medicine Archives - Not Even Past

The Odds are Stacked Against Us: Oral Histories of Black Healthcare in the U.S.

By Thomaia Pamplin

Thomaia J. Pamplin is a graduate student at the University of Texas MD Anderson/UTHealth Graduate School of Biomedical Sciences. Pamplin’s research focuses on the elderly, black community in Houston and their interactions with the healthcare system. She hopes her research will advance Narrative Medicine, a field that highlights the importance of knowing patients beyond their symptoms and causes. Pamplin aspires to be a doctor who lives up to that ideal in her own career.

Distrust in the U.S. healthcare institution has been pervasive in the black community for many generations. Although young African Americans may be far removed from atrocities like the Tuskegee Syphilis Study, in which hundreds of black men were inoculated with syphilis without their informed consent and without any treatment, the mistrust seems to be handed down through subsequent generations. This lack of confidence in the healthcare system is reflected in studies that show the black infant mortality rate in the U.S. is twice as high as white infant mortality. The excess risk experienced by African-American infants reflects factors that are unique to the black experience in the U.S., including area-level poverty, differential access to pre-and perinatal care and other socioeconomic differences.[1] Studies have also shown that patients’ perceptions of their health care providers’ attitudes toward their ethnic or mental health status affect a patient’s decision to even pursue healthcare provisions.[2] Stereotypes like “the strong black woman,” also pressure women to not seek help or when seeking help, to feel as though better care is provided for non-black patients.[3]

Unidentified subject, onlookers and Dr. Walter Edmondson taking a blood test as part of the Tuskegee Syphilis Study (Photo Credit: NARA, Atlanta, GA via Wikimedia Commons)

The Institute for Urban Policy Research and Analysis at the University of Texas reported that “Blacks of all socioeconomic levels are disproportionately affected by stress-related diseases that translate into a radicalized life expectancy.” They also found that throughout the U.S. there is a shortage of mental health professionals especially serving in low-income areas. There is a wide gap between the life expectancy of Black and White people in the U.S.; this gap “can be attributed to higher death rates among Black men and women due to heart disease, cancer, stroke, diabetes perinatal conditions, and homicide.” Many of these ailments are the leading causes of death for other marginalized groups in the U.S. Some of the recommendations this report makes is to expand Medicaid, health communities’ model, increase representation of black healthcare professionals, strengthen the social and economic structure of these communities, and promote health in all legislative policy.[4]

There are roughly one million practicing physicians in the US and less than 6 percent of those physicians are African-American.[5] Meaning that for the 44 million black residents of the U.S., there are about 60,000 black practicing physicians.[6] That is one black doctor for every 700 black patients. This is not to say that only African-American physicians can treat African-American patients, but distrust in healthcare institutions could potentially be alleviated by having providers be of the same ethnicity as the patient.

As the statistics of black health disparities rise and the need for healthcare intervention is increasing, the black church in the U.S. has the potential to mobilize people to seek medical care. Studies have shown that health interventions in black communities through the church have been successful, especially in early cancer detection.[7] Women play a “cornerstone” role in black churches and one study of Pastors’ perceptions on the health status of the black church and African-American communities found that “African-American women focus much of their time and energy caring for others within their church and less on their own health and well-being.” [8]

One way to understand the causes of racial health disparities, and the role of women in health care, inside and outside of black churches, is through oral histories, such as the interviews I conducted among lower-income women from a small congregation in southeast Texas. Two of their stories follow.

Black Nurse in North Carolina, March 1962 (via DPLA)

All Eyes on Mindi
“I remember being in school, in the classroom and not understanding what was being taught,” Mindi told me one day at a public library in South Texas. As she talked, I noticed big brown eyes peek from the edge of the wall near us. Glancing at me then, at her mom’s back, Mindi’s daughter was intimidatingly protective for a forty pound, four-year-old. Her thick, black hair was twisted in pink bow berets, somewhat resembling her mother’s short locs. The little girl skipped away after gathering the intel she needed.

“I was never bold,” Mindi told me “I was quiet and shy. And then I didn’t want to hurt people’s feelings… but now I can’t be that way anymore.”

Most of the 33-year-old mother’s career has been in education which is unsurprising when you hear her musical Texan accent. It sounds like at any point she can sing a song about a task, which would probably motivate all the kids in the library to start working.

“I would have blackouts and zone out,” Mindi continued. She had never been diagnosed with a learning disorder; however, these episodes did affect how the future educator learned. “What the teacher would say went over my head… I would have to focus ten times harder and read chapters twice over…I was always the one who needed the curve.”

In adulthood, the blackouts occurred at the worst of times, but the third incident was the most frightening. One day, while Mindi was driving her car, she had a blackout seizure and struck a pole. She didn’t drive for eight months after the accident. This incident forced her health to become her family’s top priority.

In June 2016, four months before her first seizure, Mindi’s eldest son, twelve-year-old Jay, moved out of her home and into his grandmother’s. “I was always so excited to have a family of my own, so what really caused the sickness is when I felt like I lost my son…My family was separated, my body just–” She paused, her hands were in front of her chest, the back of her hands faced me as one cupped the other. She moved her chest forward as if the words could be pulled from her, but instead, she relaxed her body, took a breath, and restarted. “He was there, but I felt like I was grieving him. I felt like I took it too hard.”

Mindi attributed the conflict she had with her son to her personality, “my son took advantage and ran with it…He would run away from home over the slightest thing. If I asked him to wash the dishes and I’m asking him for the third time, I’m not going to ask as nicely. Then bam! [He’d] run away.” She recalled how he would talk back to her but not to her husband, she didn’t believe he respected boundaries with her, but in actuality, she recalled, “those boundaries weren’t set with him, with my husband, or with my coworkers. I had to go and do that at the age of 32.”

Mindi began to see neurologists in efforts to treat her seizures. She took numerous tests, but the results would always come back normal. “I remember being hooked up to all these gears, and the physician would be doing random things to try to make me have a seizure.” He tested her as if she were epileptic, though Mindi knew that was not the case. “I just felt like based off my symptoms, he should have done different things to make me have a seizure…Rather than doing all the things by the book. I thought he should have gone outside of the box…read a little deeper into my demeanor.”

“I remember asking God to help me. I don’t want to be a victim. Deuteronomy 30:19, God says we have the power to control the mind. So, we get to choose.” Mindi internalized this idea; she would tell herself, “Mindi, you can’t be quiet and shy, speak up. If this didn’t work, then go to another doctor.” She became firmer with her physicians because her triggers were continuously overlooked by them, until finally, she met with a specialist who she felt saw her condition for what it was. “I felt like the ball was back in my court,” she said. “My best doctor is the psychiatrist that I’m seeing now. When he diagnosed me, he didn’t use all these medical terms. He put it into a form that I could understand, he explained that it was a chemical imbalance…He explained what my brain was doing and why. I wasn’t just blown off…I actually feel like I have a personal relationship with him…He wanted to see my symptoms and I was able to actually have a full-blown anxiety attack in front of him… His approach seemed more fact-based rather than assumption, that’s what I liked.”

“I have a lot of eyes on me. They’re waiting on my next move” Mindi said of her family as her daughter dashed into my view again, glancing at the both of us. According to Mindi, her increased self-advocacy has even affected the way her children communicate. “If they ever feel some type of way,” Mindi said, “they say it, and I can now give them an answer on their level to make them understand.” For her mental health, Mindi said “I can’t let anything linger. I can talk now freely…open[ly] and honest[ly] and however you receive it, I’m sorry that’s how you receive it because I have to say it for myself.”

The Treatment of Not “Very Important People”
I met with Canjie in her home in southeast Texas. Her living room had dark hardwood floors and a giant widescreen TV on the wall. The evening news was on. Canjie is a woman in her 60s. She’s tall and has a short wispy afro, along with a sweet small grin that frequently lights up her face when she greets you or laughs.

Canjie learned the importance of self-advocacy after the first time her mother became drastically ill. “She always had heart trouble,” Canjie told me. One day, about twenty-seven years ago, she called her mother from work, only to hear mother “talking out of her head,” unexpectedly she seemed mentally unwell. Canjie told her, “Momma, get ready I’m coming down there.” She drove from Houston to San Antonio, even though her mother insisted she not come. When she arrived in San Antonio, Canjie’s sister and son took her mother to see her primary care physician, a man she had been seeing for decades. “She trusted him,” Canjie remembered. Though to her family, Canjie’s mother seemed to clearly be in pain and very confused, the doctor said nothing was wrong with her. The next day, they took Canjie’s mother to see the same physician because she was increasingly unwell. Her son and the doctor argued, they “almost got into it,” Canjie said, because of the neglect her mother was receiving even after being in his care for years. Canjie remembers the older white male doctor condescendingly shaking his finger in her 24-year-old son’s face and her son angrily told him to take his finger away. Canjie’s sister had already put their mother back in the van they had come in. They had to return home quickly because a shooting had erupted in the area, “there was always some shooting going near [my sister’s] house,” where Canjie’s mother stayed.

They decided to take her to the ER, the next day “[we] found out her gall bladder was about to burst.” She remembers the ER doctor saying, “Oh yes, we’ve got to do surgery.” He also told them that their mother would not have much time to live without treatment. This incident motivated Canjie throughout her life to advocate better for herself and loved ones. “These doctors…they’ve got a lot of patients and it’s just about a job for them,” she said.

Her mother did pass away eventually, and afterwards, Canjie decided she wanted to find the doctor that had so egregiously dismissed her family. She found that he was illegally prescribing drugs to his family and other people, “so they had arrested him,” she reported. “This man was not right,” she told her family, “he didn’t give a damn about Momma. He was just making money…She made it through that, but it was a mess, I promise you that.”

Texas Hospital, 1970 (via Wikimedia Commons)

In most clinics, Canjie believed people were “being treated like cattle.” She recalled going to one’s doctor’s office, giving a few details of symptoms to a medical assistant, then only being in contact with a doctor for less than five minutes, before he diagnosed her and described her medication. She also believed that she was prescribed medication too quickly at times. “My potassium was low,” she recalled, “and right away, [my physician] wanted to write me a medication, and I said ‘No, let me see what I can do.’ So, I came home, and I started eating bananas every day. When I went back to him, my potassium was normal. I would’ve gotten that medicine for nothing.” This was 15 years ago, and she has never had a problem with potassium insufficiency since.

She does have favorable healthcare experiences, including a primary care physician, Dr. S. “What I liked about him [was] we could talk. He didn’t rush you. You know, these doctors get you and try to rush you out because they have the next patient to get [to] because of insurance [companies] and stuff. Well Dr. S, he was on that same kind of insurance, but he would sit you in his office and talk to you for 30 minutes. He didn’t rush you out… you’d have the time to ask him all kinds of questions.”

“I really loved being his patient,” she continued, “I liked his nurse. I liked the whole experience, but he decided 20 years down the road…that he wanted to do the VIP program. That’s where doctors have specific patients that pay them and have 24 hours access to them. So, they pay them not only what the insurance pays but outside of that… another $2000 a month or something of that nature,” she explained. Dr. S asked Canjie if she wanted to join the program, but she declined. “It’s for the chronically ill,” she said, “and rich [people]” she added lightheartedly, “not for me, you know?” As she said this, I searched her face for anger or disappointment, but there was no trace of resentment for not being included as a “Very Important Person” with her favorite primary care physician.

Conclusions
Mindi faced a problem that many parents and teachers experience, the weight of being responsible for many children’s upbringing. She was responsible for the development of her own children, as a Sunday-school and dance teacher, her community’s children, and as an educator, dozens in her district.

Her personality was such that her own needs and desires were not prioritized by others or herself at times. But with the intensity of her seizure condition increasing, her priorities changed. It was a very difficult road to becoming a better advocate for herself in every sphere, especially as a patient.

Mindi is typical of trends seen in black churches where their female members take on a heavy load of responsibility to others that can become detrimental to their own health. One reason Mindi wanted to share her story with me was to encourage other women with similar lifestyles, to start saying “no” more often, to take on less responsibility, and to prioritize their own health in order to live a better life.

Canjie’s experience demonstrates the difficulty of achieving good results even with advocacy. She learned to be a better advocate when her mother’s health was in danger. She used that knowledge to cut the costs of her own healthcare treatment and find physicians who she thought treated her well. Ultimately, Canjie settled for lesser healthcare experiences because her favorite physician could no longer afford to see her or anybody who could not pay the “VIP” price.

What’s at stake here is the survival of marginalized people. There is an incredibly difficult road to advocating enough for one’s self or family. The amount of advocacy needed is drastically different among different groups of people. The doubled mortality rate of black infants compared to white infants shows this. Even with evident advocacy, good treatment is still inaccessible for certain people.

There are dozens of stories like Mindi’s and Canjie’s that have been publicized and many generation’s worth of stories that have not reached the public.

This research was supported by the UT College of Liberal Arts Engaged Scholar Initiative.

References:
[1] Lauren M. Rossen, Diba Khan, and Kenneth C. Schoendorf, “Mapping Geographic Variation in Infant Mortality and Related Black–White Disparities in the US,” Epidemiology 27: 5 (2016). doi:10.1097/ede.0000000000000509
[2] Akhavan, S., Tillgren P., “Client/Patient Perceptions of Achieving Equity in Primary Health Care: A Mixed Methods Study,” International Journal of Equity Health 14:65 (2015). doi:10.1186/s12939-015-0196-5
[3] Nicolaidis, C., Timmons, V., Thomas, M.J., et al., “’You don’t go tell White people nothing’: African American women’s perspectives on the influence of violence and race on depression and depression care,” American Journal of Public Health. 100:8 (2018):1470–1476. doi:10.2105/AJPH.2009.161950
[4] Michelle Roundtree, “The State of Black Lives in Texas Health Report Health Report,” The University of Texas at Austin Institute for Urban Policy Research & Analysis. March 2019
[5] Kaiser Family Foundation. “Professionally Active Physicians.” https://www.kff.org/
[6] United States Census. https://www.census.gov.
[7] Slade, J.L., Holt, C.L., Bowie, J., et al. “Recruitment of African American Churches to Participate in Cancer Early Detection Interventions: A Community Perspective,” Journal of Religious Health 57:2 (2018):751–761. doi:10.1007/s10943-018-0586-2
[8] Gross, T.T., Story, C.R., Harvey, I.S., Allsopp, M., Whitt-Glover, M., “’As a Community, We Need to be More Health Conscious’: Pastors’ Perceptions on the Health Status of the Black Church and African-American Communities,” Journal of Racial and Ethnic Health Disparities 5:3 (2018):570–579. doi:10.1007/s40615-017-0401-x

To learn more, consider these suggestions for further reading:
“The Never-Ending Mistreatment of Black Patients” by Jessica Nutik Zitter (The New York Times)
“The State of Black Lives in Texas Health Report” by Michell A. Roundtree Ph.D., et al, March 2019
“Doctors Don’t Always Believe You When You’re a Black Woman” by Joanne Spataro (VICE)
“Black Women are Dying from a Lack of Access to Reproductive Health Services” by Lathasa D. Mayes (TIME)
“America is Failing its Black Mothers” by Amy Roeder (Harvard T.H. Chan School of Public Health)

You might also like:
Black Women in Black Power
Episode 80: Colonial Medicine and STDs in 1920s Uganda
Contraceptive Diplomacy: Reproductive Politics and Imperial Ambitions in the United States and Japan. By Aiko Takeuchi-Demirci (2018)
Industrial Sexuality: Gender in a Small Town in Egypt
#Blacklivesmatter Till They Don’t: Slavery’s Lasting Legacy

The views and opinions expressed in this article or video are those of the individual author(s) or presenter(s) and do not necessarily reflect the policy or views of the editors at Not Even Past, the UT Department of History, the University of Texas at Austin, or the UT System Board of Regents. Not Even Past is an online public history magazine rather than a peer-reviewed academic journal. While we make efforts to ensure that factual information in articles was obtained from reliable sources, Not Even Past is not responsible for any errors or omissions.

Mapping & Microbes: The New Archive (No. 22)

by Christopher Rose

Can the microbe speak?

It’s 5:30 pm, and I’ve been staring at my computer screen for over eight hours. There’s a crick in my neck, my breathing is shallow, my blood pressure has elevated, and the entire Giza governorate has just disappeared off of the map the instant that I finished tracing its borders—for the third time. I take a deep breath, utter a few choice unpleasant words under my breath, make sure to save my work, and turn off the computer. Today, the dragon has won.

I am two weeks into what I had originally, and naively, thought would be a one-week project to map the outbreak of epidemic and epizootic diseases in Egypt during the First World War, which comprises a subsection of my dissertation project. It’s not a great time to be working on Egypt, as it’s become nearly impossible to get research clearance from the Egyptian government. Funding has also become a near impossibility: my optimism at being named a finalist for a Fulbright in early 2016 was short lived; the program was suspended due to security concerns before awards were announced.

While online resources are scarce, I did find that the Egyptian government’s official gazetteer has an online index of its entire run since the 1870s. Over the course of several days, I discovered that the gazetteer was a virtual treasure trove of exactly the sort of data I’ve been looking for: reports of disease outbreaks in detailed locations up and down the Nile Valley. Over a week, I compiled a spreadsheet of almost 800 records for the period between late 1914 and mid-1919.

The question, of course, was what to do with this data. I was certain the diseases would tell me something, if I could just figure out how to get them to speak.

Map showing typhus outbreaks in Egypt, September 1, 1914 – May 31, 1919 (created by Chris Rose)

It was Julia Gossard, a UT alumna now teaching at Utah State University, who pointed me in the direction of the Programming Historian, a website dedicated to helping historians use digital tools to process data through modeling, mapping, and other methods. I didn’t have time to learn a programming language, but mapping was an idea I liked. The site has several columns about creating maps, using open source mapping software. While I’m a big fan of open source, especially when it replaces costly technical software, I was a bit uneasy about the lack of support for the platform – in short, I foresaw the ability to get myself into trouble, but not out of it.

A little digging around led me to the unexpected find that UT has an institutional subscription to ARCGIS, which is the (otherwise very expensive) industry standard mapping platform. Using UT’s institutional subscription to Lynda.com, I started training myself to use ARCGIS.

Had I known what I was getting myself into, I probably wouldn’t have dived right in.

Mapping the data required me to tag each record with the latitude and longitude of the reported location. This led me to one of the key stumbling blocks for all scholars of the Middle East who’ve dabbled in the digital humanities—so much data is out there on the web, but much of it is transliterated from the original language. There is no universally recognized Arabic-to-Latin transliteration method, and the potential inconsistencies are well on display in the web’s largest open-source geographic database, Geonames.org. While some of its Egyptian entries contained the original names in Arabic script, most did not, leaving me to guess—frequently incorrectly—how they might have been rendered. Since Geonames is open-source, I added the names both in Arabic and one of the more commonly recognized transliteration systems to Geonames’s database as I went, which will hopefully make someone else’s life a little easier.

People fleeing a cholera outbreak at the port of Boulaq (near Cairo) in 1883 (via Wellcome Collection)

Finally, it was time to start mapping, and herein lay another challenge. ARCGIS has an expansive built in library of open source data, which included, as I had hoped, administrative maps of Egypt. I very quickly realized, however, that the administrative borders of the early 21c did not correlate directly to those of the early 20c. At least one governorate has since been split into three and there were a lot of unfamiliar names on the maps. I discovered that the UT Libraries has a copy of the 1917 Egyptian census, which has a big fold out map of the country. I scanned it, brought it home and compared it to the current maps … and realized that it was probably going to be easier to draw the 1917 map in ARCGIS rather than try to adapt the contemporary maps.

The process took nearly two weeks, employing long forgotten Photoshop skills (yay for bezel curves!), tracing a century old map and rendering it onto a satellite image of contemporary Egypt. The resultant map is, as they say, “good enough.” It’s probably got a distortion of around 2 miles, but it’ll never appear in print at that level of detail. Maybe when my monograph becomes a best-seller, I’ll hire someone to re-draw it.

I learned that ARCGIS has some quirks. It has a tendency to freeze up every 60-90 seconds. I quickly learned to save my work every time I did anything, a lesson that came in handy when, for some reason, the entire Giza governorate vanished inexplicably … three times … after I drew it. (The following morning, I discovered that the governorate hadn’t vanished, it was just invisible. I still don’t actually know why).

Finally, the big day came. After the blood, sweat, tears, swearing, and yelling at the cat, the map was finished. I overlay my disease data, and sat back to look at the results.

Children playing in a poor neighborhood of Alexandria under quarantine during an outbreak of typhus, sometime around WWI (via Wellcome Collection)

Have the microbes told me a story? They have. As I set forth on the next phase of my project, I have clusters of locations and specific dates to look for. But the maps have also given me more questions—Is there a correlation between a two-year outbreak of cattle plague and the rampant inflation in the cost of food during the war? Does the death of 139,000 Egyptians due to influenza at war’s end have anything to do with the eruption of a populist uprising just six weeks later? And why is this most deadly epidemic absent from the press and the pages of the official gazetteer?

I also realized the importance of presenting my data in this visual form. No one is going to go through all 800 records on my spreadsheet, but the map provides a clear snapshot of my subject and the questions it raises, and it makes a visual case for the argument I’m laying out in my dissertation. In this form, it will make my modest contribution to this field of study more convincing and accessible.

The New Archive series highlights various uses of digital tools in humanities research. More from the series:

Charlie S. Binkow explores Honest Abe’s Archive
Joseph Parrott highlights the digitalized political posters collected by archivist and artist Lincoln Cushing
Maria José Afanador-Llach discusses her experience at a Digitilization Workshop in Venice
Daniel J. Cohen and Roy Rosenzweig, Digital History: A Guide to Gathering, Preserving, and Presenting the Past on the Web

Great Books on Women’s History: United States

Not Even Past asked the UT Austin History faculty to recommend great books for Women’s History Month. The response was overwhelming so we will be posting their suggestions throughout the month. Here are some terrific book recommendations on women and gender in the United States.

Penne Restad recommends:

Jill Lepore, The Secret History of Wonder Woman (2014).

A lively, often surprising, narrative history that chronicles the adventures of Wonder Woman, the comic strip devoted to her prowess, and Marston, the man who imagined her, in the center of the struggle for women’s rights in the U.S.

Erika Bsumek recommends:

Margot Mifflin, The Blue Tattoo: The Life of Olive Oatman (2011).

In 1851, the 13 year old Oatman was part of a Mormon family traveling west. She was captured by the Yavapai Indians and then traded to the Mohave, who adopted her. The book tells her story and provides some valuable context on the various Mormon sects, the tensions and troubles faced by American Indians in the face of American expansion, and how one young woman experienced it all.

Laurie Green recommends:

Jeanne Theoharis, The Rebellious Life of Mrs. Rosa Parks. (2013)

Think you know who Rosa Parks was? Jeanne Theoharis’s biography will change your understanding of the woman who became famous for triggering the Montgomery Bus Boycott in 1955 when she was “too tired” to relinquish her seat on a city bus to a white passenger. The book tells you the real story of Parks’s militant activism from the 1930s to the 1990s and her frustration with being recognized as a symbol, not a leader.

Emilio Zamora recommends:

Cynthia E. Orozco, No Mexicans, Women, or Dogs Allowed; The Rise of the Mexican American Civil Rights Movement (2009)

The book is a re-examination of the League of United Latin American Citizens, the longest running Mexican American civil rights organizations. Orozco is a well-known historian who incorporates women and gender in her histories of Mexican Americans. In this instance, women are placed at center stage in the cause for equal rights and dignity.

Jackie Jones recommends:

Ellen Fitzpatrick, The Highest Glass Ceiling: Women’s Quest for the American Presidency (2016).

A great read and couldn’t be more timely! The book focuses on three women candidates for the presidency: Victoria Woodhull (ran in 1872), Margaret Chase Smith (1964), and Shirley Chisholm (1972).

Daina Berry recommends:

Talitha LeFlouria, Chained in Silence: Black Women and Convict Labor in the New South (2016)

From the UNC Press website:

In 1868, the state of Georgia began to make its rapidly growing population of prisoners available for hire. The resulting convict leasing system ensnared not only men but also African American women, who were forced to labor in camps and factories to make profits for private investors. In this vivid work of history, Talitha L. LeFlouria draws from a rich array of primary sources to piece together the stories of these women, recounting what they endured in Georgia’s prison system and what their labor accomplished. LeFlouria argues that African American women’s presence within the convict lease and chain-gang systems of Georgia helped to modernize the South by creating a new and dynamic set of skills for black women. At the same time, female inmates struggled to resist physical and sexual exploitation and to preserve their human dignity within a hostile climate of terror. This revealing history redefines the social context of black women’s lives and labor in the New South and allows their stories to be told for the first time.

Charlotte Canning recommends:

Jayna Brown, Babylon Girls: Black Women Performers and the Shaping of the Modern (2008)

An award-winning cultural history of the African American women who were variety performers on chorus lines, in burlesques, cabarets, and vaudeville from 1890 to 1945. Despite the oppression they experienced, these women shaped an emerging urban popular culture. They pioneered social dances like the cakewalk and the Charleston. It is an ambitious view of popular culture and the ways in which women were integral to its definition.

Bruce Hunt and Megan Raby recommend:

Kimberly Hamlin, From Eve to Evolution: Darwin, Science, and Women’s Rights in Gilded Age America (2014)

While there is an enormous literature on the reception of Darwin’s evolutionary theory, this is the first book to examine the responses of women. This book is a lively account of how ideas about human evolution figured in debates over women’s rights in the late 19th century, by a recent UT American Studies PhD.

Megan Seaholm recommends:

Jennifer Nelson, More Than Medicine: A History of the Feminist Women’s Health Movement (2015)

Nelson provides an excellent addition to the growing literature about the women’s health movement that began in the 1960s. She concentrates on reproductive health and reproductive rights from abortion referral services organized before Roe v. Wade through the National Black Women’s Health Project organized in 1984. This is a good read and an important contribution.

Mark Lawrence recommends:

Elaine Tyler May, Homeward Bound: American Families in the Cold War Era (1990)

Elaine Tyler May examines the resurgence of traditional gender roles in the years after the Second World War, arguing that a desire to enjoy postwar prosperity and to escape the dangers of the nuclear age drove Americans back to conventional norms. The book brilliantly blends women’s, social, political, and international history.

Judith Coffin recommends:

Nancy Cott, Public Vows : A History of Marriage and the Nation (2000)

The changing stakes of marriage for the nation and for men and women — gay and straight. Readable, smart, and connected to the present. Nancy Cott helped write several amicus (friend-of-the-court) briefs in the marriage cases before the Supreme Court.

For more books on Women’s History:

Great Books (Europe)

Great Books (Crossing Borders)

Indrani Chatterjee, On Women and Nation in India

Our 2013 list of recommendations: New Books on Women’s History

An Emotional Database: The New Archive (No. 8)

By Henry Wiencek

One of the core values of studying history is objectivity: an ability to weigh evidence, read documents and then dispassionately judge the actions of our ancestors. But let’s be honest, it’s impossible to study the past without feeling something. Confusion, fascination, excitement—this is what motivates historians to spend their days poring over obscure manuscripts.

Is it possible that emotions actually help to produce better history? Sweden’s Hagströmer Medico-Historical Library of medical arts thinks so. So when readers navigate its stunning online archive of medical, zoological and biological documents from the 15^th-20^th-century world, “Emotion” is literally a search option. In addition to place and topic, users can select a set of documents based on the feelings they evoke.

And each category seems very appropriately titled. “Beautiful” cues a stunning collage of images from across time and space: a 17^th-century Dutch anatomical display of the human skeleton, an early modern Italian etching of mythical beasts, and one Viennese botanist’s exquisite rendering of a strawberry. True to form, “Scary” turns toward the macabre, with gruesome surgical photographs of American Civil War amputees, a 16^th-century doctor’s guide to battle wounds and a European naturalist’s perturbing bat exhibit. “Fascinating” lies somewhere in between. There are photographs of French psychiatry patients gawking at the camera as they’re examined, sublime—yet slightly unsettling—medical lithographs of the human form, and even a 19^th-century physician’s guide to the miracle of life. Depending on your mood, you can also peruse the Artistic, the Colorful, the Instructive, the Marvelous, the Remarkable and the Strange.

The Hagströmer Medico-Historical Library of medical arts is a strange, colorful and captivating resource for scholars and the general public, especially those interested in the history of science, medicine and its visual portrayals. But its unorthodox design openly challenges the assumption that historians ought to leave their emotions at the archive door. Instead, it asks users to take a risk—to forgo the comforts of traditional categories and experiment. And perhaps most importantly, the site acknowledges that our own emotional reactions are of historical significance. By declaring 17^th-century medical drawings to be “strange,” we reveal our own modern biases—arrogance, even—about the past. This is a subversive new form of research in which emotions do not distort historical understanding, but actually enable more of it.

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Photo Credits:

Screenshot of Wunderkammer’s “Fascinating” gallery (Image courtesy of the Hagströmer Medico-Historical Library)

Anatomical plate from Traité complet de l’Anatomie de l’Homme, 1867–1871. Found in Wunderkammer’s “Fascinating” section (Image courtesy of the Hagströmer Medico-Historical Library)

Portrait of a psychiatric patient from Mécanisme de la physionomie humaine, 1876. Found in Wunderkammer’s “Fascinating” section (Image courtesy of the Hagströmer Medico-Historical Library)

Health Care: A Historical Snapshot

by Sally Clarke

All the debates about health insurance have emphasized how expensive health care has become. According to the Center for Medicare & Medicaid Services, as of 2010 (the most recent year available) health care constituted 17.9% of the U.S. economy. Health care expenses have risen steadily since 1929, as shown in the first chart. The second chart indicates that this expenditure has had a good payoff: life expectancy has risen from about 60 years in the 1920s to just short of 80 years today. (The big dip in 1918 reflects the influenza pandemic.) One task of historians is to identify disjunctures between the past and the present, and the two charts illustrate this point.

(Source: Historical Statistics of the United States: the Millennial Edition On-Line, series Bd33 and Ca74; Center for Medicare & Medicaid Services, “National Health Expenditures,” accessed May 11, 2012.)

(Source: Historical Statistics of the United States: the Millennial Edition On-Line, series Ab644; U.S. Bureau of the Census, Statistical Abstract of the United States: 2012, Table 104; and Sherry L. Murphy, Jiaquan Xu, and Kenneth D. Kochanek, National Vital Statistics Reports, 60.4 [January 11, 2012], accessed May 11, 2012.)

Going back to 1929, health care claimed less than four percent of the economy, and less than ten percent of Americans had hospital or surgical benefits. Yet in the fifty years from 1880 to 1930, life expectancy rose from 40 to 60 years, or by the same amount as in the years since 1930. How was it possible for life expectancy to rise as much in the first historical era as the second without recording a surge in health care expenses?

A doctor examines a child before administering a vaccine in 1941.

Scholars point to two important improvements in life expectancy. First, there was a sharp fall in infant mortality. Massachusetts provides the best data on these early years. In 1872, 19 out of 100 infants did not live to see their first birthdays. Throughout the 1880s and 1890s the infant mortality rate remained above 150 deaths per 1,000. By 1929, however, the rate had fallen to 62 deaths per 1,000. Second, life expectancy improved because there was a drop in deaths tied to tuberculosis and other diseases like measles, typhoid, scarlet fever, and diphtheria. TB was the worst of diseases, but it dropped from 194 deaths per 100,000 in 1900 to 71 deaths in 1930. These declines came about before vaccinations were available, so what explains the drop in mortality rates?

A child waits to receive a measles vaccine in 1941.

One source for the rise in life expectancy was improved hygiene in the care of infants. A second source was improved public health, notably the eradication of bovine TB and the pasteurization of milk. Improvements also stemmed from better nutrition. Data is limited, and while from 1909 to 1930 per capita consumption of calories on a daily basis was flat, production of many fruits and vegetables, such as oranges and carrots, rose. Processed foods also became common. I would add another development: the fall in the workweek. During the late 19^th century, Americans worked an average of 10 hours a day, six days a week. By the end of the Great Depression the workweek had shortened to roughly 40 hours a week. People did not physically wear out in the 1930s, as they had in the 1880s. They also did not suffer the number of industrial accidents that they had faced during the late 19^th century.

In many ways, the two historical eras are not comparable. But there is one insight from this review of the years before 1930. To the extent that nutrition was important in the first era as a “cheap” way to boost life expectancy, nutrition remains one cost-effective strategy in reducing diseases like diabetes and raising life expectancy today.

All statistics are found in Susan B. Carter, et al., Historical Statistics of the United States: Millennial Edition Online (New York: Cambridge University Press, 2006).

Photo credits:

Arthur Rothstein, “Dr. Tabor examining Randolph Darkey, before inoculating him against measles, in the community health center, Dailey, West Virginia,” December 1941

U.S. Farm Security Administration/Office of War Information Black & White Photographs via The Library of Congress

Arthur Rothstein, “Elizabeth Darkey, daughter of one of the project families, waiting in the health center to be inoculated against measles. Dailey, West Virginia,” December 1941

U.S. Farm Security Administration/Office of War Information Black & White Photographs via The Library of Congress

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