Docent Discussions: What Does Grover Cleveland’s Tumor Have to Do with Genital Warts?

Welcome, Mütter fans and medical history enthusiasts, to the latest issue of Docent Discussions, The Center for Education’s ongoing series that offers you an inside perspective on the Mütter Museum as told by our dedicated team of museum docents.

Last time, Lindsay Freed opened our series with a look at Chevalier Jackson, a Fellow of the College of Physicians of Philadelphia who collected over 2,000 swallowed objects he extracted from patients. Today, we turn the reigns over to Joe Walsh. Joe first visited the Mütter Museum in 1975. He became a docent in 2013 following a 34-year career as an OB/GYN physician. When he isn’t giving tours at the Mütter Museum, he is applying his love of science, history, and education at the Franklin Institute and in a monthly hyper-local history column for the Friends of Matthias Baldwin Park

Take it away, Joe!

My goal on tours is to make connections between the items, rather than have a linear trip through disconnected items. The Worden Room, often considered the “side room” on the lower level contains several fascinating objects which have connections that may not be immediately obvious at first glance. This post discusses two fascinating objects: the oral tumor removed from President Grover Cleveland and a necklace made of genital warts.

Grover Cleveland’s Tumor and The Genital Wart Necklace

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

Wet specimen jar containing Grover Cleveland’s tumor.

President Grover Cleveland noticed a rough surface inside his mouth in 1893. His physicians felt the area was an oral cancer and needed an immediate operation. However, there were significant political considerations, as Cleveland was a supporter of the Gold Standard and wanted to repeal the Sherman Silver Purchase Act. His Vice President did not share those views, so Cleveland was reluctant to hand over power, even temporarily. The surgery was conducted in secret aboard the Oneida, a boat owned by his friend Commodore Elias Benedict. The tumor may be seen in a case in the center of the Worden Room.

A clear glass jar containing a set of genital warts connected together by string

Wet specimen jar containing a “necklace” of genital warts.

The necklace of genital warts was created not to be worn as jewelry but to allow easier study of the warts suspended in liquid in the storage jar from a string. The collection from an unknown donor is from the 19th Century. Treatment at the time included an injection with cocaine to provide pain relief followed by the application of “powerful caustics” such as nitric or chromic acid. Modern treatments involve numbing with local anesthetic and then removal via surgery, cryotreatment, or laser treatment.

What’s the Connection?

Cleveland’s verrucous carcinoma has a controversial association with human papillomavirus (HPV), but in the years since, many oral cancers have definitively become confirmed as associated with HPV. It has been known that HPV is associated with cervical cancer since 1982. Genital warts are caused by certain strains of HPV and are often the first external manifestation of the presence of the virus. HPV can be transmitted through sexual contact and can rarely lead to female and male genital cancers and anogenital cancers.

The HPV vaccine is the only vaccination that helps protect both men and women from many different types of cancer associated with exposure to strains of HPV. About 150 strains of HPV have been identified, but the vast majority of cancers are caused by 40 of those strains. The initial vaccine, Gardasil by Merck, was made available for girls between ages 9 and 26 in 2006. Gardasil covered four subtypes of the virus.

In 2011, the CDC recommended that boys also be vaccinated. In 2014, the latest vaccine, Gardasil 9, which covers 9 subtypes of HPV was approved. In 2018 the Gardasil-9 vaccine, the only one currently available, was recommended up to age 45, expanding the age group targeted for vaccination.

HPV-related cervical and vaginal cancers have decreased since the introduction of the vaccine, but rates for oro-pharyngeal and anal related cancers have increased.

Thanks, Joe, for your insights. If you want to hear more from our docents, check out Lindsay’s piece on Chevalier Jackson as well as an interview with several of our docents about their experiences during the COVID-19 pandemic. To learn more about Grover’s Cleveland’s secret surgery, check out our article on the subject.


“Genital Warts Necklace,” Memento Mütter, accessed July 2, 2020.

“Grover Cleveland – Secret Surgery,” University of Arizona Health Sciences Library, accessed July 2, 2020.

“The HPV Vaccine: Access and Use in the U.S.” KFF, accessed July 2, 2020.

CPP Curiosities: Henrietta Lacks, HeLa, and Medical Consent

Logo for CPP Curiosities

Hello, everyone, and welcome to our latest installment of CPP Curiosities. In the past we have focused on interesting, unusual, and thought-provoking topics from the history of medicine. 

The College of Physicians of Philadelphia denounce the racial injustices and systemic racism directed at people of color. We must strive to have a Philadelphia within which every person’s potential is recognized and encouraged to develop. Because of our unique position, we are morally obligated to speak about health and health care disparities as a cause, as well as a result, of inequality. As an institution so committed, we stand firmly with Black Lives Matter.

We must also acknowledge the role of medicine, as well as people affiliated with this organization, in perpetuating and advancing injustice. While medical advances theoretically benefit everyone, in numerous cases those advances came at the expense of communities of color. Medical science has also provided justification for bigotry, intolerance, and the exploitation of people of color. For example, a past article in this series examined the Holmesburg Prison Experiments, a series of dermatological experiments conducted on Philadelphia inmates by Albert Kligman, a Fellow of The College of Physicians of Philadelphia. We also examined College of Physicians Fellow William S. Forbes, who utilized African American remains stolen from a Black cemetery in Philadelphia as medical cadavers. Today, guest writer Amanda has chosen to highlight the contributions of Henrietta Lacks to the advancement of science, addressing the important ethical questions raised when scientists make those advancements without individuals’ knowledge or consent.   

Her name isn’t as familiar as many others throughout scientific history. She wasn’t a part of genetics or cancer biology textbooks until recently, but she has played an enormous role in the progress of cellular biology and scientific research in general. Her name is Henrietta Lacks, and her cells gave rise to the immortal cell line HeLa.

Henrietta Lacks was born August 1, 1920 in Roanoke, Virginia. She spent the first part of her life working her family’s tobacco fields and running around with her siblings and cousins. When she was twenty-one, she married her cousin David, or Day as he was known in the family. Soon after their marriage, Henrietta and Day moved to Baltimore in pursuit of better job opportunities.

Photograph of Henrietta Lacks

Image Source: © July 3, 2001 vol. 98 no. 14 7656-7658; National Academy of Sciences, U.S.A.

In 1950, just before she learned she was pregnant with her fifth child, Henrietta felt that something was off with her body. She felt something she described as a ‘knot’ in her womb before and during the pregnancy, and it did not go away as expected after she gave birth. She continued as normal for about four months until she found blood in her underwear. It wasn’t time for her period, so she was concerned. Henrietta went to her usual doctor who thought she might have contracted syphilis, but she tested negative. Her doctor suggested she see a physician at Johns Hopkins’ gynecology clinic, the only major hospital in the area that would admit Black patients. A Johns Hopkins gynecologist found a nickel-sized lump the color of ‘grape jelly’ on the mouth of her cervix. A biopsy revealed the lump was malignant, and she planned to have it treated at Hopkins. She didn’t tell her family, not wanting to worry anyone about something she would be able to deal with on her own.

At that time, radium was the standard treatment for invasive cervical cancer like Henrietta’s. During one treatment, the doctor in charge removed two tissue samples—one healthy and one cancerous—from her cervix. Neither the hospital nor the physicians told Henrietta they were doing this or asked for her permission. After one more radium treatment, Henrietta received weekly X-Ray treatments. The treatments appeared to be working and Henrietta returned to her normal life. However, in June 1950, Henrietta began experiencing abdominal pain and trouble urinating. During a trip to her doctor, her physician looked her over but could not find anything obviously wrong and sent her home. She returned to the hospital a couple of weeks later, again reporting pain. Again, doctors found nothing of concern and sent her home. Three days later, the pain had grown so intense that Henrietta could barely walk. She returned to Johns Hopkins again whereupon doctors found a large mass attached to her abdominal wall that had almost completely occluded her urethra. The cancer had spread throughout her body. Her doctors deemed her condition inoperable and sent her home to rest. She was later treated with increasing doses of radiation to help alleviate her pain but neither that nor morphine could help relieve it. In August 1951, Henrietta came back to Johns Hopkins, and this time she wanted to stay. By late September, the cancer was so widespread, and Henrietta was in so much pain that her doctors discontinued all treatments except pain management. Henrietta Lacks died on October 4, 1951.

Meanwhile, the cells doctors removed from Henrietta Lacks’ cervix continued to multiply and thrive. George Gey, the cellular biologist tasked with working with Henrietta’s cells, was extremely excited to discover that her cell line was immortal. This meant Henrietta’s cells were capable of dividing and surviving indefinitely if they were cultured in an appropriate environment. This made them an indispensable tool for cellular research. The cell line was named “HeLa” after the first two letters of her first and last name. The HeLa cell line quickly became highly sought after by researchers. It was used in countless research projects, including the Salk Polio vaccine, projects to illustrate that cancer was not communicable, and tests to examine the toxicity of certain substances on cells.

Image of HeLa cells

HeLa cell, immortal human epithelial cancer cell line, SEM. Credit: Anne Weston, Francis Crick Institute. Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Henrietta Lacks’ family did not learn about her immortal cells until the 1970s. In 1970, researchers learned that the HeLa cell line had contaminated several other cell lines. Researchers at Johns Hopkins reached out to Henrietta’s family, asking for blood samples to help them differentiate between the different contaminated cell lines. Her family was confused. This was the first that they had heard of her cells being saved and used for research. They didn’t have much of a science education so they didn’t understand what the scientists on the phone were telling them. Was Henrietta still alive? No one had asked them for permission to use her cells or explained to them how her cells would be used, and research involving her cells had gone on for twenty years without her family’s knowledge.

HeLa cancer cells

Human HeLa cancer cells, mitosis. Credit: Paul Andrews/Univ. Dundee. Attribution 4.0 International (CC BY 4.0)

Henrietta Lacks’ cells introduced the question of who “owns” cells or tissues once they’ve been removed from a patient’s body. Does the patient have any say in what is done with their tissue? In 1951, when physicians removed Henrietta’s cells, the law said that no patient consent was necessary and that cells no longer belonged to the patient after removal. In 1981, the federal government introduced “The Federal Policy for the Protection of Human Subjects,” also known as “The Common Rule.” According to the Common Rule, physicians must notify patients if any part of their case might be used in research and obtain their consent.

Henrietta’s family also thought they had a right to a portion of any money that might come from the use of her cells. Johns Hopkins reported that they had never made any money from her cell line. In fact, her cells had been sold to thousands of laboratories around the world by George Gey and his research department. Currently, her cells are still available for purchase with no restrictions, but the National Institutes of Health did reach an agreement with the Lacks family in relation to her genomic sequencing information in 2013. Now if a scientist wanted to access Henrietta’s gene sequence they would need to apply for access and be approved by a board on which two of her family members sit. It is a small victory for the Lacks family.

The case of Henrietta Lacks brings up a lot of important ethical questions. Yes, the HeLa cell line has gone on to play an enormous part in so many important scientific innovations. But is it right? Should we continue to benefit from the medical developments her cells brought about when her family is in an economic position to not be able to enjoy those same benefits? Henrietta and her family gave modern medicine a gift but what have they been given in return?


DeNeen l. Brown, “Can the ‘immortal cells’ of Henrietta Lacks sue for their own rights?” Washington Post, June 25, 2018.

Wynne Parry, “Controversial ‘HeLa’ cells use restricted under new plan,” LiveScience, August 7, 2013.

Rebecca Skloot, The Immortal Life Of Henrietta Lacks (New York: Crown Publishers, 2010).

Docent Discussions: Chevalier Jackson Collection of Swallowed Objects

Welcome, medical history enthusiasts, to the debut issue of a brand new series hosted by the Center for Education of The College of Physicians of Philadelphia. Docent Discussions is an ongoing series that gives you an inside perspective on the Mütter Museum as told by our dedicated team of museum docents.

Our first installment is hosted by Mütter docent Lindsay Freed.

Headshot of Mütter Museum Docent Lindsay Freed

Mütter Museum docent Lindsay Freed

What is your favorite exhibit in the Museum and why?

The Chevalier Jackson Collection of Swallowed Objects is definitely my favorite thing in the museum. I love it so much because it speaks volumes to the dedication that one physician embodied to his trade, to public health, to research, and to the improvement of protocols designed to save lives. The objects in the cases are fun, quirky, and astonishing, but they tell a much deeper story about Dr. Jackson’s life and his incredible work. He created the catalogue of objects in order to better his own and the field of otolaryngology’s understanding of what “foreign bodies” might look like, how they ended up in the throats and airways of children and adults, and how to most safely remove them. He was also clearly a deeply weird and deeply focused guy, which I relate to on a spiritual level. Chevalier Jackson’s work revolutionized the removal of foreign bodies, making the procedure safer, less surgically invasive, and much less likely to lead to infection, complications, or death. His various biographies, including The Life of Chevalier Jackson — An Autobiography tell all about him and his amazing contributions to medicine, and can be acquired on the internet.

Swallowed Objects from the Chevalier Jackson Collection, College of Physicians of Philadelphia

Swallowed Objects from the Chevalier Jackson Collection, College of Physicians of Philadelphia

Chevalier Jackson Collection

Dr. Jackson created a collection of objects retrieved from his patients.  Often, if the patient (or the child patient’s parents) could not afford to pay for the procedure, Dr. Jackson asked only to keep the retrieved item.  The Mutter Museum has 2374 items which were either inhaled or swallowed and then retrieved by Dr. Jackson during his nearly 75 years of practicing medicine.

Biographical Information:

Chevalier Jackson was born in 1863 and grew up on a farm in western Pennsylvania.  His first known retrieval from a tube was using an instrument he developed to retrieve a dropped drill bit from a well on the family farm.  This extraction led to a career in which he developed the endoscope, first used in 1890 to remove a ‘tooth-plate’ from the esophagus of an adult.

Jackson attended what became the University of Pittsburgh and attended medical school at what became Thomas Jefferson University.  He returned to Pittsburgh to practice and decided to specialize in laryngology.  In addition to being known as the Father of Endoscopy, Dr. Jackson also successfully lobbied for the passage of the Federal Caustic Poison Act of 1927, which required the labeling of poisonous or corrosive substances.

Dr. Chevalier Jackson

How has this exhibit inspired you to do something different in your own life?

I think the Chevalier Jackson Collection honestly inspires me to buckle down on making sure I have a life’s work. The prolific nature of the swallowed objects is an indication of Dr. Jackson’s passion for his work, and his unwillingness to compromise standards for data collection and the pursuit of better solutions to serious issues. I’ve been putting off applying for programs to get a Master’s in Public Health for about a year now, but looking at this exhibit helps me write a few emails and attend a few info session webinars and start getting serious about it.

What is the strongest or most unusual reaction you’ve seen in the museum?

People playing a sort of “tag yourself” /meme / game with the Chevalier Jackson Collection (“Oh I’m this one, the prosthetic gold tooth! This monopoly piece is so you, though!”)

More information about the Chevalier Jackson Collection at the Mutter Museum may be found here.


Chevalier Jackson: The Father of American Bronchoesophagoscopy, Arthur D. Boyd, MD;

Wikipedia page

Pandemics Past and Present: Accounts from our Mütter Docents

A nurse with a mask over her face.

An image of a plague doctor next to the stylized text "Going viral: infection through the ages"

In October 2019, the Mütter Museum opened Spit Spreads Death: The Influenza Pandemic of 1918-19. When the exhibit opened, Spit Spreads Death was a fascinating review of the impact of the 1918-19 influenza pandemic in Philadelphia. A companion exhibit on the evolution of germ theory, Going Viral – Infection through the Ages, debuted soon after. While these were important subjects in their own right, these exhibits achieved a new level of relevance with the novel coronavirus (COVID-19) pandemic.

Three docents at the Mütter Museum have experienced the current pandemic in ways they never would have imagined when first introduced to the exhibit on the “Spanish Flu.” Tosef Miller, David Schwarzkopf, and Julie Rakestraw are here to talk about their experiences at the Museum, initially guiding tours through the exhibit and then personally experiencing COVID-19.

When did you become a docent at the Mütter? What was your motivation for doing so?

Tosef Miller (TM): My five year anniversary is soon! In 2015, I got involved in the education department’s youth programs for minorities interested in STEM. I became a docent in 2016 with encouragement from the education department. I had no idea what I was getting into— I was so shy! People from my hometown would be shocked to know I do a lot of public speaking now. Growing up, I was that kid who never talked. I remember times my family took me to Rita’s, told me I could get whatever I wanted, and then said I had to order it for myself. I couldn’t do it! So they’d eat ice cream in front of me and I went without any!

David Schwarzkopf (DS): I became a docent 3-4 years ago after 40 years as a physical therapist. I wanted an opportunity to combine my interest in history, medicine and science and involvement with the Mütter Museum provided a perfect combination. I love to bring in the stories of the people who were once alive and are now worthy of our respect for their contributions to our understanding. My goal is to bring their stories to life for today’s visitors.

Julie Rakestraw (JR): My family has been visiting the Mütter for years and I was always fascinated by the people behind the artifacts. When I retired from DuPont in 2019, I finally had the time to become more involved and to bring information about the displays to others. After shadowing and practicing, I completed my first tour on March 2 of this year.

Did you participate in the Spit Spreads Death commemorative parade in September 2019? Who was your named pandemic person; did that person survive the pandemic?

TM: I was the Access Lead for the parade. It was my job to make sure everyone who couldn’t walk the whole three miles of the parade got to join in at the climax. I held a custom sign for a family whose relative passed away, but we didn’t have records of the death certificate. The family couldn’t make it, so I held the sign to honor their relative in their place.

Can you describe your initial response to the Spit Spreads Death exhibit? What part of the exhibit most resonated with you as you did the initial tours?

TM: Figuring out how to do tours for the exhibit was initially quite challenging because there are not a lot of physical items to describe. Most of the museum is organized like an old-fashioned medical school, with thousands of objects on display to maximize knowledge. I could stand in one corner of the museum for a half hour and still not get to everything. Those objects often elicit strong feelings when the audience sees them, but they aren’t self-explanatory. So in most of the museum, the docent’s job is to give a backstory and explain what exactly the audience sees. Once they know that, they can interpret the object.

In Spit Spreads Death, the objects on display themselves tell a story. The docent doesn’t need to tell it. The newspaper clippings, interviews with families affected by the pandemic, parade video, and chorus chanting the names of the deceased are all stories the audience can interpret without the docent’s help. They tell a story of profound, collective loss. They tell a story of how communities rebuild in the face of extreme uncertainty. They tell a story of how ripples of this pandemic still affect the world today.

Figuring out how to keep myself relevant and valuable in this section of the museum was a challenge. I found myself rattling off scary statistics, which captured people’s attention and memories, but wasn’t a satisfying tour to present. So I tried to engage with the guests in a less academic, more individual way. Spit Spreads Death wants visitors so share their stories, so I always start by asking if anyone had a relative affected by the 1918 pandemic.

If there wasn’t anyone with a relative story, I focused on connecting the emotions of the exhibit to the present-day world. I would ask a volunteer to type in their address to see how many people died on their street. It makes people curious and they think of their neighbors differently.

Later, I watched my own neighbor die of coronavirus and get taken away in a van. It was so sad, especially because I didn’t understand what was happening at first. I was just like, “Why is there a van parked outside my house? Who are those people in blue PPE suits?”

We have copies of over 700 death certificates for museum guests to keep. The death certificates are for people who died in Philadelphia during the peak day of the virus— all hospital beds were filled. I challenge people under 25 who visit the museum by asking them “Who here can read cursive?” It’s always entertaining for the older guests to watch the young ones struggle to decipher handwritten cursive. Student groups love it because there’s always one kid in the class who can read it, and so suddenly everyone is shoving their death certificate in that kid’s hands and asking, “What does it say? What was her name? Where did she live?” When I was finally feeling better from coronavirus, it hit me how close to dying I had been. I wondered what font my death certificate would use. I wondered if 100 years from now, kids would be able to read it. Or would they say, “Times New Roman is so hard to read… Why isn’t this Comic Sans? Where are the emojis?”

DS: The Spit Spreads Death exhibit and experience were so overwhelming for the children on my school group tours. To help them process it and give some perspective, I talked about the annual flu season and the SARS epidemic which began in 2002. We also discussed the importance of their immune systems and ways they might be able to increase their immune response. The teachers loved it when I focused on getting enough sleep (most high school students don’t), improving their nutritional habits by eating well, and hand washing. The visual of the impacted neighborhoods also seemed to resonate most as the students looked at where their families lived.

JR: The coronavirus had just been acknowledged in China when I first started in January 2020. Even over the 2 months of 2020, I noticed a huge shift in the attitudes towards the Spit Spreads Death exhibit. Initially, it was viewed as something interesting that happened over 100 years ago and we were now able to see some of the artifacts like the use of whiskey in medicine. Then people began to ask questions about whether it could happen again, and whether it might happen here.

I highlighted the exhibit of the Christmas presents that had been bought by a young mother before her death in 1918. That display, showing presents that her family had left in the attic for years afterward, really showed the human side of the tragedy. Then I would discuss the rise in numbers of students at a school for orphaned children, including some who still had a living parent but were just too expensive or time-consuming to have at home.

When the Museum reopens, it will be important to connect the losses this year with the stories of people in Philadelphia who were impacted not just directly by the virus but economically as well.

As the calendar turned to March 2020, and the coronavirus was well known to be circulating in Europe in addition to China and other places distant from us here in Philadelphia, how did the narratives change in your tours? What kind of questions did you receive?

TM: A lot of times, students see the name Spit Spreads Death and chuckle at the innuendo. But after coronavirus reached the news, no one laughed or commented on the name. They listened intently as soon as I said pandemic. People were scared, but they were also looking for answers. Spit Spreads Death had some of those answers.

I would say on my tours, “This flu is what coronavirus is today. In a few weeks, you guys will see. Everyone had to wear masks and it was illegal to spit in public. Kids got a badge for turning someone in for spitting.” Some teachers rolled their eyes when I said coronavirus! I’m sure they were sick of alleviating fears of coronavirus in their classrooms. At that point in time, even among College staff, many people thought coronavirus was blown out of proportion. Some people disliked that I compared coronavirus to the 1918 flu and saw the comparison as feeding into mass hysteria, but I’m sure their stance has changed! Now, the societal parallels are crystal clear.

JR: By mid-February, the interest shifted to how the virus spreads and the impact of big crowds as centers of contagion. The graphic showing a ward full of patients and overwhelmed medical staff in 1918 differed from the news out of China and then, by March, New York City only in appearance of modern clothing and equipment. The human cost was no longer history from their great-grandparents’ lives but was happening in 2020.

The pile of pine boxes in the corner representing what was used when funeral homes ran out of traditional coffins and pictures of piled bodies suddenly seemed current. In April, we were seeing trucks full of bodies on the news and it seems unreal to me that we are repeating this historical event.

With the world experiencing increasing spread before the US really acknowledged the presence of the virus here, did you change your approach to tour groups or take any additional precautions?

TM: I stopped signing up for interactive touch exhibits on the weekends. I was very scared to go anywhere but work and home in case I caught coronavirus and infected my home care clients. I have a reputation for being germaphobic, so I don’t think it was surprising to anyone when I sent an email saying “I’m alarmed. How are we supposed to wipe down touch objects between visitors? The way it’s done now seems unsafe.” One of the key components of the previous Civil War exhibit’s touch object lesson is about how wood couldn’t be sterilized, so it felt ironic to be a public health institution handing out unclean objects to guests to handle in the early stages of the US pandemic.

JR: When I did my tour on March 2, I was very conscious of using my pocket hand sanitizer, keeping my hands away from my face, and minimizing the surfaces I contacted. In ordinary times, I always hold the handrail on the stairs (many years of DuPont safety meetings) but I did not touch it at all that day. I washed my hands thoroughly before and after the tour. I also spent more time with the group talking about the importance of good hygiene practices.

Please provide any details that you’re willing to share on your personal experience with COVID-19, Including initial symptoms, disease progression, or any unusual symptomology you experienced. Did you go to the hospital and were you admitted? How long did it take to fully recover, if you feel that you have done so?

TM: I woke up with an ominous feeling Friday, March 20th. I considered refusing to go to my essential job due to an instinct I couldn’t name. A strong force told me that due to circumstances beyond my control, today would be my last unrestricted, free day. I decided to buy a week’s worth of vegan Chinese food —a huge burden to my fragile finances — on my way home from work in case I couldn’t feed myself next week.
That evening, my Goth housemate had never looked closer to death. They had just returned from NYC. They were pallid, even for a Goth. They wobbled into the kitchen, saying they could not eat or drink anything without vomiting. I coaxed them into trying a mango lassi. It seemed to settle their stomach— the first food or drink to stick for 24 hours. Their countenance instantly became bright again. Defensively, they insisted they didn’t have coronavirus; it was just a typical sinus infection mixed with allergies. I listened to the denial in horror as I didn’t believe it for a minute. The writing was on the wall. My house had coronavirus.

A week of sleeping more than usual quickly spiraled into dangerous territory. I was young, a mediocre gym rat, lacked a cough and my thermometer lied— so I believed I was fine, because that’s what American news was reporting. I remember being confused about how to tell if I should go to the hospital or not. Everything just says “go if you experience dizziness, shortness of breath, or confusion.” I told my housemates, exasperated, “It’s a respiratory illness; by definition you have difficulty breathing… What metric am I supposed to use to judge?” The typical response is “go if you have blue lips” but my thoughts were, “By the time my lips turn blue, I won’t have any idea that they’re blue, and I am beyond an ER waiting room. I need an ambulance ASAP. So that’s not a useful metric.”

Well, I was right to be concerned. I was too sick to judge how sick I was, even without blue lips. It was like nothing I’d ever felt before— reality became dreamlike. I never fully “woke up” each day. I lost my electric toothbrush for over a week— I had no idea where it went. Eventually, I went to do laundry, and my toothbrush, toothpaste, and a bunch of spoons were in my hamper. Logically, I know it must have been me that put them there, but I had no memory of when or why I did. Little things in my kitchen shuffled around, too, so I could only shrug when my roommate asked me what I did with the sugar jar lid. We were equally confused when it appeared on the very top shelf of the pantry, so high I must have gotten on a chair to put it there. I was demented. I was having moments like the stereotypical “What’s the remote control doing in the fridge?”
I was lucid enough, at times, to be aware of how sick I was. I remember trying to call Mazzoni Center, but the opening message had changed. It was several minutes long and I couldn’t listen long enough to dial the extension for the medical clinic. The words didn’t make sense. I sat on the couch angrily, telling my roommate I couldn’t listen to the whole menu. She shrugged and told me to redial. We were all sick— and lucky if we saw each other once a day. The four or six hours I was awake per day were not necessarily aligned with anyone else’s waking moments.

In hindsight, it was obvious I needed medical attention. But I didn’t have a cough, so I didn’t know. I developed strange symptoms— I got pink eye and puffy eyelids. My hair died, so I buzzed it and shaved my beard. My face skin simultaneously peeled and developed acne. My pee turned orange and concentrated before any of the lethargy hit, when my symptoms were still limited to “I think I’ll take a nap today.” My legs ached. I became very greasy. Did I feel feverish? Yes, but I don’t know an exact temperature because it took a few days for me to realize my thermometer was broken.

Walking up the stairs was exhausting. At times, I had to crawl on all fours to get back to my bedroom. I’d lay on the floor at the top, nauseous and waiting to catch my breath before rising to my bed. My roommate’s 15 year old elderly cat slept less than I did. He would finish his nap first! My balance was also very poor— it was like I had just woken up, jumped out of bed, and hadn’t yet steadied myself. So I could still walk and do things, I was just clumsy and not aware of my entire body. Some parts still felt asleep.

My appetite was voracious— I am a 24 year old black hole. Coronavirus did not take that away from me. I never lost my appetite. I think that is why I am alive today. I could still smell and didn’t really get any sinus issues. Things still tasted fine to me— but apparently, my taste was affected. For Passover, my roommate bought a sauce with horseradish and beets. I dumped a bunch on my matzah and ate it— then noticed my roommates staring at me in horror. It was too spicy for them to eat. All I tasted was beets! The horseradish tasted crunchy and mild to me.

Getting tested was a nightmare. None of my friends with cars would drive me. They made up excuses because they were scared. It hurt my feelings. I understand why they said no, as they thought I was asking them to die. My friend who believed the virus was a overblown came in handy— they went well out of their way to get a Zipcar and drive me. They don’t think the virus is overblown anymore, of course. We were both scared when we waited in line, the people covered in PPE looked like aliens. When I held up my ID, the tester just said, “Oh, another Bayada.” She said it in an approving way, like she admired Bayada as a company. But it made me double take and wonder how many other “Bayadas” had come this morning and were sick, too. How many of us were in the same situation, dropping like flies?

DS: Although I knew that coronavirus was circulating in Europe, I had been invited to represent my family for the Stumble Stones exhibit in Switzerland to honor Jews who had left Germany during WWII. This was a very important event, so I left March 4 on a trip to Switzerland, Germany and Ireland. I returned by March 9 and became symptomatic March 16. My COVID-19 symptoms lasted until March 27. I had fevers of 103-104 degrees F and Tylenol® would bring my temperature down to just over 100 degrees F. I was nauseous and had no interest in food or drink. My husband insisted that I keep drinking and his care is likely the only way that I avoided hospitalization. My husband did not become symptomatic and we are not sure if he was infected. Still, now in early May, I throw up if I eat beef or pork. I had hallucinatory smells. Everything smelled like garlic, so I sprayed my lemongrass scented cleaner everywhere to rid myself of the perpetual garlic odor.

I thought it would pass and didn’t think it was coronavirus because I had no respiratory symptoms. When I finally went to the doctor after five days of high fevers, the simple test in the office said that I did not have coronavirus. However, 4-5 days later, a positive test result was reported.

JR: I was not tested but my immediate family is pretty sure that we have all been exposed. My son lives in Brooklyn and experienced the now-reported “COVID toes” during his first week at home. In February, my daughter was very sick during her rotation in the Emergency Department of a local hospital and learned later that patients did receive two-week delayed positive coronavirus tests. I had a slightly elevated temperature, dry cough, and rash on my throat and chest a week after my red-eye flight from Phoenix in mid-March. My husband reports he had a few days of not feeling well about a week after the rest of us returned home.
In hindsight, we were very glad to have followed social distancing and stayed from people during that period that we were likely all contagious.

Have you been tested for antibodies, and would you be willing to or have you already donated serum as a potential treatment?

TM: I signed up to donate antibodies with the Red Cross, Penn, and Jefferson, but only the Red Cross has gotten back to me. I had an appointment Friday, May 15th, to donate. I haven’t been tested, but know that I have them because I take the Septa to my job at UPS. The train stations aren’t being cleaned because the Septa employees are sick. So the train windows and seats are covered in blood droplets from people’s coughs, plus the usual unidentifiable body fluids and bedbugs. Anyone who gets on the train at this point either has coronavirus and COVID-19 or has some immunity.

DS: After my recovery, I donated blood and plasma to Penn Medicine but will not receive a feedback report on whether antibodies were present. I am definitely curious about whether the antibodies will give immunity and for how long.

I have been reflecting on how everyone will rethink their lives and activities. Hand washing has always been a big part of my protocol due to my PT training. My awareness of what’s in the air around me has definitely increased. I have many friends in the Philadelphia restaurant and art world and really look forward to getting back to those activities and hugging my friends. But I expect that I may go to restaurants only once I am convinced that sufficient safety precautions are in place, including requiring reservations and social distancing.

JR: I did not go to the doctor so was not tested and am not eligible to donate. I did sign up for the NIH study and am waiting to learn if I will be selected to be tested.

Knowing what you do now, how will you change your presentation of the Spit Spreads Death?

TM: I usually asked guests if they have any relatives who had the 1918 flu. I now plan to ask if any have coronavirus stories they want to share and I’ll try to relate it to an experience someone from 1918 had.
I’ll also compare how the first responders and healthcare workers from them died in huge numbers, and the same happened today, where they make up a large percentage of the deaths.

Depending on how fast the coronavirus vaccine comes out, I’m going to compare it to the 20 years it took to get a functional flu vaccine.

Some things in the museum are upsetting— seeing people cry is not unusual. So I’m going to try to curb any coronavirus discussions if I sense a guest is overwhelmed emotionally. But if someone shares a story of a relative lost, I’m going to thank them for sharing. The Spit Spreads Death exhibit is a memorial to those lost in a pandemic and is a good place to let someone’s memory live.

I adored the Civil War exhibit. I was angry and heartbroken it was removed. I initially saw Spit Spreads Death as lacking from a docent’s perspective. Now, I’ve done a 180 degree turn. I think this exhibit is brilliant. It could not have come at a more perfect time. The creators of Spit Spreads Death left the museum with an enormous legacy. Spit Spreads Death not only commemorated the fallen in the 1918 pandemic; it saved lives in the 2020 pandemic. There could not be a more satisfying way to say to the fallen, “Your death wasn’t for nothing; your memory saved your great grandchildren. And, you motivated them to help others.” I get teary just thinking about it. Walking around in a mandatory mask now is not fun, but it is heartening to know we aren’t the only ones to go through this. There is an enormous human connection to the pictures of people walking around with masks on 101 years ago.

Will you say anything different about Going Viral – Infection Through the Ages?

TM: The pandemic has brought misinformation to more people’s attention online. By now, we’ve all seen the facebook mom pages full of medical inaccuracies— stuff like, “Essential oils can prevent any disease!” I can bring that up, and say, “This is a great example of miasma theory! At one point, it did agree with science. Many people still believe alternative theories of disease, like miasma theory, instead of germ theory.”

The other parting message I try to leave guests with is about the next pandemic— antibiotic resistant organisms. The next pandemic is already on the calendar. Many times guests see diseases in the museum and think“Thank god we can cure that now!” But that will not be true soon. Many nasty diseases are going to make a comeback in our lifetimes. The next pandemic may be an old pandemic. It will not be a novel disease, it will be a disease we have known for ages. Now that we have all experienced a pandemic, I think my statement will hold a little more weight with people. Before, people could acknowledge the truth of that statement. Now, people can feel the truth of that statement. It’s got emotions attached. We look at the people in the museum with wonder about what it was like to live back then. But we should also look at them and see the future.

I also think I will ask guests what they think the future of disease prevention looks like. We compare a plague doctor outfit to a modern white coat. What does future PPE look like? We are at a turning point in medicine.

The pandemic showed us the flaws with current PPE— N95 respirators are uncomfortable, inefficient after a short period of time, require a lot of resources to produce, and contaminate our oceans. Surely there is a better way. And surely the museum guests can help find that answer.

DS: I intend to focus more on the theory of Miasma and the smell of the “bad air” from the barrel in the corner. In refugee camps, there is often a lack of clean water and insufficient, nourishing foods. Areas in the US have these concerns as well.

The pictures of the virus that caused the Spanish Flu will continue to be fascinating and I look forward to discussing the coronavirus structures in comparison.

JR: I will focus more on the impact of the disease on healthcare professionals, the families of those who died, and on the changes to how society functioned. I have friends who have cried their entire commute home after working on the COVID floor of the hospital. The “new normal” that we are waiting to embrace is going to look a lot different from what we all took for granted when Spit Spreads Death first opened.

How do you anticipate you will change any behaviors in your life as we enter the ‘new normal’?

TM: I’m just grateful to be alive. I got coronavirus early— I can ride the trains and go grocery shopping without fear because I have some level of immunity. In a way, it’s a relief. The worst is over for me. My friends are still stuck inside every day, maybe for the next two years, terrified. Of course, I’m scared of infecting others, too. But since I worked in home care, I got used to washing my hands upwards of 20 times a day.
I am glad people are washing their hands more— I rarely shake hands with men because most men don’t wash their hands after they go to the bathroom! I’ve even seen doctors and laboratory PI’s walk out of the bathroom without washing their hands. Please, do better. Make your mother proud.

DS: Can crowds ever be safe? The flu vaccine helped and development of a vaccine for this coronavirus may as well. I’m rethinking flying on airplanes. As a longtime concert subscriber, I am unsure when I will feel comfortable returning to orchestral concerts. I wonder about the impact of continuing mutations of the virus and what level of immunity my illness will confer for how long.

JR: I now have a wardrobe of masks and have them placed strategically in my purse and car so that I don’t leave home without one. I view wearing a mask in public places as a way to make others more comfortable so they need to worry less about whether I could spread disease to them. I am more conscious than I was before about people coughing around me, and even though I suspect I have already have COVID-19, I haven’t had the next strain of flu or other virus.

My hope is that we recognize the importance of science and technical experts and that we become more committed to long-range thinking and planning. Development of effective medical treatments and vaccines is a massive challenge but it will be easier with sufficient investment in education, research and infrastructure. Thirty-second sound bites from uneducated people might make for good television but they don’t provide sufficient context or information for rational decision making.

Do you have any additional comments or advice you would like to provide?

TM: The flu is still a dangerous disease. My hope is that the vaccine for coronavirus will be included in the flu shot. More people will get the flu shot every year if the coronavirus vaccine is administered at the same time. And, I hope everyone reading this stays safe.

DS: From my personal experience, stay hydrated. Drink water often to help prevent even moderate dehydration. Modify your personal habits and diet to reduce your susceptibility. I had high blood pressure over my 40 years as a physical therapist. Now that my stress level is lower, I am off my medications and maintaining a healthy blood pressure.

As we develop a plan forward, I hope that the country considers and implements ways to help small rural hospitals in particular. A cousin who lives in Colorado was a doctor whose hospital closed, leaving the area residents with 100-mile drives to the nearest facility. Many hospitals spent huge amounts of money to prepare for COVID-19 patients and simultaneously stopped the elective procedures which provide necessary funding to support their operations. Development of funding policies to ensure the survival of local and specialty hospitals is key for healthcare.

Vaccine development takes time to make and distribute vaccines that are safe and effective. We need that to allow society to return to ‘normal’. I am hopeful that the Oxford labs working on SARS vaccines may provide a jumpstart. We also need sufficient personal protective equipment (PPE) and testing to allow us to return to normal.

Human/animal transmission of disease is a concern. Some people suggest that the original source of the Spanish Flu may have been cattle in Kansas, and it is highly suspected that the current novel coronavirus originated in bats. We need to think about our interactions with exotic animals particularly in markets in the developing world.

Healthcare professionals have been put under tremendous stress in the response to COVID-19. We need to continue to support them and to provide needed services and resources going forward.

JR: In addition, we need to develop a robust Public Health system in the US and ensure that we maintain its strength and vitality. Mental health problems are already being discussed as part of the burden of the pandemic and we need to increase the availability of understanding and treatment. The isolation and confinement mandated by social distancing in addition to economic stress of lost jobs and businesses are a potent combination for difficulties.

We need to ensure we have excess capacity in the healthcare system and managed stockpiles of equipment and medicines to manage when it is needed. The COVID-19 pandemic was not unexpected, but had been predicted for years and transmission of a zoonotic virus to humans was often listed as the likely cause.

Globally, we need to modify our practices to reduce this possibility to stave off the next pandemic but to simultaneously prepare to reduce its impact.

The global supply chains for key items are currently being re-examined as well, which will hopefully result in systems which are more resilient and focus less on immediate cost-savings to provide overall sustainability, quality and availability.

CPP Curiosities: Corpse Medicine

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Greetings, fellow historio-medico aficionados, Kevin here for another installment of CPP Curiosities, our semi-regular foray into interesting and unusual episodes in medical history. On behalf of all of use here at The Center for Education of The College of Physicians of Philadelphia, I hope you are safe and healthy. Past installments of our series examined a scientist who studied facial muscles by shocking people’s faces with electricity, a video game designed to teach children about type-1 diabetes, and treating patients with syphilis by infecting them with malaria. Today, I’m pleased to welcome guest writer Amanda McCall. Amanda has been researching various projects for the Center for Education, including doing great work developing the scenario for Murder at the Mütter, our annual murder mystery designed to teach the public about forensic science.

Today, she will be introducing us to the interesting ways human remains have factored into medicine.

Take it away, Amanda!

Corpse Medicine

Image of an apothecary shop with various bottles and containers stacked on shevles

Replica of a late 17th century apothecary shop in Switzerland, ca. 1920. Image Source: Wellcome Collection

There was once a period of history in which using the blood, fat, and skulls of the dead as medicine was commonplace. For several hundred years- peaking in the 16th and 17th century- the treatment for many ailments might have been a piece of one of your fellow humans. It probably sounds pretty illogical and even disgusting, right? Many physicians operated under the thought that ‘like treated like’, and the body contained a vital life force that if transplanted into the body of an ill individual could help them heal and regain their vitality. If the cadaver had suffered a violent death even better! Then even more of their bodily ‘spirit’ would be trapped in their flesh and bones. So, if you suffered from joint pain then maybe a salve of human fat would help ease your discomfort. Are nose bleeds complicating your life? Then, procure a bit of skull moss and place it in your nostrils.

Medical Mummies

Even the ancient mummies of Egypt weren’t safe from intrepid Europeans. Due to the incorrect translation of some Persian medical texts, Europeans thought that the sticky black resin found on many mummies held miraculous healing properties. The Persian text was referring to a natural mineral pitch that was found in the mountains nearby that was frequently used as a treatment for cuts, fractures, stomach ulcers, and tuberculosis. The European medical community would not discover this error for quite a while.

Using the information they believed to be true, they began exporting large quantities of mummies from Egypt in order to take advantage of all the benefits currently being attributed to these preserved corpses. Apothecaries stocked powdered mummy and also larger sections of the body for the treatment of cuts, bruises, and fractures. The demand grew so large that many merchants took to creating their own ‘mummies’ from the recently dead in order to keep up with demand. By the 18th century, treating patients with mummies was in dramatic decline, and most physicians no longer believed it useful. The last recorded listing of mummy for sale in a medical catalog was 1924.

The Benefits of Blood

1975 advertisement for Clarke's World Famous Blood Mixture. teh ad boast the mixture can cure skin conditions, cancerous ulcers, impure blood, and any other other ailment

1875 Advertisement for Clarke’s Blood Mixture. Image Source: Walsall Local History Centre

Throughout medical history, the blood has always been seen as vitally important to the way our bodies function. It was believed that conquering the blood would be akin to conquering the power between life and death. The ancient Romans thought that by drinking the blood of recently dead gladiators, they could cure epilepsy. Fresh blood was thought to be best, so if you could not afford to buy it there was always the option of vying for a prime spot near the guillotine in order to obtain it straight from the source. Blood was seen as a health tonic of sorts, able to bring back youth and vitality to the aged. It was also believed to be a possible cure for epilepsy and tuberculosis. Dried and powdered blood was also used in the treatment of nosebleeds and put onto wounds in order to stop active bleeding.

Splendid Skulls

Image of the Hyrtl Skull Collection at the Mütter Museum

The Hyrtl Skulls of The Mütter Museum

Skulls also had their place in historical medicine cabinets. The beneficial attributes of the skull could also be extracted from the moss that commonly grew on them when the skulls themselves were left out in the open, such as on battlefields or in ossuaries. Distillation in alcohol was one of the most common methods of ingesting skull materials. English physician John French had two different recipes for distilled powdered skull. One was recommended for gout, dropsy (edema), and stomach troubles. The other was thought to help with epilepsy, fevers, convulsions, and “passions of the heart”. The moss that grew on skulls was especially prized as a treatment for nosebleeds when applied directly to the affected nostril. This actually might have worked due to the fact that most powdered substances do have the desired effect on blood flow. The demand for skulls and their associated remedies grew so much the 17th century that the English had to import Irish skulls from battlefields in order to keep up.

The “Mellified Man”

Artist’s depiction of a “mellified man.” Image Source: Wikimedia Commons (Sachem31)

One very interesting tale of corpse medicine might be exactly that: a tale. I am referring to the idea of the mellified man. “Mellified” simply means to be embalmed in honey. Honey has long been known to have strong antimicrobial properties, and has been used as a treatment for cuts and scrapes throughout history.

Around the 16th century, accounts of mellified men were uncovered in Chinese medical texts, and that sparked some curiosity. According to these medical texts an elderly male member of the community would volunteer to become mellified for the good of his fellow people. He would then only consume honey: eating, drinking, and even bathing in it. After he died, he would be placed in a stone sarcophagus filled with honey and left for approximately 100 years. When the hundred years had passed, he would be removed and his remains would be portioned out and sold for a steep price in the marketplace.

There are no confirmed reports of people actually consuming this honey-preserved flesh, so it remains a medical history urban legend. We do, however, know that the Egyptians used honey as part of their embalming process, and they also left jars of it as food for the afterlife in the tombs of their pharaohs. Alexander the Great was also entombed in a gold sarcophagus filled with honey.

As we have progressed through medical history, many different ideas and theories were presented as possible treatments to cure what ails us. Corpse medicine may be considered one of the more drastic or unsavory concepts presented. Although when we think about it, it bares quite a few parallels to modern-day organ transplants or blood transfusions. So, is it really that unreasonable?

Thanks, Amanda, for an interesting piece. If you want to learn more about the handling and use of human remains, check out our articles on the cryogenically frozen remains of baseball Hall of Famer Ted Williamsthe preservation of Vladimir Lenin’s corpse, and our numerous stories on graverobbing.

Until next time, stay safe, maintain social distancing while staying emotionally close, and we’ll see you on the strange side. 

Selected Sources:

CPP Curiosities: Tackling a 1918 Flu Meme

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Fellow fellow historic-medico aficionados, Kevin here welcoming you from quarantine to the latest installment of CPP Curiosities, our semi-regular look back at interesting and unusual accounts from the history of medicine. I hope those of you who don’t have to be out are staying home and staying safe. To those of you who are essential workers, thank you for your hard work.

COVID-19 is the subject on everyone’s mind and it will remain so as the pandemic continues to rage (check out some information on coronavirus from one of the Fellows of The College of Physicians of Philadelphia). Today’s edition of CPP Curiosities is no exception.

Medical quackery and fake news are no strangers to our humble series. See, for example, our two recent accounts of fake cancer cures involving horse blood and a so-called vitamin that cannot cure cancer but can give cyanide poisoning. It comes as no surprise that medical misinformation is running rampant during the COVID pandemic with phony cures ranging from drinking bleach or liquified silver, and taking an untested malaria cure. The topic of today’s edition is a meme that has been recently making the rounds on my Facebook feed, one I feel we at The Center for Education of The College of Physicians of Philadelphia are in a privileged position to address. The meme in question shows a picture from Philadelphia’s Liberty Loan Parade, held on September 28, 1918. Above the image is the caption:

In 1918, Philadelphia prematurely ended its quarantine from the Spanish Flu to throw a parade in order to boost morale for the war effort. Some 200,000 people lined the streets on that late-September day. Within 72 hours, every bed in Philadelphia’s 31 hospitals were filled and the city ended up with 4,500 people dying from the flu or its complications within a matter of days. What is that proverb? “Those who cannot learn from the past are condemned to repeat it…”

Image of the September 28, 1918, Liberty Loan parade in Philadelphia with the following caption: In 1918, Philadelphia prematurely ended its quarantine from the Spanish Flu to throw a parade in order to boost morale for the war effort. Some 200,000 people lined the streets on that late-September day. Within 72 hours, every bed in Philadelphia's 31 hospitals were filled and the city ended up with 4,500 people dying from the flu or its complications within a matter of days. What is that proverb? 'Those who cannot learn from the past are condemned to repeat it...'"

Well, fellow historic-medico aficionados, as someone who helped developed the companion lesson for the Mütter Museum’s recently-opened (and suddenly very relevant) exhibit on the 1918-19 influenza pandemic in Philadelphia, this statement is not entirely accurate. The city did not “prematurely end its quarantine to throw a parade.” The real story is, unfortunately, even more tragic, and gives us an opportunity to examine similarities between Philadelphia health officials’ efforts during 1918 and their modern COVID counterparts.

The first cases of pandemic flu in Philadelphia appeared in early September 1918, likely brought over by infected soldiers from Camp Devers in Boston. Cases spread through the month, from military training grounds like Camp Dix (now Fort Dix) in New Jersey and Camp Meade to the factories and the Navy Yard to the general population. While flu at the time was only reportable in the city if it led to death, there arose growing concerns among Philadelphia’s healthcare workers that the so-called “Spanish Flu” had reached the city.

This happened at the same time as the city was gearing up for a massive military fundraising campaign known as the Liberty Loan. The fourth iteration of the loan campaign was to start on September 28, 1918, with massive patriotic parades held across the country to encourage people to help finance the country’s involvement in World War I. The Philadelphia area had a quota of $500 million (roughly $8 billion today) and an army of volunteer fundraisers, including Boy Scouts, war widows, wounded soldiers returned from Europe, and a host of others were determined Philadelphia would do their part, deadly pandemic flu or no.

Poster depicting the Statue of Liberty in Flames with the caption "That liberty shall not perish from the Earth. Buy Liberty Bonds. Fourth Liberty Loan.

Image courtesy of Temple University Libraries

As cases increased through the month, some health experts in the city pushed for the city to postpone the parade. Their cries fell on deaf ears. Philadelphia Mayor Thomas B. Smith held the final say, and canceling the parade, even if he was considering it, was potentially political suicide. Patriotism was highly policed during the war. Under the Espionage Act of 1917 and the Sedition Act of 1918, it was illegal to openly criticize or give the appearance of interfering with the war effort. This extended to the Liberty Loan, and any measures to interfere with the Loan would have appeared as unpatriotic at best and treasonous at worst.

In any case, against the recommendations of health experts in the city who said the large gathering of people would exacerbate the epidemic, the City held the parade anyway, and 200,000 people lined up and down Broad Street in what was at the time the largest public gathering in the city’s history.

The results are what you might expect from a virus spread through close contact. Within a week after the parade most of the city’s hospitals were overrun with sick patients. Throughout the month of October, the city was forced to open ten emergency hospitals and some private citizens opened some of their own to keep up with the ceaseless demands for beds. And then the morgues started to fill up. The city went so far as to commission a steam shovel to dig mass graves. Newspaper reporters described bodies being hauled to the morgue in horse-drawn carts, likening the city’s misfortunes to the London plague in the 1660s. Eventually, the city’s Department of Public Health and Charities banned all public gatherings on October 3, 1918, more than a full week after the parade. These included bans on large crowds, and the closures of schools, churches, saloons, and other places people gathered.

An October 1918 newspaper page with photos of men digging trenches for mass graves for influenza victims and photos of bodies piled in the Philadelphia coroner's office

Newspaper page of photos of men digging mass graves and bodies of flu victims in the Philadelphia coroner’s office. Image courtesy of the Historical Medical Library of The College of Physicians of Philadelphia

Even after the flu ravaged the city, there were still Liberty Loan boosters trying to get the city to prematurely reopen so the city could sell more bonds and make its quota. One Liberty Loan ad from the October 9, 1918, edition of the Philadelphia Inquirer read, “Most of the channels for inducing subscriptions have been closed because of a senseless panic over the so-called influenza.” By that time, there were between 500-800 reported flu deaths per day with the single worst day on October 12, 1918 (approx. 837 dead). Small Liberty Loan events still took place during the ban.

Newspaper reports did their best to downplay the impact of the epidemic. This was partly because press coverage was highly censored during World War I, with restrictions on any press that could potentially hurt morale. An editorial from the October 5, 1918, edition of the Philadelphia Inquirer denounced ban on public gatherings and cautioned Philadelphia readers that the best medicine was to not to think too much about the flu:

“Eradicate from the mind all fear. Do not dwell on the influenza. Do not even discuss it. Instead of building up a mountain of dread, fill the mind with clean thoughts, proper thoughts that are far removed from panic. The man who does this will be enabled to go about his daily tasks with a far better chance for escape than the man who yields to alarm. Anyone can bring upon himself almost any ill by making a god or a devil out of it. Act, sensibly, therefore, in the present emergency. Worry is worse than useless. What is more, it is physically debilitating. Steer clear of it, therefore, and talk of cheerful things—of health, for instance, instead of disease.” “Spanish Influenza and the Fear of It,” Philadelphia Inquirer, October 5, 1918, pg. 12.

The city’s health officials struggled to keep up with the cases. Local residents acted as volunteer ambulance drivers, set up an emergency hotline to handle flu cases, and helped dig graves. Medical students from the local med schools were pressed into service as doctors, as many practicing physicians were overseas. The epidemic eventually subsided and the ban on public gatherings was lifted on October 31, 1918. Roughly 14,000 Philadelphians died over a six-week period (much higher than the 4500 mentioned in the meme) and over 17,500 died during the entire pandemic, the largest totals relative to population of any major American city.

The Mütter Museum is currently closed in response to the COVID-19 pandemic. However, when we do reopen and you happen to be in the Philadelphia area, be sure to check out Spit Spreads Death: The Influenza Pandemic of 1918-19 in Philadelphia to learn more about the 1918 influenza pandemic and lessons we have (and have not) leaned from what some call “the forgotten pandemic.”

Until next time, stay safe, stay well informed, and always treat memes with skepticism.

Also, as always, catch you on the strange side!

Special thanks to Jane E. Boyd, PhD.

CPP Curiosities: Piercing

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Welcome, fellow historico-medico aficionados to our latest installment of CPP Curiosities, our look back at weird and downright fascinating aspects of medical history. Past installments have examined dubious cancer cures such as Vitamin B-17 and krebiozen, an alleged Persian mummy, and the Greek demigod of medicine who conquered death. This latest installment of CPP Curiosities draws upon a lesson available here at the Mütter Museum, and who better to explain it to you than our resident Museum Educator, Marcy Engleman.

Marcy, the floor is yours!

I have spent years educating students who visit the Mutter Museum. The topics range from forensics to Civil War medicine. But my favorite lesson is body modification. In this lesson, I talk about Chinese foot binding, tattooing, corsetry, and more. The topic from that lesson that I wanted to highlight for this blog is piercing.

Man has been wearing jewelry for millennia, possibly back to Neanderthal days. But in 2016, some Australian scientists found an artifact in a rock shelter that has changed our thinking about body modification. They found a piece of kangaroo bone, shaped long and thin, for the purpose of wearing in the nose septum. It is presumed that warriors might wear a bone in their septum to intimidate their enemy, making them look scary and fierce. Scientists dated this bone to approximately 44,000 BC!

Piercing, the act of cutting or puncturing the skin to insert a piece of jewelry, appears in many cultures across the globe. The reasons for piercings vary, including indicating social ranking or class, displaying tribal affiliation, and intimidating enemies. They can also serve aesthetic purposes or demonstrate rites of passage. For example. women of the Aleutian Islands would wear sea lion whiskers as earrings, as a token of marrying a good hunter. During the Elizabethan Era (late 16th century Britain), English noblemen would wear at least one ear piercing as a symbol of wealth.

Ears aren’t the only body part to be pierced. Navel piercing, mostly a modern fad, dates to Ancient Egypt where royals pierced their navels to demonstrate nobility. Nose piercings were common among African and Indian cultures and gained popularity in Great Britain and the United States during the counterculture and punk movements of the 1960s and 1970s. Between the 14th and 16th centuries, the Aztecs and Mayans used tongue piercings as a form of blood sacrifice.

Lip piercings are common in cultures around the world. Mursi women in Ethiopia have the choice to pierce their lower lips around the age of 16. Over the course of weeks and months, the girls stretch the hole in the lower lips, wearing plugs made of clay or wood. It is often seen as a sign of reproductive potential and social adulthood.

One of the oldest examples of piercing comes from “Ötzi the Iceman,” a body of a man discovered by hikers in the Alps in 1991. It is estimated that he lived approximately 5,300 years ago. Scientists have been able to recreate his appearance, discover his last meal, estimate what he was wearing. They also found was covered with tattoos and his ears were pierced. The gauges on his ears stretched his lobes as wide as 7-11mm.

That is just a brief introduction to one form of body modification. If you are an educator and are interested in learning about more, you can bring your students to the Mutter Museum and book our Body Modifications lesson!

Thanks, Marcy. For our full list of lessons, including Body Modification, check out our website. Until next time, catch you on the strange side!



CPP Curiositites: Bad Medicine, Part Two: Vitamin B17

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Hello, greetings, and salutations, fellow medico-historico aficionados, and welcome to the latest installment of CPP Curiosities, our semi-regular foray into weird and interesting chapters in medical history. This is part two in Bad Medicine, our ongoing subseries on dubious and fraudulent cancer cures. This series is a complement to Mixed Signals: A Study of Cancer, our new Mütter Museum exhibit developed by students in the Karabots Junior Fellows Program. Last time, we looked at Krebiozen, a miraculous substance derived from horse blood that, while not curing cancer, led to its purveyors getting charged with over forty counts of fraud and destroyed the reputation of one prominent university vice president.

This time around, we are going to keep the dubious medicine train rolling with a look at a “cure” you might have been sent by your conspiracy-minded relative on Facebook. Hang on tight, because we are taking a look at Vitamin B17.

Image Source: Historical Medical Library of the College of Physicians of Philadelphia

Vitamin B17 treatment, also known as amygdalin or laetrile treatment, is based on a semi-synthetic compound called laetrile. Laetrile is derived from amygdalin, a compound found in the pits of several nuts and fruits although most commonly associated in this context with apricots.

Amygdalin treatments date back to the 1930s; however, their alleged cancer benefits are usually associated with the father-son duo of Ernst T. Krebs, Sr., and Ernst T. Krebs, Jr. The former was a physician from San Francisco who ran afoul of the Food and Drug Administration in the 1920s for peddling a substance called Syrup Leptinol, a supposedly magical cure-all derived from parsley that could allegedly cure influenza, pneumonia, and asthma. His son, meanwhile, was a self-proclaimed biochemist who claimed to isolate laetrile from apricot seeds in the 1940s. According to the Krebs and their supporters, cancer is not caused by genetics, environment, or lifestyle; rather, it is the result of a vitamin deficiency. By this line of reasoning, to cure cancer one simply needs to reintroduce the necessary vitamin back into the body. Krebs, Jr., claimed to discover this missing vitamin, dubbing it Vitamin B17. His alleged cancer cure gained traction in the 1970s, inevitably attracting scrutiny from members of the medical and scientific communities.

Krebs, Jr., and his magical cancer cure raised several red flags. An exposé published in the June 26, 1977, edition of the New York Times revealed the so-called Dr. Krebs, Jr., had no medical degree. The extent of his formal scientific training was a tumultuous three years at Philadelphia’s Hahnemann Medical College where he was expelled twice. The article further revealed his highest degree was an honorary doctorate from American Christian College, a now defunct small Evangelical Christian college based in Tulsa, OK, that did not issue doctorates at all.

Krebs’ decision to characterize laetrile as a vitamin rather than a pharmaceutical appeared to be an attempt to circumvent the rigorous testing required for pharmaceutical products to get federal approval, and a 1977 report from the Food and Drug Administration accused him of doing just that. The American Institute of Nutrition Vitamins does not recognize B17 as a vitamin; it is more accurate to consider it a supplement, and supplements, unlike pharmaceuticals, are not subject to rigorous scrutiny before going to market. Current FDA regulations place the onus on a supplement’s manufacturer to ensure the product is safe and does what the product’s marketing claims it does.

Scientifically speaking, there is no evidence that laetrile is a useful or effective cancer treatment. In fact, the evidence suggests the opposite as laetrile, when taken in high enough quantities, especially when taken orally, can cause cyanide poisoning. A study reported in the January 28, 1982, issue of The New England Journal of Medicine tested laetrile treatment on 178 cancer patients. The study reported it offered no therapeutic benefits and, citing the risk of cyanide poisoning, concluded, “Amygdalin (laetrile) is a toxic drug that is not effective as a cancer treatment.” In the 2010s, the Cochrane Collaboration, an independent non-profit medical research firm, examined over 200 separate studies investigating laetrile treatment. In a 2015 report, the organization concluded there were no discernible benefits in laetrine/amygdalin as a cancer treatment, and its cyanide toxicity made it more harmful than helpful:

“The claims that laetrile or amygdalin have beneficial effects for cancer patients are not currently supported by sound clinical data. There is a considerable risk of serious adverse effects from cyanide poisoning after laetrile or amygdalin, especially after oral ingestion. The risk-benefit balance of laetrile or amygdalin as a treatment for cancer is therefore unambiguously negative.” Miazzo S and Horneber M, “Laetrile Treatment for Cancer (Review),” The Cochrane Library (2015), No 4.

However, some of laetrile treatment’s supporters see something more sinister afoot. G. Edward Griffin, a self-proclaimed journalist, filmmaker, and author of World Without Cancer: The Story of Vitamin B17 accused the Food and Drug Administration, the American Medical Association, the American Cancer Society, and the National Cancer Institute of deliberately suppressing the clinical benefits of laetrile treatment, collaborating with drug companies who financially benefit from the status quo. Claims of government/corporate suppression of the “real” cancer cure are widespread on the internet.

The Food & Drug Administration outlawed Laetrile in 1980. Those who attempt it today have to either travel outside the US or have it smuggled into the country.

If you’re looking for more information on the controversy surrounding Vitamin B17, a July 17, 2017, article for Buzzfeed addressed the topic in detail.

Until next time, catch you on the strange side!

CPP Curiosities: Bad Medicine, Part One: Krebiozen

Logo for CPP Curiosities

Greetings, again, fellow historico-medico aficionados, and welcome to the latest installment of CPP Curiosities, our (semi) regular segment on all things thought provoking from the history of medicine. Past installments have run the gamut, from baseball legend Ted Williams’ cryogenically frozen remains, to the Greek demi-god of medicine who defeated death, to graverobbing after graverobbing after graverobbing.

On November 5, 2019, The Mütter Museum of The College of Physicians of Philadelphia unveiled a brand new exhibit examining cancer biology. Mixed Signals: A Study of Cancer addresses how cancer behaves, common cancer types, the three most common forms of treatment, and ways to help reduce your risk. The exhibit was created by students in the fifth cohort of The Karabots Junior Fellows Program, a three-year summer and after-school program for Philadelphia high school students interested in careers in healthcare and medicine. The exhibit was part of a joint program with Swarthmore College to teach the public about cell signalling and cellular miscommunication and was made possible through a grant from The National Science Foundation. Students in the Karabots program also designed a complimentary lesson designed to teach middle school students about the ways cancer behaves and the relationship between cell signaling and cancer.

Main exhibit label for Mixed Signals: A Study of Cancer

The three most common forms of cancer treatment are colloquially known as “slash, burn, poison,” referring to surgery, chemotherapy, and radiotherapy. But what if I told you that you can treat yours or a love one’s cancer without resorting to surgery, medication, or radiation? Maybe there’s a magic pill that can cure cancer with none of the side effects of mainstream treatments? Maybe illness is just a state of mind, one we can counteract with the right degree of positive thinking? All this and more are out there for you…for a price.

Our students’ diligent efforts to learn about cancer inspired me to do some cancer research of my own. This led me down a research rabbit hole of cancer treatments and cures that are, for lack of a better term, not legitimate. It may come as no surprise that there is a long history of people peddling false or unproven cancer cures, taking advantage of cancer patients and their loved ones desperate for a miracle.

Alleged miracle cancer cures take on many forms, from supposedly natural supplements, to synthetic chemicals, to hitherto undiscovered anti-cancer agents hidden in the body, or even magical cancer-killing machines. However, their advocates share some notable similarities regardless of their angle. Most argue that cancer has some simple root cause that has hitherto eluded physicians, a root cause that has a simple chemical or mechanical solution. That solution specifically targets the cancer, quickly and easily destroying it with absolutely no side effects. Moreover these techniques have been known for years; however, their use is being suppressed deliberately by mainstream medical organizations, governments, pharmaceutical corporations, or a legion of other confederates who withhold the truth so they can profit from the suffering of cancer patients.

So, with in mind, join me for a journey through some spurious scientists, miracle-pushing machinists, and dubious doctors in a series I am calling Bad Medicine.

Bad Medicine: Episode One, Krebiozen

Image Source: Historical Medical Library of the College of Physicians of Philadelphia

In the late 1940s, Yugoslavian physician Stevan Durovic claimed to develop a miraculous cancer cure while living in Argentina. His chemical, initially dubbed “substance X” and later renamed Krebiozen, was allegedly derived from a substance extracted from horse blood. According to Durovic, cancer was caused by a lack of this mysterious “Krebiozen” substance in the body, and adding more either through pills or injections caused cancer cells to shrink.

He brought his supposed miracle cure to the United States in 1951 and established the Krebiozen Research Foundation in Chicago, Illinois. There he developed some powerful local connections, including U.S. Senator Paul Douglas and Dr. Andrew C. Ivy. Ivy was a prominent cancer research scientist, a former medical adviser for the prosecution at the Nuremberg Hearings who claimed credit for developing the Nuremberg Code for medical experimentation on human test subjects, and Vice President of the University of Illinois. Ivy became Durovic’s gateway into the mainstream medical community, introducing his alleged cure to the world in a 1951 press event. Douglas, meanwhile, managed to secure Durovic, his brother, and their families permanent residency in the United States.

However, such bold claims inevitably attracted scrutiny. In 1959, the National Cancer Institute with endorsements from the American Cancer Society and the American Medical Association called upon Durovic to allow researchers to test the drug’s efficacy. Durovic long asserted that the development of Krebiozen was a closely-guarded secret, which is often a red flag when it comes to medical research as many studies rely on reporting findings so other scientists can verify a study’s claims. Researchers later concluded that Krebiozen was nothing more than mineral oil containing creatine monohydrate, a naturally-occurring substance responsible for muscle growth (today creatine supplements are frequently used by people with muscle growth deficiencies or in bodybuilding).

In 1965, Durovic, his brother Marko, Ivy, and Dr. William F.P. Phillips were brought up on 42 counts of fraud as well as other charges related to the manufacture, sale, and use of their phony cancer cure. While a jury acquitted them of all charges in January 1966, the FDA banned interstate transportation of Krebiozen outside of Illinois and the Illinois legislature banned its sale in 1973. Once a prominent physician, Ivy’s reputation never recovered. (For more on the FDA’s investigation, there is this fascinating account by former FDA lawyer William Goodrich, pgs. 41-47.

For more information on the Krebiozen case, see this September 15, 2018, overview in The Chicago Tribune and this August 26, 2017, Washington Post article on FDA scientist Alma Levant Hayden, who scientifically proved Krebiozen was a fraud.

With that, our first installment of Bad Medicine is in the books. I hope you’ll tune in for our journey to find the “real” cure for cancer.

Until next time, catch you on the strange side!

Air Pollution: How Air Affects Us, and How We Affect Air

Healthy environments lead to healthy inhabitants. Just as much as we affect the environment with our actions, the environment affects us whenever we interact with it, which as you can imagine happens quite often. One of the most important necessities for our body is oxygen, which of course comes from the air. Since we depend on the contents of the air so much, it goes without saying that pollution in the air is not good for humanity, or anything on the planet for that matter. This kind of pollution is a bigger killer than some may realize at first glance, and it is highly likely it will continue to get bigger at the current rate. Currently, outdoor and indoor air pollution are responsible for 4.2 million and 3.8 million deaths per year respectively. Over 90% of the world’s population lives somewhere in which air quality falls outside of the standard air quality guidelines as set by the WHO.

A photograph taken in Philadelphia

A photograph taken in Philadelphia, the Mütter Museum’s hometown

Air pollution is also responsible for the following:

  • 29% of all deaths and disease from lung cancer
  • 17% of all deaths and disease from acute lower respiratory infection
  • 24% of all deaths from stroke
  • 25% of all deaths and disease from ischaemic heart disease
  • 43% of all deaths and disease from chronic obstructive pulmonary disease

Despite air pollution affecting every population, there are certain populations that are actually more affected than others. Generally speaking, lower income countries, as well as communities that live near high traffic and industrial sites are the ones that are most likely to be impacted by pollution in the air. About 90% of deaths mentioned in the aforementioned premature death statistic happened within countries that are considered mid-income to low-income.

Encased coal miner's lung

A visual example of how breathing in poor air can affect lungs on a greater scale to give an idea of how similar effects can take place on an everyday level.
Image taken from Mütter Museum collection.

Another important factor to take note of when speaking of air pollution is people who already have pre-existing conditions unrelated to the pollution. The pollution can worsen an existing condition, especially in young children and elders. These include heart disease, lung disease, and asthma. Even lungs that are not fully developed yet can have reductions in their growth rate or ability to function if exposed.

Our own health isn’t the only thing at risk. The environment that we all live in is doomed to meet a similar fate if air pollution stays a prominent factor. The climate and ecosystems all around the globe can deteriorate as much as we can, and they already have started to show some signs that they are. Specific pollutants such as methane and black carbon are powerful contributors to changes that can be alarming in the long run such as climate change and productivity in agriculture. Just looking at recent events, such as how climate change is talked about politically, or how the amazon forest fires started up, we can see that the once negative possibilities of pollution are already starting to become a reality, and will only get worse if things are not changed from their current state.
What can we do? First, it’s vital to know what role we as a society have in making air pollution worse. Some of the ways that humans have a direct impact on air quality include:

  • Fuel combustion
  • Generating of heat and power
  • Industrial work
  • Burning of waste
  • Using polluting fuels to cook, heat, and light
Factory emitting exhaust into the sky

Factory emitting exhaust into the sky; one example of many of how we pollute the air.

It is becoming more apparent each day that we need to take some sort of action if we want air pollution to stop affecting us and the environment. This is not a problem that will just go away if we wait long enough. Cooperation across all sectors in reducing our reliance on damaging aspects of life, while a hard task to accomplish, is crucial to kick-starting the end to the problem. Society needs to start making the change to cleaner transportation and power before the negative effects become worse than they already are, and that should just be the beginning. Changes in city structuring, recycling as much as possible, replacing appliances that are damaging, and much more can help make a difference both in the short and long term. If you care about the issue, it can’t hurt to spread the information in any way you can, as awareness on the problem at hand is the first step to making the change. You can’t just buy another Earth if it goes kaput like you can with a cell phone or something like that, so it’s important to take care of the one we have.

Environmental Defense Fund: Health Impacts of Air Pollution
World Health Organization: Air Pollution