The trajectories of tuberculosis (TB) and opera met in the mid-nineteenth century most notably with the production of La Traviata in 1853, and then La Bohème near the century’s end. With eminent scholars Linda and Michael Hutcheon, we talk about how these trajectories converged and how these resulting two operas then brought attention to the medical effects of the infection and the sociocultural influences on its spread. We also discuss how the discovery of germ therapy during the time between the staging of these operas affected the way social behaviors changed accordingly, that is, from understanding TB as hereditary to understanding it as infectious. We play audio clips from parts of the operas pertinent to perspectives provided. 

A big thanks to Drs Linda and Michael Hutcheon who in addition to providing their expertise and perspectives during the podcast, also contributed ideas for the production. 

Links
– The combined bio for Linda and Michael Hutcheon.
– The New York Metropolitan Opera on-demand video service where you can get access to high-quality video productions of La Traviata and La Bohème among many other operas and performances. (There could be a 7-day free trial available).
– Homer Simpson performing as Rudolpho in La Bohème singing Oh Dio! Mimi!
– We covered the effects of TB as an aesthetic ideal of beauty during the nineteenth century as represented in paintings earlier in episode 5.

Audio Credits
La Traviata
Preludio (National Philharmonic Orchestra; Richard Bonynge cond London Records 1979)
Prendi, Quest’È L’Immagine (Orchestra of the Opera House, Rome; Tullio Serafin cond; Victoria de los Angeles (Violetta); EMI Records Ltd 1960; digitally remastered 1992)

La Bohème
O Soave Fanciulla (Berlin Philharmonic; Herbert von Karajan cond; Mirella Freni (Mimi); Luciano Pavarotti (Rudolfo); Rolando Panerai (Marcello); London Records 1972)
Si. Mi Chiamono Mimi (ibid)
Mimi È Una Civetta (ibid)
Mimi È Tanto Malata! (ibid)

La Bohème photo from wikicommons

Back when I was doing my internship at Pennsylvania Hospital, I was so surrounded by history I felt like I was working in a museum. Even the china we dined on in the hospital cafeteria sported the original historic pattern. And when we finished our training, a brass plaque with our names went up on the same wall as the plaques of our predecessors going back to the 18th century.

At the time, none of this was widely known. But fortunately, Pennsylvania Hospital now has an actual museum, open to the public just in time for the nation’s 250th anniversary. The Pennsylvania Hospital Museum is compact yet chock-full of art, architecture, artifacts, and documents, and has at once become a must-see destination in Philadelphia.

Although Bellevue Hospital has roots that go back to 1736, it started out as an almshouse. Pennsylvania Hospital was the first institution in the colonies founded specifically as a hospital, established in 1751 by Benjamin Franklin and Thomas Bond. The 1756 building housing the museum is a National Historic Landmark. Not only is it considered an important example of Georgian architecture, but its cornerstone even bears an inscription by Franklin referring to King George II.

The landscaped grounds are a serene oasis in the middle of Philadelphia’s Society Hill neighborhood and include a Physic Garden containing herbs and plants used for medicines in the 18th century.

As one enters the building, the first room encountered is the pharmacy, which remained in use until 1927 and now contains interactive displays. A fire engine purchased in 1803 sits in the foyer at the base of a grand staircase. After ascending to the second floor, visitors enter America’s first medical library, a handsome wood-paneled room containing more than 13,000 volumes from floor to ceiling, including one of the nation’s most complete collections of medical books published between 1750 and 1850.

The third floor houses the nation’s oldest surgical amphitheater. In the era before electricity, it was illuminated by skylight, so surgeries could only be performed on sunny days. (I must confess that we interns used to sneak into this room when on call. It was spooky in the middle of the night!)

For me, as a psychiatrist, the highlights of the museum were the exhibits on mental health. I have previously written in MedHum about Benjamin Rush, often called the father of American psychiatry, whose portrait is on view here. Rush served on the staff at Pennsylvania Hospital from 1783 until 1813 and was known for his groundbreaking and humane treatment of the mentally ill. Metal shackles once used as restraints are also on display, although hopefully they predated Rush’s tenure.

Another psychiatric pioneer whose portrait hangs in the museum is Thomas Story Kirkbride, who came to Pennsylvania Hospital for residency training in 1834. When the psychiatric wards exceeded capacity and a satellite facility was built on 101 acres in West Philadelphia, Kirkbride was named superintendent. His ideas about the layout and design of mental institutions became highly influential, leaving an imprint on hospitals throughout the country.

Initially called the Pennsylvania Asylum for the Insane, the new campus eventually became known as the Institute of Pennsylvania Hospital. I completed my residency training there, but over time it was no longer financially viable, and it closed in 1997.

How fascinating to learn that Francis Scott Key, of “The Star-Spangled Banner” fame, wrote a poem titled On Visiting the Pennsylvania Hospital. And to see 18th-century anatomical casts used for teaching at a time when formal dissection was illegal.

There is so much history in this museum that I could not absorb it all in one visit. With its addition, Philadelphia further demonstrates its role as the cradle of American medicine. Indeed, one would have to travel to London to find a larger assemblage of medical historical sites.

In one very busy day—or a more leisurely two-day trip—a visitor can now experience this museum, plus the College of Physicians of Philadelphia and its famous Mütter Museum, while also stopping to see The Gross Clinic by Thomas Eakins. (The painting alternates between the Philadelphia Museum of Art and the Pennsylvania Academy of the Fine Arts, but will spend 2026 at the latter.)

Bravo, Philadelphia!

Benjamin Rush:  Reflections from a Psychiatrist 

Guy Glass 09.02.24 0

A founding figure in American psychiatry, known for pioneering reforms, but also controversial for his treatments and complex contradictions in beliefs and practices.

For more information about the museum, visit Pennsylvania Hospital Museum.
Web image from Wiki Commons

DAVID HSU: What do you think is the importance of medical humanities to you at this point? 

JACKIE DUFFIN: I think it is a very satisfying way of filling in the gaps that are generated by traditional medical training and medical experience. It invites reflection, and it invites growth, and it especially encourages criticism. And those things were certainly not there in my training. Therefore, it is comforting and inspiring, both of those things for me.  

When you say it that way, there’s a certain subversive quality to medical humanities. Am I catching your answer right?  

Yes, I guess that is exactly right. Subversiveness goes with the territory of what we do as historians as well. Everyone thinks that history is about the past, but the questions that we ask of the past are generated by the present and also the inherited wisdom that we have. And there has to be curiosity and a willingness to admit that the trajectory might not have been as straightforward as is sometimes pretended.  

How do you respond to the saying that basically history is written by the victors? 

That statement is also a reminder that what might be out there as the master narrative isn’t exactly the truth or isn’t exactly the whole story. And the losers will have their own story. And sometimes that’s worth exploring. Of course, my view of medical humanities is very much affected by the fact that I am a historian. And more than any other aspect of medical humanities … that’s what interests me the most. In fact, I don’t mind admitting that the medical humanities boom that we’ve witnessed in the last decade and a half or so has been a wonderful vehicle for enhancing the presence of history in medical schools​,​ and our visibility. I’m happy to hitch my wagon to it, but I don’t claim any expertise in all the other disciplines that participate.  

One of the things I think is useful for history with respect to ​present and ​future doctors is how history is a mirror image of the clinical process and the scientific process. And that’s something that I raise​d​ with my students all the time when I was teaching, that you begin with a question. As medical practitioners, you ​also ​have a question​;​ ​i​t is the chief complaint of the patient. What is wrong with me? Why do I feel this way? And as a doctor, you consult the patient, you explore the history, you do the physical examination, and then you touch base with the clinical wisdom that’s available to you through ​the medical ​literature. And you come up with a diagnosis, which ​​determines the direction of action. As a historian, you have the question​:​ where did this come from? Or why do we do this? Or what happened then? And with your question, you interrogate the past, looking at all of what has already been published, which is the equivalent of the medical literature, but also looking at things that have been ignored, like the stories of the losers, for example. And you come up with an interpretation. And that is a direct parallel with the ​process of ​diagnosis. You can push this even further to make an analogy with a scientific experiment where you have the hypothesis, the method, et cetera, and you come up with a conclusion. I think that demonstrating history as a discipline to healthcare professionals opens up their imaginations to seeing the practice of what they do is something that’s malleable, that’s anchored in time, that’s affected by culture and society. So, my role in the medical school was to do that. It was a privileged position. But I had no idea how successful I ever was. I have a sneaky suspicion that a lot of my faculty colleagues and maybe a large number of the students just thought I was there for comic relief and entertaining stories to be told in the meantime. That’s okay. I accept that if that gave me permission to weasel my way into the curriculum or introduce new ideas. 

Tell me a little bit about this medical humanities boom over the last 15 years. What’s going on?  

As you know, medical schools are evaluated. They’re accredited by committees. And things come along that are the flavor of the month. ​P​rior to the medical humanities boom, there was an ethics boom. Many medical schools didn’t have ethics, but they looked around and they thought, oh, we better get ethics because everyone has ethics. If they got ethics, it made them look ethical. That happened in the 90s. I saw that as a real problem for people teaching history of medicine. I got along great with our ethicist at Queen’s. It wasn’t her fault, but she was my biggest enemy. Because if the school had to devote some time to what they called ​“​soft science,​”​ they would rather have the ethicist than the historian because the ethicist got them brownie points on the accreditation. ​​ 

​​T​here was a time when the American Association for the History of Medicine was meeting in Chicago in May 2014. And we happened to be meeting at the same time as the Academy for Professionalism in Healthcare. So the brass of the American Association asked to have a meeting with their leaders to find out how they managed to convince all the medical schools they needed ethics and in particular succeeded in having questions about ethics education in the exit surveys. They did not really understand our problem. I think ethics had the media going for it and the power of a number of ​high-profile​ malpractice cases that had come along. ​It​ became obvious that patients wanted to make sure their doctors were legal and ethical, and ​t​he schools wanted to give the students tools to address these concepts. It became almost urgent. 

In fact, I did some Medline searches on this at the time. The number of articles addressing history of medicine basically tanked. And the number of articles addressing medical ethics soared. There was always an interest in medical ethics. It goes way back. Hippocrates even talks about this. And then there was codification in the 18th century. But what ​arose ​in the late 20th century was this concern that it should be transferred to the students as some kind of rubric that would help them in their future to ​educate them and help them ​behave ​ethically. ​And then that sort of plateaued and along came medical humanities. 

Accreditation saw ​​this as very good for student life. They saw it as very good for student education. If you could enhance the possibility of getting a positive accreditation of your medical school, then you would acknowledge that you should have something called medical humanities. But under that umbrella, there could be just about anything. And that’s the problem with it as a discipline. It doesn’t really have a single method. It embraces so many other sorts of​ fields​. That’s the beauty of it, but it’s also the confusion of it when it tries to make its way in a curriculum that is as rigid as a medical school structure. 

In Canada we now have a society for ​Medical Humanities, the Canadian Association for Health Humanities​. I’ve attended some of the meetings but the disappointing thing about it from my perspective is there’s almost never anything about history. 

I’m curious. If history is not emphasized as part of medical humanities what is? 

Presumably it’s ethics again and reactions to technology. I think ethics underpins a lot of it​,​ but medical ethics is a very distinct discipline​,​ as is history. We’re not the same thing. We respect each other but we’re very different. So medical humanities usually include, at the Canadian meetings at least, a lot of literature, of readings, both fiction and nonfiction. It includes the arts, music, poetry, visual imagery, trauma, drama, dance, etc. And often the papers in the meetings that I’ve attended are​ almost all​ about individual case studies​: ​e.g, “We tried this at our medical school​;​ and then we did an after​-​survey about whether it worked or not. Of course, our students loved it because it was fascinating​,​ and it wasn’t memorizing the elements in the periodic table. It was something that took them out of themselves.” Often medical students have other hobbies before they get to medical school, which are sadly neglected because there’s no time for anything else. And these activities provide an outlet for them to recover their previous selves and their identity.  

I think another agenda of ​Medical Humanities ​is to raise awareness of the differences between peoples — the difference between your patients, for example, and yourself, and to be prepared to tolerate it. So that’s a subliminal message of many of these things, causing you to see the world and other people in a different and more tolerant way. That’s basically what goes on in the medical humanities conferences. People get very excited about these opportunities, a drama presentation, a collect​ive​ reading, something that they might have done together, or artwork that medical students do based on their clinical learning and then having a show about it. That kind of thing gets reported. And then … it sort of sinks into an oblivion until the next meeting comes ​​​​along.  

So it sounds like the way you’re describing it, there’s a little bit of the study of history of medicine versus medical humanities. The two are not fully in sync in your mind.  

No, they’re not fully in sync in my mind, but I accept and welcome history being seen as part of ​ ​medical humanities. I think it’s an opportunity for us as historians to maintain our place and our credibility in medical schools.  

The presence of history in medical education has gone up and down over the centuries. There have been full-fledged chairs in History of Medicine. In a distant past, they went away​ and​ they came back. What is expected of it has probably also changed through time. But now, since it seems medical humanities is an easier way​ ​to open the door to medical schools, history can be part of it. I don’t know. It would be really interesting to find out if ethicists feel the same way as I do about it. I find that some medical humanities programs are peopled by or run by doctors who are so well-intentioned​–​ very, very well-intentioned​–​ but they really don’t have any expertise in anything but medicine. The best of them, obviously, are experienced clinicians who’ve had a lot of encounters and are thoughtful and reflective about those encounters. But there’s no method. It’s not a single discipline. It’s a quilt with a whole bunch of different patches in it.  

What do you think about medical humanities and maybe more specifically the history of medicine as a vehicle for the broader mass of people out there?  

I’ve written ​11 ​books and the most recent one to get published is this one. [She holds up a copy of ​Covid-19: A History​]. What I was doing was getting it down for everyone. It’s a history for everyone. It’s not aimed at medical students or doctors or anybody in particular. It’s aimed at Canadians basically, but it talks about the whole pandemic from a global perspective. What I want to do is remind people of the personal stories that go with the pandemic, about the dilemmas of decision-making and policy choices, about the scientific endeavors that are so easy to mock or make fun of. And ​clearly,​ I’m revealing my colors. I believe in vaccines. I believed in the public health measures. I point out in this book about the value of quarantine. When you don’t know what the pathogen is and you haven’t got a clue what the incubation time is because it’s a previously unknown pathogen, quarantine is not a stupid thing to do​,​ because you are waiting to find out how dangerous it ​might ​be and put some parameters around it. I think​–​ and again, I’m speaking only from a history perspective, not medical humanities in general​–​ I think it was important to unpack what was behind those decisions that many people got so angry about. And yet they were lifesaving decisions in many cases. Sometimes perhaps it was over the top, but it was because we didn’t know what we were confronting. 

During that book writing, I served as a volunteer contact tracer at the Kingston ​[Ontario] ​Public Health Unit. I had to phone up citizens all over our area and get them to quarantine because they’d been in contact with someone who had COVID. That was very eye-opening for me because I realized at what level you had to pitch why it was a good thing to do. And at the outset, when we didn’t know what the parameters were, we were telling people who’d been exposed to COVID to stay home for 14 days. Kingston was the only health unit to use volunteer contact tracers, but we worked really hard and Kingston had the best ​​outcomes of COVID cases in the country for a brief time. It didn’t last forever, but it was like a flagrant, on-the-spot demonstration of something that has been known for years, since at least 14^th-century plague.  

What do you make of that now that we’re in 2025 and people are so over this stuff now​,​ that​ ​there’s this feeling I get that people are saying we will never go into quarantine again? 

That’s why I wrote the book. Actually, I was invited to write it, and I had to think about whether I wanted to or not. One of the reasons I decided to write about it was that my thesis advisor, Mirko Grmek, wrote a history of AIDS right at the beginning of the pandemic. And I thought, well, I can’t write a history of COVID because it isn’t over and it may never be over. We may always have COVID. And then I remembered that Grmek had written that history of AIDS at the beginning of the AIDS epidemic. He set down where it came from. He studied the historical possibilities. He had the science too. I realized he was at the end of his life, and I’m at the end of my life. And I thought, OK, maybe this is what I need to do​,​ to accept the task of writing it as it is, right now. Now ​I’m very depressed​ by these negative attitudes. But I do hope that when the next pandemic comes-​-​and there will be another pandemic​,​ with a new pathogen that we haven’t seen before​,​ and there will be conspiracy theories about where it came from​–​ I hope that the public health agencies will remember that quarantine from 14^th-century plague worked really well​,​ and that’s what we need to do again if we don’t want to overwhelm our finite resources in hospitals and health care units to look after people. The more you implement those measures, the fewer people die. It makes a huge difference​,​ and you can actually see it. So the story is there. Whether or not it will be believed, whether or not the argument can convince the naysayers, I have no idea. All I did was set it down and hope.  

You have a historian hat, which is the critical, sometimes subversive side and then you also have the medical doctor establishment side, the scientific side. It gives you a unique lens to look at the COVID pandemic and the consequences that came afterwards.  

It’s been the story of my life. I worked in cancer care at the end of my career at Queen’s and patients would tell me really interesting things​.​ I loved talking to them and hearing what they thought about what was going on. And some of them held what I would think of as wacky ideas or they’d utter doctor​-​blaming ideas. Then the doctor in me would feel very defensive about their accusations of the mistakes or the neglect of my colleagues, even colleagues I’d never met. But when it comes to the history of medicine, I feel terribly responsible for the bad things that doctors may have done, even if it was not deliberate, but out of ignorance, because they didn’t know what was going to be discovered next​;​ or ​due to ​misplaced enthusiasm for something that turned out not to be as great as everybody thought it would be. And I’ve seen that with respect to certain drugs in my career. I’m old enough to remember thalidomide babies​;​ I was a child when that happened. But the impact of it was enormous​: ​what pills could do to us and how they might harm us. There’s a new biography out that I ​reviewed for ​Medhum of Francis Kelsey, the Canadian​-​born American health official who spared the United States from the damages of thalidomide. An amazing and courageous decision because there was great pressure on her to approve the drug and she didn’t. So we had the tragedy in Canada and they didn’t in the United States​,​ which was fascinating for me to learn at this stage of my life, because I remember being so horrified and ​thinking, ​how could doctors let us down? 

There are also other procedures that were once considered important to do that we have done away with, not because they shouldn’t ever have been used, but because something so much better came along. The most striking example of that that I remember are pneumoencephalograms. Pre-CT scans, if you thought there might be a space​-​occupying lesion in the brain, you put the patient under a sort of an anesthetic. You took out a modicum of CSF and injected the same volume of air. And then you strapped them to a chair and you ​​rotated them around, taking x-rays while the bubble of air moved all around the brain to see if there was a space​-​occupying lesion. It was brutal, painful, but it was the only way to find out if there was a space​-​occupying lesion in there. And of course, you could tell only if it was bulging on the surface of the brain. It took days for patients to recover with headache and vomiting. Every medical student in my class of​ ​1974 was required to go and witness one of these so that we would not order it frivolously. And in that same year, CAT scans were introduced and nobody would ever do a pneumoencephalogram again. Ever, ever, ever. But does that mean that all the doctors who were involved in ordering pneumoencephalograms or taking the x-rays were evildoers? I don’t think so. They were trying to help. They were trying to make a diagnosis. But it was excruciating.  

If you could fix medical education and its relationship to history, what would you want done?  

I’ve written about this for a long time. I was so lucky at Queen’s; I really was. They let me get away with a lot. From my hire in 1988 until I retired, I thought the best way to bring history into medical education was to infiltrate it. The historian has to be very tolerant and very flexible. But what you do is you introduce the history of whatever it is they’re studying at any given time. History of anatomy in anatomy if they’re doing the anatomy course. History of physiology in physiology. History of pathology (essentially is the history of disease) in pathology. The timing really is everything because it’s synergistic with what they’re learning at the same time.  

With that method, you are preceded by a guy in a white coat, and you’re followed by a guy in a white coat. It gives you credibility vicariously by the people who are around you. But it makes it seem relevant in a way that otherwise it ​wouldn’t be​. If you make ​it ​an optional, elective course, the students automatically know that it’s not important. So, I refused to teach electives when I got hired at Queens, which meant that I had to meet every department head to beg for time to do a history session. There were 25 departments at the time, and only three said yes. They were​–​ anatomy, pathology, and obstetrics; I’m forever grateful.  

Early on, faculty members of those departments would come to my inaugural class on the history of their discipline. I think they were slightly checking out how “nice” I would be to their field: the history of obstetrics, for example. But they approved the approach. The most willing departments were those units in the medical school with a lot of curriculum hours​,​ ​s​o they were able to feel generous. ​“​We will give her an hour.​”​ 

But one department head said to me, “I can’t do that. History, I love history. You’d be invited to give an ​after-dinner​ speech at our annual meeting. That would be really good. But we only have 80 hours in the curriculum. And if I gave you one of those hours, they might miss something important and kill somebody.”  

I said, “Oh, thank you​,​” ​a​nd I ​went​ back to my office feeling rejected. Only later did I think of the right reply, “If you don’t give me one of your 80 hours to make them skeptical about everything else you’re going to teach them in the other 79 hours, then they really might kill somebody.” That was the answer I should have said.  

It’s about the time constraint; you can’t offer an entire course. Medical students are not going to be historians. They’re going to be doctors. So what you want to do is sensitize them to the fact that what they see as knowledge now is something that has evolved through time, through human endeavor, something that is destined to change in the future. So history is a reminder of life-long learning. And if you time it right, then it is relevant and interesting. Not all students are going to like it, but they don’t all like pharmacology either. 

And the other thing that the medical school let me do, bless their hearts, is to grant my wish for one question on every exam.  

I remember this actually.  

It was a question of credibility; a way of forcing the medical school to commit to the idea that history was important.  

All right. To wrap up, we’ll get back to Medhum. what would you like to see us do in the months and years to come? 

I’m really a special interest voter on this because I was for 25 years involved with the Literature Arts and Medicine Database. And I contributed hundreds of annotations to that database​. ​I hope MedHum is a place where people who want to use literature–mostly literature is what I think of, but there​ are ​other things there, ​for example ​film​ reviews​–in a way that will deepen their understanding of a situation, or for enhancing education, or for whatever purpose, because that’s how the database was used, that it will be there, accessible to people who want those things.  

​​​​So for me, I get to go there when I feel like it. I get to browse. I get to pick around. I already knew some of the people and from our meetings, I’ve gotten to know new ones. I think you, people of your vintage​,​ should be deciding its purpose, in terms of determining the direction and the flavor of this entity, which hopefully will have a big reach and get to the people who need to see i​​t​. You​ ​​have a better sense. You’re closer to the users. I’m not trying to be gloomy about it. I just know that it’s entirely possible that it needs to go someplace that I can’t even imagine. 

Dr. Jacalyn Duffin was the Hannah Chair of the History of Medicine at Queen’s University from 1988 to 2017. She was also a practising hematologist. In 2020, she was awarded the Order of Canada. 

More importantly, she’s one of my favorite people in the world. Medical school wouldn’t have been the same without her gentle encouragement and unending enthusiasm. Dr. Duffin, thanks for everything. 

Web image by Medhum.org

Posts Written by Dr. Jacalyn Duffin

Book ReviewLitmed

The Conjure-Man Dies: A Mystery Tale of Dark Harlem by Rudolph Fisher  

04.22.26 453

Book ReviewVideo

A Civil Action by Jonathan Harr 

04.21.26 643

Book ReviewFocusVideo

Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection by John Green

04.13.26 665

FocusReflection

Craftivism is Activism

03.23.26 635

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Henry’s severe illness and his difficulties accessing treatment prompted Green to contemplate the horrifying statistics of tuberculosis and the paradox of our extensive knowledge about it. More than one million people still die every year from this ancient disease; yet the bacterial cause was elucidated a century and a half ago, and effective treatments have been around since the 1950s. Barring eradication, the germs mutate and become resistant. Given dire living conditions, it spreads. Effective therapy can be prohibitively expensive. “The cure is where the disease is not, and the disease is where the cure is not” (p. 5). People die where cures cannot be obtained. 

History is woven though Henry’s story, but so are politics, culture, and economics: the discoveries, the 19^th-century romanticization of ‘wasting away,’ the hard realities of pharmaceutical development and delivery. Henry has survived, become healthy and an inveterate TikToker and youtuber. He even has an episode on the power of storytelling. But other people that we encounter through this tale have died. 

We still have tuberculosis because statistics de-personify it, and geography allows ignoring it. Green uses Henry’s story to invite us to ‘[t]hink about how rare and precious humans are, and how many of them you get to worry for and care about. Then if you can, find a way to multiply that 1,250,000 times’ (p. 189).  

The book flows easily in language that is clear and accessible, a tribute to Green’s experience in writing young-adult fiction. In the end, without denying the benefits of medical interventions, he calls for a focus on the real cause of tuberculosis: injustice—tolerated and unchallenged. ‘Ultimately,’ he writes, ‘we are the cause’ (p. 184).  

Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection
John Green
New York: Penguin/Crash Course Books
2025
ISBN 9780525556572 

Web image created by Medhum.org

Out of the gay rights activism in the 1970s came AIDS activism in the early 1980s. By then, the incidence and severity of AIDS had become evident and caused enough fear to generate social backlash against those with the disease. This, along with federal government insouciance at the time, made it necessary for gay rights activists to extend their remit into advocacy for health care specialization and research advancements for AIDS. The expanded activism was visible on the streets and at governmental research institutions (e.g., National Institutes of Health). Where it was also taking place, and not in such an obvious way, was within certain hospitals.  

San Francisco General Hospital answered the call first in 1983 when it created a special unit for the care of people with AIDS in “Ward 5B.” The unit was in operation through its move in 1986 into Ward 5A to accommodate more patients, and until 2003 when advances in antiretroviral treatment of AIDS made the unit no longer necessary. But throughout, the struggle to maintain and advance the unit medically, socially, and politically persisted. The documentary film, aptly named “5B,” covers the struggles, successes, and failures of the unit, and the activism required of the staff and advocates for its creation and ongoing viability.  

From the Inside 

The story is told from various perspectives through interviews with key figures in the unit’s development and operation, and with archival footage of the unit and AIDS activism in the community. The most prominent among the key figures is Cliff Morrison, a clinical nurse specialist who spearheaded the idea for the unit and then managed it. Several other nurses who served in staff and supervisory positions are also featured. Participating physicians include Paul Volberding, an oncologist at the time who became pivotal in the development of effective HIV treatments, and Julie Gerberding, a physician treating patients on the unit who later became the Director of the Centers for Disease Control (CDC). Lorraine Day, the chief of orthopedic surgery at the hospital when the unit opened, is heard often as an opposing voice. Hank Plante, a local television news reporter, also appears frequently to offer his perspectives on many of the social and political issues swirling around the unit. Among other participants are AIDS activists, volunteers, and family members of unit patients. 

Several storylines frame the documentary including how nurses drove the unit’s inception and then were instrumental in running it. “Nurses were in charge,” said Volberding, admiringly. Interwoven throughout the film are the experiences of the patients and individual nurses, including one nurse who was infected with HIV from a needle stick. “Those nurses were the real heroes,” said one activist.    

Rare is the story, though, about heroes who aren’t confronted with daunting challenges, and thus this documentary includes a storyline involving attacks the unit nurses encountered from inside the hospital. The nurses of this unit practiced in ways they considered safe but not in such a manner that would preclude them from touching patients or require them to don so much protective gear they become unseeable. Nurses and clinicians from other units objected and did not want to be compelled to adopt practices they thought endangered them on the occasions they took care of AIDS patients. The film follows this story through union grievances and public debates to their conclusion, which sided with the unit nurses and their advocates. The spirit of activism among the unit staff was pivotal in fending off the many challenges they faced. 

Keeping in Touch 

The documentary reveals stark juxtapositions that can manifest in the midst of an infectious epidemic, and in particular when an epidemic selects an identifiable group that is unwelcome in mainstream society. Two juxtapositions that stand out are the emotion of love with that of fear, and those who are deemed worthy with those who are considered disreputable. 

No treatments for the HIV infection or for the many horrid and lethal diseases resulting from AIDS were available when the unit opened—it was “a very, very unpleasant death” as one nurse put it. The nurses saw a big part of their role as offering love: “Here you were allowed to love your patients.” They offered it through human touch. Morrison’s view was, “If we can’t save these folks, we’re going to touch them.” To touch the patients in this way required that they balance it with the risk of exposure to infection and still comply with universal precautions. Nevertheless, fear was prevalent—some people were “truly hysterical” according to Gerberding—and it touched off conflict among the health care staff. “People were afraid…we found ourselves attacking each other…everyone was so stressed,” is how Volberding described the situation. This balance is one that is continuously negotiated in health care settings, but it was more pronounced during the early years of the AIDS epidemic, and at San Francisco General, it had to be mediated by hospital and union officials. 

At the time unit opened, and for a long while after, people with AIDS were scorned. The gay lifestyle was linked to the disease and so a view held by many was that the gay community deserved to be struck down by this plague. They were not worthy of all the human resources, technology, and money the disease required. The documentary brings this sentiment to life by showing the actions some people took to prevent getting these patients help, and the actions governments didn’t take to help them. Also shown, however, was how the activism of health care professionals and others in Ward 5B helped to overcome these obstacles. Without it in the case of the unit in Ward 5B, the activism in the streets outside the hospital alone may not have been enough.  

But Then 

These fevers abated some when medical advances produced treatments that obviated the need for AIDS units, and changes in societal attitudes led to more acceptance of gay lifestyles. The next epidemic that targeted marginalized and susceptible groups would determine whether lessons learned from the time of this unit had been incorporated in response protocols. That opportunity came the year this documentary was released in 2019 when Covid struck elderly people first and hardest, and especially those in communal living arrangements.  

Note: 

The documentary was featured on the podcast episode, How Terrible It Was: Three Takes on the AIDS Crisis with Dr. Ross Slotten, which can be accessed here on medhum. In addition to the documentary, the podcast episode included the novel, The Great Believers, and the memoir, The Plague Years: A Doctor’s Journey through the AIDS Crisis were discussed. The author of the memoir, Dr. Ross Slotten, joined the podcast as a guest. 

Title image credit: 
James Steakley, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons 

Documentary information: 
Film title: 5B
Directors: Paul Haggis, Dan Krauss 
Studio: Vertical Entertainment 
Viewing source: Amazon Prime 
U.S. release date: June, 2019 
Run time: 134 minutes  

Trailers from 5B Film

In the throes of the early AIDS crisis, people began stitching panels to remember their loved ones. The panels were joined in quilts, and the quilts were joined with each other until they became bigger than a tennis court, bigger than a football field. So unwieldy it became, the giant quilt had to be broken into pieces in order to be manipulated. Chunks would tour on display. It now has a virtual existence too and is curated by the National AIDS Memorial.

In 1989, Robert Epstein and Jeffrey Friedman made Common Threads, a 79-minute documentary, narrated by Dustin Hoffman. Based on the AIDS Memorial Quilt, their film traced the stories of five people who had died through the words of their grief-stricken friends and family. The survivors describe the solace that they had derived from quilting memorial panels for their loved ones. They also refer to milestones in the disease history: the president who would not utter the word; the movie star who acknowledged his own disease only after 15,000 had already died. The five divergent tales serve to emphasize the awesome scope of the tragedy: each panel and each name must recall an equally unique and cherished life cut short. In their final scene, the AIDS quilt lies on the Mall in Washington as names of hundreds of loved ones are read by grieving families and friends.

As the drone-less but steady camera slowly pulls back high above the patches of color in the evening light, I was reminded of the famous, expanding scene midway through, Gone with the Wind, as Scarlet O’Hara picks her way through the waste of Civil War wounded and dead. Common Threads is equally political, and it too is a love story. It won the 1989 Academy Award for Best Feature Documentary. I cannot help but imagine that the quilt and the film helped to generate the protections against discrimination of people living with HIV/AIDS provided by the Americans with Disabilities Act, signed into law in 1990.

Stitchery, knitting, embroidery, macramé and crochet have long been significant components of occupational and art therapy for mental and physical health (Leone 2021; Youngson 2019). But they have been marshalled into numerous anti-war, anti-discrimination, pro-environment causes with remarkable aplomb, talent, and humor. Remember the pink Pussyhats from the Women’s March in 2017? Patterns for them still abound on the web. The possibly antediluvian origins of crafting protest are featured in history and fiction: recall Charles Dickens’s knitters at the foot of the guillotine (Tale of Two Cities, 1859); or Margaret Atwood’s Zillah who makes art from dryer fluff, calling it “naive surrealism with a twist of feminist lemon” (Cat’s Eye, 1988); or even Peggy Erhart’s more frivolous parking-meter protest in small-town America (A Dark and Stormy Knit, 2024).

Self-described “craft nerd,” Betsy Greer coined the word “craftivism” in 2003. She wrote Knitting for Good (Roost Books, 2008) and edited an anthology that goes well beyond knitting to other techniques and contexts (Craftivism, Arsenal Pulp Press, 2014). Scholars have noticed (e.g., Moreshead and Salter, 2023; Vachhani et al, 2025). The diffuse movement has even found critics who challenge its “white, feminist appropriation of graffiti,” and seek to empower it to “evolve and become a more intersectional” practice (Close, 2018).

References 
Close, Samantha. Knitting activism, knitting gender, knitting race. International Journal of Communication 12 (2018): 23-23. 
Leone, Lauren. Craft in Art Therapy. Routledge, New York and London, 2021 
Moreshead, Abigail, and Anastasia Salter. Knitting the in-visible: data-driven craftivism as feminist resistance. Journal of Gender Studies 32.8 (2023), 875–886.
Vachhani, Sheena J., Emma Bell, and Alexandra Bristow. The Affective Micropolitics of Craftivism: Organizing social change through the minor gesture. Organization Studies 46.4 (2025): 525-547. 
Youngson, Bel. Craftivism for occupational therapists: finding our political voice. British Journal of Occupational Therapy 82.6 (2019): 383-385. 

Web image by Medhum.org

One of the most horrifying events of that year was the prisoner revolt at the Attica State Prison in upstate New York in early September. I did not live in New York at the time and have only a vague recollection of reading the newspaper reports of what happened. But ask anyone living in New York who was at least 15 years old at the time and they will tell you that they have vivid memories of what transpired over the five days from September 9-13. In this extraordinary book, Heather Ann Thompson recounts in all its gory detail the prisoner uprising, the bloody retaking of the prison by state troopers, and the nearly thirty years of investigation and legal wrangling that occurred in its wake.

By the late summer of 1971, there had been prisoner rebellions in state penitentiaries across the country including a nearby high security facility in Auburn NY. There was increasing tension and escalating prisoner protests against the inhumane conditions in all prisons including overcrowded cells, limited access to food and fresh air, and routine brutal treatment at the hands of the correction officers. Finally, Attica Prison erupted on September 9 after a minor skirmish between guards and prisoners. The prisoners took 38 hostages and over a thousand prisoners escaped their cells and crowded into the prison yard. They created a communal space to take care of each other that was equipped with meager resources. There was a central meeting area for the leaders of the uprising. They created a human shield around the hostages to protect them from harm.  

Over the next four days, there were intense negotiations between prison officials and the prisoners. A team of observers including Tom Wicker was  brought in at the request of the prisoners to serve as witnesses and act as potential mediators. Finally, after negotiations fell apart over the prisoner demand for amnesty, the troopers, without warning, dropped tear gas cannisters from helicopters and stormed the yard. Tragically, when the dust had settled, 32 prisoners and 11 hostages had been killed by bullets fired by the troopers. This terrifying sequence of events is described in the first third of the book. The remaining part details how prison wardens destroyed critical forensic evidence and collaborated with state politicians up the chain to Governor Nelson Rockefeller’s office to portray the events as a successful suppression of a radical-supported attack against the state. They solicited false testimony and pursued a one-sided prosecution of the prisoners for the murder of one guard and several prisoners. There are too many villains in the story but also some true heroes – a coroner who refused to back down from his post-mortem examination showing that all the victims were killed by gunfire, knowing that only the state troopers had firearms. The prisoners who confronted the legal system, defense lawyers willing to take up the cause of the prisoners, a brave state lawyer who was an essential whistleblower, all were vital in the pursuit of truth. At the end, the justice system failed nearly everyone involved, and Attica Prison remained an important part of the New York State correction system. The only monument is a stone at the entrance to the prison memorializing the hostages who died. 

This book is over 500 pages long. Along with another thick book, titled A Bright Shining Lie: John Paul Vann and America in Vietnam, it sat on a shelf in our apartment forever. For some reason that I cannot explain, I picked the book up recently and could not pull myself away from this intense and horrifying story. For more than a decade, Heather Thompson immersed herself in the archives and interviews with key actors in the Attica uprising story. She unearthed the bloody shirt that had been removed from two victims of the siege. Her research is evident on every page.

There are two deeply disturbing underlying themes in the book. The impact of politics and the sheer desire to retain power had a distorting influence on how the uprising was handled and how it was investigated. After watching Nixon get elected as the law-and-order candidate, Rockefeller felt compelled to take the same stance. Consequently, he refused to get involved in the negotiations or visit the prison, something that may have lowered the temperature and enabled a peaceful resolution of the siege. It is disquieting to read how many politicians and officials put self-interest and survival ahead of the pursuit of truth.   

In the immediate aftermath of the uprising, systemic changes were made to improve the well-being of the prisoners such as limits on the amount of time they could be put in solitary confinement, more time outside each day, better food, and access to legal resources. But over time, things slowly began to revert and look more like 1971 than 2021. There has been a continued growth in the number of prisons and a prison population that is larger than in any other Western country. There is disproportionate incarceration of Black and Hispanic men, often for mild offenses that would not warrant detention in a high security prison. Mistreatment of prisoners, unfortunately, is more the rule than the exception. Many explanations are offered – political positions, self-interest, and institutional inertia. But it does underscore how hard it is to make change real.  

As the country as a whole and the medical profession in particular undergo scrutiny about racist attitudes and practices, this book is a reminder that it will take an extended and concerted effort to achieve equal treatment for citizens in the penal system and in the health system. It may be easy for some to justify harsh treatment of criminals in prison or poor people living in squalid conditions. But we need to remind ourselves that a society can only be judged based on how it treats the most unfortunate within it. This applies across the board, housing, education, and healthcare.

Blood in the Water: The Attica Uprising of 1971 and its Legacy 
Heather Ann Thompson 
Miscellaneous Winner of the 2017 Pulitzer Prize in History 
Publisher Pantheon Books 
Place Published New York 
Edition 2016 
Page Count 724 

Web image by Larry Farr 

Lucy
Felice, first of all, can you talk a little about your background, what you were doing professionally just before and during the time you did the Database?

Felice
I was on the faculty at NYU School of Medicine. I was trained with a PhD in physiology, was hired as a physiologist, and I taught medical students physiology, but most of my life. I’ve had this dual interest in literature and in biology. And in fact, that’s from high school on, and when I started college, I had to make a decision about whether to major in English or in biology. And I decided to major in biology because I thought, well, I can do literature on my own any day, and I’ll never be able to make it a profession. Whereas, you know, I can’t do science on my own, I have to be trained. And so that was the path I took, which was a science path, but I never lost my interest in reading and thinking about literary things. And let’s see, at one point I decided to start a discussion group with the medical students and any faculty who were interested. It was a small group, and it changed from year to year, but we met once a month, and I would, initially, pick out readings. They were short readings because students don’t have much time to read non-medical stuff– poetry, short stories, essays, and that continued for several years. At the same time, and really, I have to say that without my husband’s help and interest in what I was doing none of this would have happened because he of course, was interested in the use of technology, computers in medical education, but he was also interested in what I was doing with my literary stuff. So he set up a database for me on my own computer.

Lucy
And this was in the early 1990s.

Felice 
Yes, 1993 or thereabouts; he set up a computer program for me so that I could keep track of the readings that I was doing with the students, because I didn’t want to repeat anything with the same group, essentially. And I also was kind of following the work of Joanne Trautman Banks, who was a pioneer. She really was the one who started the field. I have to give her full credit. In 1978 she published a book of annotations of literature that had to do with medicine. I don’t really remember how I found it, but it was very helpful in my own work with the students. I decided, basically, to copy what she did, with some modifications of my own, in my own database that my husband Marty Nachbar helped me to set up. So to begin with, that’s what we did. Marty’s idea was that I should recruit other people in the field who were doing this kind of teaching with their students, and who might be interested in submitting annotations to this database. And secondly, that we should make it online, so that anybody out there who has access to the internet could stumble on this thing and maybe get interested. And the idea, his idea, was that it might expand the whole field, which was, at that time, just literature and medicine.

Lucy 
I had the privilege of knowing your husband and saw how he was really ahead of his field.

Felice 
He was a visionary. Definitely not just with that, but with all kinds of stuff that had to do with tech. You know, computers in medical education.

Lucy 
He was a big help to me when I had a grant from the NIH to do a project. He really zeroed in on its strengths, its weaknesses, and helped me in a very generous way. Just to backtrack a little bit, how did you choose the work that you shared with the students? What were you looking for when you selected certain work?

Felice 
I really had a pretty broad range of what I chose, and how I looked for it. Of course, if it was something to do with doctor or resident or medical student experience with patients– that was what I was looking for. But then there was patient experience, also from the patient’s perspective, how they were interacting, and what their feelings were about their illness or disabilities. And then as I started getting interested in this, I decided I really needed more training, and I decided to get a master’s degree, not in literature, but in something that was called at that point, humanities and social thought– that was the track at NYU in one of their master’s programs. And through that, I got really interested in the social thought part and societal issues that directly or indirectly affected medical practice, patient experience, and so forth. So that really also was important for me to get that degree, because when I started recruiting other faculty from other institutions, they [thought] I was an imposter. I was coming into that field without any background other than my interest in it. And they did not think highly of my intrusion into their field, and I don’t blame them. But you know, when they got to know me and what I was doing, they sort of became more accepting. But the thing that really clinched it was when I started this degree program, because then they felt okay, she’s serious. She’s going to get some professional training that makes it more legitimate to be associated with her. But of course, it was a really great thing for me, because it did give me a lot more background for what I was doing and what I would like to have been doing.

Lucy
You were very successful in recruiting a national board of editors.

Felice
Yes–the contributors were from all different places. They were very interested in making this a national internet-based project, because they were interested in furthering the field, and they saw the potential if it was on the internet, But initially I also had two NYU medical students who helped me choose material and write annotations. And then the site, especially once it became web based, was heavily used by so many and got so many hits–about a million a year. 

Lucy
It’s clear that the users went beyond medical students and physicians. What do you think attracted the wider audience?

Felice 
Well, I would occasionally get some notes, you know– I think there was a mechanism– I don’t remember exactly, where a user could contact me or somebody who was paying attention at NYU. What I found really interesting was there were patients who were using it. I don’t know what percentage of the users were patients, but there were patients who found stuff that was helpful to what they were going through. And so that was interesting to me, and I thought it was important, you know, it wasn’t my original intent to reach out to patients. It was really more of an education-based thing, but there it was. And why not?

Lucy 
We’re all patients at some point in our lives.

Felice 
Yes, right. That’s exactly true– issues about death and dying, not necessarily for the individual person, user, but family of theirs, friends who were in serious medical situations–all of that, it makes, made sense. So the audience became very broad.

Lucy 
And also you expanded the format.

Felice 
Well, first of all, when we started in 1993 there wasn’t a worldwide web. It didn’t exist. There was an internet. But the program that allowed people to access the internet was called Gopher, G, O, P, H, E, R. It was much more primitive but that’s what we started with, we put the annotations on this gopher program. Marty’s associate, Roy Smith, was instrumental in helping to set up the gopher program. Roy maintained his interest in our project as it moved forward. Then maybe a year or two later, I don’t know what the time lag was, but when the World Wide Web became available to anybody, I recognized that that would be really important, because it allowed you to make links with hypertext. You could make links between annotations; if you were referring from one thing to another; you could make links to art if you were annotating an art piece. You could make links –that was so key. So the web was just great. That was the way to go. And we were just lucky that it was there pretty early on.

Lucy
You recognized its potential.

Felice
And that wasn’t just Marty, actually. That was me.

Lucy 
And you chose the format of annotation versus a longer review. Was your goal to divide it into summary and commentary, specifically so that people understood what the work was about, but also how it connected to medicine and health? 

Felice 
I was going back to the format, or a slight modification of the book that Joanne Banks published in 1978. I think she used key words and a short paragraph about what the work was about. I think I expanded it to make both a summary and a commentary, because I thought that would be more helpful to people. I was modeling this thing after what she had done in 1978 and then again, she published another version, an updated version, I think, in 1982. In fact she and I had a phone conversation about our respective projects. 

Lucy 
One of the strengths of the web site was open access. You didn’t have to subscribe. That was important to you, I would imagine,

Felice 
Marty was very insistent on that. There were people who said, Oh, you should be charging something or whatever. And he said, No, if you want to make people aware of this field, you just make it completely accessible,

Lucy 
And it stayed that way, and the new site is open access. That leads me to ask, what do you think the role of health humanities is now? 

Felice 
You know, with all this artificial intelligence stuff, –I was reading about, or I saw online, a woman who, instead of having people as friends, she has some kind of an AI setup. And she’s not the only one, apparently, who’s, you know, relying instead of on human contact –on these bots. To me, it’s mind boggling. So I think there is definitely still importance to making this kind of work accessible and promoting it. And I also think it still should be part of medical education, health education, and it should be accessible to anybody who wants it.

Lucy 
Moving on to our new project. It’s based on the database but one of the differences, in my view, is that we’re including reviews that are a little more in depth than the annotations. How do you feel about what’s going on with the new site and how it’s evolved? And you can be honest. I mean, please.

Felice 
I think it is different from the database, and that’s good. It’s fine. You have your own vision of what you’d like to accomplish, and I think it’s working well, you’ve recruited people who’ve written some interesting things, not annotations, but more like essays. And you’ve expanded it so you have included art. I don’t know what else you’re planning to do, but I think it’s a good site, it’s valuable. It’s nice to have something up there that’s medical humanities related. And I really admire what you’ve done. 

Lucy 
Thank you. I think one difference is, you pioneered using links in the old database, and we’re using links much more now that it’s possible to do so. So if we review a book, then the author is interviewed by someone, we might link to the YouTube video. That’s been interesting to do and adds to what we can offer. It’s hard to know who’s using the site. We’re still in the very early stages, but I think it has a fairly broad appeal beyond just practitioners whether they’re doctors, nurses, or trainees, and I’m trying to have the public be interested in the work that we choose.

Felice 
I think you have your vision of the website, and that’s what you’ve voiced here, but it’s not my view of medical humanities.

In fact, I found this online at George Washington University, on their medical humanities site, and they quote me, but they don’t acknowledge that it was me, where I wrote: “Medical Humanities is an interdisciplinary field that includes the humanities, social sciences and the arts and their application to medical education and practice,” and then whatever education materials people develop that are designed “to help students develop and nurture skills of observation, analysis, empathy and self-reflection, skills that are essential for humane medical care.” [Quotes are from the GW website and were at the original NYU medical humanities site.] Especially the first part that I read, I mean that it is a broad, interdisciplinary scholarly field. That is how I have always, or at least for many years, maybe not in the very beginning, looked at it. So that’s a little different from what you are trying to do. And I’m not criticizing you in any way. I mean, I’m just recognizing that there is a difference in what you want to do with your site and what we did with ours.

Lucy 
One of the things that the database could do was show different cultures and describe experiences that the students themselves might not have directly. MedHum is a bridge into other cultures, and that’s what I mean when I say it is a lens on the human experience. That by reading literature, by reading about other societies, and what people who live in those societies go through, which you know only too well, it broadens your ability, hopefully, to empathize and to understand the differences among people.

Thank you, Felice for speaking with me today and for your editorial guidance throughout the years. It’s been an extremely fruitful collaboration.

Web image by Medhum.org

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Hours later, after she has tried all the methods known to her, Agnes is asleep next to Judith’s pallet. Hamnet, overwrought that he is about to lose the “other side to him,” crawls from his pallet to Judith’s side, beginning to feel poorly also. He arranges himself next to Judith in a way that made it almost impossible for people to tell them apart, hoping as Death came to take her, it would be fooled into taking him instead. “And if either of them is to live, it must be her. He wills it. He grips it…He, Hamnet, decrees it. It shall be.” (p. 169) 

When Agnes awakens, she eventually discerns that “her daughter has been spared…but, in exchange, it seems that Hamnet may be taken.” (p. 208) She reinitiates the treatments she had tried on Judith, but nothing works. Hamnet takes his last breath. Agnes wonders how she could have saved him, how she could have missed Hamnet being at risk before she is able to comprehend: “he is dead, he is dead, he is dead.” (p. 219) 

From this event on, O’Farrell constructs the trajectory of the family’s grief with a particular focus on Agnes. Her grief is amplified by resentment and incredulousness over her husband’s return to London soon after the burial because he feared his work as an actor and playwright would lose irretrievable ground with a prolonged absence. These emotions and grievances reach a crescendo over a period of years before understandings are reached and catharsis experienced. 

The Plague Comes for the Twins 

Easily lost in the gripping story O’Farrell tells and the emotional torrents she evokes is the chapter explaining how the plague reached the twins. She takes the modern-day, biomedical understanding of the complex chain of events involved in the spread of plague and weaves it into how she imagines it could happen amidst everyday life in the countryside outside London during the 1590s.  

A basic biomedical reference O’Farrell could have consulted in piecing together a credible sequence of events leading to the twins’ infections would likely include the same details provided in a summary of plague spread published in the 2021 volume of the American Journal of Medicine*: 

An ancient disease, its bacterial agent (Yersinia pestis) is an aerobic, gram-negative coccobacillus in the family Enterobacteriaceae. Its primary vector for transmission is the Xenopsylla cheopis flea, although roughly 80 species of fleas can carry it. During the Black Death, the flea was transported by the black rat or Rattus. A controversial new theory argues that ectoparasites such as human fleas and lice also spread the disease during the second plague pandemic [1347-1665]. Fleas can also survive in infected clothing or grain. The bacteria multiply in infected rodents and block the fleas’ alimentary canal, causing the fleas to regurgitate the Y. pestis bacteria into its animal host…Plague transmission is generally from infected fleas by rodent vectors or, rarely, in clothing or grain but may also occur through ingesting contaminated animals, physical contact with infected victims, or direct inhalation of infectious respiratory droplets. 

O’Farrell could also find plenty of well-researched historical accounts of the plague impacts at the time and place she set the novel. The plague affecting Stratford then is thought to have first entered England in 1348 from ships docking in cities along the southwestern coastline. England struggled with it almost constantly for more than 300 years until it dissipated after 1665. From this biomedical and historical background, O’Farrell created a realistic framework for the story, and a reasonable representation of the all the factors needed for the infection to find the twins in 1596 Stratford.   

She starts her explanation of how the twins got infected by specifying that,  

two events need to occur in the lives of two separate people, and then these people need to meet. The first is a glassmaker on the island of Murano in the principality of Venice; the second is a cabin boy on a merchant ship sailing for Alexandria on an unseasonably warm morning with an easterly wind. (p. 140) 

The glassmaker is filling an order for decorative glass beads received from a dress shop in Stratford, England. But, because of a recent hand injury, a fellow worker is given the job of packing the order. This worker doesn’t know that the glassmaker “usually pads and packs the beads with wood shavings and sand to prevent breakage. He grabs instead a handful of rags from the glassworks floor and tucks them in and around the beads.” (pp. 140-141).  

Meanwhile, the merchant ship has docked in Alexandria, and the cabin boy has been sent ashore for provisions. He quickly encounters a man with a monkey, and the monkey quickly jumps on the cabin boy, and then all over the boy, passing along three infected fleas. One of them accompanies the boy back onboard ensconced “in the fold of the red cloth tied around the boy’s neck, given to him by his sweetheart at home.” (p. 144) The flea doesn’t stay there long. It jumps into the fur of one of the ship’s cats the boy picks up and nuzzles. Soon after the cat is sickened by its passenger and seeks comfort on the hammock of a midshipman, who upon approaching his hammock for a night’s sleep, finds a dead cat. The flea, now needing a new place to live “makes its way, by springing and leaping, to the fecund and damp armpit of the sleeping, snoring midshipman, there to gorge itself on rich, alcohol-laced sailor blood.” (p. 144) Three days later, the midshipman is dead. 

The ship arrives in Murano to pick up cargo including the glass beads. The cabin boy and the glassmaker come eye to eye as the glass beads are loaded onto the ship. And at that moment, the monkey flea, which had found a way back to the boy after time with some of the ship’s rats and its chef, leaped onto the glassmaker. He and many others in his factory subsequently succumb to “a mysterious and virulent fever.” (p. 149) 

In the hold of the ship now heading to England, the progeny of the monkey flea leap from dying rats to cats lying on top of the boxes filled with the glass beads until the cats die. The fleas eventually “crawl down into these boxes and take up residence in the rags padding the hundreds of tiny, multi-coloured millefiori beads (the same rags put there by the fellow worker of the master glassmaker…)”. (p. 148) The ship arrives in London and the boxes of glass beads are taken to a wharfhouse where they are stored for about a month before picked up for further transport. 

O’Farrell ends her tale of how the plague found the twins through the delivery of the box with infected fleas to their final destination. The box of beads “still wrapped in rags from the floor of the Venetian glassworks” is transported to an inn located near the northern reaches of London. (p. 149) Then, a messenger collects the box and takes them by horseback on a two-day journey to another inn near Stratford. O’Farrell adds how during this ride the mass of infectious plague vectors and organisms intensifies. 

The fleas in the rags crawl out, hungry and depleted by their hostless stay in the wharfhouse. Soon, however, they are recovered, rejuvenated, springing from horse to man and back again, then out on to the various people the rider encounters along the way…By the time the rider reaches Stratford, the fleas have laid eggs: in the seams of his doublet, in the mane of the horse, in the stitching of the saddle, in the filigree and weave of the lace, in the rags surrounding the beads. These eggs are the great-grandchildren of the monkey flea.  

The box with the beads and the fleas is now in the town where the twins live. An innkeeper there has it, and gives a boy a penny to deliver the box to the dress shop that ordered it many months before. The fleas have found Hamnet. 

Judith is at the dress shop helping out when the box is delivered.  

The seamstress holds aloft the box. ‘Look,’ she says to the girl, who is small for her age, and fair as an angel, with a nature to match. 
        The girl clasps her hands together. ‘The beads from Venice? Are they here?’ 
        The seamstress laughs. ‘I believe so.’ 
        ‘Can I look? Can I see? I cannot wait.’ 
The seamstress puts the box in her counter. ‘You may do more than that. You may be the one to open them. You’ll need to cut away all these nasty old rags. Take up the scissors there.’ 
 She hands the girl the box of millefiori beads and Judith takes it, her hands eager and quick, her face lit with a smile. (pp. 150-151) 

The fleas have found Judith. 

When Literary Narrative Serves as Biomedical Text 

O’Farrell’s narrative, fictional model of plague spread embedded in her story imagining what could have caused the death of an eleven-year-old boy in 1596 takes into account both the virulence of the infection and the many and varied ways it can spread. To make that point, she, much as would any epidemiologist, tells of others killed as the fleas made their way from Murano to Stratford, such as workers in the glassmaker’s factory, midshipmen on the boat, and various people encountering land-based messengers carrying the box of beads to those awaiting it. In that way, her model also explains how the mortality estimates of one-tenth to one-third of the populations from frequent plague visitations over three centuries could be generated. 

O’Farrell could have left this part out of the novel without losing much of the core storyline or emotion and drama of it. Indeed, the movie version gives it only a few seconds of attention showing the twins’ father walking by a street puppet show during a scene representing the spread of and death from plague delivered from a ship. By including the chapter, however, O’Farrell compounds the drama and emotion, and reveals the complexities involved in our fates.  

And, as I recall the drudgery of reading and mastering the intricacies of infectious disease spread and pathology such as those of bubonic plague, I wish I had O’Farrell’s novel Hamnet at the time. The experience would have been enjoyable and memorable where the experience with biomedical texts were not in either way. Perhaps this application was not in O’Farrell’s mind for the book, but it could go a long way in ridding us of the plague of turgid, mind-numbing, and indecipherable biomedical prose. Whether or not she knows it, O’Farrell has in this novel brought attention to a plague of another house.  

Hamnet
Maggie O’Farrell
Alfred A Knopf; 2020

*From: Glatter JA, Finkelman P. History of the Plague: An Ancient Pandemic for the Age of COVID-19.  American Journal of Medicine 2021; 134(2): 176–181. 

Image Credits

The path of infection of plague from rats via fleas to man, by A.L. Tarter from the Wellcome Collection. Attribution 4.0 International (CC BY 4.0). 
A rat on board a ship, carrying the plague further afield, by A.L. Tarter from the Wellcome Collection. Attribution 4.0 International (CC BY 4.0) 
The word plague hovers above a victim’s face, by A.L. Tarter from the Wellcome Collection. Attribution 4.0 International (CC BY 4.0) 

The latter decision unarguably constitutes a significant setback in the struggle for reproductive rights for American women, but the history of access to abortion—and a sense of what the future might hold—may best be understood by taking the long view, across cultures. In Pushback: The 2,500-Year Fight to Thwart Women by Restricting Abortion, historian Mary Fissell does just that. Starting with the story of an enslaved woman in ancient Greece who becomes pregnant after being hired out as a prostitute by her enslaver, Fissell presents a series of case studies. Each one illustrates how women continued to have abortions through the centuries despite changing mores, laws, the influence of the church, and the irregular availability of experienced or qualified providers. The stories also demonstrate a pattern: as women gained more social and economic freedoms, the laws governing abortion became more restrictive, with the pendulum eventually swinging back in the opposite direction to a more liberal stance on abortion.

The enslaved woman in ancient Greece would likely have faced no moral sanction for seeking an abortion—her value lies in her continued availability as a sex worker, and, in her case, a singer. Documents suggest that women in her position would have had the knowledge to end her pregnancy, most likely with an herbal abortifacient, though squatting, jumping and sneezing were also recommended methods of preventing pregnancy immediately after sex. In ancient Rome, the focus on controlling fertility was somewhat different; Roman women had greater freedoms than their Greek sisters, raising concerns about adultery, which Augustus declared as a criminal offense. With  a focus on increasing the number of upper-class Romans who would rule the growing empire, controlling the fertility of elite married women was one way to achieve this end.

Leaving antiquity behind, Fissell nimbly guides us through the Middle Ages. In an era where Christianity is on the rise, and the issue of ensoulment is linked to the experience of quickening (when the pregnant woman first feels the fetus moving), the story of Brigid of Kildare was recorded. Brigid, a holy woman whose historical existence cannot be confirmed, was said to have helped a young woman miraculously end her unwanted pregnancy (a subsequent miracle attributed to Brigid helped a woman preserve her chastity).  The Church’s codified position on abortion was still more than 500 years away and for many of these early Christians, discussions of ensoulment notwithstanding, concerns around abortion as a means of covering up illicit sex appear to have weighed more heavily than any harm to the fetus.

In early modern Europe, in some parts of the continent, abortion had become a capital crime punishable by execution, a development that reflected “a larger cultural shift that sought to control female sexuality in the interests of Church and state.”  The story of Anna Harding who went on trial in 1618 was a case in point. Against the background of a witchcraft panic, Harding  admitted to providing both married and unmarried women with herbal and floral preparations to end their pregnancies. A “confession” under torture to having consorted with a demon led to Harding’s conviction and being burned at the stake. 

Indeed, herbal preparations to end unwanted pregnancies were common to societies as disparate as enslaved women in the Caribbean, who used abortions as an act of resistance, to Victorian women of all classes who sought abortions for many of the same reasons as women do today. Use of one of the herbs best known to induce abortion, pennyroyal, persisted up through the early 20^th century, although not without risk to the pregnant woman.

By this time, the idea that life begins at conception had gained a greater hold in the United States. Hugh Hodge, a professor of medicine at the University of Pennsylvania, argued this “scientifically-based” premise as early as 1839, while the Pope’s 1869 declaration that life begins at conception would have been presented as divine revelation, though Fissell posits that concern on the part of European monarchs in Catholic countries worrying about depopulation and “degeneration” may well have influenced the pronouncement.

The story of Beatrice J, a Baltimore woman, who safely achieved two self-managed abortions in the 1940s through the aid of a catheter and ergot pills to induce uterine contractions, serves as a more modern example of women who had ended a pregnancy going on to administer abortions to others. In Beatrice’s case, after her trusted pharmacist helped set her up as an abortion provider, an undercover police operation exposed her practice. A trial followed, but charges were ultimately dismissed by a progressive judge on the basis that the “client”  who visited Beatrice was not actually pregnant.

In addition, Fissell points out this was not an isolated example by any means. Even in the most restrictive settings and time periods, there appears to have been a fair amount of  tacit acceptance.  In the U.S., for example, “Physicians performed legal abortions for a variety of indications, and the rest, so-called criminal abortions, went largely unremarked. In the 1920s and ‘30s, abortion providers were rarely prosecuted, whether physicians or not, and the former were at risk only if a woman died.” Moreover, once antibiotics and blood transfusions became available in the 1930s and 1940s, the morbidity and mortality associated with these procedures would have been reduced.

The presence of abortion providers who practiced under the radar persisted throughout the ‘30s and early ‘40s, albeit with some providers using their own judgement as to who was morally deserving of their covert services.  But the 1940s and 1950s also brought a more punitive attitude toward abortion in the United States. With an increasing number of arrests of providers administering safe abortions, dangerous practices became more widespread, as did abuses by practitioners, including sexual assault on clients. In turn, these tragic stories led to the underground movement of women and their allies who supported those in need, including the Jane Collective in Chicago, a group of women who risked criminal prosecution to help others obtain safe abortions. 

While the individual stories of women seeking abortions constitute the throughline of Pushback, Fissell consistently addresses the broader factors that affected access in each of the societies she describes, including eugenics, racism, nativism, and concerns about fidelity and heredity. Enslavement and labor demands, the appropriation by physicians in the 19^th century of care that was formerly the domain of midwives, and superstitions linking women’s fertility to fertility of livestock and crops, also come under scrutiny, as does the relatively recent shift of emphasis from the importance of the life of the mother to that of the fetus.

Readers might also consider the role of medical advances as factors that have altered our understanding of pregnancy, development of the fetus, and access to abortion. Among them was the development of simple urine tests that eliminate the uncertainty surrounding pregnancy, a means of confirmation light-years away from those early societies where pregnancy was confirmed by quickening. Sophisticated imaging of the fetus via ultrasound not only confirms pregnancy at an early stage, but packs an emotional punch. Moreover, the availability of medication through pharmacies and online sources for self-managed abortions, while under threat, has created a new landscape for pregnant women. This last means of obtaining an abortion, though formulated in a laboratory, suggests a new iteration of the herbal abortifacients used by so many generations past.

Pushback succeeds at being both highly readable and meticulously researched—the volume includes an extensive list of notes and references for each chapter. Fissell, who is the Inaugural J. Mario Molina Professor in the History of Medicine at Johns Hopkins University, also writes the Substack A is for Abortion: Snapshots from the Past. As a pre-modern historian of the 17^th century, she particularly enjoys the kind of “detective work” that accompanies that study. But she was also pleasantly surprised by how much she enjoyed researching and writing on the modern period, where sources are more readily available, including data she found through Ancestry.com.

Fissell completed her manuscript before the start of the second Trump administration and aside from allusions to Roe v. Wade and Dobbs v. Jackson, Pushback does not explore the ways in which abortion became a flashpoint in our most recent national elections. (A description of politically motivated anti-vice campaigns that targeted abortion practitioners and pregnant women in the late 1940s and 1950s is included in the chapter dealing with that time period.)

But in a discussion with this writer, Fissell weighed in on current data that shows more American women than ever are having abortions despite the 2022 Dobbs ruling. “Restriction has an impact and makes abortion much more difficult and dangerous to access,” she said. “But it never stamps it out.” She also cited data that suggests roughly 66% of Americans think abortion is a decision that should be made between a woman and her doctor.  

Interestingly, Fissell did wonder at the onset of her research for Pushback whether she might change her mind on the issue. In the end, she describes holding the same views as when she started.  “Given that abortion was often shameful and secret if not [completely] illegal, I was amazed by how much I was able find out.” Her appreciation for insights from the reproductive justice movement deepened considerably as well, as it informed her understanding of women in earlier societies and the use of the term “choice,” then and now, for women in untenable circumstances.

“[Choice is] something a white woman with money can afford to have,” Fissell said. “Choice [does not apply to] a struggling waitress in a small Southern town who was raped and has two kids at home, and her wages won’t even cover their care…Casting the decision as choice means we don’t understand many women’s experiences.”     

Pushback by Mary Fissell was published by Seal Press (2025).
Web image by Medhum.org.