attractiveness and their moral character. In other words, the better one looked on the outside, the better they were on the inside. As Lavater explains, “It being granted that man is the work of supreme wisdom, is it not infinitely more conformable to wisdom that a harmony between physical and moral beauty rather should than should not exist; and that the Author of all moral perfection should testify his high good pleasure by the conformity between the mental and bodily faculties?” (Essays on Physiognomy 95). He goes on to add, “The beauty and deformity of the countenance is in a just and determinate proportion to the moral beauty and deformity of the man. The morally best, the most beautiful. The morally worst, the most deformed” (99). Furthermore, Lavater argued that a person’s moral character in life also left visual cues on the visage, as in the case of the miserly fellow below:

Caricature of a miserly man, from Johann Kasper Lavater's Essays in Physiognomy

Nature forms no such countenance; at least, no such mouth. Vice can only thus disfigure. Rooted unbounded avarice. Thus does brutal insensibility deform God’s own image. Enormous depravity has destroyed all the beauty, all the resemblance. Can any benevolent, wise, or virtuous man, look or walk, thus? Where is the man, however unobservant, daring enough to maintain the affirmative? (Lavater 110)

This aspect of physiogonomy made its way into mainstream popular culture through English author and playwright Oscar Wilde’s classic 1890 novel The Picture of Dorian GrayA friend of Gray, a handsome, young socialite, paints him a portrait. As the years go on, Gray comes to realize the painting has begun to age instead of him. Moreover, he further learns that ill deeds, such as driving a spurned lover to suicide and Gray’s murder of the portrait’s painter, lead to physical distortions on the face in the painting.

Going back to our original question of what to look for in a person, here are some stray observations. Clean teeth indicated good character but “long teeth” meant cowardice. Conforming to the logic of comic book superheroes, courage was directly proportional to one’s chin size; however, a pointed chin was a sign of artistic creativity. A large head demonstrated low intelligence. Small nostrils meant one was timid. Earnest character could be measured based on how close a person’s eyebrows were to their eyes. Speaking of eyes, the old adage of the eyes serving as the windows to the soul took on literal meaning in the work of Lavater and his disciples: brown eyes indicated kindness and vivacity, while blue eyes meant weakness, and the rare person who had gray eyes was temperamental and prone to anger.

As with phrenology, physiognomy was both shaped by and helped to shape racial and cultural prejudices of their time. White Europeans in certain regions were assumed a priori to be inherently superior than other races (for Lavater, ancient Greeks of the era of Socrates possessed the ideal facial form), and advocates of racist ideology turned to phrenology and physiognomy as scientific justifications for racial prejudice. I should also add that Lavater’s observations only applied to men, as women’s role, according to Lavater, was solely as complimentary and subservient to men (among his observations of women: “A woman with a beard is not so disgusting as a woman who acts the free thinker”).

Keen observers can see many of the same flaws between physiognomy and phrenology. They are both beliefs that based a great deal on assumptions are are difficult, if not impossible, to prove scientifically (how do you quantitatively measure a person’s honesty by measuring, say, the length of the bridge of their nose; how do you measure for courage in lions). It was a conclusion reached by anatomist Joseph Hyrtl who found no evidence of any common characteristics of criminality when he examined the skulls of dozens of European criminals.

Image of the Hyrtl Skull Collection at the Mütter Museum

Speaking of scientific challenges to physiognomy, in our next issue we will look at one influential scientist who studied the human face…by rigging electrodes to people’s faces to see what happened.

Until next time, catch you on the strange side!

CEPI Curiosities: Cartoon All Stars to the Rescue

CEPI Curiosities: Tales from Medical History's Strange Side

Hello, fellow historico-medico aficionados, this is Kevin for another installment of CEPI Curiosities, our monthly look back at the interesting and unusual from the annals of medical history. Today I am in the unenviable position of having to follow up our series of guest writers: students from the Karabots Junior Fellows Program who put together pieces examining the differences between venom and poison, the story of Chang and Eng Bunker, Harry Eastlack’s battle with FOP (fibrodysplasia ossificans progressiva), and Chevalier Jackson and his eclectic collection of swallowed objects. At the very least, I will do my absolute best to maintain the high standards they set.

Recently, the College of Physicians of Philadelphia’s Section on Public Health and Preventive Medicine has focused on smoking as a significant public health issue for 2016. On September 26, the College held a discussion by Alan Blum, MD, who addressed what he viewed as anti-tobacco activists’ failures to counter tobacco use. Yesterday the College hosted a Public Health Grand Rounds event on the role of tobacco retailers and advertisers and how their methods undermine smokers’ attempts to quit. Just last week, Philadelphia Mayor Jim Kenney announced plans to crack down on retailers’ exposure of tobacco products to children. In the spirit of these discussions, this edition of CEPI Curiosities is going to address a related campaign–drug addiction–and a highly publicized but very unusual attempt to warn kids about the effects of drugs. Allow me introduce you–or if you’re a child of the eighties/nineties like myself, reintroduce you–to Cartoon All Stars to the Rescue.

Allow me contextualize what you have just watched (or, again for my contemporaries, what you have possibly been repressing in the deepest recesses of your mind for the better part of a quarter century). During the 1980s, there began an active media campaign to warn American children about the dangers of drugs as part of the larger “War on Drugs,” a national campaign to combat the proliferation of drugs. These attempts took on a variety of forms. One of the the most famous spokespersons of this movement was First Lady Nancy Reagan with her “Just Say No” campaign, but there were numerous others. In the early 1980s, Los Angeles Police Department Chief Daryl Gates helped establish the Drug Abuse Resistance Education (D.A.R.E.) Program, wherein police officers visited schools to teach lessons about drugs and how to resist peer pressure. D.A.R.E. eventually expanded to schools nationwide. Beginning in 1989, arcade enthusiasts discovered coin-operated video games bore a title card from William S. Sessions, then head of the Federal Bureau of Investigation, informing players “Winners Don’t Use Drugs.” Television shows devoted “very special episodes” to the issue of drugs; one of the more famous (or infamous depending on your point of view) was the November 3, 1990, Saved by the Bell episode “Jessie’s Song,” in which the character Jessie Spanno grapples with an addiction to caffeine pills (the show followed with another anti-drug episode a year later with the November 30, 1991, anti-marijuana PSA “No Hope with Dope“). PSAs addressed the effects of drugs including the now-iconic “This is Your Brain on Drugs” and Paul Reubens’ (TV’s Pee-wee Herman of Pee-wee’s Playhouse and several films) segment on crack cocaine.

Image of the FBI logo with the caption "Winners Don't Use Drugs" below; this appeared on arcade video games from 1989 to 2000

A variation of this image appeared on arcade games from 1989 to 2000.

However, nothing out of the anti-drug youth media campaign was quite as epic in scale as Cartoon All Stars to the Rescue. When it first aired on April 21, 1990, the half-hour special was a television event; it ran simultaneously on all four major television networks–ABC, NBC, CBS, and FOX–as well as on several cable channels. The show was a veritable “Who’s Who” of popular Saturday morning cartoon characters, including Michelangelo from the Teenage Mutant Ninja Turtles, Alvin and the Chipmunks, Winnie the Pooh, Garfield, the ghost Slimer from Slimer and the Real Ghostbusters, the animated version of ALF (yes, ALF had his own animated series because pretty much every licensed property got one in the 80s and early 90s), the Muppet Babies, and the Loony Tunes. The special opened with a message from then-President George H.W. Bush and First Lady Barbara Bush informing youngsters of the hazards of narcotics before segueing into the feature presentation: a morality play about the effects of drugs.

VHS cover for "Cartoon All Stars to the Rescue" Source: IMDB

VHS cover for “Cartoon All Stars to the Rescue” Source: IMDB

The story follows Michael, a teenager who is addicted to marijuana who even resorts to raiding his little sister’s piggy bank to fuel his habit. Along the way, he also falls into a rough crowd who attempt to pressure him into harder drugs such as crack cocaine. His addiction prompts characters in several toys and posters in his sister’s room to come to life to halt his behavior. What follows is effectively a thirty-minute “tough love” intervention wherein the various characters show him the effects of drugs on his brain (via a psychedelic roller coaster ride with the baby versions of Kermit the Frog and Miss Piggy) and his drug-addled future as effectively a desiccated, sunken-eyed husk. In between these segments characters take turns expressing the sentiment of anti-drug slogans at the time (“There’s nothing cool about a fool on drugs,” Kermit intones; “Why don’t you just say no,” Huey from Ducktales offers). All the while “Mr. Smoke,” a aptly-named sentient smoke cloud voiced by none other than George C. Scott, attempts to keep him on his current drug-induced path. Eventually Michael comes around and swears off drugs, and Mr. Smoke is defeated by being cast out a window. The characters’ task completed, they return to the various licensed products from whence they came.

Michael and "Mr. Smoke" from Cartoon All Stars to the Rescue, Image Source: Tumblr

Michael and “Mr. Smoke” from Cartoon All Stars to the Rescue, Image Source: Tumblr

Many of these anti-drug attempts of the time, Cartoon All-Stars to the Rescue included, were equal parts well-intentioned and ineffectual. Despite once having a presence in nearly 75% of America’s schools, there is little evidence to suggest the D.A.R.E. Program had any effect on children’s choice to abstain from drugs (in fact some have argued it had the opposite effect). There’s no data to suggest any correlation between a person’s drug use (or lack thereof) and exposure to Former FBI Director William Sessions’ slogan on arcade games. Moreover, Cartoon All-Stars and other anti-drug messages’ viewpoint of drug addiction as a personal failing (“Users are losers and losers are users” went one McGruff the Crime Dog PSA; another declared “No one says, ‘I want to be a junkie when I grow up‘”) has given way to the view of drug addiction as a disease, with the addict as a victim in need of sympathy and care. The message of marijuana as a “gateway drug” has also been largely disproven by scientists. In the light of current approaches to drug treatment, many of the methods employed by the Cartoon All-Stars seem antiquated at best and potentially harmful at worst.

In fact, critics have accused the campaign of having an effect worse than what it attempted to prevent. The greater War on Drugs, of which these elements were a part, led to increased criminal penalties for drug-related offenses which led to a significant increase in the American prison population; the crackdown on drugs disproportionately affected minority groups.

Until next time, catch you on the strange side!