Category Archives: Health and Fitness

The fashionable history of social distancing



Crinolines, by design, made physical contact nearly impossible.
Hulton Archive/Stringer via Getty Images

Einav Rabinovitch-Fox, Case Western Reserve University

As the world grapples with the coronavirus outbreak, “social distancing” has become a buzzword of these strange times.

Instead of stockpiling food or rushing to the hospital, authorities are saying social distancing – deliberately increasing the physical space between people – is the best way ordinary people can help “flatten the curve” and stem the spread of the virus.

Fashion might not be the first thing that comes to mind when we think of isolation strategies. But as a historian who writes about the political and cultural meanings of clothing, I know that fashion can play an important role in the project of social distancing, whether the space created helps solve a health crisis or keep away pesky suitors.

Clothing has long served as a useful way to mitigate close contact and unnecessary exposure. In this current crisis, face masks have become a fashion accessory that signals, “stay away.”

A copper engraving of a plague doctor in 17th-century Rome.
Wikimedia Commons

Fashion also proved to be handy during past epidemics such as the bubonic plague, when doctors wore pointed, bird-like masks as a way to keep their distance from sick patients. Some lepers were forced to wear a heart on their clothes and don bells or clappers to warn others of their presence.

However, more often than not, it doesn’t take a worldwide pandemic for people to want to keep others at arm’s length.

In the past, maintaining distance – especially between genders, classes and races – was an important aspect of social gatherings and public life. Social distancing didn’t have anything to do with isolation or health; it was about etiquette and class. And fashion was the perfect tool.

Take the Victorian-era “crinoline.” This large, voluminous skirt, which became fashionable in the mid-19th century, was used to create a barrier between the genders in social settings.

While the origins of this trend can be traced to the 15th-century Spanish court, these voluminous skirts became a marker of class in the 18th century. Only those privileged enough to avoid household chores could wear them; you needed a house with enough space to be able to comfortably move from room to room, along with a servant to help you put it on. The bigger your skirt, the higher your status.

A satirical comic pokes fun at the ballooning crinolines of the mid-19th century.
Wikimedia Commons

In the 1850s and 1860s, more middle-class women started wearing the crinoline as caged hoop skirts started being mass-produced. Soon, “Crinolinemania” swept the fashion world.

Despite critiques by dress reformers who saw it as another tool to oppress women’s mobility and freedom, the large hoop skirt was a sophisticated way of maintaining women’s social safety. The crinoline mandated that a potential suitor – or, worse yet, a stranger – would keep a safe distance from a woman’s body and cleavage.

Although these skirts probably inadvertently helped mitigate the dangers of the era’s smallpox and cholera outbreaks, crinolines could be a health hazard: Many women burned to death after their skirts caught fire. By the 1870s, the crinoline gave way to the bustle, which only emphasized the fullness of the skirt on the posterior.

Women nonetheless continued to use fashion as a weapon against unwanted male attention. As skirts got narrower in the 1890s and early 1900s, large hats – and, more importantly, hat pins, which were sharp metal needles used to fasten the hats – offered women the protection from harassers that crinolines once gave.

As for keeping healthy, germ theory and a better understanding of hygiene led to the popularization of face masks – very similar to the ones we use today – during the Spanish flu. And while the need for women to keep their distance from pesky suitors remained, hats were used more to keep masks intact than to push strangers away.

Today, it isn’t clear whether the coronavirus will lead to new styles and accessories. Perhaps we’ll see the rise of novel forms of protective outerwear, like the “wearable shield” that one Chinese company developed.

But for now, it seems most likely that we’ll all just continue wearing pajamas.

[You need to understand the coronavirus pandemic, and we can help. Read our newsletter.]The Conversation

Einav Rabinovitch-Fox, Visiting Assistant Professor, Case Western Reserve University

This article is republished from The Conversation under a Creative Commons license. Read the original article.


Coronavirus: advice from the Middle Ages for how to cope with self-isolation


Enclosing of an anchoress (14th century).
Cambridge, Corpus Christi College, MS 079: Pontifical, CC BY-NC-SA

Godelinde Gertrude Perk, University of Oxford

The pandemic of COVID-19 is often called “unprecedented” – and for many people cooped up in their homes in different countries, the experience is both unparalleled and challenging. But in late-medieval Europe, individuals self-isolated professionally. Some people – women particularly – permanently withdrew from society to live walled in, alone in a room attached to a church.

Guides for, and texts written by, these female “anchorites” – as the women were known – from Britain and continental Europe give us descriptions of their way of living and recount their reflections. So what can these medieval women teach us about how to cope with self-isolation?

These anchorites chose to be confined in these cramped cells for many reasons. According to medieval religious culture, a life of prayer on behalf of others vitally supported society. Isolation empowered women to express their love for Christ, and minister to their fellow believers through their prayers and counsel. Anchorites were even presented as possessing “super powers” of interceding for the deceased in purgatory.

Furthermore, in the late Middle Ages, devotion among laypeople – people who are not clergy – flourished. Life as an anchorite offered laywomen an option to express this piety, but offered more freedom for individual contemplation (and solitude) than a nun’s life.

Warnings in guides for anchorites also hint at less spiritual motives. Life as a recluse, paradoxically, situated anchorites at the heart of their communities and could transform them into religious celebrities. Their cells often faced busy roads in bustling cities and doubled as a bank, teacher’s cubicle, and storehouse of local gossip.

A king consults an anchorite.
Beinecke MS 404 (Rothschild Canticles), Yale Library

Don’t expect comfort

The 13th-century, medieval English guide for female anchorites, Ancrene Wisse, warns recluses not to look for comfort. Instead, the anchorite should remind herself that she was enclosed not just for her own benefit, but for the sake of others too.

She is told to “gather into your heart all those who are ill or wretched” and “feel compassion”. By self-isolating, the anchorite “holds [all fellow believers] up” with her prayers. Now, nurses and doctors are urgently calling for a similar commitment from the public, when begging “Stay home for us.”

The Wisse’s advice has a flavour that feels equally relevant today. Self-isolation may be easier to bear if instead of seeing it as a stretch of boring but comfy nights in, you recognise it as an unpleasant, stressful experience – but also visualise all the people whose health you are protecting by staying home.

Acknowledging vulnerability

The earliest-known English woman writer, Julian of Norwich (c.1343–c.1416) – an anchorite – likewise encouraged readers to acknowledge their own vulnerability, but suggested perceiving it as a strength. She assured readers in her late 14th-century or early 15th-century text, A Revelation of Love, that suffering and difficulties will not defeat them:

Christ did not say, ‘You shall not be perturbed, you shall not be troubled, you shall not be distressed,’ but he said, ‘You shall not be overcome.’

Modern statue of Julian of Norwich at the west entrance to Norwich Cathedral.
Evelyn Simak, CC BY-ND

Julian promises that readers will experience emotional turmoil during any crisis but will ultimately conquer it. This promise parallels modern survival psychology. When adapting to life during a crisis, acknowledging the challenging circumstances as forming one’s real life now is essential. Yet one should simultaneously remember that one is doing one’s utmost to return to a better, pre-crisis style of living. Only by acknowledging our vulnerability – both physical and mental – and consequently taking action to protect and care for others and ourselves, will we make it through.

A reconstruction of Julian of Norwich’s cell at St Julian’s in Norwich.
Godelinde Gertrude Perk

Guarding the senses

According to manuals for anchorites, they should guard their metaphorical windows (their five senses) and actual cell windows, to prevent falling into temptation and being distracted from their prayers and meditation. The Wisse declares: “disturbance only enters the heart through something … either seen or heard, tasted or smelt, or felt externally.”

The external world can upset one’s interior world. Dutch anchorite Sister Bertken (1427-1514) recounts this confusion in a poem:

The world held me in its power
with its manifold snares
it deprived me of my strength.

Yet this nervousness about the effect of sensory input can also be understood as a medieval analogue to a warning against fake news or anxious over-consumption of news. Several guides recommend having a female friend scrupulously guarding the anchorite’s window, refusing to allow access to visitors who spread gossip and lies. Social media today can be a little like such visitors.

The Enclosure of Sister Bertken.
Photo by E de Groot & S Pieters, University of Utrecht

Keep busy, keep sane

Anchorites and writers of manuals for anchorites also reflected upon how to keep sane. Keeping occupied prevents one from climbing the walls. British Cistercian monk, Abbot Aelred of Rievaulx (1110-1167), tells his sister, an anchorite, in A Rule of Life for a Recluse that: “Idleness … breeds distaste for quiet and disgust for the cell.”

Routines are key. Anchorites recited sequences of prayers, psalms and other Bible readings at fixed points of the day. According to modern survival psychology, dividing a problem or stretch of time into manageable steps is crucial when faced with a crisis. Equally important is performing each step one by one, never looking further ahead than the next step.

Mentally absorbing hobbies, such as crafts, gardening or reading, are another time-honoured strategy for dealing with self-isolation. After recommending sewing clothes for the poor and church vestments, the Wisse assures anchorites that keeping occupied will shield their minds against temptation:

For while [the devil] sees her busy, he thinks like this: ‘It would be useless to approach her now; she can’t concentrate on listening to my advice.’

These suggestions are easily translatable to today. After all, according to survival psychology, performing manageable, directed actions with a purpose is crucial in crises. Incidentally, the Wisse also recommends keeping a cat.

On the one hand, self-isolation can feel limiting – Julian of Norwich also felt that: “This place is prison,” she said, referring either to earthly life or her cell. But the cell’s cramped space also granted medieval women a paradoxical, spiritual freedom. In his letter to the anchorite Eve of Wilton, the 11th-century monk Goscelin of St Bertin exclaims: “’My cell is so narrow,’ you may say, but oh, how wide is the sky!”The Conversation

Godelinde Gertrude Perk, Postdoctoral researcher in Medieval Literature, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.


1918 Spanish Flu Pandemic



Hidden women of history: Sonia Revid created public health ballet at the height of ‘dance fever’



Dickenson-Monteith/The Australian Performing Arts Collection

Averyl Gaylor, La Trobe University

Today’s latest medical advice is to wash our hands to the chorus of songs from the likes of Lizzo, Gloria Gaynor or Beyoncé. This is to mitigate the boredom of washing to Happy Birthday … twice!

Public health strategies have been linked to popular culture before. In the 1930s, it was modern dance that taught Melburnians how to perform personal hygiene.

Dance classes were so popular the Sun News Pictorial reported:

Doctors, Barristers, other professional men are learning or relearning dance, and there are busy classes for business and married girls, tiny toddlers, and even mothers of families, and social heavyweights.

One dance instructor, Russian immigrant Sonia Revid, specialised in the instruction of hygiene through movement.

Revid choreographed and performed ballets that taught audiences how to brush their teeth. She also published a pamphlet outlining the importance of personal hygiene. The City of Melbourne’s medical officer, John Dale, publicly praised Revid’s efforts and parents were advised to enrol their children in her classes.

Revid in full flight, circa 1935.
Rosa Ribush Collection/Australian Performing Arts Collection

Body and soul

Revid had opened her dance studio in Collins Street, Melbourne, in 1933, a year after her arrival in Australia.

The Sonia Revid School for Art Dance and Body Culture was promoted as ensuring “physical well-being and lasting health” and provided “lessons to correct specific physical defects, such as obesity, flat feet, unshapely hands, self-consciousness and shyness”.

By 1936, Revid was promoting her method as not only a way to stay fit and healthy but also as means of acquiring a “consciousness of cleanliness”.

Revid asserted the capabilities of her practice based on the evidence of a medico-social experiment she conducted on a group of poor children in 1935. Revid wanted to see whether poor children who lived in the then “slums” of Fitzroy could learn to distinguish between hygienic and unhygienic practices through dance education.

Poor hygiene had been associated with a lack of social responsibility and immorality and so Revid’s published pamphlet asked through metaphor: Do Slum Children Distinguish Light From Dark?

From her observations, Revid concluded modern dance had a cleansing capacity – performing a sort of physical and spiritual bath. Not only did it teach children how to identify hygienic and unhygienic practices, she wrote, but imparted a more hygienic constitution.

In recent years, ballet has returned to vogue as a tool for everyday fitness.

Don’t forget to smile

Emboldened by her belief in the hygienic potential of dance, Revid began to include ballets with public health messages in her performance repertoire.

Her 1938 ballet, Little Fool and Her Adventures, instructed audiences how to brush their teeth correctly and portrayed the painful consequences of poor dental hygiene.

The ballet was first performed at the University of Melbourne’s Union House Theatre and later at school halls such as at Melbourne Church of England Girls Grammar School, now Melbourne Girls Grammar. It was performed in four parts. Part one was an introduction to the protagonist, Little Fool, and to the themes of the ballet.

Little Fool Has a Toothache, the second section, told of the pain associated with dental decay. It was dramatically enhanced by a thumping musical score by the French composer, Charles Gounod, titled Funeral March of a Marionette. The score alluded to the serious medical consequences of poor dental hygiene. Audiences reported its repetitive rhythm reminded them of the thumping pain of a sensitive nerve.

The score has since become familiar as theme music for the television program Alfred Hitchcock Presents.

The ballet’s climax was in part three: The Toothache Leaves a Mark on Little Fool – She imagines she is pursued by evil spirits. This section was ominously danced to Camille Saint-Saëns’s Danse Macabre (known in English as Dance of Death). The choreography showed Little Fool overcome by delirium.

Revid’s ballet concluded with a positive message of calm vigilance. Little Fool overcame her sore tooth and departed the stage to a lively and uplifting tune.

Sonia Revid strikes a pose, circa 1931-47.
Photograph by Andre, Melbourne/Australian Performing Arts Collection, Arts Centre Melbourne

Lessons today

Little Fool remained in Revid’s repertoire for many years, providing hygienic instruction and a cautionary public health warning to all who saw it.

Revid’s dance classes and her performances taught the importance of daily hygiene and kept the community informed of best practices through the fluctuating realities of Melbourne’s public health.

With advances in medicine and technology, such as vaccines, we often take the basics for granted, losing sight of the importance of thorough handwashing until a global pandemic reminds us of its preventive power.

Although hygienic instruction hasn’t been a part of popular artistic culture for a while, in 2020 Beyoncé and Lizzo are taking matters into their own clean hands.The Conversation

Averyl Gaylor, PhD Candidate in History and Manager, Centre for Health, Law and Society at La Trobe Law School, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.


From cow pox to mumps: people have always had a problem with vaccination



© Wellcome Collection, CC BY-SA

Sally Frampton, University of Oxford

A recent surge in mumps among young adults in the UK has been linked to the 1998 MMR vaccine scare, when a now-discredited medical paper authored by Andrew Wakefield suggested a connection between the vaccine and the development of autism. The publication of the paper led many parents to refuse the vaccine for their child.

The effect of Wakefield’s paper is still deeply felt. Indeed, every week seems to bring news of an unfolding controversy about vaccination. In the UK an alarming decline in childhood vaccination rates has been recorded. Vaccine scepticism seems to be increasing – a fitting testament to these troubling times, when distrust of science and expertise permeate.

Social media is often pinpointed as part of the problem. The ease with which ideas and information about vaccination are spread on Twitter, Facebook and other platforms is causing concern. As one medical journalist observed in 2019: “Lies spread through social media have helped demonise one of the safest and most effective interventions in the history of medicine.”

Social media has undoubtedly changed the way information about vaccination is engaged with. But the media-driven nature of the debate isn’t actually that new. When vaccination began at the end of the 18th century, it quickly became fodder for commentators.

In the 1790s, the surgeon Edward Jenner had confirmed through a number of experimental procedures on patients that exposure to cowpox pustules – symptoms of a disease of cows’ udders which in humans resembles mild smallpox – could confer immunity to smallpox. Following the publication of his results in 1798, vaccination came into widespread use.

With it came immediate unease and distrust. Satirists like James Gillray capitalised upon rumours that inserting cowpox pustules into the skin might cause one to sprout cow horns, a fear which had its roots in religious and cultural stigma surrounding the pollution of blood with animal matter.

James Gillray: Edward Jenner vaccinating patients against smallpox.
Wellcome Collection, CC BY

Images like Gillray’s were an early indicator of the ability of vaccination to capture the public imagination in a way few other medical developments would over the ensuing decades. This only intensified in the mid-19th century, when the Compulsory Vaccination Act of 1853 decreed that all babies should be vaccinated. Compulsory vaccination aroused accusations that personal liberty was under threat. In its wake, resistance to vaccination ramped up considerably.

Victorian vaccination

Vaccine hesitancy was amplified by the tumultuous world of print which characterised the Victorian age.

Improved printing technologies and lower prices gave rise to a rapid increase in the number of periodicals and newspapers available. Information was democratised, as cheap papers and periodicals became accessible to women and the working classes. Medical and health issues were mined by journalists for their dramatic content, and tropes of the vaccination debate we see today were given shape by the information revolution of the late 19th century.

Indeed, it was during this time that the polarisation between “pro” and “anti” vaccination camps solidified. Use of the phrase “anti-vaccination” rocketed at the end of the 19th century. Pamphlets and magazines sprung up in opposition to its use, claiming that vaccination was a dangerous, toxic procedure that was being thrust upon society’s most vulnerable citizens: children.

The not so catchily named National Anti-Compulsory-Vaccination Reporter, a magazine which began in 1876, sold hundreds of copies every month. The paper revelled in its radicalism, its opening editorial announcing:

As sound-hearted and enlightened Anti-Vaccinators, it is our bounden duty, and should be our steady and constant aim, to work towards the complete destruction of Medical Despotism.

Meanwhile, humour publications such as Punch and Moonshine skewered organisations like the Anti-Vaccination League for their zealotry and irrationality. In an of age of self-professed scientific medicine, the movement’s association with radical religious beliefs and other non-conforming lifestyle choices, such as vegetarianism and abstinence from alcohol, made it a target for lampoonery.

An illustration in Punch, 1872. ‘A snobbish mother resistant to her daughter’s doctor using a vaccine from their neighbour’s child.’
Wellcome Collection, CC BY

A polarised debate

Anti-vaccination publications believed they were deliberately excluded from a press that was in the pocket of the state and who sought to suppress the true dangers of vaccination. Publications such as The Times had become the gatekeepers of public opinion – in 1887 the paper claimed to have suffered from “an epidemic of letters about vaccination”. But anti-vaccinators lambasted newspaper editors as “shamelessly unprincipled and venal” for refusing to publish that correspondence which was critical of vaccination.

This is an accusation that has its echoes in conspiracy theories that continue today. The prominent American anti-vaccine organisation Children’s Health Defense has denounced the mainstream media for being under the thumb of Big Pharma and ignoring the voices of those harmed by vaccines.

As this shows, there has always been a potency to the vaccination debate few other medical practices generate. The provocative issue of children’s health at the heart of it, and the tension vaccination evokes between notions of collective responsibility and the freedom to choose what we think best for our bodies has made it an emotive, highly polarised debate that has been brewing since the 19th century. This has always been galvanised by sustained media interest.

But there is a complexity to vaccination that polarisation does not properly unpack. What of, for example, the many people who would not identify as “anti-vax”, but instead form a loose group who are hesitant about vaccines and may delay or choose only some vaccinations?

Social media may amplify division between the two camps, but it builds upon a long history of media outlets constructing it.The Conversation

Sally Frampton, Humanities and Healthcare Fellow, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.


A Brief History of the Lobotomy


The link below is to an article that takes a brief look at the history of the lobotomy.

For more visit:
https://lithub.com/a-brief-and-awful-history-of-the-lobotomy/


Infographic: Timeline of Medical Technology


The link below is to an infographic/timeline of the history of medical technology.

For more visit:
https://coolinfographics.com/blog/2019/4/5/5000-year-timeline-of-medical-technology


100 years later, why don’t we commemorate the victims and heroes of ‘Spanish flu’?


File 20190118 100292 x8l4i8.jpg?ixlib=rb 1.1
Women were at the forefront of managing the influenza pandemic.
AUSTRALIAN WAR MEMORIAL

Peter Hobbins, University of Sydney

At Sydney’s enormous Rookwood Cemetery, a lichen-spotted headstone captures a family’s double burden of grief.

The grave contains the remains of 19-year-old Harriet Ann Ottaway, who died on 2 July 1919. Its monument also commemorates her brother Henry James Ottaway, who “died of wounds in Belgium, 23rd Sept 1917, aged 21 years”.

While Henry was killed at the infamous Battle of Passchendaele, Harriet’s headstone makes no mention of her own courageous combat with “Spanish flu”.

Harriet’s story typifies the enduring public silence around the pneumonic influenza pandemic of 1918–19. Worldwide, it killed an estimated 50-100 million people – at least three times all of the deaths caused by the First World War.




Read more:
Why historians ignored the Spanish flu


After the disease came ashore in January 1919, about a third of all Australians were infected and the flu left nearly 15,000 dead in under a year. Those figures match the average annual death rate for the Australian Imperial Force throughout 1914–18.

Arguably, we could consider 1919 as another year of war, albeit against a new enemy. Indeed, the typical victims had similar profiles: fit, young adults aged 20-40. The major difference was that in 1919, women like Harriet formed a significant proportion of the casualties.




Read more:
World politics explainer: The Great War (WWI)


Deadly flu spread rapidly

There was no doubt about the medical and social impact of the “Spanish flu”. Although its origins remain contested, it certainly didn’t arise in Spain. What is known is that by early 1918, a highly infectious respiratory disease, caused by a then-unknown agent, was moving rapidly across Europe and the United States. By the middle of that year, as the war was reaching a tipping point, it had spread to Africa, India and Asia.

About a third of the entire world’s population was infected with Spanish flu.
Macleay Museum, Author provided

It also took on a much deadlier profile. While victims initially suffered the typical signs and symptoms of influenza – including aches, fever, coughing and an overwhelming weariness – a frighteningly high proportion went rapidly downhill.

Patients’ lungs filled with fluid – which is why it became known as “pneumonic influenza” – and they struggled to breathe. For nurses and doctors, a tell-tale sign of impending death was a blue, plum or mahogany colour in the victim’s cheeks.

This, sadly, was the fate of young Harriet Ottaway. Having nursed a dying aunt through early 1919, in June she tended her married sister Lillian, who had come down with pneumonic influenza.

Despite taking the recommended precautions, Harriet contracted the infection and died in hospital. Ironically, Lillian survived. But in the space of less than two years she had lost both a brother to the Great War and her younger sister to the Spanish flu.

An intimate impact worldwide

Indeed, as Harriet’s headstone reminds us, this was an intimate pandemic. The statistics can seem overwhelming until you realise what it means that about a third of the entire world’s population was infected.

Whatever your heritage, your ancestors and their communities were almost certainly touched by the disease. It’s a part of all of our family histories and many local histories.




Read more:
How infectious diseases have shaped our culture, habits and language


It wasn’t just victims who were affected. Across Australia, regulations intended to reduce the spread and impact of the pandemic caused profound disruption. The nation’s quarantine system held back the flu for several months, meaning that a less deadly version came ashore in 1919.

But it caused delay and resentment for the 180,000 soldiers, nurses and partners who returned home by sea that year.

Leaflets like this one from Victoria tried to warn people of the dangers of Spanish flu.
Board of Public Health, Victoria/Public Records Office of Victoria

Responses within Australia varied from state to state but the crisis often led to the closure of schools, churches, theatres, pubs, race meetings and agricultural shows, plus the delay of victory celebrations.

The result was not only economic hardship, but significant interruptions in education, entertainment, travel, shopping and worship. The funeral business boomed, however, as the nation’s annual death rate went up by approximately 25%.

Yet for some reason, the silence of Harriet’s headstone is repeated across the country. Compared with the Anzac memorials that peppered our towns and suburbs in the decades after the Great War, few monuments mark the impact of pneumonic influenza.

Nevertheless, its stories of suffering and sacrifice have been perpetuated in other ways, especially within family and community memories. A century later, these stories deserve to be researched and commemorated.




Read more:
Speaking with: Peter Doherty about infectious disease pandemics


Despite the disruption, fear and substantial personal risk posed by the flu, tens of thousands of ordinary Australians rose to the challenge. The wartime spirit of volunteering and community service saw church groups, civic leaders, council workers, teachers, nurses and organisations such as the Red Cross step up.

They staffed relief depots and emergency hospitals, delivered comforts from pyjamas to soup, and cared for victims who were critically ill or convalescent. A substantial proportion of these courageous carers were women, at a time when many were being commanded to hand back their wartime jobs to returning servicemen.

In resurrecting stories such as the sad tale of Harriet Ottaway, it’s time to restore our memories of the “Spanish flu” and commemorate how our community came together to battle this unprecedented public crisis.The Conversation

Peter Hobbins, ARC DECRA Fellow, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.


The History of Aspirin



A brief history of fake doctors, and how they get away with it



File 20180409 176959 1cm1f78.jpg?ixlib=rb 1.1
Impersonation of doctors is a modern phenomenon that grew out of Western medicine’s drive towards professionalism.
from shutterstock.com

Philippa Martyr, University of Western Australia

Melbourne man Raffaele Di Paolo pleaded guilty last week to a number of charges related to practising as a medical specialist when he wasn’t qualified to do so. Di Paolo is in jail awaiting his sentence after being found guilty of fraud, indecent assault and sexual penetration.

This case follows that of another so-called “fake doctor” in New South Wales. Sarang Chitale worked in the state’s public health service as a junior doctor from 2003 until 2014. It was only in 2016, after his last employer – the research firm Novotech – reported him to the Australian Health Practitioner Regulation Agency (AHPRA), that his qualifications were investigated.

“Dr” Chitale turned out to be Shyam Acharya, who had stolen the real Dr Chitale’s identity and obtained Australian citizenship and employment at a six-figure salary. Acharya had no medical qualifications at all.

Cases of impersonation, identity theft and fraudulent practice happen across a range of disciplines. There have been instances of fake pilots, veterinarians and priests. It’s especially confronting when it happens in medicine, because of the immense trust we place in those looking after our health.

So what drives people to go to such extremes, and how do they get away with?

A modern phenomenon

Impersonation of doctors is a modern phenomenon. It grew out of Western medicine’s drive towards professionalism in the 19th century, which ran alongside the explosion of scientific medical research.

Before this, doctors would be trained by an apprentice-type system, and there was little recourse for damages. A person hired a doctor if they could afford it, and if the treatment was poor, or killed the patient, it was a case of caveat emptor – buyer beware.

But as science made medicine more reliable, the title of “doctor” really began to mean something – especially as the fees began to rise. By the end of the 19th century in the British Empire, becoming a doctor was a complex process. It required long university training, an independent income and the right social connections. Legislation backed this up, with medical registration acts controlling who could and couldn’t use medical titles.

Given the present social status and salaries of medical professionals, it’s easy to see why people would aspire to be doctors. And when the road ahead looks too hard and expensive, it may be tempting to take short cuts.

Today, there are four common elements that point to weaknesses in our health-care systems, which allow fraudsters to slip through the cracks and practise medicine.

1. Misplaced trust

Everyone believes someone, somewhere, has checked and verified a person’s credentials. But sometimes this hasn’t been done, or it takes a long time.

Fake psychiatrist Mohamed Shakeel Siddiqui – a qualified doctor who stole a real psychiatrist’s identity and worked in New Zealand for six months in 2015 – left a complicated trail of identity theft that required the assistance of the FBI to unravel.

Last year, in Germany, a man was found to have forged foreign qualifications that he presented to the registering body in early 2016. He was issued with a temporary licence while these were checked. When the qualifications turned out to be fraudulent, he was fired from his job as a junior doctor in a psychiatric ward. But this wasn’t until June 2017.

2. Foreign credentials

Credentials from a foreign university, issued in a different language, are another common element among medical fraudsters. Verifying these can be time-consuming, so a health system desperate for staff may cut corners.

Ioannis Kastanis was appointed as head of medicine at Skyros Regional Hospital in Greece in 1999 with fake degrees from Sapienza University of Rome. The degrees were recognised and the certificates translated, but their authenticity was never checked.

Dusan Milosevic, who practised as a psychologist for ten years, registered in Victoria in 1998. He held bogus degrees from the University of Belgrade in Serbia – at the time a war-torn corner of Europe, which made verification difficult.

3. Regional and remote practice

It’s easier to get away with faking in regional or remote areas where there is less scrutiny. Desperation to retain staff may also silence complaints.

“Dr” Balaji Varatharaju fraudulently gained employment in remote Alice Springs, where he worked as a junior doctor for nine months.

Ioannis Kastanis had worked on a distant Greek island with a population of only around 3,000 people.

4. It’s not easy to dob

Finally, there are two unnerving questions. How do you tell a poorly trained but legally qualified practitioner from a faker? And who do you tell if you suspect something is off?

The people best placed to spot the fakes – other hospital and health-care staff – work in often stressful conditions where complaints about colleagues can lead to reprisals. If the practitioner is from another ethnicity or culture, this adds an extra layer of sensitivity. It was only after “Dr Chitale” was exposed that staff were willing to say his practice had been “shabby”, “unsavoury” and “poor”.

So, why do they do it?

The reasons for fakery are as diverse as the fakers. “Dr Nick Delaney”, at Lady Cilento Children’s Hospital in Brisbane, reportedly pretended to be a doctor to “make friends” and keep a fling going with a security guard at the same hospital.

On a more sinister level, there are possible sexually predatory reasons, like those of bogus gynaecologist Raffale Di Paolo. Fake psychiatrist Mohamed Shakeel Siddiqui said he only did it to help people.

There are also the less easily understood fakers, like “Dr” Adam Litwin, who worked as a resident in surgery at UCLA Medical Center in California for six months in 1999. Questions only began to be asked when he turned up to work in his white coat with a picture of himself silk-screened on it: even by Californian standards, this was going too far.

So how do we stop this happening?

Part of the problem is our cultural dependence on qualifications as the passkey to higher income and social status, making them an easy target for fraudsters. Qualifications only reduce risk, but they can’t eliminate it. Qualified doctors can also cause havoc: think Jayant Patel and other bona fide qualified practitioners who have been struck off for malpractice, mutilation and manslaughter.

Conversely, no one complained about “Dr Chitale” in 11 years. The only complaints Kastanis received in 14 years were from people who thought his Ferrari was vulgar. The German junior doctor had an excellent knowledge of mental health-care procedures and language – obtained from his time as a psychiatric patient.

The ConversationMost of these loopholes can be closed with time and patience. What would help is if hospital and health-care staff felt sufficiently supported to report their suspicions to their employer, rather than to their colleagues. This would foster a more open culture of flagging concerns about fellow practitioners without fear of formal or informal punishment. It might also uncover more “Dr Chitales” before anyone is seriously harmed.

Philippa Martyr, Lecturer, Pharmacology, University of Western Australia

This article was originally published on The Conversation. Read the original article.


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