The Menace of the Barber Shop

In 1904 The Lancet considered the many risks to health posed by modern life. The collecting together of more and more people in the bustling spaces of the city was, they wrote, a perfect means of disseminating infection. ‘Everything used in common must teem with bacteria, from the cab or the omnibus to the telephone’; bus conductors held coins between their teeth before pressing them into the hands of passengers; and supposedly healthy convalescent homes crowded sickly patients together like hothouse flowers.

V0019668 A barber shaving a man; another man sits in the background a

Wellcome Library, London.

Even the most innocuous of places could pose grave health risks, and The Lancet was particularly concerned with one: the barber shop. This was an establishment that catered to a large number of people in quick succession, all of them in direct bodily contact with the barber and his tools. Medical concern about barber shops was evident both in Europe and America. A doctor speaking to the American Public Health Association in 1897 recalled that he had recently seen a man in his surgery whose face was ‘covered with eruptions’. After finishing his day’s work, the doctor went to the barber’s and, as he waited his turn, saw that the man in the chair was his earlier patient. Leaving with some haste, he ‘resolved that his face should never again be shaved by a barber’.

We might assume that the central concern when discussing the barber’s role in the transmission of infection was the razor. Accidental nicks and cuts were an ideal way of transmitting potentially serious infection from one person to another, especially if equipment was not sterilized after each customer. Certainly, barbers were – from the end of the nineteenth century – more aware of such dangers. The Progressive Barber (1909) – a guide produced by the Wisconsin State Barbers’ Board – forcefully underlined the seriousness of taking good care with razors, asking readers how they would feel if they were responsible for the transmission of syphilis.

 

V0019622 A head of a barber made up of the tools of his trade. Engrav

A head of a barber made up of the tools of his trade. Wellcome Library, London.

More often, though, concern centred on the less evocative implements of the barber’s trade: sponges, powder puffs, towels, combs, and brushes. These were thought to aid the spread of various skin diseases, from ‘barber’s itch’ (ringworm) to impetigo and eczema. As dermatology developed more fully as a specialism in the last quarter of the century – with the establishment of the British Journal of Dermatology in 1888, for example – there was increasing interest in the epidemiology of such conditions. Doctors repeatedly drew attention to the shaving brush as a vehicle of infection. Unlike metal implements such as scissors and razors, shaving brushes were not regularly sterilized and were often used on several customers in succession, swirled around in a common soap bowl of lukewarm water.

To reduce the risk of infection ‘the principles of the operating-room [were] extended to the barber’s shop’, echoing the barber’s older role as surgeon. Metal combs – easily sterilized – began to replace bone and celluloid; styptic pencils (to staunch bleeding from small cuts) were done away with; powder puffs were discarded in favour of cotton wool; and paper towels recommended in place of cloth. By the early years of the twentieth century, the barber’s trade had a much more ‘scientific’ air about it than it had fifty years previously. The Progressive Barber provided short biology lessons to the reader, listing conditions of the skin that signified serious disease, and setting out detailed instructions for the making-up of antiseptic solutions – the barber had become a sort of public health inspector and chemist rolled into one. The manual concluded its advice with a stern warning that signified this vision of the trade as one that was au fait with modern hygienic developments: ‘Condemned Relics of the Old-Time Barber Shop’.

 

For much more on the history of barber’s, and the relationship between hair and health, I recommend popping over to Dr Alun Withey’s blog.

‘Koch’s Lymph’ – A story by I. T. Mera

Browsing through the pages of Foaia Ilustrată (Illustrated Sheet), a nineteenth-century periodical published in the town of Sibiu, in what is now Romania, I came across a serialized ‘novella’ carrying an intriguing title: ‘Limfa lui Koch’ (Koch’s Lymph). The author, Iuliu Traian Mera (1861-1909), was born into a clerical family in the picturesque village of Şiria in Arad County. He studied medicine in Vienna and went on to become a balneologist of some repute, establishing a practice in Carlsbad/Karlovy Vary, in the present Czech Republic, a place well known for its hot springs. He was also a writer and journalist and became involved in the Romanian national movement, most prominently through his association with the cultural and literary society Romania Jună (Young Romania), which was established in Vienna in 1871.

The story was published in five consecutive issues of Foaia Ilustrată in March-April 1891. It is a moving account of the devastation wrought by tuberculosis in the nineteenth century and the hopes invested in the possibility of a cure. The protagonist, a young lady called Aniţa, is the daughter of a well-to-do ‘proprietor’: Mr Ioan Zamfirescu, a man who has already lost his wife and two other children to pulmonary tuberculosis. Aniţa is engaged to be married to the young lawyer Dimitrescu, when the first signs of illness appear: a burning sensation in her chest, an unpleasant, ‘salty’ taste in her mouth, followed by a cough and the familiar spitting of ‘red, warm’ blood. Despite the fact that Dimitrescu cowardly abandons her—the news of Aniţa’s illness soon becomes the talk of the whole town, illustrating the stigma associated with this disease—she decides to fight for her life and for the happiness that seems to have eluded her all her life.

Aniţa’s story is a grim reminder that even the most economically privileged members of society were not immune to the dangers of tuberculosis. [1] Her father does not spare any effort in an attempt to save his last surviving child. He first takes her to Bad Gleichenberg in the southern part of what is now Austria, in the hope that its clean air and spring waters would provide a ‘complete cure’ for his daughter. Her condition improves temporarily, only to deteriorate again upon her return home in September 1890.

Robert Koch

Foaia Ilustrată, 13/25 January 1891

By the beginning of November, the ailing girl’s hopes are pinned on a new form of treatment, as the ‘political newspapers’ announce that Prof Koch, the ‘eminent bacteriologist of the Faculty of Medicine in Berlin’, has discovered a method that can ‘absolutely cure’ tuberculosis. The story of Koch’s 1890 announcement of the discovery of tuberculin—also known as lymph—and its subsequent failure as a therapeutic agent is well documented [2]. What is interesting about Mera’s story is that it beautifully captures the public expectations associated with the new treatment and illustrates the ways in which the public accessed scientific knowledge and research. The above reference to ‘political newspapers’ is not haphazard. On the contrary, it suggests that this type of publications were usually the first to disseminate new scientific ‘discoveries’ to a broad public. But the reliability of their reports was subject to questions. When Aniţa asks her doctor if he has read the latest newspapers and whether the ‘news about Koch’ might be true, his response reveals some of the concerns associated with daily journalism:

Let’s wait, my dear young lady; the political newspapers publish so much news. They have many columns and issues to fill. Let’s wait until the medical journals and Koch himself speak.

While her doctor continues to remain sceptical about the efficacy of the lymph, Aniţa’s hopes flourish with the increase in press coverage. Her life revolves around the reading of newspapers; she naively believes that ‘European’ newspapers are more deserving of trust than local publications, on account of their ‘reliable correspondents all over the world, who would not endanger the reputation of their newspapers by publishing a false piece of news’. She even begins to question the professional ability of her doctor, whose more advanced age appears to make him less inclined to accept ‘the newer progress of science’ than younger practitioners.

The much awaited confirmation finally arrives on the 13th of November, when a medical journal from Berlin publishes Koch’s testimony about the new treatment of tuberculosis. Among those afflicted with the disease, the euphoria is general:

How many sweet and great hopes awoke in the hearts of thousands and perhaps hundreds of thousands of patients, who had believed themselves to be standing at the gates of death. And suddenly, as if by some mysterious miracle, they saw themselves saved, saved—returned to the world and to this worldly life.

The announcement of the new cure causes an exodus of patients and doctors to Berlin:

Only two days later, there was a great migration of people towards the capital of the German Empire. Doctors went to study the new method, patients to regain their lost health. Some of them, who could not endure the travails of the long winter journey died on the road or in one of Berlin’s hotels, far away from their country and their relatives. But they died with Koch’s name on their lips, with a smiling face, cheered by the hope of recovery.

Aniţa is among those who attempt the trip abroad, in search of the ‘miraculous lymph’. She is in a privileged position, since her father’s influence and money allow her to make the trip to Vienna, where injections of tuberculin were already available. The first injection triggered powerful side-effects: chills, fever, nausea, headaches, pangs of pain in her joints. The second and the third seemed to bring some amelioration in her symptoms, easing her cough and breathing. But the next three injections did not bring about the much desired relief: on the contrary, her symptoms worsened. Life finally leaves her body around the same time that ‘doubting voices began to be heard about the effect of Koch’s treatment and the poor patients began to understand from the doctors’ conversations, from the evolution of their disease, that the hopes that had animated them were nothing more than a treacherous dream, an illusion that they could no longer reach’. Aniţa breathes her last in the arms of her inconsolable parent, her final words, ‘Father, please don’t be upset’, a sad reminder of the many forgotten tragedies of tuberculosis in the nineteenth century.

It is a  tragedy that continues to unfold. Far from being consigned to the history books, tuberculosis remains a very real problem in Romania, which has the highest incidence of this disease among EU countries. Multidrug-resistant tuberculosis, the outcome of an inefficient public health system, improper treatment and lack of public awareness is a particular problem, whose full extent and social impact is yet to be properly acknowledged and tackled.

[1] In Illness as Metaphor (1978), Susan Sontag writes about the romanticization of tuberculosis since the eighteenth century and how, despite the fact that it was ‘often imagined as a disease of poverty and deprivation—of thin garments, thin bodies, unheated rooms, poor hygiene, inadequate food’, it was also an ‘index of being genteel, delicate, sensitive’.

[2] See Christoph Gradmann’s work: ‘Robert Koch and the Pressures of Scientific Research: Tuberculosis and Tuberculin’, Medical History, 45 (2001): 1-32; ‘Robert Koch and the White Death: from Tuberculosis to Tuberculin’, Microbes and Infection, 8 (2006): 294-301.

Amelia Bonea

Who Let the Dogs Out?

The phrase “black dog”, when it doesn’t bring to mind Led Zeppelin IV, is usually associated with Winston Churchill, whose favoured term it was to refer to his depression. Churchill’s black dog in recent years has given its name to a major charity for the treatment of depression and related mood disorders, the Black Dog Institute, whose logo makes clear the link:

Black-Dog-Institute-LogoThough he is its most famous exponent, the metaphor’s origins predate Churchill by a considerable margin. The black dog’s pedigree has been documented more exhaustively than I can recount here (see, for example, the excellent essays of Paul Foley and Megan McKinlay ); however, it is generally thought that Churchill, probably thanks to his childhood nanny, adopted a phrase that had made its way into the English folk lexicon via the language’s most famous lexicographer. The metaphor is attested a number of times in the correspondence between Johnson, Boswell and Mrs Thrale, with Johnson in particular relishing its many possible extensions. “I shall easily forgive my master his long stay”, he writes in 1778 in reference to Mrs Thrale’s dispirited husband, then convalescing in Brighton, “if he leaves the dog behind him”.

Whether the black dog was by that point already on the loose in the common parlance is difficult to determine, however it does make several appearances in one of Johnson’s favourite works – “the only book that ever took him out of bed two hours sooner than he wished to rise”, as Boswell recounts – Richard Burton’s seminal 1621 study of humankind’s endless battle with depression, The Anatomy of Melancholy. One reference is of especial relevance, the case of Cardinal Crescence, who, says Burton, “died… desperate at Verona; still he thought a black dog followed him to his death-bed, no man could drive the dog away”. Other sources make reference to the flaming eyes of the beast that could not be seen by the cardinal’s servants and whose appearance seemed to hasten Crescence’s death.

Returning to Churchill’s lifetime, the black dog metaphor is used occasionally in the literature of the late nineteenth century. Robert Louis Stevenson displays a certain fondness for it, using the same stock phrase beloved of Churchill – “the black dog was on his back” – in his New Arabian Nights of 1882, and later making freer use of it as a hallucination suffered by the sea captain in Treasure Island in 1883. It is tempting to point to The Hound of the Baskervilles as another instance, but owes more to the folk tradition of the spectral hound. At any rate, while Conan Doyle certainly plays with demonic dog device, the mystery’s denouement leaves us not with a hellhound but with a painted pooch at the wrong end of a shotgun shell.

Less, if any, attention has been given to a rather obscure novel that appeared some five years before The Hound of the Baskervilles in which the evil black dog features prominently: Mary Kingsley’s sensational The Carissima: A Modern Grotesque. The story concerns a young Englishman named Constantine Leversedge, whose travels in South Africa bring him to a mining camp, several days’ ride from any town. Suffering from a fever by the time he arrives, he discovers that all the men, woman, and oxen in the camp have died of thirst. The sole survivor is a dog that Leversedge spots lying upon the body of child whose throat it had ripped out so as to drink its blood. Leversedge attempts unsuccessfully to kill the dog twice before leaving the camp, but soon realises that the dog is following him, keeping pace with his horse. Like Cardinal Crescence, he is haunted by its luminous eyes, “yellowish-green discs” that shine out “mile after mile, all through the night”. He reaches the coast and sets sail for England but one night on board the ship he sees the dog again: “I only saw its eyes – two glowing green discs a trifle bigger than a sixpence”, Leversedge recounts. The explanation he attempts makes an intriguing connection between the spectral dog of folk myth and the metaphorical dog of the folk saying:

“I knew something very evil was upon me. In that dead camp I had seen a Thing-Too-Much. For there is a Thing-Too-Much, you know, in nature, in men and women, in what happens.”

Leversedge posits a link between the trauma that precipitated his depression and his subsequent hallucination, confounding the distinction between the psychological and the supernatural. Kingsley’s story takes an unexpected turn from this point. It transpires that Leversedge’s fiancée, Charlotte, is able to summon the dog by performing a tarantella, which she has been doing in order to drive Leversedge to suicide so that she can inherit his vast fortune. The nature of the dog is never made entirely clear, nor is any complete explanation offered for Charlotte’s ability to control it through her piano playing, and the reader is left to wonder in what infernal obedience school she acquired this handy knack. Nevertheless, The Carissima makes an interesting footnote in the history of a phrase.

Melissa Dickson