Still Breathing: Respiratory Images From The Burns Archive

This is a classic pose of a French physician listening to a patient’s chest with a monaural stethoscope. He is demonstrating the proper use and position of the instrument. European physicians used and posed with monaural stethoscopes until the mid-1930s. The monaural stethoscope invented in 1818 by French physician, Rene Laennec, remained the standard instrument for examining the chest in much of the world, because of European influences. In 1855, an American, Dr. G. Cammann, produced a practical and superior instrument, the binaural stethoscope with flexible rubber tubing. The binaural scope not only offered better acoustics but ambient sound was drowned out because both ears were used. Another major advantage is illustrated in this photograph. Not only did the short, about 7 inch, monaural instrument require physician to get close a patient who often had severe, contagious, infectious disease but the instrument also had to be placed squarely on the skin, again putting the physician uncomfortably close. The long rubber tubes of the binaural stethoscope allowed the physician to listen to the chest at a safer distance.

The population in a city’s poor and immigrant neighborhoods often mistrusted mainstream doctors. They preferred to be treated by self-medication and non-traditional therapies offered by local practitioners or street vendors. Too often the ailment turned out to be tuberculosis. While this nineteenth century scourge cut across all social classes it particularly struck those living in poorly ventilated cramped, city slums. This well dressed street doctor advertises his cough elixir to Londoners in 1877 claiming “Prevention better than Cure”. The doctor’s high shoes indicate a shortened leg-problem. English social photographer, John Thomson, took this picture for his book on street life in London. Patent medicines appeared to help most patients, as their base was usually alcohol, opium or some other powerful agent. 

The color dramatically draws attention to the raw, eaten away appearance of this patient’s face. Lupus, was a generic term used to describe any of the conditions in which a patient’s face looked like as thought it had been chewed by a wolf (Latin ­lupus). This is a case of superficial and deep tissue infection by tuberculosis. Cutaneous manifestations of tuberculosis were quite common in the pre-antibiotic era and had to be differentiated from syphilis. These ‘lupus’ patients often wore masks or covered their face when in public. Because the public could not often identify the difference between the facial deformities caused tuberculosis from those caused by syphilis, social ostracism became the norm.

There was one problem with extensive loss of the nose that was difficult to hide, the dreaded infection ‘ozena.’ Ozena was an ailment of much prominence in the pre-bacteriological/antibiotic era because it accompanied many infectious and neoplastic diseases of the nose. Ozena is derived from the Greek word meaning ‘to stink’. The infection of the nasal cavities resulted in a foul nasal discharge and a fetid breath. Nasal sprays or the inhalation of various chemical vapors were often prescribed. With the development of bacteriology the organisms causing ozena were identified as Klebsiella ozena and Bacillus foetidus. With the conquest by antibiotics of tuberculosis and syphilis ozena is mainly seen today as a manifestation of atrophic rhinitis, a marked degeneration of the nasal mucosa. This occurs most commonly as a hereditary malady but is also associated with the injudicious use of nasal sprays and drops.

Physicians advertising began as photographic technology improved and the costs reduced. In Terra Haute, Indiana, Dr J. S. Gordon promoted himself as ‘The Developer of The Lung Renovator - The Great Lung Therapy.’ Lung disease was the number one killer in the nineteenth century and some physicians capitalized on the publics need for a therapy. Some of the efforts were laudable while others were not.

Under developed lungs with concomitant respiratory distress is among the serious problems a premature infant faces and one of the leading causes of their death. One of the marvels at the turn of the century was the invention of the incubator by Marx of New York. The incubator was used to treat and nurture premature infants delivering warm air to a vented closed heated container. The simple warmth helped babies survive. Although today younger and younger infants are surviving because of the care received in the modern neonatal units, respiratory function remains one of the major hurdles.

It was the pioneer work of Danish physician, Neils Ryberg Finsen, M.D. (1860-1904) in light therapy that set other minds working to develop a wide range of light treatment modalities from heliotherapy to the sun lamp. In 1893, in Copenhagen, he began his experiments showing ultraviolet rays either stimulated growth or killed the bacteria in lower organisms. In further research he studied the effect of light on living organisms and by 1896, had created the field of “phototherapy.” Finsen was able to demonstrate that invisible ultraviolet light, had therapeutic value.

In the last decades of the nineteenth century Edward Livingston Trudeau, M.D. (1848-1915) and others established the efficacy of rest and fresh air treatment for tuberculosis and other chronic lung conditions. By the end of the first decade of the twentieth century hundreds of outdoor hospitals, sanitariums and rest homes were established in the United States. The most common type of tuberculosis quarters were associated with an established hospital.  On hospital grounds hundreds of private isolation huts as seen here were built. Nurses and doctors made rounds on the patients as if they were on one huge ward. Many patients were housed for extended periods of times sometimes for years. In the charity hospitals of the era working class patients were housed in long wards with outdoor terraces or in good whether beds or cots were brought outside for their use. In some localities public and social conscious societies paid for patients to have some time of the year at special isolation camps.

More In-depth Accounts Of These Stories and Many Others Can Be Found In:
RESPIRATORY DISEASE: A Photographic History, 1845-1945 (4 Volumes)