Bioethics in History: Museum of Health & Medicine « Berman Institute Bioethics Bulletin

Bioethics in History: Museum of Health & Medicine

March 30, 2015

There’s a clear affinity between bioethics and the history of science. The history of science is (like all history) a story of changing values. Bioethics, the collective examination of ethical issues in health and research, benefits from reflection on past triumphs and missteps. In this series of posts, I highlight ethical puzzles (and droll odds and ends) to be found in museums and archives of scientific, technological, and clinical history.

The National Museum of Health and Medicine began its life as the Army Medical Museum, a collection of military medicine and surgical research specimens. Curators visited Civil War battlefields to collect contributions and take photographs. Military doctors were directed to keep and submit pictures, case histories, and interesting samples. After a dispatch of some of the archives to the National Library of Medicine in 1956 and many name changes, it became the National Museum of Health and Medicine in 1989.

The collection has been used for medical research and education, most notably the publication of The Medical and Surgical History of the War of the Rebellion, a six-volume, 3,000 page set of illustrated books considered one of the first major American contributions to medicine.

Museum staff were also involved in medical research, with a particular focus on infectious diseases prevalent in the military. The reason for this is immediately clear as you look through samples from the early collection; two-thirds of the soldiers who died in the Civil War were killed not by battle, but by disease. At left is a midcentury diorama depicting the experimental administration of typhoid vaccines, which were invented and first tested in 1910 by Dr. Frederick Russell, then a museum curator and an instructor at the Army Medical School. The vaccine proved successful in volunteers from the museum and medical school and became compulsory for the entire Army in 1911.

Improvements in helmet technology and emergency medicine have kept countless soldiers alive who in earlier times would have died of head wounds. As a result, traumatic brain injury is an important area of research. In this rendering of a soldier’s real injury, a portion of the skull was removed to allow room for swelling of the brain and then a prosthetic implant was used to replace the bone.

Displayed alongside the acrylic skulls are these ancient Peruvian skulls showing evidence of trepanation. The reasons (physical? spiritual?) for trepanation in ancient cultures remain a source of disagreement, but the practice was likely the first form of neurosurgery. While we can’t assume that the Peruvian and American skulls were cut open for the same reason, the comparison is nonetheless interesting – no matter how far surgery has come, the basic biology of the skull persists.

The museum holds a number of “celebrity” specimens, including the bullet that killed Abraham Lincoln and photographs of Albert Einstein’s brain.

Neither of these things turned out to be especially exciting to look at. My apologies. But, at right: the sad skeleton of Able, one of the first monkeys sent into space. At left: a skull gilded in the 19th century!

Bioethics Highlight:

A number of displays pointed to the complicated role of medicine in warfare. In one example, temporary Civil War hospital Camp Letterman treated both Union and Confederate soldiers after the Battle of Gettysburg, discharging survivors to Philadelphia or Baltimore. Confederate soldiers shared tents, leisure time, and the same quality of care with the hospital’s Union soldiers. Medicine created a space in which the war was secondary to saving lives.

In a newer exhibit on the Iraq War, an Air Force major describes “lifesaving procedures… chest tubes, central IV lines, even open thoracotomies… done with an intensity and unity of effort to rival any battlefield.” In this context, medicine is its own battle – not a separate space, but rather an integral part of one side’s war effort. Trauma care acts as a critical component of the fight itself.

Is one model of wartime medicine better than the other? They are adaptations to very different conditions. After civil war battles, tens of thousands of wounded soldiers littered the battlefield, dying. Saving one side’s soldiers while leaving the other’s to die of exposure would have been needlessly cruel. The very nature of a civil war (“brother against brother”), also probably made Unions caregivers sympathetic to Confederate patients. Today’s warfare looks very different, however. The efficient triage and transport system used in Iraq has been called a “6,000 mile ICU” from the “war theater” back to the US. Soldiers are quickly extracted to be treated in transit and in the safety of distant hospitals. There isn’t as much room for the kind of compassionate medicine that would transcend battle lines.

This museum struck me as uniquely sensitive to the identities of patients. In a large exhibit on emergency field medicine, I could not find a single instance in which a soldier is recognizable – the bodies of doctors and nurses always block the faces of patients. Yet placards list the names of people who weren’t necessarily “important.” Individual bullets are labelled by who they killed. There’s also an exhibit on the evolving science of identifying human remains, which emphasizes the nation’s duty to restore the names of lost soldiers.

The military patient is treated a little differently than the civilian patient, then. The soldier’s physical suffering is not treated as a spectacle, but her name must be remembered. At least in this respect, the museum does an exceptional service to the people whose bodies and experiences it archives.

With that being said, the older specimens are associated with full medical records, photographs, and stories about injuries. Without the protections of HIPAA, curators were able to keep and present full histories. This means we can look back and make eye contact with patients from the past. The current vogue for ostentatious facial hair and heavy pomade makes examining Civil War-era photos especially jarring. The men, who look earnestly at the camera, look young, wounded, and very familiar.

To everyone’s benefit, wartime has been used as an opportunity for medical and scientific research. Difficult as it may be to look the subjects of early surgery and infectious disease medicine in the face, it’s also nice to see them presented as not just case studies, but people.

The National Museum of Health & Medicine is located at 2500 Linden Lane, Silver Spring, MD. Admission is free.

Previous posts in this series:
The National Dental Museum
Pharmacy Museum, Basel