REVIEW: McCleery on Connelly and Künzel, ‘Disease, Disability and Medicine in Medieval Europe’

Erin Connelly, Stefanie Künzel, eds. Disease, Disability and Medicine in Medieval Europe. Oxford: Archaeopress Archaeology, 2018. 156 pp. $58.00 (paper), ISBN 978-1-78491-883-5.

Reviewed by Iona McCleery (University of Leeds) Published on H-Disability (September, 2019) Commissioned by Iain C. Hutchison (University of Glasgow)

Printable Version: http://www.h-net.org/reviews/showpdf.php?id=53951

The editors of this collection of ten short papers, deriving from a conference in 2014, write in their introduction that the focus of the conference was “infections, chronic illness, and the impact of infectious disease on medieval society, including infection as a disability in the case of visible conditions, such as infected wounds, leprosy, syphilis and tuberculosis” (p. 2). Although most of the papers have been updated since the conference, it would have been good to have allowed the authors more room to further develop their case studies. A longer introduction might also have helped to explain in more detail how infectious disease and chronic illness can be stigmatizing and disabling. Some of the papers takes this aspect for granted; others provide fascinating glimpses of the effect of chronic dysentery, scarring, or cysts on the daily life of individuals, but they do not have the space to expand. As a result, the collection focuses more on representations of disease and illness than on disability–although one or two papers are difficult to fit even into this broader remit–but there are still several insightful studies that might interest historians of disability. 

The two papers that most explicitly engage with physical impairment are both excellent examples of how archaeology has transformed the history of health, medicine, and disability. Both papers are interdisciplinary, drawing also on narrative sources, especially miracle collections. Cathrin Hähn identifies often quite fragmentary and difficult-to-interpret objects in burials as assistive aids dating from 600 CE-800 CE in Merovingian Gaul (northern France and northwest Germany). These probable prostheses, protective braces (ortheses), or metal caps used to reinforce the ends of long-since decayed wooden walking sticks or possibly crutches were buried in the graves of early medieval people whose skeletons present with damaged or absent bone in the lower limbs. The author suggests that the presence of these items, long after Christian conversion ended the ritual deposit of grave goods, meant that these objects were very closely associated with the individual’s bodily integrity during life. 

The second archaeological paper is by Cecilia Collins on the evidence for infectious disease in medieval Iceland using the bone changes that such conditions leave on the skeleton. The paper could function very well in a teaching context as an accessible short introduction to palaeopathology, including its limitations for understanding medieval health and disease, while providing useful contextual information on Iceland between the tenth and nineteenth centuries. The conditions considered, based on analysis of approximately 1,300 skeletons, are leprosy, tuberculosis, treponemal disease (syphilis), and hydatid cysts caused by parasitic tapeworms. This last condition provides a fascinating insight on a little-known, but quite common, impairing condition (examples of such growths recovered archaeologically were 15-20 cm in diameter so would have affected nearby bone and organs). It could have caused death after years of pain. 

Other highly interesting and well-written papers in the volume include Lucy Barnhouse’s close study of a miscellany of medical texts and practical recipes (part of MS Laud Misc 237 in the Bodleian Library in Oxford). She hypothesizes that it may have been adapted for use by a hospital run by nuns in a German-speaking region during the late Middle Ages. Also stimulating is Clara Jauregui’s study of daily life in Barcelona’s leprosarium in the late fourteenth century and based on the hospital’s extraordinarily detailed financial account books. If anyone still thinks that medieval people with leprosy necessarily led a stigmatized and isolated life, this essay would dispel such myths. The small hospital in Barcelona clearly was a compassionate and well-supplied place with a mobile and characterful community within it. 

Although there are a few essays that could have done with more updating, proofreading and help with English, and greater consistency with stylistic conventions, especially as regards longer citations and the presentation of translations versus original language texts, this is a valuable collection. All the authors were PhD students in 2014 and are now early-career researchers. This collection’s interdisciplinary approach to past health through literature, archaeology, scientific methods, and ecclesiastical records therefore represents the future direction of medical history. 

Citation: Iona McCleery. Review of Connelly, Erin; Künzel, Stefanie, eds., Disease, Disability and Medicine in Medieval Europe. H-Disability, H-Net Reviews. September, 2019. URL: http://www.h-net.org/reviews/showrev.php?id=53951

REVIEW: Virdi on Draycott, ‘Prostheses in Antiquity’

by H-Net Reviews

Jane Draycott, ed. Prostheses in Antiquity. Abingdon: Routledge, 2018. 214 pp. $140.00 (cloth), ISBN 978-1-4724-8809-1.

Reviewed by Jaipreet Virdi (University of Delaware) Published on H-Disability (November, 2019) Commissioned by Iain C. Hutchison (University of Glasgow)

Printable Version: http://www.h-net.org/reviews/showpdf.php?id=53417

A photograph of an Egyptian toe frequently circulates on social media and various online periodicals. It is not your usual toe. This one is made of wood, intricately engraved to include a toenail; is affixed to leather binding and dates from 1069 to 664 BCE; and is currently housed in the Cairo Museum. Found attached to a woman buried in a tomb near the ancient city of Thebes, archaeologists speculate that this toe is likely the oldest prosthesis ever found. The Cairo Toe reframes our conception of the history of prostheses, extending the time line of the invention of invention further back in antiquity, where stories of gods and gladiators were woven together with artisanal creations for everyday life.

In recent years, there has been an expansion of historical scholarship on disability in the ancient world.[1] These works have unraveled how ingrained disability was in ancient societies—there was no word or category for “disability” because kings, tradesmen, and gods alike all encountered disability and deformity. As Annie Sharples puts it, the ancients perceived disability not as an opposition to normality, but as a “part and parcel of human existence.”[2] Such perceptions of disability, deformity, and impairment are also covered, for instance, in the essays in Christian Laes’s edited volume, Disability in Antiquity (2016)as well as Laes’s cultural survey, Disabilities and the Disabled in the Roman World (2018). Surveys on the history of surgery, amputation, war injuries, and medical care in antiquity have also presented broader perspectives on social and cultural perceptions of disability. Similarly, scholarship on the history of prosthetics has expanded since Katherine Ott, David Serlin, and Stephen Mihm’s 2002 edited collection, Artificial Parts, Practical Lives as well as becoming deeply rooted into museum studies.[3] Yet there is little intersection between histories of disability in antiquity and the lived lives of prosthetic users—how prostheses were designed to be used and how users in turn, designed and modified their prosthesis to better fit their bodies.

Prostheses in Antiquity sets out to fill that gap. Based on a conference hosted at the University of Wales Trinity Saint David in 2015, this volume “focuses primarily on prostheses as material objects and considers their role (or roles) in the cultures and societies of classical antiquity” (p. 10). As Jane Draycott asserts in the editor’s introduction, prostheses were social objects with a complex set of meanings that impacted the daily lives of disabled people, including how these objects were navigated as nonmedical devices. After all, even though prostheses of classical antiquity were not considered therapeutic, nor do they appear in ancient medical literature, their materiality and artifact existence indicate how carefully and comprehensively makers were designing prostheses for proper usage. The eight chapters cover a broad range of prostheses, most frequently discussed in literary, documentary, archaeological, and bioarchaeological evidence: teeth, hair, toes, and limbs, as well as the broader cultural contexts and ideals of injury and impairment, including the ambiguity of prosthesis use.

Jacky Finch’s fascinating chapter brings together material culture, prostheses, and archaeology to reconstruct the Cairo Toe and another ancient Egyptian prosthetic toe, the Greville Chester Toe. Since “the rarity of these artefacts precluded their use in a laboratory trial,” Finch’s research team relied on volunteers to construct working models as design copies of the original (p. 35). Since the toe is made of wood and research revealed the craftsman used chisels to retain the anatomy of the foot, a carving expert was recruited to the team—the 2007 British Bird Carving Champion, no less! Two volunteers with missing big toes wore the prosthesis and provided valuable insight into the functionality of the design and its usefulness. This intersection of making, replication, and experimentation is a fascinating way to approach the history of prostheses, for understanding prosthesis use certainly provides crucial insight to the lived experiences of disabled people in antiquity.

The chapters by Jean-MacIntosh Turfa and Marshall Joseph Becker on dental appliances, and by Jane Draycott on prosthetic hair, enable us to rethink the usage of seemingly cosmetic prostheses and their inception as representing class distinctions. Since the diet of Etruia was healthy and dental profiles of skeletons did not indicate regular loss of teeth, “it would appear that the lost front teeth of Etruscan women of the upper classes wearing ornamental appliances may reflect a deliberate phenomenon” (p. 62). Likewise, in considering the cultural and social importance of hair to ancient Romans, Draycott demonstrates how wigs and hairpieces were not always an indication of poor health or stigma of hair loss, but “another means for the Roman elite to demonstrate conspicuous consumption” (p. 79).

Lennart Lehmhaus’s chapter turns to the existence of prostheses in rabbinic discourse in the Talmudic corpus. Acknowledging that such sources are biased, and anonymous with a collective authorship, they nevertheless reflect how prevalent prostheses and disability were in the ancient socioreligious Jewish world; as a result, discussions around prostheses tend to be “confined to permission or prohibition of usage on certain occasions … in a certain status … or in different religious realms” (p. 113). Josef Eitler and Michaela Binder’s chapter also examines socioreligious contexts surrounding prostheses, this time by examining the archaeological evidence of burial grounds, focusing on the discovery of a sixth-century middle-aged man with an amputated foot replaced by a wooden prosthesis, discovered at the Hemmaberg excavation in Australia. Turning to the functional aspects of prostheses, Katherine van Schaik’s chapter reevaluates ancient descriptions of paralysis and blindness in order to suggest how to (re)define prostheses in ancient and modern contexts.

On the “prosthetic imagination,” Anne-Sophie Noel explores whether the lived experiences of prostheses during the fifth century inspired Greek literary tragedies, including how objects became transformed into living things and whether they can be ascribed agency. Similarly, Ellen Adams broadens debate about the terminology used in discussions of prostheses to assess whether modern studies can be applied to antiquity. Drawing on scholarships from disability studies, psycho-prosthetics and sign language, Adams’s paper is an interesting contribution to existing scholarship on “normality.” However, the discussion of modern auditory aids, the Deaf community, and the cochlear implant are completely out of context given the focus of this book. I am wary of attempts to anchor modern discourse to antiquity. As Draycott asserts in the introduction, this volume is one of the few to tie disability history, material culture, and ancient history scholarship together, which presents for an exciting growth in the field. Recourse to metaphorical analysis, literary devices, and anachronistic summaries, unfortunately, diminishes the agenda. Nevertheless, Prostheses in Antiquity is an exciting collection that will appeal to a wide range of experts interested in the subject.

Notes

[1]. See the Disability History and the Ancient World website, accessed October 30, 2019, https://www.disabilityhistory-ancientworld.com/. 

[2]. Anne Sharples, “Survival of the Fittest? Experiencing Disability in Antiquity,” Warwick Globalist, November 11, 2015, http://warwickglobalist.com/2015/11/11/survival-of-the-fittest-experiencing-disability-in-….

[3]. See “Case Study: Prosthetics in Museums,” Disability and Inclusion: Resources for Museum Studies Programs website, Art beyond Sight, accessed October 30, 2019, http://www.artbeyondsight.org/dic/case-study-prosthetics-in-museums/.

Citation: Jaipreet Virdi. Review of Draycott, Jane, ed., Prostheses in Antiquity. H-Disability, H-Net Reviews. November, 2019. URL: http://www.h-net.org/reviews/showrev.php?id=53417This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

Review of Williamson, Bess, Accessible America: A History of Disability and Design by Elsbeth Bosl

Bess Williamson. Accessible America: A History of Disability and Design. New York: NYU Press, 2019. 304 pp. $30.00 (cloth), ISBN 978-1-4798-9409-3.

Reviewed by Elsbeth Bösl (Universität der Bundeswehr München) Published on H-Disability (October, 2019) Commissioned by Iain C. Hutchison (University of Glasgow)

Printable Version: http://www.h-net.org/reviews/showpdf.php?id=53666

Bess Williamson is an associate professor of art history, theory, and criticism at the School of the Art Institute of Chicago. A historian of design, material culture, and arts by training, she received her PhD in American history from the University of Delaware with her thesis on the links between design and disability rights in the United States from 1945 to the present.

The primary topic of this book is the relations and interdependencies between politics, design, and social movements. The research objective explored is the advent, proliferation, and differentiation of accessible design. Williamson’s concept of access in the context of disability is that architecture, infrastructure, and products be physically usable. Her analysis therefore concentrates on physical disabilities and so may perpetuate a dominant bias found in much disability history writing during the last decade. This is, however, not only a deliberative decision on methodology by the author, but reflects a feature of disability rights activism and is characteristic of the logic of accessible design where easily visible and comprehensible artifacts such as curbs and stairs have long been at the center of attention.

Williamson’s analysis is shaped by a social-constructionist perspective. Access does not just happen and neither does disability: when activists, designers, experts, tinkerers, and users address everyday technologies and architectural features as either barriers or as accessible, they define disability as a phenomenon emerging from the material environment. This could be interpreted as the reason for disabilities, but also the key to inclusion. Williamson’s stance on design is that it can be a device and vector for empowerment, but also for critique—by designers who speak against their own profession, by disabled persons who protest at societal attitudes, by critics of access legislation and disability rights.

Apart from that, the political inscribes itself into artifacts and designs; they become politically charged. Thus they are both products of political contexts and factors that influence political discourse. It is intriguing to read how the notion of access has been weighed against other US ideals such as civic autonomy, capitalism, freedom, the rights of the individual, the free market, and individualism. Both advocates and opponents of accessible planning and building invoked such typically American ideals. Activists from the 1970s onward, for example, saw access legislation as a means to independent, self-determined lives. Opponents regarded federal and other legal regulations as a severe threat to autonomy, individualism, and independence. Some feared an interventionist state and a steered economy. Other opponents primarily attacked the costs of access and weighed the concerns of a perceived minority over the interests of the majority. This was not a question of money only, but also of rights and equality. Were a small number of disabled people to have greater rights than the many able-bodied people—and even at the expense of that majority mainstream? While there was always a strong belief that access should not place an additional financial burden on the public, reduce the functionality of the “normal,” or interfere with aesthetics, such calculations were particularly intense in the 1980s within the political climate of the Ronald Reagan (1911-2004) administration (1981-89). 

The book also spells out nicely how closely the ideal, the politics, and the realities of access or non-access are connected to categories such as race, social class, income level, and gender. Indeed, access may be even more about poverty than about disability. Throughout her book Williamson gives examples of how environments and architecture were manufactured around an ideal of male, white, able-bodied people—especially in designs by architects of the first phase of modernity such as Charles-Édouard Jeanneret Le Corbusier (1887–1965), or witnessed in streamlined vehicle design of the 1940s and 1950s. Such concepts and innovations were not created with disabled people in mind. However, this does not mean that disabled people did not embrace these developments. Access may have been limited, difficult, or risky, but people with disabilities have always been adept at finding ways to reach an accommodation with both the public and private environments with which they are confronted, even when many spaces remained inaccessible to them. However, as the author shows, they went to remarkable lengths to gain entry to these hostile environments and devised ingenious devices to achieve these goals. Many of these responses resulted in alterations and compromise solutions of last resort that today may appear to us as degrading practices—and many of them were—but they should also be recognized in the historiography as examples of very smart self-help.

While accessibility has been an important field of research within disability studies, historians of disability have only recently begun to look into the materiality and the meaning of technology, building, and design. This is especially true for the non-US context, while in the United States, Williamson’s book is the third by a historian of design and material culture to appear within two years: Aimi Hamraie published Building Access: Universal Design and the Politics of Disability in 2017 and Elizabeth Guffey published Designing Disability: Symbols, Space and Society in 2018From the point of view of a historian of both technology and disability, this new interest is a welcome development. All three authors make an important point about the differences between a normative concept, a policy statement, a template, and actual, individual user experiences. They combine to increase the presence of disability as a category in design history.

Williamson bases her study on archival material, periodicals and other published sources, and interviews conducted in the course of disability history projects. One chapter, for example, is based on interesting archive material from the Disability Rights and Independent Living Movement Collection at Berkeley. The author strives to take not just the perspective of planners, architects, bureaucrats, or experts of various kinds, but to embrace those of users. However, individual disabled persons who were outside the architectural professions, and were not core figures in disability activism, are particularly dominant in the initial chapters, but they have little presence in the latter chapters where, sources permitting, it would have been nice to hear their voices continue with greater resonance.

The book is structured around seven chapters. Chapter 1 is about government policies and regulations in the aftermath of the Second World War, when the honoring and rehabilitation of disabled veterans was at the core of political interest. There were three major technical components to these policies: prosthetics were meant to complete the individual, customized cars were intended to take them to work and back, and accessible houses were to help reinforce US family and gender norms. It is very interesting to read that driving an automobile as a veteran was, in the postwar period, openly regarded as a material symbol of masculinity and freedom; it was advertised as such by car manufacturers and medical experts, even leading to a national car subsidy for veterans. However, despite provision of prosthetics, cars, and houses, the many barriers of the built environment faced by disabled veterans were largely ignored. Rehabilitation was regarded as the responsibility of the individual. Furthermore, high-tech prosthetics, wheelchair-accessible housing and specially equipped cars were components of an aid system limited to veterans. Disabled people who were not eligible for veterans’ programs received much less attention, especially in the spheres of financial support and technical aids.

Chapter 2 focuses on the University of Illinois at Urbana-Champaign because this was the first university campus where, in the 1950s, wheelchair-accessible devices were installed. Williamson traces the creation of a coordinated set of ramps, curb cuts, and customized interior building. This first systematic intervention into the built environment was devised largely by Timothy Nugent, the university’s rehabilitation services director. The chapter is about his and other rehabilitation experts‘ views on access: access was proposed as a means of medical and social rehabilitation and integration into the labor force and civil life. It was also rather enforced on people with disabilities. They were expected to perform, to be resourceful, well-disciplined, and tough. Access was not regarded as a right; it was given as a help so that the disabled individual could commit to his or her responsibility to function within society and overcome disability. Williamson calls this the rehabilitation approach to access. It was by no means a US phenomenon but was also typical of 1950s and 1960s Europe. The 1961 American National Standard Specifications for Making Buildings and Facilities Accessible, to, and Usable by, the Physically Handicapped was to become the model for many European standardization attempts; clause 117.1 suggested measurements for access while maintaining that the problem was largely the person, not the environment, and that access should be realized without much cost or design change.

Chapter 3 is an innovative discussion, marvelously devoted to DIY approaches, to tinkering and homemade adaptions to gadgets, medical equipment, and tools. I like that the author puts emphasis on the role of DIY constructions and ingenious inventions by persons with disabilities and their families, these being exacted during the 1940s to 1960s before there was a public debate, special design interest, and advocacy action. The background story is one of US consumerism and white middle-class lifestyle ideals. Williamson’s focus is on disabled veterans and polio survivors and their families. This is because these were the two groups of people with physical disabilities that dominated media coverage and received the most government attention in the postwar period. Williamson’s account of DIY and self-help journals is a fascinating and engaging read. It is about resourcefulness, inventor spirit, and agency. Williamson also makes clear that while white middle-class veterans and polio survivors may have been a privileged group at the time, they were also under significant pressure. There was strong expectation that they should “achieve,” meaning that they were supposed to operate “normally” in the spheres of consumerism and work, be independent and productive, fulfill mainstream gender roles, and keep their impaired condition private, ideally mimicking a nondisabled state. In an atmosphere of consumerism where consumption lay at the core of US civic identity, they could do this by shopping, having hobbies, and caring for their homes. However, mass-produced aids to achieve all these objectives were scarce and limited in variety. So there was a constant need for disabled people to be creative, to devise things independently. This matched well with a general trend towards DIY activities in these decades. Thus, tinkering to create access was both normal and normative, as well as extraordinary because adjusting to disability had an entirely different meaning to DIY undertaken for enjoyment or self-expression. It is important to note, too, that this kind of disabled peoples’ approach to access had an entirely different nature from rehabilitation specialists’ concepts of defining regulations and guidelines. The former was personal, experiential, imaginative, and local.

Chapter 4 shows how this latter type of knowledge, that of rehabilitation specialists, about barriers, access, and disability, became the reference base for the emancipation movement that emerged in the later 1960s and the 1970s. The movement promoted the new idea of a new type of expert: the disabled person as a specialist of disability. Experiential knowledge was now regarded as the most valuable type of knowledge and the rehabilitation specialists’ and the authorities’ take on disability and access was largely rejected by the movement. Williamson traces the advent of the new stakeholder and interest groups in accessible planning and building to the disabled student group that began the independent living movement at Berkeley. She then turns to the 1970s, when a nationwide emancipation movement was born. It quickly assumed the character of a civil rights movement—inspired by the boom in wider civil rights issues at that time. The concept of and the fight for access were at the core of the disability rights movement. Activists drew on individual experience and expertise and at the same time called for legislative action. In the wake of this, access became more and more a matter of standards and measurements. It was increasingly defined in quantitative terms.

Questions of scope and quantity are continued in chapter 5. It discusses how proponents and opponents of accessible design discussed the rights issue. These debates focused on calculating costs and benefits, and weighing the benefit of a perceived small group of people against the concerns of what seemed to be the majority. The 1973 Civil Rights Act addressed disability as a civil rights issue and thus access became a civil right by law. But was it worth the effort, or was accessible design still a design excess? Should communities afford this, and did they need it at all? Williamson uses the example of the public bus system to demonstrate how opponents of accessible design suggested the extension of individual transportation by, for example, dial-a-ride-taxis as an alternative; additionally, to them, taxis seemed less costly and more comfortable. The backdrop to those arguments was the conservative preference for privatization and for self-interested companies over federal programs or even legislation under the Reagan administration. Separation was preferred over integration while at the same time these opponents of access regulation asserted that disabled people gained more benefit from separate provision. While the disability protest movement of the 1980s grew ever stronger, it experienced a harsh backlash from conservatives. Williamson portrays the 1990 Americans with Disabilities Act as a victory for the rights movement that made access enforceable, but she also points out that rights were increasingly quantified and the material objects in question remained the subject of heated debates.

Chapter 6 moves on to examining design principles and development from ergonomics to Universal Design. Before ergonomics, designers worked with highly standardized measurements and statistical averages that allowed for little variation. Ergonomics took variation as a starting point. In the meantime, disabled persons were increasingly regarded as consumers of the mass market. They began to be attractive to companies and access was increasingly defined by market logics. Williamson is critical of Ron Mace’s 1980s concepts of Universal Design and Design for All, although these were very appealing at the time. The idea of design usable by all people and for everyone appears more inclusive at first glance than the design of special, add-on accessibility technologies. Universal Design, however, veils power and class issues, and “gloss[es] over disability in favor of aesthetic and functional appeals” (p. 150). The emphasis on “all” may easily conceal power relations and inequalities in society. Who might this “all” be, anyway?

Chapter 7 focuses on more recent developments in design and politics. Williamson contends that while accessible design is now ubiquitous and some features, such as ramps, are iconic, there is not much reason to feel celebratory. There is still a lot of resistance and ADA rights have to be pushed through by lawsuits. What is more, ramps and other devices of access are not the end of exclusion. She quotes an artist’s bon mot of “beautiful progress to nowhere” to illustrate this (p. 186). The rights movement has made much progress, but to where, precisely? What has really changed? Williamson leaves this question unanswered, turning instead to discuss a new development in design, the concept that disability these days is made more visible and readable from the artifact. Prosthetics and devices take into account fashion and individual style preferences. It is interesting to read that disabled people branded their own design as “crip design,” borrowing from crip culture. She also argues that disabled designers in general see and create things differently, inscribing their different experiences into their products. But maybe this chapter is a little too enthusiastic about fashionable prosthetics design and chic wheelchairs. Obviously, those are great achievements, but such items are often only available to a user elite or even a few avant-garde users. Here the narrative appears rather teleological (design turning into the better) and misses out on power and income inequalities. Options for self-expression are still limited—maybe not by design, but certainly by financial resources. It is great that design is much more varied these days, but disabled persons’ choices often are not independent. In her conclusion, Williamson touches on these limitations directly when she highlights recent curbs in disability rights and threats to financial aids under the Trump administration.

The author’s overall political point is clear: access is not the same as inclusion. And access is not the same as ramps, door measurements, or variety of choice in prosthetics. Different needs and wishes have to be addressed by very different design approaches—if they can be addressed by design at all. For example, the realm of the sensory impaired asks for very different design approaches—light design, sound design, texture design, et cetera, all of which are quite different from issues of physical mobility.

Williamson treats access as an ideal, that is, something easy to understand but hard to reach. She demonstrates convincingly that the idea of a universally accessible world for all of us is both an illusion and not even what all disabled people want or need—particularly if access means the compulsion to function and behave “normally.” Disability cuts through the mainstream ideas of functioning and participation. Not everyone needs or wants to function or do things the “normal” way even if this is possible with the help of a certain type of design. There needs to be room to live differently. This kind of choice, she argues, needs to be given greater respect.

To have shown such ambivalences and paradoxes is a merit of this investigation. Altogether, this book is easy to like. It is free of jargon. The many short summaries are very useful. They are placed either at the opening or at the end of each chapter. The contents of this book are a win for historians of disability as well as for historians of technology, architecture, and design. I certainly recommend it.

Citation: Elsbeth Bösl. Review of Williamson, Bess, Accessible America: A History of Disability and Design. H-Disability, H-Net Reviews. October, 2019. URL: http://www.h-net.org/reviews/showrev.php?id=53666

REVIEW: Robson on Reber, ‘Tuberculosis in the Americas, 1870-1945: Beneath the Anguish in Philadelphia and Buenos Aires’

by H-Net Reviews

Vera Blinn Reber. Tuberculosis in the Americas, 1870-1945: Beneath the Anguish in Philadelphia and Buenos Aires. New York: Routledge, 2018. 348 pp. $149.95 (cloth), ISBN 978-1-138-35950-5.

Reviewed by Charmaine Robson (University of New South Wales) Published on H-Disability (October, 2019) Commissioned by Iain C. Hutchison (University of Glasgow)

Printable Version: http://www.h-net.org/reviews/showpdf.php?id=53717

This is a study of two cities—Buenos Aires in South America and Philadelphia in North America—and their experiences of tuberculosis in the period 1870-1945. In the nineteenth century, this disease emerged as a major cause of infirmity and mortality internationally, linked to the rise of urbanization and industrialization, but for most of this period it was poorly understood. Tuberculosis in the Americas 1870 to 1945 by historian of medicine, Vera Blinn Reber, opens at a time when advances in European biomedicine occurred, leading to international consensus on the etiology and treatment of tuberculosis. Crucial to this development was the emergence of germ theory and, in particular, identification of the causative bacillus by Robert Koch (1843-1910), Mycobacterium tuberculosis, in Berlin in 1882. But a cure did not follow until 1945, when streptomycin, a newly discovered antibiotic, was found to be effective. In the intervening years, with 8-15 percent of all deaths worldwide attributed to tuberculosis, the disease became both a global public health issue, with measures to prevent the spread of the disease, and the subject of medical research in the battle to find a cure. This forms the medical context for the social and public health histories presented in this book.

Tuberculosis in the Americas has seven chapters plus an epilogue. The first chapter focuses on medical and scientific discourse in relation to tuberculosis from the 1890s to 1920s. In this period, the theory of heredity was gradually replaced by that of contagion, as reflected in public health policies of isolating the tuberculosis sufferer from society. Chapter 2 describes Philadelphia and Buenos Aires during the period under discussion. It shows that in many ways these cities were like others of their time and, interestingly, resembled one other. As of the 1920s, they had become leading cities of their respective nations and modern centers of commerce, education, and manufacturing, with a rising middle class and growing migrant populations. By 1907, deaths from tuberculosis in both Buenos Aires and Philadelphia exceeded deaths from all other infectious disease epidemics. Both cities established internationally recognized research and treatment facilities for tuberculosis, but local variables, such as climate and culture, to some extent differently shaped the sites and nature of medical institutions that found acceptance for tuberculosis treatment in the two cities. 

In chapter 3, Reber analyzes the incidence of tuberculosis and its consequences for the cities’ migrants, both from within and outside the Americas. To the extent that these groups occupied the lowest socioeconomic positions, this chapter offers both a class and race critique of public health policies. Its conclusions echo what historians have found elsewhere: the correlation of tuberculosis deaths with substandard living and working conditions led to anxiety about the spread of the disease from the migrant poor and was accompanied by targeted, morally judgmental interventions from charities and government.[1] However, Reber also points to positive responses by authorities in their initiatives to improve housing and green spaces, which ultimately resulted in ameliorating the poor health of their citizens and lessening the risk of contracting tuberculosis.

Chapter 4 examines the medical treatment of tuberculosis patients. It does an excellent job of explaining the available tests, treatment regimens, and education campaigns during this period, as well as the different sites of treatment—home, outpatient clinics, and hospitals. With a subtitle of “Patient and Physician Experiences,” we might expect this chapter to consist mainly of diverse first-person perspectives, but this is not the case. The only substantial accounts were between Dr. Lawrence Flick (1856-1938) and his wealthy patient, George Macklin, as conveyed in Bargaining for Life: A Social History of Tuberculosis, 1887-1938 (1992) by physician Barbara Bates (1928-2002). There is little to substantiate the chapter’s early claim that “gender, class and age” affected diagnosis and treatment, despite some allusions to these different categories (p. 123). Read on to the next two chapters, and class and age are subject to some analysis. Chapter 5 expands on tuberculosis treatment by looking at life in the sanatoria, with an interesting section on patient protest and how it differed between the two cities. Chapter 6 is an excellent study of tuberculosis measures for children, especially the poor of Buenos Aires and Philadelphia. As Reber reminds us, governments were willing to foster expensive public health measures for the young in the interests of producing “vigorous, patriotic adults who could serve in the military and contribute to the national economy” (p. 216).

Chapter 7 considers the two cities against the background of international tuberculosis policies and practices, providing glimpses of, for example, Spain, whose changing relationship with Argentina was reflected in the latter’s shifting medical discourses. The epilogue does three things: it provides the aftermath to successful antibiotic therapy in the 1940s, it sums up the book’s content, and it provides an analysis of the late twentieth-century tuberculosis global outbreak.

Tuberculosis in the Americas relies on a rich selection of sources for its evidence, including the secondary literature and government archival records. The book is replete with tables setting out a myriad of statistics, connecting tuberculosis deaths to occupation, age, place, et cetera. Reber’s main point is that, while modern medical advances were crucial to combating tuberculosis in Philadelphia and Buenos Aires, improved living and working standards and access to health services were also essential to the decline of tuberculosis in the two cities. 

The importance of this book does not lie in any significant break with current historiographical themes and insights of tuberculosis history. Indeed, Reber makes the point that Philadelphia and Buenos Aires were not exceptional in the approaches taken to manage tuberculosis in this period. Her work, to quote the editors of one volume on tuberculosis history, is an example of the several “studies that show the contingent character of anti-TB policies across time and space.”[2] Nonetheless, Tuberculosis in the Americas contributes to tuberculosis and public health history through its painstaking documentation and broad-ranging study of institutions, treatments, medical discourse, and social conditions in these two cities of North and South America.

Notes 

[1]. See, for example, Emily K. Abel, Tuberculosis and the Politics of Exclusion: A History of Public Health and Migration to Los Angeles (New Brunswick, NJ: Rutgers University Press, 2007); and Matthew Gandy and Alimuddin Zumla, eds., The Return of the White Plague (London and New York: Verso, 2003).

[2]. Linda Bryder, Flurin Condrau and Michael Worboys, “Tuberculosis and its Histories: Then and Now,” in Tuberculosis Then and Now: Perspectives on the History of an Infectious Disease, edFlurinCondrau and Michael Worboys (Montreal: McGill-Queen’s University Press, 2010), 8.

Citation: Charmaine Robson. Review of Reber, Vera Blinn, Tuberculosis in the Americas, 1870-1945: Beneath the Anguish in Philadelphia and Buenos Aires. H-Disability, H-Net Reviews. October, 2019. URL: http://www.h-net.org/reviews/showrev.php?id=53717

REVIEw of martin atherton’s deafness, community and culture

Martin Atherton. Deafness, Community and Culture in Britain: Leisure and Cohesion, 1945-1995. Disability History Series. Manchester: Manchester University Press, 2016.

Reviewed by Holly Caldwell (Chestnut Hill College)
Published on H-Disability (August, 2019)

Commissioned by Iain C. Hutchison (University of Glasgow)

Prior to the introduction of sign language and schools
designed for the deaf in the early nineteenth century,
deaf individuals were often isolated not only from the
“normal world” but also from each other. Consequently,
such entities as educational, charitable, and religiousbased societies were among the first to establish institutions to address the needs of this population during
that period, and their efforts would engender the development of deaf clubs and societies in the mid-twentieth
century. In Deafness, Community and Culture in Britain,
Martin Atherton examines the history of deaf clubs in
postwar Britain and the social, cultural, and psychological benefits that involvement in such clubs afforded its
members. He argues that it was in deaf clubs where deaf
people “first experienced what might be regarded as a
normal life,… one in which they did not form a misrepresented and misunderstood minority” (p. 50). Much like the use of sign language, which contributed to the formation of group identity and self-identity in the deaf community, in many ways deaf clubs allowed for and encouraged participation in leisure and sport and represented a central factor in the creation and vitality of Britain’s deaf community.
This book is primarily targeted at audiences specializing in deaf studies, but it will also appeal to scholars
interested in disabilities studies, as well as the social and
cultural histories of clubs and community life. Deafness,
Community and Culture in Britain is divided into nine
chapters, with the first and final chapters serving as the
introduction and conclusion, the latter considering the
future of deaf clubs in Britain. The remaining seven chapters are fairly chronological in scope and explore such
different themes as the social impact of poor laws, the influence of deaf-sponsored newspapers, and the ways deaf clubs served their members through leisure, cultural, and sport-related activities. Drawing on deaf clubs in northwest England as a case study, Atherton argues that due to the area’s varied urban and rural settings, such as factory towns, coalfields, and satellite towns, this particular region serves a “microcosm of all aspects of the wider deaf
experience in post-war Britain” (p. 2).
The first organized network of deaf societies, according to Atherton, appeared soon after the change in the
1601 Poor Laws, a set of laws that categorized the poor
into two distinct groups—the deserving and the undeserving. In short, the deserving poor were those whose poverty was through no fault of their own. The undeserving poor, on the other hand, were poor because of personal vices, such as laziness or other character flaws.
In his telling, deaf societies and clubs trace their origins
to the 1834 Poor Law Amendment Act, a set of laws that
essentially made it more difficult for “deserving” individuals to claim relief from religious or philanthropic agencies. Following the change in legislation, and in direct
response to the “suffering deaf people were experiencing as a result,” Atherton argues, deaf societies began to
form (p. 40). Though this shift in legislation coincided
with the creation of new societies pertaining to the deaf,
the author’s use of the term “society” in this historical
context is a bit confusing. For example, in describing
philanthropic organizations, such as the Edinburgh Deaf
Society, which were created to provide gender-specific
vocational training in such trades as printing, shoemaking, and needlework, as well as church-related missions that were established for the deaf to guarantee that they
received spiritual instruction, it is unclear how institutions and organizations fit the typical description of a
society or what would later become a club in the postwar era. More important, such organized societies do
not necessarily fall within the parameters of how the author has characterized “community” in this book, which
he borrows from linguist Carol Padden’s definition. For
Padden, there are three common features of a community: the sharing of common goals, a shared geographic location, and the freedom to organize the social life of its members.[1] While Padden’s definition itself is certainly not being called into question, the context in which it is used by Atherton and the ways such terms as “society,” “clubs,” and “community” are used interchangeably at times and over fairly broad historical time periods are rather confusing. Readers who are unfamiliar with these terms, especially with regard to how they applied to the deaf community and the ways their significance shifted over the course of the nineteenth and twentieth centuries, might wish for more analysis of how this process evolved over time.
While deaf individuals did not necessarily engage in
leisure activities that differed from their hearing counterparts, it was the broader social, cultural, and psychological benefits that made these relationships particularly impactful. Benedict Anderson’s notion of the “imagined community” (Imagined Communities: Reflections on the Origin and Spread of Nationalism [1991]) figures heavily into Atherton’s analysis of Britain’s deaf community and the clubs they eventually formed. Drawing on Anderson’s theory of the “imagined community,” Atherton suggests that the representation of such a community “could be found on a couch, in a holiday camp or even on board a cruise ship…. The location was less important in terms of understanding the reality of ’the deaf club’ than the people who engaged in a particular activity” (p. 9). The network of deaf clubs that was established allowed deaf people the opportunity to “develop notions of identity based on mutual deafness and a communal form of social, cultural, and linguistic expression” and thus to contribute to the formation of self-identity and group identity (p. 75). In addition to examining how societies and clubs were formed, Atherton explores the theoretical underpinnings of the emotional and psychological rewards that arose from participating in various clubs, sporting events, and cultural activities, such as attending the cinema. In this sense, “deaf clubs provided both a geographical centre for the deaf community and a social network through which existing notions of community and identity could be maintained” (p. 60).
Throughout the book, Atherton underscores the importance of British Deaf News (1955-95), as well as its predecessor British Deaf Times (1945-50), two publications
that not only helped disseminate news but also kept the
deaf community informed of local social events. When
members of a community read the same newspaper or
text, they built the same “cultural values and ideas,” and
the sharing of such values and ideas allowed for their
large-scale transmission, thus contributing to the development of what Anderson referred to as “nationhood” (p.76). Here Atherton argues that British Deaf News built a camaraderie with its deaf readers and, to some degree, served as a means of communication between deaf people for the first time in the era before such technology as email and textphones. This discussion, especially Atherton’s focus on community-based reporting, is interesting, but it suffers from what many historians of print culture would argue can be difficult to pin down: what does selfreporting actually reveal and to what degree can historians rely on these figures? Relatedly, while print runs provide data as to how many copies were printed, such figures do not necessarily inform us how many people actually read its contents or how far-reaching the influence of a particular message was. In addition to exploring the role of print culture, it would be interesting to see how the deaf community developed and shared its “cultural values and ideas” by incorporating oral testimonies from former club members.
Increasing urbanization throughout the nineteenth
and twentieth centuries contributed to dislocation of different social groups but also led to growth in leisure activities. These coinciding forces, Atherton asserts, gave
deaf individuals, who would have otherwise been geographically isolated, the opportunity to be gathered together in contact with those of similar background and
shared language in order to develop cultural attachments.
He describes deaf clubs as “a direct response to this social
dislocation, providing opportunities for socialising and
sharing leisure activities that had not been previously
available” (p. 70). The degree to which deaf people shared
similar backgrounds or experiences, other than the fact
that they were deaf, is unclear from Atherton’s analysis.
For example, in his discussion of deaf clubs and organizations, he mentions that there was a keen class distinction and that deaf clubs have traditionally been working class (and primarily white) with few members of the professional class. While he highlights that the perception that deaf people from minority ethnic backgrounds were reluctant to join remains “open for debate,” there is little mention as to whether or not there was equal membership among men and women (p. 55).
As the first scholar to examine the inner workings
of deaf clubs in Britain, Atherton certainly had his work
cut out for him as availability of sources, such as personal testimonies, is limited. However, it is rather surprising that the bibliography does not list any secondary
sources on deaf history or studies predating the book’s
2012 original publication date. In addition, the author’s
primary evidence is largely drawn from two sources: the
publications British Deaf Times and British Deaf News.
While this book is undoubtedly intended to provide insight on how deaf clubs operated, such institutions certainly did not exist in a vacuum. More historical context on how deaf clubs and their members interacted
with the broader community (and nation) would have
been beneficial. The reader is left with little to no understanding of how British policy or trends—social, cultural, or political—might have influenced or affected the
deaf community, which lends itself to a myopic recounting of how the clubs functioned in northwest England. In
particular, Atherton makes some very interesting points
about economic disparities and social class that existed
within the clubs and the ways these phenomena played
out within sporting teams as well as the relationship that
existed between deaf teams and their hearing counterparts. This work is certainly a conversation starter and is a welcome addition to the field of deaf history.
Note
[1]. Carol Padden, “The Deaf Community and Deaf
Culture,” in Constructing Deafness, ed. Susan Gregory
and Gillian M. Hartley (London: Pinter Publishers, 1991),
40-45.
If there is additional discussion of this review, you may access it through the network, at:
https://networks.h-net.org/h-disability
Citation: Holly Caldwell. Review of Atherton, Martin, Deafness, Community and Culture in Britain: Leisure and
Cohesion, 1945-1995. H-Disability, H-Net Reviews. August, 2019.