107. Using Illustrations and Spare, Focused Writing to Tell the History of Healthcare

My guest is Tegan Kehoe, who is a public historian specializing in healthcare and science at the Russell Museum of Medical History and Innovation at Massachusetts General Hospital in Boston. Her book, Exploring American Healthcare through 50 Historic Treasures, was published in February 2022.

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Writing & Editing | episode 107

Using Illustrations and Spare, Focused Writing to Tell the History of Healthcare

Wayne: [00:00:00] Hi, Tegan, welcome to the podcast and thanks for taking the time to do this. 
 
 

Tegan: Hello. Thank you very much for having me. 
 
 

Wayne: I just wanted to start by saying, I really liked your book. I didn't get to read at all, but I will finish the book not only because of the style, but because I'm interested in the topic healthcare.
 
 

For folks who haven't read it yet, the book is great. And simple in the best sense of the word. It shows the history of healthcare by means of talking about various artifacts through time. And each of those—there's 50 of them—each of those, if you do the math, works out to about, I would say around five pages or so. 
 
 

And there's an illustration usually with each of them, if not always. It’s very relatable, very informative. And of course you're aiming at a general audience. This is not for specialists. And I think that contributes a lot to satisfying them [00:01:00]. How did that method come to you and what was the fact that you were aiming for a general readership a main player in that kind of structure and  format? 
 
 

Tegan: Yeah, I think it was. So I'm a museum professional as well as a historian and writer, and so aiming at a general audience is my bread and butter. I think what can make history really fun is talking with people who aren't necessarily specialists. And this book, Exploring American Healthcare through 50 Historic Treasures, is actually part of a series. I didn't write the whole series, just the one book. But it's a series that is fairly new. I think the first one came out a year or two ago from this publisher. 
 
 

And so the format of the series is exploring X topic through 50 historic treasures. And those historic treasures are artifacts or historic sites. And the artifacts are in museums across the country. So it is a format that is very well suited [00:02:00] to casual readers, people who are interested in a topic, or maybe who aren't even sure they're interested in the topic. 
 
 

My subject is healthcare and, people will pick it up just out of curiosity rather than necessarily knowing that they're particularly interested in that. And I think that the artifacts are really great entry points because. They make things less abstract. Medical history on the surface can sound like it is very much about the theory. I'm interested in the history of the theories in science, and that does come up in the book, but it's not where you start in any chapter. It's not about what someone was seeing under a microscope in 1880 and how that compared to what theories about what might be in microscopic materials would've been in the 1600s. A little of that is in there, but you're also seeing thermometers that are being used to [00:03:00] keep track of someone's three-day fever, which was one of the first names for what we now know as the 1918 influenza, and a doctor's bag and midwife's tools and things that are the stuff of daily life. It's just an entry point for people. 
 
 

Or I shouldn't say just, it is an entry point, but it's also much more because it gives us an opportunity to look at specifics. Real people's lives, whether or not those real people were famous. And I could go on and on about just the format because it's tied to my other professional life, my museum life, but I think that's a good introduction to that format.
 
 

Wayne: And frankly, in fact, I could dedicate this entire episode to asking you about the format because I think it's a main, it's a major factor in my opinion of how of why it's so successful and enjoyable. I'll ask you one more question about it.
 
 

What I imagine is just to take a contrast—and I don't want to be too unfair to the [00:04:00] other side: say, someone who was writing a scientific book for their peers, for example. An academic writing for their peers would be something that was large chapter chunks with illustrations that were not given much care and would probably be line drawings. I'm not being disdainful or snide about that; it has its place. But it's a very different experience. And it's also a very different readership. One might speculate that the scientist, the academic who picked up your book would say, “Yeah I know all that. And thanks for the illustration.” They would want the other one. But I I'm interested in healthcare, especially these days (maybe a lot of people are interested in healthcare), and it's just really excellent the way you do it. 
 
 

And the other thing I would applaud you for is it is very … I can very blithely say, “Oh, there's five pages of text about,” whatever topic you're talking [00:05:00] about. It takes a lot to put something into five pages of text that doesn't seem too thin, or doesn't seem to be detailed, but focusing on a certain aspect and ignoring others. This is what I would call difficult writing. And what I wanted to ask about the writing. Do. Do you tend to be a kind of what I would call spare (in the best sense of the word), clear writer anyway, or did you really have to work your muscles to do this one?
 
 

Tegan: That's a great question. I think that I am not naturally spare. Typically a draft of one of these chapters would run two to three times the length of the finished product. I do have more experience than many writers in really distilling and condensing what I do because I write artifact labels for museums and exhibit text for museums. 
 
 

So it [00:06:00] wasn't my first attempt at really streamlining what I'm doing. But no, I agree with you that it's difficult and I appreciate that kind of acknowledgment, that it’s something that my book does. Getting it down from the two to three times the length version to the final version was always a challenge. When I write, I'll start to write, then I'll switch to outlining, then I'll switch to writing again. I'll put things in brackets, say, come back to this. Or cite Amy Lonetree here, site so and so here, not all at once. And then once I elongate that and fill out the bits that I have bracketed to come back to later, that's when I end up at the two to three times the length. And bringing it back down is often, it's often a process of, once I see it on the page, picking one or [00:07:00] two points that are the main things I'm talking about, and figuring out which things are distractions from the reader's perspective, recognizing that I cannot tell them everything that I know about the subject. And even though I'm writing nonfiction, figuring out what the story is, keeping mostly to the story and the pieces of context for the story. For a lot of the topics that I was writing about, there isn't one story to be told. I'm picking a story and I want to make sure that I'm fair in how I pick those stories and not excluding marginalized voices or making a very complicated topic simplistic, or things like that. 
 
 

And I think that I succeeded more often than not, but I won't assume that I succeeded every time with that. The writing is easy compared to editing. 
 
 

Wayne: I'm not surprised frankly to hear that you were conscious of that because [00:08:00] otherwise maybe it would never have been published because the publisher would've said, “What could we do with this thousand-page book?” Or it would've been super simplified and it wouldn't be satisfying for the reader because it would be a nice illustration with, say, half a page of text and it's just not enough. So there's a Goldilocks spot in there somewhere, at least as I say in what I read, I think you've hit it quite well.

I'll just say as a side note, I’m doing a similar thing. I'm writing a biography of a writer from the 18th century and I'm writing it for the general reader. So I'm facing some of the same challenges you must have faced. I'm not writing it for academics, I'm writing it for people who would be interested in this life story. And so I'm having to cut out without simplifying or patronizing or anything like that, and you have to be careful what you do, not only on the patronizing side, but [00:09:00] also on the “You left out this!?” side. Congrats on that. Really well done. And speaking of the 18th century, one of the things I have to say is that I love any book that starts with an illustration of a cancerous scrotum from the 18th century. That's going to be a book that I'm going to read. Or a model of it, right? So, I'm doing it as a joke here now, but it's a real thing that you can look at and as a photo, and it gives you something that you wouldn't have if there was nothing there, or if again, if there was a line drawing of it, that would be not the same thing. 
 
 

What I wanted to, if I could indulge you—but if I could just pick out a couple of the ones that I have looked at, and if you could just chat a little bit about them just to give listeners an idea of the kind of the book it is.

So one is called, one of the [00:10:00] chapters, one of the 50, is called “No Wrong Way to Eat,” which by the way has one of my favorite sentences in it: “The simplest solution for people who can't chew or sit up is food mush.” I thought, I'm about five years away from that … But anyway, “No Wrong Way to Eat.”
 
 

Tegan: So this chapter was inspired by a friend of mine, actually, whose daughter uses a feeding tube. And the first time she heard that I worked in history of medicine, she asked me, “What do you know about history of feeding tubes?” And I said, “I'm sorry, almost nothing.” And then it came up again in conversation another time. 
 
 

And so when I was putting together this book, I was thinking, This is a representation issue. My friend doesn't see her daughter in anything that she's seeing about history of medicine. Her daughter's fairly young and doesn't read yet, so it's not for her, but maybe when she's older. And so I was interested in the history of feeding tubes, the history of different [00:11:00] ways that people have eaten, including food mush. And that chapter was an adventure in keeping things simple and getting multiple, somewhat disconnected stories into one narrative. Because I could not find a good example of a feeding tube in a museum collection.

So my process for looking for artifacts was a combination of things. Many museums now have their object catalogues online, similar to a library catalogue, but with some distinctions. And so I was able to search many different museum catalogues. Few of them are aggregated. And searching through their catalogues for this list of maybe 60 or 70 different topics I was looking for to get 50 artifacts, searching through a couple of hundred different museum catalogues. 
 
 

And then I also reached out directly to a number of museums. Either because it looked [00:12:00] like they might have something I was interested in and they didn't have a catalogue online or I'm a part of a professional organization for librarians and museum professionals in the history of medicine. 
 
 

So I am part of a professional organization for museum professionals and librarians and archivists in the history of medicine. And so I tried to represent as many of the museums from that group as I could in the book. Just a little boosterism there. So I reached out to a number of colleagues just by email looking for various artifacts and wasn't able to find a feeding tube. Doesn't mean it's not in any museum.

And I also was trying not to repeat museums. So, for [00:13:00] example, the Smithsonian Museum of American History could have covered probably half the book with artifacts that would've been different stories, but similar ones to the ones that I have in here. But I wasn't writing a Smithsonian book. And so in order to get both the breadth and depth, I was looking around. 
 
 

But what I did find was pap boats, which is how the chapter starts, so you would know. But for listeners, a pap boat was typically ceramic and it was a lot like a gravy boat in shape. That's what boat means in this context rather than sailing boat. And it was a tool that was used up through maybe the mid–19th century for administering food mush or pap, which was typically water or milk with flour or bread crumbs: getting nutrition into someone who either long term or short term, because of disability or illness, wasn't able to chew their food. And so that became [00:14:00] the point of entry for this. And then from there I talked about the history from pap boats and the first attempts at feeding tubes, to where we are now, where there are a wide variety of types of feeding tube from temporary to long term. Entering the body at various different points, mouth or nose or through a stoma, a surgically created hole into the stomach or below the stomach. That one in particular was an adventure. 
 
 

Wayne: That's a lot there. That’s awesome because I remember the illustration. It, you're very right, it looks like a gravy boat with a top on it, sort of a cross between a gravy boat and a teapot. And to come from there to, I don't have a lot of experience with feeding tubes, but to come from there to, like you're saying, making a surgical incision in the stomach and having a tube going into that, what a story that is. What a contrast that is. 
 
 

Tegan: Absolutely. Yeah. And things that you wouldn't [00:15:00] expect until you start to think about it and then make perfect sense, that feel unrelated, but aren't, were a big part of that. For example, antibiotics being discovered was a big part of feeding tubes being successful because if you're creating a stoma, a, a new hole in someone's body, you want to make sure that if there's an infection, that infection isn't fatal. Because that would really defeat the purpose of trying to feed someone. So that whole process is a really interesting evolution. 
 
 

Wayne: I’m smiling because I like your sense of understatement. “That would defeat the purpose.” 
 
 

Tegan: I feel like sometimes understatement is one of the only ways to have a sense of humour about some of this really gruesome history because there is so much in the book that's depressing, that occasionally just, putting things in context, there is the way to laugh about it. 
 
 

Wayne: Yeah, no, that's right. And anyway and life in general medicine or otherwise needs to be laughed at, that's for sure. [00:16:00] The next one I wanted to ask you about is called “A Wooden Leg in a Mechanized World.” 
 
 

Tegan: Sure. So that chapter, for the listeners, that chapter is about a prosthetic leg from the 19-teens, I believe. I no longer have my book memorized. I accidentally did during the editing process. And so that prosthetic leg was used by someone who had worked on a railroad and had lost his leg in a work accident on the railroad. And so the chapter is the only chapter in the book on prosthetic limbs. 
 
 

Tegan: The chapter looks at the history of prosthetics, largely leading up to the point where this gentleman got his prosthetic, culminating for him in the leg that he used for the rest of his life. Talking a little bit about what happened with prosthetics after that, because they have come a long way since the 19-teens. 
 
 

And part of the reason for the chapter title, the “Mechanized World,” is that prosthetics really had a boom starting with the Industrial Revolution because the need for prosthetics had a boom. Industrial accidents just caused many more people to lose limbs. And then war time often created boons in prosthetic manufacture and in people working on prosthetic technology. The company that produced this particular leg, although I'm looking at the 19-teens for much of the chapter, it started right after the Civil War with the Civil War veteran who was an amputee. 
 
 

And so the chapter also looks a little bit about a little bit at [00:17:00] disability stigma. In the early 20th century, there was plenty of it. But the way the stigma worked was extremely capitalist in the sense that if someone was able to make a good life for themselves economically while having a physical disability, they were often considered to be a quote unquote “successful cripple.” 
 
 

It's really uncomfortable language for a variety of reasons. And a lot of the advertisements for prosthetics at the time, including in railroad workers magazines and journals (because that was a market for prosthetics) was people who worked on railroads would talk about how invisible these prosthetics were, how you could wear it under your pants and socks and shoes and no one would know you were wearing a prosthetic, which—I don't know that they really were that invisible because the way it would change someone's gait would be much more marked than some prosthetics today. But yeah, it's really interesting. [00:18:00] The stigma was changing, but it was a very big part of the life of a prosthetic user. 
 
 

Wayne: It's interesting about stigma, of course. No one would dare use successful cripple, I don't think, these days. However, it's a very common thing to hear about prejudice or bias against people with disabilities of various sorts. Plus ça change … we've not gotten much better as a species in that way for sure. 
 
 

Tegan: Yeah. And the phenomenon of inspiration porn, looking at people with disabilities or various other differences from the mainstream and saying, “Wow, look at this person, how much they've accomplished. If they can accomplish that, then you can accomplish anything.” And yeah, it kind of is the same logic as the very capitalist “successful cripple”: if this person makes money, then they're great, and if they don't, then their disability is a problem. 
 
 

Wayne: And there's something very extremely patronizing about it, right? Just the way it's phrased just it's pretty [00:19:00] grotesque really.

So I wanted to end off by asking you a couple of questions about modern healthcare. And these are ones that, from one of the profiles that I read of you, you had suggested that these could be questions that you would be interested in answering or would be able to. Have you ever heard of COVID? 
 
 

Tegan: I have in fact.

Wayne: Interesting. You must be keeping up with the news. And the question I wanted to ask is actually one that you suggested that I'm very interested in. Is it normal for people to be this upset about vaccines, if you look back through healthcare history? For it to be such a topic of dissension and disagreement and just argument generally?
 
 

Tegan: Yes and no. I think that it is frustrating for me as someone who knows a lot about the history of vaccine production and also the history of the types of testing and regulation that we have both in the US and globally for developing and producing and distributing [00:20:00] vaccines. It's frustrating to me because I know that the vaccines that we have for COVID are so safe, so well tested, so much better than some of the less controversial vaccines from a few generations ago. But there's different levels of controversy in different cultural moments.

And of course there are a lot of factors that go into vaccine hesitancy. Some of it can be not understanding the science, but also people who have had a bad experience with a doctor who was condescending or patronizing or misdiagnosed them or various things like that, are less likely to trust. People who have never had the opportunity to have a healthcare provider with important cultural things in common with them, whether that's racial or ethnic or religious or social class or many of the various other things. Distrust of Big Pharma as well as distrust of the various government entities that are distributing these [00:21:00] things. So there are so many different factors and I attempted in my book to look at the different factors that help people make healthcare decisions regardless of what the outcome of that decision is. The polio epidemics in the mid–20th century. Vaccines overall were very much welcomed. They were hotly anticipated. Vaccine technology had really just come into its own in that period. 
 
 

Shortly after the polio vaccine, we got the first generation of many of the childhood vaccines that we get today. So that's an example of something very different to the reception of vaccines now. And smallpox vaccines. There's a different story and in some ways the same story almost every generation. 
 
 

In my book I talk a little bit about the kind of early development of smallpox vaccines, but people are vaccinating for smallpox up through about the 1960s through 1980s, depending [00:22:00] on where in the world you are. It's actually been eradicated, the only human disease that has been eradicated. 
 
 

Much of the legal precedent in the US around vaccines—can a government force someone to be vaccinated?—comes from debates over smallpox sometimes when the vaccine wasn't very safe yet because they're using 19th-century technology. Sometimes when the public health departments who are vaccinating people were really being pretty brutal and cruel in terms of just, public health officers flanked with police officers tearing through a tenement building or, something like that where it's really not an informed consensual relationship. But also these court cases in this precedent come from genuine attempts to control a deadly disease. 
 
 

And many of those attempts were really important, were really successful. And of course, globally it has been successful. We don't have [00:23:00] smallpox anymore. Smallpox apparently had a very distinctive smell when someone had the characteristic sores. And most people alive today have no idea what that smells like because there, there aren't any examples of it anymore. I have no idea what smallpox smells like, and as a historian, I'm just a tiny bit wistful about that. And then I remember the greater context and I'm glad that I don’t know. 
 
 

Wayne: The ignorance is blissful, isn't it? Anyway, Tegan, this has been really fascinating. For listeners, I would highly recommend this book. It's really something you can read straight through. It's something you can look at the table of contents and see the 50 chapters and say, “Oh, wow, I'm very interested in this.” And go in and still make sense of what's there. I found the chapters very self-contained as well. You didn't need to follow through necessarily from top to bottom, from [00:24:00] beginning to end. Thanks for taking the time to do this. I really appreciate it and good luck with your book.