Bad habits and political excitement

Thanks to an archivist colleague, Vicki Tobias, at the University of Wisconsin-Madison for sharing this: Reasons for Admission It cites the Trans-Allegheny Lunatic Asylum without further details. However, I can attest to the truthfulness of these Reasons for Admission based on the research I’ve done into historic medical records and U.S. census mortality data.

These old-fashioned expressions have multiple functions in historic medical documentation. As you can see in the Trans-Allegheny graphic, some Reasons for Admission are clinical labels (“Asthma”, “Brain Fever”, “Female Disease”) while others are mini- medical histories (“Shooting of Daughter”, “Decoyed Into the Army”) and a subset of the second category attempts to assign blame (“Snuff Eating for 2 Years”, “Parents were Cousins”). Given space, humans tend to tell stories; I found similar repurposing of medical “forms” in my PatientsLikeMe study.

I am fascinated by historic medical expressions like these because they represent pure thought completely untrammeled by formal medical terminological systems. This is not pure *physician* thought, either: like the mortality data I’ve collected from US Census records, these expressions are sometimes the product of a dialogue between physician and family member, with the physician turning into a transcriptionist to capture the information (just as they do today). We can even picture the conversation: “What brought your wife here, Mr Smith?” “She’s been grieving ever since the death of her sons in the war.” Or alternately: “Novel reading. It’s that dadblamed novel reading. I blame it on the public library.”

There *were* no formal medical terminological systems that were shared across institutions prior to 1958. While individual hospitals have for centuries developed their own internal problem lists and taught them to trainee physicians, these were not formally *shared* lists, and once Newbie Physician left the hospital where he interned, he was likely to have to learn a new list. This process works fine until Hospital A has to share data with Hospital B; at that point, they need to agree on what diseases are — a struggle we continue to live with in the 21st century.

My personal favorite historic term? From the US census: “Ran away with the cars.” That turned out to be a man who died in a railroad accident (“the cars” means “railroad” at a certain point in human history).

Author: cat

Associate professor at the University of Wisconsin-Madison

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