Heroin in the hospice: opioids and end-of-life discussions in the 1980s

Which drugs should be available for people nearing the end-of-life and suffering pain? What are the limits of appropriate opioid use in modern medicine and within society? The story of heroin in palliative care during the 1980s remains largely untold, and it’s one thoroughly infused with politics, social values and cultural norms of the time.

I write about this in my forthcoming book and in the newest edition of the Canadian Medical Association Journal. Here are the highlights.

1. In 1979, a celebrity doctor and syndicated columnist, Kenneth Walker, who wrote under the pseudonym W. Gifford-Jones, launched a nationwide campaign to legalize heroin (diacetylmorphine) for Canadian patients with terminal cancer.
2. This story showcases how the politics of pain, opioid addiction, and proper end-of-life therapies present enduring challenges in Canadian society, challenges which remain vital today
3. The early 1980s was an historical moment that saw a renewed discussion of opioids in end-of-life care, but also a time in which the prescribing of strong opioids such as oxycodone began to increase in the United States and Canada.
Please read my full article in the Canadian Medical Association Journal.

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Cocaine and Colombia

The first line of a recent Washington Times story about cocaine in Colombia spells the country incorrectly. ‘Ninety-five percent of the cocaine sold on the streets of the United States today comes from Columbia.’ Don’t get me wrong, we all make mistakes. But c’mon. Really? Then, the rest of the article mixes the spellings.

It’s weird.

Here’s what’s going on, according to the Economist:  “In October some 200 FARC troops here, like up to 15,000 of their comrades across the country, will assemble at a designated area and start putting their weapons into containers under the watchful eyes of a UN mission that will later supervise their destruction. ‘There’s optimism, but there’s also a lot of mistrust,’ says a burly man who is the civilian leader in the FARC territory and gives his name as ‘Grossman.’

The FARC’s disarmament and conversion into a political party is the crux of a peace agreement forged over four years of hard talking in Havana and signed in Cartagena on September 26th. It is not quite true to say, as Juan Manuel Santos, the president, told the UN General Assembly on September 21st, that ‘the war in Colombia is over.’ There are other illegal armed groups. But the struggle between the FARC and the state, exacerbated in earlier years by right-wing paramilitaries, was by far the biggest conflict. It was responsible for most of the 220,000 deaths due to conflict and thousands of kidnappings seen over the past five decades. It displaced perhaps 6m people.

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The agreement comprises 297 dense pages. It is of enormous complexity and involves controversial trade-offs, especially between peace and justice. Politically, if not legally, it can only come into effect if it is ratified by Colombian voters in a plebiscite on October 2nd. Polls suggest that around 60% of those that turn out will vote Yes. But will enough do so to meet the minimum 4.5m votes (13%) campaign in which the naysayers, inspired by Álvaro Uribe, a former president, accuse Mr Santos of selling out democracy and claim he could and should have struck a harder bargain. The Yes campaign counters that its opponents really favour war.”

Essentially, this was the best deal that could be struck.

Even the conservative Washington Times, which can’t even spell the country’s name properly, agrees.

“The White House, the Drug Enforcement Administration, State Department and Department of Defense all have means to coordinate with and assist Colombia in fighting drugs. It’s time to recognize the FARC peace deal for what it is — necessary but dangerous — and take steps to avoid the growth of a narco-state in Colombia that could well fuel a drugs-and-crime epidemic in the United States.”

With all the discussion over Donald Trump’s cocaine habit, Colombian policy seemed particularly relevant!

Here’s a classic!

 

 

Sports and Sports Medicine in CBMH/BCHM

Do you have an Olympic hangover? Missing the thrills and excitement? You’re not alone. People are clearly pining for more of Bolt and Biles, Phelps and the Fijians. But fear not. You can get your fix in CBMH/BCHM.

Back in 2011, the journal held a special issue on sports and medicine. The editors, Eileen O’Connor and Patricia Vertinksy, argued that “elite sport” and “sports medicine are increasingly at the forefront of public consciousness, especially when the Olympic Games come to town…”

But they’re aim was to push beyond the Olympics. It would be an error, they suggested, to “confine the historical study of sport medicine to the world of high level athletics,” considering the linkages “between exercise, sport and medicine for all age groups and in different regions of the world goes back millennia.”

Nevertheless, the Olympics get some attention! Thankfully. In James Rupert’s Genitals to Genes: The History and Biology of Gender Verification in the Olympics and Parissa Safai’s A Healthy Anniversary? Exploring Narratives of Health in Media Coverage of the 1968 and 2008 Olympic Games, readers are exposed to scientific and mass media analyses of the games. Both are excellent and topical articles!

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The former is very interesting, especially since the 800 metre women’s final was the most controversial race of the Olympics. Some in the race openly questioned whether Caster Semenya of South Africa should have been allowed to compete due to a condition called hyperandrogenism, where an athlete’s testosterone level is elevated. It’s also been suggested that Francine Niyonsaba and Margaret Wambui might also have a similar condition. According to the National Post, Poland’s Joanna Jozwik, who was fifth in Saturday’s final, and Great Britain’s Lynsey Sharp, who was sixth, both openly questioned the fairness of female athletes competing with high levels of testosterone.

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Canadian Melissa Bishop placed 4th

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If you’re interested in sports in specific geographical regions, then you can also get your fix. Bouchier and Cruikshank, in Abandoning Nature: Swimming Pools and Clean, Healthy Recreation in Hamilton, Ontario, c. 1930s-1950s, address Canada. Gertrud Pfister tackles “Sports” Medicine in Germany and Its Struggle for Professional Status, whereas the prolific public historian Vanessa Heggie showcases Sport (and Exercise) Medicine in Britain: Healthy Citizens and Abnormal Athletes. It’s a remarkable set of essays.

And below was a remarkable race!

For more on what I’m doing with the CBMH/BCMH, please see the announcement here.

 

Drug History in CBMH-BCHM

The Drug Policy Alliance, an organization dedicated to the promotion of drug policies based on science, compassion, health, and human rights, recently published an article entitled the “The Real History of Drugs.”

The author, Tony Newman, asks “why are some drugs legal and some prohibited? Why do we arrest approximately 600,000 Americans each year for marijuana possession, but sell tobacco and alcohol on most corners? Why do we lock up people who use meth for years, and dole out the similar drug Ritalin to our children?”

He then answers these questions with a single statement: a mixture of racism, stigma, and the individuals perceived to be using the illegal drugs.

At the same time, the article points toward short, slick videos that address the “real” history of substances, including cocaine, cannabis, and

MDMA

as well as LSD

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The video are well-produced and easily digestible.

Here’s the thing, though. Any “real” history of drugs will require a close reading of Canadian Bulletin of Medical History/Bulletin canadien d’histoire de la médecine.

In the realm of pharmaceuticals, you have Jackie Duffin’s In View of the Body of Job Broom: A Glimpse of the Medical Knowledge and Practice of John Rolph, Stephen Francom’s Pharmacy Records at the Archives of Ontario: Their Form, Content, and Value for Research, Laura Hirshbein’s Masculinity, Work, and the Fountain of Youth: Irving Fisher and the Life Extension Institute, 1914-31, and Peters’s and Snelders’s From King Kong Pills to Mother’s Little Helpers—Career Cycles of Two Families of Psychotropic Drugs: The Barbiturates and Benzodiazepines.

(In fact, the entire volume in which Peters and Snelders published their work contains wonderful, wide-ranging drugs-related articles.)

Then, in the realm of intoxicants and addiction, there’s Krasnick’s Because there is Pain: Alcoholism, Temperance and the Victorian Physician, Dan Malleck’s “Its Baneful Influences Are Too Well Known”: Debates over Drug Use in Canada, 1867-1908, Catherine Carstairs’s Deporting “Ah Sin” to Save the White Race: Moral Panic, Racialization, and the Extension of Canadian Drug Laws in the 1920s, and Dan Malleck’s (yes, Malleck again) “A State Bordering on Insanity”?:Identifying Drug Addiction in Nineteenth-Century Canadian Asylums.

Look, this is not a comprehensive list of all the articles that tackle drugs in CBHM-BCHM. Instead, this is just to provide a flavour…

So, when you’re looking for the “real” history of drugs, go further, dig deeper, and read happily. When you’re looking for answers to questions like those posed by Tony Newman, hit up the CBHM-BCHM.

Enjoy.

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For more on what I’m doing with the CBMH/BCMH, please see the announcement here and be sure to visit https://cshm-schm.ca/

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The Weight of History/The History of Weight in CBMH/BCHM

Or, History has Heft: On Public History and Debates about Weight Loss

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Trying to lose weight isn’t a new phenomenon. Consumers have long searched for a safe and effective approach to lose weight. At the same time, a strong debate persists about the genetic component of obesity, new scholarly sub-fields (see Fat Studies) are emerging questioning the stigmatization of overweight individuals, and our body images are being shaped by these forces. Historians have a crucial role to play in the way in which individuals, communities, and health authorities conceptualize bodies and think about weight.

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In The Wonderful Wizard of Oz, written by Frank L. Baum, all of the characters are searching for something. Dorothy is looking for a way home. The Scarecrow wants a brain, whereas the Tin Man wants a heart and the Lion desires courage.The only way to attain their goals is to visit the Wizard of Oz in the Emerald City. Only with his magic will their wishes be granted. As it turns out, the wizard is a total fraud. He’s just an ordinary man trying to protect his position and his empire. He’s a charlatan looking out for himself.

It is the same with TV’s Dr. Oz. As Americans (and Canadians) seek out their own desires,  be it weight loss or low blood pressure, it’s best to be wary of false wizards.

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In 2014, Dr. Oz was called before a Senate committee on consumer protection and given a public lashing for his promotion of fraudulent weight-loss products. He admitted he was a bit of a cheerleader, using flowery language, although he suggested that it was important to advertise multiple views on the show. He also admitted that some of the products he’s suggested his viewers use don’t necessarily have “the scientific muster to present as fact.” For many, Oz came across as a quack and a huckster.

svetol-green-coffee-extract-benefits
Promoted by Dr. Oz

John Oliver, of Last Week Tonight, came down hard on Oz. He taunted and belittled the TV doctor. He used all the bells and whistles he could, including a tap-dancing Steve Buscemi, to continue the public lashing. Likewise, New York Times columnist Frank Bruni described Oz as “a carnival barker” and “a one-man morality play about the temptations of mammon and the seduction of applause….” Then, a group of high-profile doctors called for the removal of Oz in a public letter. They suggested he was pushing “miracle” weight-loss supplements with no scientific proof that they work. He displayed an “egregious lack of integrity,” said the letter, and Oz had shown “disdain for science and for evidence-based medicine.”

In 2015, I decided that I had something to offer about this matter. I felt that, having written about the history of the pharmaceutical industry and diet pills, I could contribute to the understanding of Oz. His influence on people. The role of spurious products in the marketplace. More specifically, I thought I could move beyond the walls of the so-called Ivory Tower and link my academic research with the public and maybe even policy-makers, as Kathleen O’Grady and Noralou Roos have advocated for.

As they put it, “An average paper in a peer-reviewed academic journal is read by no more than 10 people, according to Singapore-based academic Asit Biswas and Oxford researcher Julian Kirchherr, in their controversial commentary “Prof, No One Is Reading You,” which went viral last year….as many as 1.5 million peer-reviewed articles are published annually, with as many as 82 percent never cited once, not even by other academics. In other words, most academic writing rarely influences thinking beyond the privileged circles in which it is constructed – and the vast majority of it is far from influencing public policy and debate on critical issues.”

So, why not try a short piece aimed at the public? Oz was topical, after all.

It was not the first op-ed/web-based article that I had written for public consumption, nor will it be the last. However, the result was stunning. I criticized Oz rather severely (using some of the same language above) and certain readers pushed back hard. Because Oz was a supporter of organic and natural foods, and because he often positioned himself as anti-GMO, I was, by default a supporter of big business, of Monsanto, and a product of the right-wing establishment. It was startling that my piece on Oz would generate such animosity.

Perhaps I shouldn’t have been surprised.

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This is where the Canadian Bulletin for Medical History/Bulletin canadien d’histoire de la médecine comes into the story of The Weight of History/The History of Weight. Because any historian wanting to engage with weight loss, dieting, and public health in Canada (as well as beyond) must – absolutely must – engage with CBMH/BCHM.

Obesity is not the exclusive focus of all CBMH/BCHM articles addressing health, food, and dieting, although such works as 1987’s “Juan Luis Vives: A humanistic medical educator,” 1993’s “Medieval Women’s Guides to Food During Pregnancy: Origins, Texts, and Traditions,” and 1995’s “Promoting Good Health in the Age of Reform: The Medical Publications of Henry H. Porter of Philadelphia, 1829-32,” showcase the evolving knowledge of nutrition and proper eating in general sense.

More specifically, Lori Loeb explores Upper Canadian quacks and spurious diet drugs in “George Fulford and Victorian Patent Medicine Men: Quack Mercenaries or Smilesian Entrepreneurs?”  Fulford, a Canadian senator and philanthropist, made his fortune from a product called Dr. Williams’ Pink Pills and he serves as a window into the patent medicine industry, which included various obesity “cures.” For Loeb, “Popular obesity cures…were mostly citric acid in water. The dangers of a minority of medicines, especially soothing syrups, which contained laudanum and chlorodynes should not be minimized, but many medicines were not only benign, but even appropriate for common ailments. Indigestion remedies were largely bicarbonate of soda. Rhubarb pills were good laxatives.” (130) The article is useful for a variety of reasons, but one of the more crucial has to be the discussion of professionalization, evolving safety standards, and developing medical knowledge surrounding the patent medicine industry. Essentially, Loeb is placing Fulford – an influential operator in the medical marketplace – under a microscope.

Then, there’s the journal’s approach to alternative medicine. Through such works as Ziadat’s “Western Medicine in Palestine, 1860-1940: The Edinburgh Medical Missionary Society and Its Hospital,” Heap’s “Physiotherapy’s Quest for Professional Status in Ontario, 1950-80,” Jasen’s “Maternalism and the Homeopathic Mission in Late-Victorian Montreal,” and Furth’s Paterson lecture on “Becoming Alternative? Modern Transformations of Chinese Medicine in China and in the United States,” readers have been exposed to conflicts within professional and scientific medicine over alternative medical knowledges, as well as upstart organizations.

What becomes clear in these articles, in addition to Barbara Clow’s excellent work on “Mahlon William Locke: ‘Toe-Twister’“, is that unusual therapies and counter-knowledges in medicine generate tremendous heat. The topic may be “toe-twisting” for arthritis or anti-vaccination narratives or diet pills or organic food/anti-GMO foods – these issues are all of the hot-button variety. And the CBMH/BCHM clearly underlines this. Hence, I should not have been surprised by the response to my Oz article.

Skip ahead.

In 2011, Roberta J. Park wrote about weight loss and public health with “Historical Reflections on Diet, Exercise, and Obesity: The Recurring Need to“Put Words into Action.” She cited how the American Centers for Disease Control estimated that more than one third of all adults and nearly one fifth of children were obese. And she argued, as the title of her paper suggested, more had to be done! It was time to put “words into action.”

Thereafter, in an incredibly ambitious article, Park tackled the historiography and history of diet, exercise, and obesity in (a) the Classical World; (b) the 1700s and 1800; and (c) the 1900s. She concluded with a clarion call – that it was time “sports medical personnel, including physical educators, should embrace lessons from…past successes in promoting exercise and sport among children and adolescents, and rekindle practices once popular and effective but now abandoned.” (397)

Of all CBMH/BCHM articles on weight loss, Park’s is the work most grounded in public policy – and the one most strident in its call for change. For historians and other academics to push for change!

The debate over diet drugs and body image continue. We still gobble up quick-fixes peddled by celebrities and we still search for drugs that will make losing weight painless. As Americans and Canadians continue to struggle with obesity, the history of diet pill regulation may continue to display familiar patterns. At the same time, the CBMH/BCHM can act as a tool in fostering new pathways in the months and years ahead.

Vaccine History in CBMH/BCHM

Vaccine & Immunization History in CBMH/BCHM

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The roadway to effective, accepted vaccines in history is neither smooth nor straight. Vaccines naturally induce potent social, political, and economic responses. They raise questions about scientific authority and the production of medical knowledge. Even more, vaccines have challenged the physician’s influence over patient-consumer choice in the medical marketplace, as anyone who watched Jenny McCarthy shape the discussion over autism and anti-vaccination can attest.

jenny_mccarthy

 

In 2016, commentators and historians are addressing this subject with verve. Many texts – hastily rushed to print after widespread media coverage of Jenny McCarthy’s campaign against vaccines – are aimed at a general audience, whereas others target more specialized academic and historical audiences. Two fine entries in the latter group include Elena Conis’s Vaccine Nation: America’s Changing Relationship with Immunization (Chicago UP, 2014) and Stephen Mawdsley’s very recent Selling Science: Polio and the Promise of Gamma Globulin (Rutgers UP, 2016), both of which concentrate largely on the second half of the twentieth century.

*Conis was the plenary speaker at the recent meeting in Calgary*

* Mawdsley, of course, is CSHM-SCHM ‘s website manager and editor *

And with Karen L. Walloch’s important new book, The Antivaccine Heresy: Jacobson v. Massachusetts and the Troubled History of Compulsory Vaccination in the United States (Rochester UP, 2015), we are exposed to much earlier wrangling over vaccination – specifically, compulsory vaccination – in the United States. Set against the vivid, shifting backdrop of Progressive-era ferment and, more particularly, a modern paradigm of public health predicated on the rise of bacteriology, Walloch examines the landmark Jacobson v. Massachusetts decision of 1905, which upheld a state statute mandating vaccination.

For the authors listed above, resistance to immunization or other medical decisions is not borne out of singular ignorance, nor is it always a function of big government, anti-medical establishment paranoia.

(To be sure, there are very real consequences of ignoring the best scientific evidence on inoculating agent – and there are dangers in not redressing the consequences of ignoring the best scientific evidence and tackling counter-narratives, as in the case of Nicoli Nattrass’ The AIDS Conspiracy: Science Fights Back. I have noted this elsewhere).

However, by treating antivaccinationist views coolly, and in seeking to appreciate why well-educated and reasonable people objected to medical innovation, the authors are suggesting that we may develop more sophisticated responses to vaccine counter-narratives and counter-knowledges in the present.

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Vaccine history is old hat for CBMH/BCHM readers, considering such scholars as Katherine Arnup, Barbara Tunis, Maureen Lux, and W.B. Spaulding have all contributed to the historical discussion of inoculation and vaccines.

Indeed, the very first article of the very first issue focussed on Dr James Latham, a “pioneer inoculator.” According to Barbara Tunis, “little has been known of his life or subsequent career” and the “intention of this short biography” was to “examine the broader content of his career as an inoculator and his years in North America.” (1) In unpacking his life and medical practice, Tunis finds that Latham, who lived from 1734-1799, was “materialistic” in his approach to the craft and “following a trend already established in England and America…” (11) It’s an intriguing article!

Later, William Spaulding’s “The Ontario Vaccine Farm, 1885-1916” builds on the work of Tunis and charts Canada’s response to smallpox.  “Established in 1885 by Dr. Alexander Stewart, a local physician, the Ontario Vaccine Farm was the first institution to produce smallpox vaccine in Ontario,” writes Spaulding. (54) The Farm originally consisted of a converted barn where Stewart employed government-approved methods for obtaining and processing vaccine from inoculated calves – and the article is made even more interesting through its inclusion of illustrations.

In 1992, Katherine Arnup once more placed a spotlight on Ontario vaccination, with “Victims of Vaccination?: Opposition to Compulsory Immunization in Ontario, 1900-90.” And, just as Elena Conis and Karen Walloch have recently underlined the tense back-and-forth, push-and-pull among supporters and detractors of vaccination, Arnup does the same. On the one hand, she focuses on the social and political dimensions of a particular struggle over compulsory vaccination against smallpox in the city of Toronto during the first two decades of the 20th century. One the other hand, Arnup turned to contemporary debates, “to the current controversy over the use of the pertussis vaccine, examining the work of the Committee Against Compulsory Vaccination, the group battling against immunization legislation…” (159-160)

And her conclusion certainly presages many of the findings and sentiments found within recent work that give more credence to anti-vaxxers, vaccine hesitance, and vaccine resistors:

“One of the lessons that history can teach us is that in dismissing the opponents of immunization as ‘mere nonentities’ we underestimate the appeal that their message has. Although the vast majority of parents today opt for immunization for their children, increasing numbers of people are expressing concerns about its safety. While there are undoubtedly fanatics among the opponents of immunization, there are also many thousands of concerned parents, wondering what is best for their children.” (171)

In its balance and tenor, it’s strikingly similar to what’s emerging now!

Finally, with Lux’s “Perfect Subjects: Race, Tuberculosis,and the Qu’Appelle BCG Vaccine Trial,” the historiography shifts further forward chronologically and begins to include Indigenous peoples of Canada. The article also recasts Canadian vaccine history somewhat, as it uses themes of experimentation and colonialism to help tell a story about medial knowledge creation and Tuberculosis.

It’s a harrowing piece of scholarship (think Ian Mosby and Susan Reverby) that has the ability to make the reader uncomfortable, even angry. As Lux puts it, “The BCG trial at the Qu’Appelle reserves must be viewed in the historical context of Native-White relations. Native people were viewed as primitives and strangers in their own land and in need of fundamental change.” (291)

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Why do we question vaccines? And who are the thought leaders involved? Are they respectable, or are they hacks? And, more importantly, what can we glean from past debates about vaccines? Yes, the answers to these questions are being debated in brand new scholarship related to the United States and elsewhere, but (as noted in a previous post) it’s exciting that CBMH/BCMH readers were exposed to such historical questions from the journals’s beginnings.

(Please watch for a French version soon)

For more on what I’m doing with the CBMH/BCMH, please see the announcement here.

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FRENCH VERSION

Lhistoire de la vaccination et du vaccin dans le CBMH/BCHM

L’histoire nous montre que la route qui mène à des vaccins efficaces et acceptés est truffée d’embuche. Les vaccins entrainent systématiquement d’importants bouleversements sociaux, politiques et économiques. Ils soulèvent des questions relatives à l’autorité scientifique et à la production de savoir médical. Par ailleurs, les vaccins ont contesté l’influence du médecin pour tout ce qui a trait au choix des patients-consommateurs sur le marché médical, comme tous ceux qui ont pu voir Jenny McCarthy mener la discussion sur l’autisme et l’anti-vaccination peuvent en témoigner.

En 2016, les commentateurs et les historiens se penchent sur ce sujet avec brio. Beaucoup de textes (imprimés à la va-vite après une importante couverture médiatique de la campagne de Jenny McCarthy contre les vaccins) sont destinés à un public profane, tandis que d’autres ciblent des auditoires d’universitaires et d’historiens plus spécialisés. Citons comme contributions notables dans la seconde catégorie Vaccine Nation: America’s Changing Relationship with Immunization (Chicago UP, 2014) et Selling Science: Polio and the Promise of Gamma Globulin (Rutgers UP, 2016) par Elena Conis et très récemment par Stephen Mawdsley, qui se concentrent principalement sur la seconde moitié du XXe siècle.

* Conis était la conférencière en séance plénière lors de la récente réunion à Calgary *

* Mawdsley, bien sûr, est l’administrateur du site CSHM-SCHM *

Et avec l’important nouveau livre de Karen L. Walloch, The Antivaccine Heresy: Jacobson v. Massachusetts and the Troubled History of Compulsory Vaccination in the United States (Rochester UP, 2015), on apprend que les querelles concernant la vaccination aux Etats-Unis sont bien plus anciennes (en particulier, la vaccination obligatoire). Avec pour toile de fond cette ère Progressiste vive et mouvementée et, plus particulièrement, un paradigme moderne de santé publique fondée sur l’influence grandissante de la bactériologie, Walloch examine la décision historique Jacobson v. Massachusetts de 1905, qui a confirmé une loi de l’État rendant obligatoire la vaccination.

Pour les auteurs énumérés ci-dessus, la résistance à la vaccination ou à d’autres décisions médicales n’est pas le fruit d’une ignorance singulière. Elle n’est pas non plus la conséquence systématique d’une méfiance paranoïaque envers un gouvernement puissant ou envers le système médical.

Pour sûr, ignorer les meilleures preuves scientifiques concernant l’agent inoculant n’est pas sans conséquences et il est dangereux de ne pas pallier à cette ignorance des meilleures preuves scientifiques et de ne pas lutter contre les récits révisionnistes, comme dans le cas de The AIDS Conspiracy: Science Fights Back par Nicoli Nattrass. Et j’ai constaté ça ailleurs.

Cependant, en examinant les points de vue « anti-vaccinationistes » froidement, et en cherchant à comprendre pourquoi des personnes aussi bien éduquées et raisonnables ont pu s’opposer à l’innovation médicale, les auteurs suggèrent que l’on peut aujourd’hui développer des réponses plus sophistiquées aux récits révisionnistes et aux contre-vérités.

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Les lecteurs de CBMH / BCHM en sont bien conscients, étant donné que des chercheurs comme Katherine Arnup, Barbara Tunis, Maureen Lux et W.B. Spaulding ont tous contribué à la discussion historique de l’inoculation et les vaccins.

En effet, le tout premier article du tout premier numéro portait sur le Dr James Latham, un « pionnier de l’inoculation. » Selon Barbara Tunis, «  on connait très peu de sa vie ou de sa carrière ultérieure» et «le but de cette courte biographie » est « d’examiner le contenu plus large de sa carrière en tant « inoculateur » et ses années en Amérique du Nord. » (1) En examinant sa vie et sa pratique médicale, Tunis estime que Latham, qui a vécu de 1734 à 1799, était «matérialiste» dans son rapport à sa pratique et «suivait une tendance déjà établie en Angleterre et en Amérique … » (11 ) C’est un article fascinant !

Par la suite, « The Farm Vaccine Ontario, 1885-1916 » de William Spaulding s’appuie sur les travaux de Tunis et analyse la réponse du Canada à la variole. « Fondée en 1885 par le Dr Alexander Stewart, un médecin local, la Ferme à vaccin de l’Ontario (Ontario Vaccine Farm) a été la première institution à produire le vaccin contre la variole en Ontario», écrit Spaulding. (54) La Ferme se composait initialement d’une grange aménagée dans laquelle Stewart employait des méthodes approuvées par le gouvernement pour l’obtention et la fabrication de vaccins à partir de veaux inoculés. Les illustrations rendent l’article encore plus intéressant.

En 1992, Katherine Arnup mit une fois de plus en lumière la vaccination en Ontario, avec « Victims of Vaccination?: Opposition to Compulsory Immunization in Ontario, 1900-90. » Et, tout comme Elena Conis et Karen Walloch ont récemment souligné les tensions liées au va-et-vient parmi les partisans et les détracteurs de la vaccination, Arnup fait de même ici. D’une part, elle s’attarde sur les dimensions sociales et politiques d’une lutte particulière portant sur la vaccination obligatoire contre la variole dans la ville de Toronto au cours des deux premières décennies du 20e siècle. D’ autre part, Arnup s’intéresse aux débats contemporains : « la controverse actuelle concernant l’utilisation du vaccin contre la coqueluche, examinant les travaux du Comité contre la vaccination obligatoire (Committee Against Compulsory Vaccination), qui luttait contre la législation de vaccination …» (159-160)

Et sa conclusion précède certainement beaucoup d’idées et d’impressions que l’on peut trouver dans certains travaux récents qui donnent plus de crédibilité aux anti-vaccinationistes, l’hésitation des vaccins et des résistances de vaccins :

« L’une des leçons que l’on peut tirer de l’histoire, c’est qu’en rejetant les adversaires de la vaccination comme de « simples nullités », nous sous-estimons la portée de leur message. Bien qu’aujourd’hui la grande majorité des parents opte pour la vaccination de leurs enfants, beaucoup de personnes émettent des réserves quant à sa sécurité. C’est sûr qu’il existe des fanatiques parmi les opposants à la vaccination, mais il y a aussi des milliers de parents inquiets qui se demandent ce qui est le mieux pour leurs enfants. » (171)

Dans son équilibre et sa teneur, c’est étonnamment similaire à ce qui est en train d’émerger !

Enfin, avec « Perfect Sujets: Race, Tuberculosis and the Qu’Appelle Vaccin BCG Trial, » écrit par Lux, l’historiographie se penche sur des sujets plus contemporains et commence à inclure les peuples autochtones du Canada. D’une certaine manière, l’article refonde également l’histoire du vaccin au Canada, étant donné qu’il a recours aux thèmes de l’expérimentation et du colonialisme pour raconter une histoire de la création des connaissances médicales et de la tuberculose. C’est un article poignant (cf. Ian Mosby et Susan Reverby), qui a la faculté de mettre le lecteur mal à l’aise, voire en colère. Comme Lux le dit, « Le procès BCG dans les réserves Qu’Appelle doit être étudié dans le contexte historique des relations autochtones-Blanc. Les autochtones étaient considérés comme des êtres primitifs et des étrangers au sein de leur propre pays et comme nécessitant un changement fondamental. » (291)

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Pourquoi nous interrogeons-nous sur les vaccins ? Et qui sont les leaders d’opinion concernés ? Sont-ils respectables ou sont-ils des imposteurs ? Et, de manière plus importante, que pouvons-nous tirer des débats d’antan sur les vaccins ? Oui, les réponses à ces questions sont débattues dans de nouvelles études portant sur les Etats-Unis et ailleurs, mais (comme indiqué dans un précédent post), c’est stimulant de penser que les lecteurs de CBMH/BCMH ont été exposés à de telles questions historiques depuis les débuts de la revue.

 

Medical History and the Arts!

Walt Whitman,  John Keats, and Franz Schubert. Literature, poetry, and classical music.

In the early stages of cataloging the Canadian Bulletin of Medical History/Bulletin canadien d’histoire de la médecine for the University of Toronto it has become abundantly clear that the journal showcased the intersection medicine, health, and the arts. (Here’s the announcement about what I’m actually doing.)

In 2014, the New York Academy of Medicine held its second annual Festival of Medical History and the Arts, which celebrated the 500th birthday of anatomist and humanist Andreas Vesalius. Vesalius’ groundbreaking De humani corporis fabrica (The Fabric of the Human Body) of 1543 remains one of the key Renaissance texts. It profoundly altered medical training, anatomical knowledge, and artistic representations of the body.

Page 174 of Andreas Vesalius’ De corporis humani fabrica libri septem, available at National Library of Medicine

 

While few figures have been so influential to the arts, learning, and medicine – and while Vesalius’ influence has persisted over the centuries in anatomical training, representations of the body and the visual arts – other important figures in the Arts deserve attention, too.

The CBMH/BCHM was addressing this as early as 1984, when S.E.D. Shortt probed Walt Whitman’s and Richard Bucke’s fiery friendship. In “The Myth of a Canadian Boswell: Dr. R.M. Bucke and Walt Whitman,” Shortt seeks to correct the view of Bucke, one of the most notable figures in Canadian mental health history. And he recasts the Bucke/Whitman relationship as one of “symbiosis rather than of master poet and sycophantic admirer.” (55) It’s a fascinating read and timely, especially since the New York Academy of Medicine just this month held a public forum on Walt Whitman, ‘Manly Health,’ and the Democratization of Medicine.

http://whitmanarchive.org/multimedia/image007.html?sort=year&order=ascending&page=1
Available at the Walt Whitman Archive

 

Thereafter, in 1986 (Vol 1) CBMH/BCHM placed a spotlight on the early medical career of John Keats and Franz Schubert’s terminal illness.

For G. Hetenyi, in the early 1980s “considerable uncertainty” still existed about Schubert’s terminal illness and the cause of his death in 1828. Thus, his article, “The terminal illness of Franz Schubert and the treatment of syphilis in Vienna in the eighteen hundred and twenties,” is part biography, part nosography. (51-52)

It ably locates Schubert within a particular medical culture (Vienna) and provides a unique window into his musical career. Along the way, Hetenyi raises some tantalizing questions: Was Schubert being poisoned? Was he suffering from Typhus?

 

Finally, “Keats as a Student at Guy’s Hospital” offers a wonderful snapshot of medical training within an elite institution, as well as the “varied profession.”  According to Donald Goellnicht, “Keats is famous first as a poet, second as a letter-writer, and hardly at all as a man of medicine.” (65-66)

John Keats – available on Biography.com

The goal, then, is to furnish a fuller portrait of Keats’s background. And the reader is exposed to the volatile nature of the medical field in the early 19th century, the gritty and grotesque world of anatomical and surgical education, and absorbing accounts of leading physicians, including Ashley Cooper who was widely regarded as one of the best medical lecturers in Europe.

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In essence, the earliest issues of CBMH/BCHM sought to highlight the crossroads of medicine, health, and the arts, which is, of course, very fashionable now.

The University of Toronto has recently started a Health, Arts, & Humanities Program, while the University of Saskatchewan just launched a Health Studies Program. And this is simply the tip of the iceberg. Many more universities and many lecturers/physicians/educators are evaluating the relationship between Medicine and the Arts.

It’s affirming that Canadian Association for the History of Medicine/  Société canadienne d’histoire de la médecine was doing this from the journal’s inception.

By Lucas Richert @DrLucasRichert

 

 

Medical History on the Move

I have a new blog post on the University of Toronto’s site.

 

I’m incredibly excited to be working with CBMH/BCHM and University of Toronto Press over the summer months. It will be my pleasure to help out with journal’s migration to the UofT’s publishing platform. As part of this transition, we are moving all of the back issues onto UofT’s server, and in some cases enhancing them, with abstracts and keywords. The journal is about to publish its 66th issue, so there are lots to consider!

As the journey commences this summer, I’ll be posting and tweeting about the process – all of the amazing stops and bumps in the road, as well excellent articles and contemporary health and medicine issues dating back to the mid-1980s. I’d guess holidays would come first, but I encourage you to share and participate in the voyage as much as you can!

For updates see, @DrLucasRichert and LucasRichert.com

Lucas Richert, PhD

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