 All right, so it is my pleasure to welcome you all to our, our, the last of the interdisciplinary conferences prior to spring break. So next week is spring break, so there will not be a noon conference, but the following week, the following week there will be, I'll be giving the talk. So it's my pleasure to introduce Michael Rossi, who is an associate professor of the history of medicine at the University of Chicago and a faculty member of the McLean Center. He received his A.B. from Columbia University and a PhD in the history and anthropology of science, technology and society from MIT. Dr. Rossi is an historian of medicine and science in the United States from the 19th century to the present. His work focuses on the historical and cultural metaphysics of the body, how different people at different times understood questions of beauty, truth, falsehood, pain, pleasure, goodness, and reality vis-à-vis their corporeal selves and those of others. So really, I think a very, very interesting set of topics. I do think one of the absolute great things about the McLean Center is the interdisciplinary nature of our conversations and to have people like Professor Rossi coming on a regular basis, the case conference and engaging in discussions with us is really fantastic. So join me in welcoming Professor Rossi. Thank you. Thanks for that introduction and thank you all for coming today. So today I just wanted to talk to you a little bit about, well, as you can see up here, oh, wait a minute. I think that these might not be the correct slides, but yeah, is it, oh shoot, can we recalibrate real fast and can I send you something that's, okay, I was doing this in haste. Sorry. Let's take this one more time. Sure. I'm sure that that's the, let me see, okay, I was working too fast. We can do this faster, right? Okay, great. I'll let me just resend. Yes. All right. Sorry, everyone. Okay. You know what? I don't. Go ahead. Let's just do what the, yeah, let's just do what these, what happened to it? All right. Thanks. Let's do this again. I'm sure somehow I managed to lose the actual slides. So these are going to be draft slides. So you'll see there will be some placeholder information that I'll, that I'll talk us through. So thank you for your indulgence. So as I said, so I am, I am still going to be talking about aesthetics and clinical ethics. And I changed the title slightly from, from an introduction because actually this is more like some preliminary thoughts. This work combines. Some of my older work into, you know, the history of the body and sort of how we see and feel and think about the body and some much newer work. So it's really kind of an introduction to, for me as well as, as well as perhaps for you. And so one thing I'm very interested in, in doing here, if you would, if you'd indulge me is I'd like to stress test this work some. So if you can, you know, we could really put it through the ringer. That would be, that would be helpful. So what I'd like to do today is I'd like to proceed in five parts. So first I'd like to provide a little bit of, oops, there we go. Yeah. So first I'd like to provide a little bit of, of an introduction, right? So in this introductory part, I want to maybe define a few terms, maybe set a few principles. I want to give you a warrant. So like why, why we should think about this at all. And also I'd provide some, some background for this question. That's going to be specific to, specific to us and to the work we do at the McLean Center in particular. So that'll be the introductory part. Then I'll just take you through methods very quickly. So and again, just discuss a couple of different ways of approaching this problem, not exhaustively, but just to give you a sense of where I'm coming from and we can go, we can get as granular on that as we want to. And then, let's see, then I will provide a historical case study. So we'll look at sort of a, the ways in which aesthetics and clinical ethics have changed over the course of about like a hundred years, so say from about 1850 to 1950 with a little wiggle room on either side. And then finally, I'd like to offer some other points for discussion and maybe some conclusions and questions. And also, do we know what's the, what's the usual policy here? We do questions as we, questions as we go, questions at the end. Great. So let's do, let's do questions as we go. And one thing I would ask is just because I'm, I might have to take my glasses off in order to see my notes. And that means that you're all blurry. So if you, if you have a question, either, either feel free to yell or like I have sort of like reptile vision. So if you move, I'll, I'll see you. But yeah, so if you can be ostentatious, that'd be helpful. Okay, so let's just get into the sort of basic principles. So at first glance, the question of this question of what is ethics or what are ethics and what are aesthetics might seem to be ethics and aesthetics might seem to be parallel endeavors, right? You know, they might be seen, might seem to be moving in kind of similar directions, but, but never really crossing. So, you know, a kind of rough, rough and ready definition of, of ethics might be something like principles that govern behavior, right? Or standards of right and wrong. And there's different ways you can sort of cut morality and ethics, right? So, you know, one thing I think we can think about for the purpose of, for the purpose of our work. And this talk is that in many ways, you know, I would argue that in many ways ethical principles guide our actions, guide it even most mundane of our actions, right? There's some sort of ethical principle underlying it. And yet ethics, as we know from case conference, you know, ethical principles really only tend to rise to the surface in moments of conflict, right? And so this is when we become aware that, that there is a ethical course of action. Aesthetics meanwhile, we usually think of as dealing with principles of beauty and taste, right? So like what is, I don't know, what is, what is beautiful or what kinds of, what particular kinds of cultural forms are desirable at particular moments. And, you know, and we might also, but we might also think about aesthetics as dealing more broadly with just questions of, questions of sensation in general. So the word aesthetic is derived from, from the word esthesis, which just means sensation, right? So you might think about aesthetics as the study of, of sensations or, you know, sensual qualities, or even maybe, you know, the study of reaching very broadly the study of empirical sense data. And so again, so there's one way of thinking about this, where we can think of, you know, ethics as being about actions, whereas aesthetics are about feelings, and you know, they're kind of similar, but they work, they never come to cross. But as many philosophers have pointed out, as many philosophers, and also an occasional artist and the occasional physician have pointed out, in reality, it's often not so different, not so easy to differentiate the two. And so we could see, we could see the conflation of aesthetics and ethics in some of the earliest days of clinical medicine. And so this is a quote from the physician, Claude Bernard from 1865. Bernard is one of these sort of founders of clinical medicine. So he's the considered the quote unquote father of physiology, right? One of the first people to think, to think analytically about the chemical processes that go on in living creatures. And very often he studied these chemical processes by vivisection, so you just cut open a live animal and sort of see how its parts worked. And so what Bernard said about the work of the physiologist, and I'll read this to you here. He said, the physiologist is no ordinary man. He's a learned man, a man possessed and absorbed by a scientific idea. He does not hear the animal's cries of pain. He's blind to the blood that flows. He sees nothing but his idea and organisms which conceal for him the secrets he has resolved to discover. And so in other words, for Claude Bernard and for his students, at the founding of physiology, at this founding moment of what would become recognizable as modern medicine, we see that there's a need to ignore pain, right? So you need to ignore pain, ignore unpleasant sounds, unpleasant sights, in order to get at the truth. And so here we see a kind of aesthetic consideration tied up in an ethical consideration, right? And the prescription for behavior, how ought a good physiologist act? Well, a good physiologist ought to sort of take pains to block out aesthetic qualities that might be otherwise distracting. And I should note here, by the way, as far as ethics go, and as far as examples of conflict go, Bernard was not unanimously accepted as thinking that a good physiologist should ignore the pride of animals. In fact, his wife and his daughter both came to despise him and founded the first animal rights movements in Europe. So again, as far as aesthetics and ethics go, it's kind of a good object lesson in some ways. And then we might look at other, there's other kinds of ways of thinking about this. So again, this is, the Schoenberg quote is from 1946. So again, other people who commented on the diffusion of ethics and aesthetics. Oh, it also should be, that should be Arnold Schoenberg, not Arthur. But Schoenberg says that music arises not from I may, but I must, right? So authentic music is an ethical imperative, he thinks, not an aesthetic one. The poet Joseph Brodsky in his, I believe this is from his 1988 Nobel Prize speech, says that aesthetics is the mother of ethics. And philosopher Ludwig Wittgenstein probably most narrowly of all these people really explored the diffusion of ethics and aesthetics. One of his earlier remarks about this, though, is that aesthetics and ethics are one. Insane. So, and so I think what the important thing is that what all these people and others mean when they discuss ethics and aesthetics in this way is that, is that sensations or esthesis, right? Are some of the first ways that we interact with and identify moral values, which are the basis of ethical actions, right? So in other words, we might think of ethics as existing sort of up here in the music of the spheres, but what someone like, certainly someone like Wittgenstein wants to know is that ethics are sensational first, right? This is how we identify, how we identify something as being either an ethical principle or an ethical conundrum. And in fact, I would say that we have this, we see this a lot in case conference without, I think we'll have to say this without going to specifics, right? Like, so many times in our case conferences, you know, we know that ethical, that ethics consults are often triggered by moral distress, right? So moral distress is a feeling, right? It's a feeling attached to an intellectual principle, but the distress part is a matter of sensation. And for that matter, you know, we often, more often than not, the consults involve matters of miscommunication or mistrust, right? And so not necessarily ethical conundrums as ethical conundrums, right? But matters of feeling, how are people interacting with one another? And indeed, for that matter, we also think about, you know, oftentimes they might involve, say, patients behaving in ways that, while they might not be physically dangerous, are nevertheless, you know, unpleasant or perhaps hateful in the words of the essay about the hateful patient. And so at root, what I want to point out is that at root, these sorts of cases are feelings as much as considerations of actions or principles, right? So that's the sort of the first, the first layer, big question I would say something like, the first layer of ethics is, in fact, aesthetics or sensation, feeling. Okay, so more generally, though, and this will put us on, I think, even more solid footing, more generally, as Wittgenstein put it, and this is one of the reasons, it's a little bit of an outlier in the way that he thinks about this, but more generally, he said that ethics and aesthetics both involve, and I'll quote him directly here, quote, the inquiry into the meaning of life or into what makes life worth living, right? And so, and I like this turn of phrase because it points to the salience of aesthetics for clinical medical ethics, right? You know, we often speak about or consider medicine as being in the business of preserving human lives, but of course, what I think we often mean is that one of the core concerns of medicine is making life worth living, right? And what that is is a judgment of feeling, right? So this is an aesthetic judgment as much as a moral judgment. Okay, so these are some of the real-world kind of events or the happenings in case conference that got me thinking about this in the first place, but it's all very abstract. So one of the questions we want to ask is how do we get at a solid pragmatic sense of how this plays out like in the world? And again, there's more than the numerous approaches, more than I'm about to show you here to get at this. The three ways we might consider doing this are through fields like or through the practice of ethnography, philosophy, or history. And so I've been thinking about this a lot and of all these approaches, I think ethnography has to be the best. And so in terms of ethnography, what this would mean would be, you know, have an anthropologist or maybe a sociologist, follow physicians around or caregivers around more broadly and try to trace in really my new detail how caregivers and how their patients identify ethical concerns. And so we might think about what kinds of sensations they report, what kinds of structures underpin these sensations, what kinds of tones of voice people use with one another. This is all kind of, these are all predecessors to ethical actions. We might also ask how people report feeling in particular encounters. And actually I'd be very interested to know and maybe we could talk about this in discussion. What moral distress actually feels like in a clinical setting, right? So we sort of use it as a cue, but what is that, what does it actually, we're to break it down into phenomena? Like what is it actually like? Okay, so ethnography would be the best way of doing this. It's also extremely time consuming. So it's time consuming, it's expensive, and it has some serious IRB considerations attached. So again, I'd welcome the chance to do this study with anyone here, but could not do it for today. We might also think about philosophy. And so I would defer to Dan, but this certainly has the benefit of drawing from a vast body of expertise, right? So people who have thought long and hard and in some cases for continually hundreds of years about these questions. From what I've read of the medical ethics and aesthetics literature, though, it's fairly thin still. And again, I'd love to know more about this, but from what I've been able to glean, there's not a lot of work in this. And it tends to be very abstract or at a way higher level than, at least it seems possible for me to synthesize. So too little particularity. And then of course there's history, which as a historian, I tend to historicize every question. And so this is a tendentious way of approaching this idea. But history too has pros and cons. And so on the heavy con side, historians are not, historians are not very good at telling people what they should do. So historians are very good at saying, well, of course, when something happened and maybe what happened, why it happened and how it turned out, things like this. But they're not very good at saying, at sort of predicting the future or saying how people ought to act. And so, and that's just by the nature of the field. We study things in the past. And I guess, I mean, I guess technically everything we experienced is technically in the past, but we study things in the far past. So that's the con side. On the pro side, one of the ways that the fusion of ethics and aesthetics shows up most clearly in clinical settings does tend to be in retrospect. So again, even in case commentary, we're usually thinking about things that have happened and we're sort of analyzing past events. So there's a strong historical element to case conference. And the sort of ethical and aesthetic considerations show up most clearly in moments of controversy. And again, as I said, with ethics, usually our ethical ideas emerge in moments of controversy or some sort of clash. And so controversies in medicine often have ethical and aesthetic roots. And these show up really well in the historical record. And so of course, as I said, there's a tendentious reading of why history is the right way to do this, but I submit to you that I think it's up to the task. Okay, so let's see what else I want to say about that. All right, so I think that in this case we will go on to the case study that I have. So one of the best ways to get at this question is through this case study I have, it will be a case study into aesthetics, ethics and institutions. And again, as I said, it's gonna, we're gonna look at a period of roughly 100 years from the middle of the 19th century to the middle of the 20th century. And this is sort of, this is gonna be a very, what historians call a periodization. Also, by the way, are we, I can be labor the point of actually what historians do, but a lot of it involves just like sort of reading people's old mail and old texts and stuff like this. And trying to understand why people did the things that they did or why people think the things that they think. And oftentimes this is a very good way, depending on your sources, right? There's a very good way of getting at people's, both actions and their mentality, right? So in some ways, very much this fusion of what people are feeling, but also how these feelings make them act or how these feelings frame their actions. And so, yeah, and so we'll be looking at these three periods. We'll be looking at the mid 19th century. And we'll be looking at the sort of aesthetic of gentlemanliness in the clinical setting. We'll then look at the turn of the century in which sort of purity comes to replace gentlemanliness as a guiding force. And then we'll look at the mid 20th century, which tends to introduce the idea of sort of workmen like efficiency, right? So we have gentlemanliness, gentlemanliness, purity and efficiency. So that's where we find ourselves. What else do I want to say about that? Oh, the only other thing I want to say is that again, these are not, I shouldn't say that one aesthetic replaces each other. It's more like a sort of palimpsest where we sort of have layers and layers accumulating. Okay, so one way we can sort of get at this question is inspired. So we'll start in the mid 19th century. And one way we can get at this question is by reading texts from the era like this one. So this is D. Daniel Webster-Cathill's Physician himself. This is a very common book at the time. And it's in fact widely classified as a book on medical ethics. And so this is in other words, a book by Cathill on how to behave as a physician. Like how should physicians, how should you study? How should you treat your patients? And most of all, how should you position yourself to be an effective physician? And one thing we see when we read this book is that behaving in a manner that is both professional and trustworthy and that allows one to attain good clinical outcomes was not simply a matter of learning or best practices or implementing knowledge. And in fact, the full title of the book is the physician himself and what he should add to his scientific requirements. Again, sorry, I don't have the slide for this, but it'd be easier to see. But again, the physician himself and what he should add to his scientific requirements. And so this is a book saying that it's not enough just to know science. It's not enough to have, well, in this period you might or may not have gone to medical school, but it's definitely not enough to have a scientific knowledge to be a good physician. You need to add other elements. And among these elements are aesthetic considerations. So that is giving patients a sensation or a feeling that you are a good doctor. And one of the ways that someone does this is by appearing as a gentleman. And so this might seem superficial, but it was in fact a sort of essential part of being a serious doctor. This is how you prove that in addition to your sort of scientific requirements, you are also trustworthy, sober, and ethical. So again, appearance is a necessary part of ethics. And so as Kathol says here, this is from the first edition of his text, he says, a physician must take care to be neat in personal appearance. Above all else, wear a clean shirt and a clean collar. For if you dress well, people will employ you more readily, accord you and accord you more confidence, and therefore they will expect a larger bill and will pay it more readily. And so what we see here is that you have a need to convey gentlemanliness and confidence, and this will be down to your benefit as a physician and indeed to the benefit of the field as a whole. And this of course assumes that a doctor is doing good, assuming that doctor is doing good, it also means looking good. The reverse I should say is also true. So he says, do not under any plea be a leader of loud or frivolous fashions, as though your starchy foppishness and love of fine clothes had overshadowed all else. He says discard also glaring neckties, flashy breastpins, loud watch seals, brilliant rings, fancy canes, colognes, perfumes, attitudinizing, and all other peculiarities in your dress. He goes on to say more, but I can skip that part. Okay, so in other words, don't be this person. So this is a foppish doctor from the 1900s. Okay, so again, this is self-serving advice in some ways. So this is advice on how to behave as a doctor so that you get paid more and paid more frequently, but it's also one with an ethical underpinning. And the same advice goes for the doctor's office. So here the aesthetic should be one of like learned sobriety. Okay, well, I'll read you a different quote. So this is, so among one of the things he says is that in your doctor's office, you should again display no miniature museums with sharks heads, stuffed alligators, porous shells and pale butterflies, no bugs, ships, steamboats, mummies, snakes, fossils, stuffed birds, lizards, crocodiles, beetles, tapes worms, devilfish, ostrich eggs, fornitz nest, or anything else that will advertise you in any other light than that of a physician. Okay, so that's one thing. So don't have a miniature museum like this in your office. He also says, take particular care to avoid making a display of instruments and tools. Keep from sites such inappropriate and repulsive objects as catheters, syringes, stomach pumps, obstetric forceps, splints, trusses, amputating knives, skeletons, grinning skulls, jars of amputated extremities, tumors, mannequins, and the unright fruits of the uterus. Also avoid such chilling and coarse habits as keeping vaginal specular or human bones on your desk for paperweights. So in other words, don't be gross. And again, this tells us a few things. So first of all, the fact that a text on medical ethics spends a good deal of time on ornamentation, again, on aesthetic considerations, tells us that this is a real concern for physicians at the time, particularly for those that wish to make medicine more professional. Second of all, this tells us that there's a particular aesthetic associated with scientific bearing. So it's not enough to know science. So you must also present yourself as a gentleman, present a gentlemanly heir. And finally, this tells us something about the ethical concerns of the profession. And this is, I think, probably the most important takeaway, which is namely that the cathol and the people that he's writing about are concerned mainly with physicians themselves, unless with patient care. And then if we think about, again, Brodsky's line, well, actually, he says, oh, I don't have that quote here. Okay, well, we'll go back here. If we think about Brodsky, Brodsky also says that every new aesthetic reality makes man's ethical reality more precise. So the aesthetic stance of 19th century doctors made their ethical commitments more obvious to us. And so we can see some, and let's see, we can move on and see some practical consequences of this gentlemanly stance in an 1850s controversy over childbed fever or parol fever. So let's say, here we go. So some important background. So in the 19th century, hospital is usually the last place you want to go if you're sick. If you can go anywhere else and you're sick, if you have anyone in the world who will take care of you, other than physicians in the hospital, you would want to go there. Hospitals tend to be dark. They tend to be damp. They tend to be cold. They're often run like prisons, so people describe being treated more like inmates than patients. In the case of Bellevue Hospital is famous. This is an etching of Bellevue Hospital, circa 1888, so they're often rat infested. In fact, Bellevue Hospital is held out in this period as one of the worst things about New York. And so one of the worst things about 19th century New York is pretty bad. And they also are known, hospitals are known, for having way higher rates of mortality than in the general population. So there's a whole host of things that are called hospital diseases, including gangrene, including septicemia, and including childbed fever. Now let's see. Oh, okay, that comes in a minute. So as we now know, this is in no small part because of physician's own behavior. So physicians in this period would take nothing of waking up in the morning and dissecting a cadaver along with their medical students. Then they might go amputate a leg. Then they might deliver a baby. Then they might perform some sort of minor surgery, all without changing clothes or especially paying attention to washing their hands. So you can imagine they have sort of gore on their hands all day long. And indeed, physicians work mainly in their street clothes. And so these are some examples of drawings of medical students from the period. If there are any medical students in here, you can behold. And so you can see here he's sort of smoking and he has a large mug of beer on top of his anatomy books. This is an example of someone, again, an example of someone who's dressed like a dandy. So you don't want to be this person, right? This is not a sober and reflective individual. I don't know if you can see this also. The motto here is we murder to dissect. So again, it gives you a sense of how of the esteem with which medicine is held in the late 19th century. And so as you're likely aware, some doctors did attempt to change this trend in mortality. So you've likely heard of Ignaz Semmelweis, for instance. So in Vienna's large maternity clinic, Semmelweis made medical students under his supervision wash their hands with chloride of lime. And chloride of lime is kind of like bleach. Interestingly, the reason that he did this is not necessarily because of germ theoretical reasons, but because it smelled strong. And so in a time in which disease was often thought to be conveyed by a fluvia or smells, like if you could introduce something that smells good, then maybe that will fight disease. So he had his students rinse their hands in chloride of lime. And sure enough, rates of pyropereal fever plummet. So they go from something like 33% to 3%. Similarly in 1843, okay, again, this is not the actual olivaruminal homes quote, and the data is wrong too, that should be 1843. But in 1843, the American physician olivaruminal homes published this piece called The Contagiousness of Pyropereal Fever, suggesting that the disease is largely iatrogenic. So it's carried by doctors. And again, he recommends that physicians should wash their hands more frequently to stem the tide of this really dangerous disease. And now, of course, these seem like good solid common sense measures, right? These are easy to implement, and they're easy to see as successful. But at the time, they're incredibly controversial. And this is not because people thought that the science was wrong particularly, right? So we're on the, in 1840s, 1850s, we're on the cusp of a germ theory of disease. There's still a lot of debate over whether disease is caused by, you know, it's caused by atmospheres or by sort of poisons that may be carried by hands or ferments, right? But it's not, it's not that it's impossible that a physician that disease could be transmitted chemically in some way. But what people that disagree with Samuel Weiss and Holmes suggest is that it's offensive to consider that doctors who are gentlemen would be able to carry disease, right? So one of Holmes's competitors is a man named Charles Meigs, who's a Philadelphia physician, and he publishes a large broadside against Holmes's account of pure peril fever, saying among other things that a doctor is a gentleman and a gentleman's hands are always clean, right? And so, and so, and here again, yes, I have a note here that he also says that Holmes is a lot younger than Meigs at this point. So these sort of Meigs and indulges in these ad hominem attacks saying that Holmes is a Jejun and fissionless young doctor who doesn't understand that all doctors are gentlemen. So in other words, it's not possible for a gentleman to carry disease on his hands. And again, in this case, by clean, Meigs doesn't just mean free of dirt. He means sort of, he means more like virtuous, right? Or able or something like this, right? And so what Meigs and what the people who think like Meigs believe is that by suggesting that doctors should wash their hands, they're actually undermining the profession. They're saying that all this work that we did to try to look like gentlemen and dress like gentlemen and not keep skulls on our desks and all this stuff is all going to fall apart if we just go around admitting that we're causing disease by not washing our hands because that implies that we're dirty, right? Or again, not clean, not gentlemanly. And so again, what I want to say here is that this is an aesthetic quality, right? So gentlemanly cleanliness that drives a behavioral concern, right? So how should doctors behave? And in fact, there's an ethical concern to like, what is the profession to be like, right? So how should we relate to the profession? And so again, just to call your attention here, there's not much concern with patients at this point, right? It's mainly concerned with solidifying the profession as something that is honorable or gentlemanly. Okay, so that's that. So let's smash cut to the turn of the century. As we know, by the late 19th century, so this is the 1800s or 1890s, most, although not all physicians had accepted the germ theory disease, first of all. So hand-watching is no longer controversial. And I should also say that when germ theory, so germ theory is still controversial up until like even past 1910, you could still feel, you could still find people disagreeing with germ theory. But again, it's often on moral grounds and not on scientific grounds. So someone like, what's a good example? Like someone like Florence Nightingale, for instance, comes out strong against germ theory, not because she doesn't think germs are real, but because she thinks that if you start to say that it is germs that cause disease rather than people's behaviors, rather than sort of moral corruption or rather than like a notion of filth, then what incentive do people have to behave well to keep themselves clean, right? If it's all just germs and people can run wild and just believe it on the germs. So very often protests against germ theory were launched on moral rather than scientific grounds. In any case, with the acceptance of germ theory, we also see new aesthetic values arising to, again, not to replace gentlemanliness or some sort of a notion of gentlemanly propriety, but sort of complement and supersede them. And so instead of gentlemanliness, the aesthetic value of guiding medicine came to be seen as something like purity. It's a purity in this case meant something, again, something different from cleanliness, whereas purity is not the same as being clean. And it's indeed something different even than gentlemanliness. It means something more like clarity or transcendence or almost a sort of priestliness, right? And so in turn, this implies a moral clarity, right? The ability to shed preconceptions, the discipline to see the truth about disease even though it's difficult. And so, and again, this idea of priestliness is not my own turn of phrase. Many doctors came to see modern medicine and this aesthetic of purity as being something akin to an ecclesiastical sort of doctrine. So William Osler, who's sort of considered the father of modern medicine in the United States, called this the gospel of the body, right? So this idea of modern medicine, it preaches the gospel of the body, he says. And if I had sent you to the right slides, what I would have is a great picture of William Osler from the period from 1919. There's a postcard of William Osler as an angel sort of hovering over Johns Hopkins Hospital, chasing out these like germs which kind of look like spiders or something like this. So try to imagine William Osler, like kind of looks like a William Osler bobblehead doll with wings floating about Johns Hopkins. And so of course, in addition to symbolic forms like Osler as an angel, this sort of purity takes other practical forms. So in this period, we see the invention of disposable rubric gloves. We see autoclaves. We see face masks. Let's see, oops, I don't have the face mask slide here. We see the, and we also see the introduction of the white lab coat. So this is Ernst von Bergmann who is credited as the sort of inventor or the person who popularized the white lab coat as a symbol again of physicians, both scientific acumen and purity. Moreover, in addition to the white lab coat, we also see the white hospital room, the white operating room, and more generally we see the color white as an aesthetic value that indicates sort of the moral value of scientific purity. And so this is one, this is a patient's account from 1910. So the patient says in 1910 that, quote, everything in the little hospital room was a spotless white. There's a white child floor, white iron chair, white rocker, white bed, small white table, not a microbe to be seen with the best regulated microscope. Let's see, do I have the other quote? Okay, so a physician of the period also put it that, as he said, quote, white, the ancient symbol of purity indicating always a freedom from moral and physical contamination was the obvious choice of color in the development of the hospital. And let's see, and then goes on to say, not only the profession but the public came to look upon a glazed white surface as the criterion for antisepsis. And so again, here now notice, there's a practical value to making everything in the hospital white. It's hard to disguise dirt on a white surface. But more important is the fact that the public comes to look upon the glazed white surface as a criterion for purity. And so the other way to think about this is that in the period, in this period, people understood that you could have a non-white aseptic or antiseptic surface. You didn't have to have the color white to avoid germs. But the color white was important for symbolizing a kind of scientific purity. And so therefore it was essential to practice. Let's see. And indeed, it was not just, and this was sort of a hospital-wide phenomenon. So let's see. And so, yeah, so again, another anonymous physician put it this way, he said, white is a clean color and an all-white operating room will lend itself to habits of cleanliness better than any other color because dirt of any kind will intrude itself to such an extent that the nurses or cleaners will have to remove it, right? And so, again, this is like the ethical, the idea of practice of cleaning and practice of keeping cleanliness revolves around this sort of symbolic purity embodied in the color white. Let's see. Moreover, there's a practical concern. So in addition to being clean, moreover, as this commentator puts it, boards of directors like to show their beautiful white looking operating rooms, and usually the operating room is one of the showplaces of the hospital. So in other words, it's not only important to have white because it's a clean surface. It's also important because if you are trying to drum up money for your hospital and hospitals in this period are almost always underfunded, it's great to have an all-white operating room where you could take people, they could take wealthy donors in and say, look, this is our white operating room and it looks pure, it looks scientific. And again, it will guide, it will lead to good clinical outcomes down the road. So in other words, so we see again, the aesthetic values of the white room overlapping with a moral value of purity, which then has ethical implications. So this idea that medicine is a place of truth or an institution that can be trusted. And again, there's also practical value. So we've also moved from a hospital as being a place that you want to avoid at all costs to a place that you'd want to go. If you are sick, so people will come to hospitals, people will trust doctors, wealthy donors will invest in again, we have better outcomes for medicine, better outcomes for patients. This brings us finally, I hope, yes, to the mid-20th century. So this is a period where we see a shift from thinking about purity to thinking about efficiency and again, efficiency is a practical value, a moral value and an aesthetic value all at once. And so by the middle of the 20th century, we see medicine is on a much firmer footing than it was for the past 100 years. For the first time in history, doctors as a profession are becoming trusted by wider publics. Biomedicine, so there are still controversies by the middle of the 20th century as to exactly what kind of medicine is the best. So there's still some pushback from homeopathy and osteopathy. But largely biomedicines are the kind of medicine that's practiced today by everyone in this room, I believe, is trusted by what is the sort of a standard, right? Any given doctor in any given hospital one or any given practice, one would hope would follow more or less the same practice as any other, which if I didn't emphasize it before, that was not the case for much, certainly much of US practice. So up until about 1880, if you wanted to be a doctor in the United States, basically you can just say I'm a doctor. And if someone would come to you for treatment, then there's your practice. And your medical school isn't standardized, right? So you could take as many courses as you want, you could take them out of order, right? So all of this is by the 1920s, all of this has been solidified into sort of a more or less standardized system, which redounds to the prestige of the profession. Nevertheless, and so along with this, rather than ever the less, we see a shift in aesthetic values, again of the sort of sensory values involved with seeing and experiencing the world, again for caregivers and patients alike. And so rather than gentlemanliness in this environment or priestly purity, instead doctors now encourage each other to think of themselves as workmen and their hospitals as workplaces. And so this is one doctor from 1927 puts it, I can't remember this person's name. All right, the name will come to me, but as this one doctor puts it in 1927, shop efficiency nowadays takes a great consideration of lighting work and benches and saving of workmen's eyes. Is not the surgeon also a workman and is not his work about as important as any we can think of? And so this to me is sort of fascinating. So we pause for a second to consider what we're seeing here. Over the course of less than a century, doctors have gone to being gentlemen, ideally, a gentleman with clean hands to sort of priests who have to embody the sort of white purity to workmen. And to workmen who should have, it is implied a similar sort of standard of efficiency in their work and similar kind of workflow standards, industrial standards. Other physicians talk about hospitals as factories for healing. And indeed, again, I wish I had this graphic for you. There's a sort of dramatization of this idea from 1930 in which you see a sort of, again, a shining white pure hospital. So I'm going to try to paint a word picture for you rather than the actual picture. You can imagine there's a shining white hospital in the middle where on the left are these sort of the unwashed downtrodden masses kind of styled as immigrants going into the hospital and they're all sort of, they're all dressed in dark clothes and then they enter the hospital and then on the right, there's a stream of people who are dressed in sort of middle class like 1930s garb. And so the idea here is that hospitals have become factories for healing, but also factories for acculturating people to kind of modern living, right? And again, this is a practical value, but it's wrapped up in a sort of, a sensation of feeling. Okay, and so that's when considering surgeons' eyes, again, as well as patients' well-being, it became clear that even though white was pure, it was not an efficient color, right? And so the, I mean, in long and short, the glare from white operating rooms is seen as being an impediment to effective surgery, right? It strains people's eyes, nurses dislike, and they say so quite frequently and vociferously they dislike working in all white environments. It's enervating, people get tired, people get cranky, right? So clearly, even though white is a pure color and even the donors like it, it is antithetical to a workman-like environment. And so as a result, physicians and hospital designers started to experiment. So here, for instance, is the operating room of Harry Sherman, circa 1913 or so. And so Sherman, rather than favoring a black scheme, as is in San Francisco, I think, rather than favoring a black scheme, Sherman favored a green and red scheme or a green and gray scheme. Because again, because of the discomfort that he experienced optically when doing surgery. Let's see, do we have, yes. And so interestingly, the way he justified this is he said the color scheme, again, of the operating room should start from the red color of blood, end of the tissues, and therefore he advises that green, the complementary color of red should be chosen for the color of the floor and the veins caught. I'm sorry, this is 1915, not 1913. And he goes on to say, actually, I mean, I say, how are we on time? I don't want to belabor this point too much. Okay, we'll get some time. Well, I don't want to belabor this point too much, but he actually goes on to say that the exact shade of green that he selects is chemically the same thing as the iron and hemoglobin. So he's like, he takes the chemical formula of blood and sort of flips it on his head and then turns it into green for his operating room. And so what this is interesting to me is that rather than having the starting point be purity, rather than trying to banish everything that is embodied from the operating room, now he's taking blood and putting it right back into the very center of operating room aesthetics. So let's not ignore, let's in fact not be like Bernard at all, we're not going to ignore the blood and we're not going to try to have an all-white pure environment or aesthetic environment where we're going to have like blood be front and center, although it will be flipped to be green. And so other physicians similarly engage this move towards non-white operating rooms. Not everyone does spinach green, some people do red sheets and dark gray walls or gray sheets. Lead gray is pretty frequent. All black sometimes happens, although not all that frequently. And the last thing I would say, let's see, do we have, nope. So, Professor, I'm very sorry about the slide situation. Suffice to say that while white is seen as innervating to doctors, it's also seen as being bad for patients as well. As one, as one doctor puts it, white suggests sterility, coldness, and lacks all power to create pleasurable and healthful sensations. Right, so here the idea is that if you put patients in a, in an all-white room, it's actually bad for their health, right? It's not only annoying to doctors, but being unable to experience pleasant sensations is bad for healing. And so this doctor goes on to say, what if nature had provided forest walls of white leaves, or carpets of white grass, or limitless ceiling of white? Oh, God forbid, right? And so as a side note, because we've talked about, we've talked about generative AI before in case conference, this is my first foray into AI picture making. And again, I don't have it to show you. I tried to get one of like a chat GPT kind of program to make me a picture of an all-white forest with white trunks and white grass. It would not do it. So apparently it's inconceivable even to the soulless AI that there should be an all-white forest. So this doctor was onto something. And instead, you know, so instead of an all-white hospital room, again, this doctor notes that the patient or the person recovering from sickness, quote, needs the therapeutic reaction of the positive colors. And again, I wish I had this to show you. There's this whole scheme in the 19 teens after World War I of experimenting with colors for shell shock treatment, for instance. So one common shell shock treatment at the time is to put a patient in an all-yellow room, like actually a yellow room with a blue ceiling, right, to sort of simulate the soothing colors of nature, right? And again, so again, we see this an idea that esthesis or aesthetics is useful for efficient healing. Okay. And so I'm going to just skip ahead a little bit. Right, I guess the point here being that we see here an aesthetic value, so a value of feeling being converted in this case to a therapeutic value and in turn, the therapeutic value becomes an ethical value, right? You know, we ought to use more colors in the hospital because it's good for patients, because it's good for physicians, because it's efficient. And so the concern here, I should say, our concern right here is not whether this is sort of medically or biologically or psychologically correct, although I'd be interested in your opinions on this. The point is that we have serious people who are considering aesthetic value as a matter of medical ethics, right? As a matter of how should doctors or hospital designers or administrators behave? And so by the 1950s, well, this is not very useful, but by the 1950s, we see most operating rooms are dominated by these green and blue and sometimes gray schemes. Doctors become more colorful places, again, not just in the name of practicality, but in the name of feeling and the pursuit of values like pleasure and healthfulness. And so in 1955, so not this quote, there's a Canadian doctor in Wilson who says, again, this is from 1965, one of the most radical changes made in recent years has been the great interest in the use of color in the modern ward. And then he goes up to say, there's no doubting the effect which pastel walls and ceilings have on the well-being of our patients. And so again, this is aesthetics in the service of greater values than just sensation or sensual pleasure, right? So we're not making patients happier or even healthier, but again, we're sort of building greater trust in the institution. Okay, and so since the 1970s, this is actually not from then, this is a, I think this is a hospital an OR in Tehran, I think, actually in the 1970s. This has been a sort of the watchword of sort of clinical aesthetics. Okay, so that was that's one again, really quick, and again, I apologize for the missing slides, but it's a really quick scan through a historical approach to how we might sort of identify moments of this thesis in medical ethics. There's a couple of other places we might look. So we were just upstairs. Well, okay. So for instance, our own Leon Kass arguing against the cloning of humans has an essay called The Wisdom of Repugnance. And so again, we could certainly we could take issue with the message of the wisdom of repugnance. But Kass's message is basically that if you feel discussed at something, it is wrong, right? And so in this case, I think he feels discussed at human cloning. And so then he says, we ought to avoid things that feel bad to us because wrong feeling is a sign of something being ethically amiss. And again, I should say, disagree with this argument in the paper, but it serves as a point of evidence that this sort of line of thinking has not gone away. We were just talking about eugenics upstairs. In the 1920s, the eugenics movement gives us another good example about how ethical standards influence medical thinking. So on the left, we have a Jane Davenport is the daughter of a famous eugenicist, Charles Davenport. And so in the 1920s, she did a composite sculpture of what she calls the average American man. This was displayed at a eugenics conference alongside this sculpture by Tate McKenzie of the 50 strongest athletes at Harvard. So he sort of mushed them all into one person. And the conclusion was supposed to be clear for conference goers, right? If you want the average American man to look like this, not like this sort of figure with slumping shoulders, he looks slightly apologetic. And yeah, actually, I don't see much wrong with him myself, but that could be my own bias. As a slight person myself. And so again, the point here is that this is an object lesson in what people should be like, right? And so it's a stance of the demands action delivered through aesthetics. Let's see, even thinking about things like communication. So again, a lot of the times in case conference, we talk about clarity of communication right in about setting expectations with people that we communicate with. Even that is sort of an aesthetic value. So clarity is an aesthetic value in medical behavior, right? So this is a cartoon from the, I want to say this is from the 1860s, I think, yeah, from the 1860s. And so here we have like, this is again, before you did medical school, before there was rigorous medical school, people would apprentice. And here you have the apprentice asking, asking the doctor, if you please, sir, shall I fill up Ms. Twaddle's drafts with water? And the practitioner says, dear, dear, dear, Mr. Bumps, how much often much I mentioned the subject, we never use the term water, we must say aqua distillata, right? And so the idea here is, of course, that to be a good physician, in this case, he's saying that you have to be unclear, right? You have to mystify your patients. I think we actually take the opposite task, attack and try to make things clear for people. But again, the point here is that clarity, we might think of clarity as an objective quality, right, or something that could be objectively measured. In fact, it's more of a feeling, or at least the way that we ascertain clarity initially comes to us from a sensation of either clarity or obscurity. And so let's see, I think, yeah, okay, so that I think I've talked long enough. Let us, because I don't really have, well, I don't have a good concluding slide, so I guess I'll turn it over to questions or discussions. Thanks. Well, I guess what would you say to, so I think, I mean, my first reaction is that I would take a more, I think I would take a more, I would take a more expansive definition of aesthetics, for one thing. I mean, possibly not one. And actually, I think that, I don't know, again, you'd be able to say this better than I, but it strikes me that someone like, again, like someone like Wittgenstein, right, would not say that aesthetics are about beauty necessarily as much as feeling or percepts. Would you disagree with that? Well, then you'll have to correct me more at some point, but yeah, I don't know. I guess I would say that the short of it is I would say that I would want us to expand aesthetics to include more than beauty, so more than like things like sensation, right? So again, and then to your question, like the FOP would say, so the FOP would say, yes, I'm beautiful and therefore it's good, right? The person regarding the FOP-ish doctor would say, I'm repulsed and therefore it's not good, right? And so they would be, so the person arguing against the FOP would argue for a position of initial like, I don't know, stomach turning or revulsion or something like this. Yeah, so I would say, yes, although I guess in my, yes, although in my head, I would say that they are distinct because it's more like the aesthetic would be the initial impulse that allows us to extrapolate a moral position, right? So I think I would separate them slightly, although I don't feel, I don't feel wedded to this point. And again, and the reason I would do that is just because it's partially for a practical reason, because again, if I had the funding and time, and if it was even, I don't even know if this would pass IRB approval, I do think it would be interesting to get at the points at which to sort of survey people or to observe the points at which sensations either inform or frame or otherwise illuminate ethical positions. So like I said before, I'd be really interested in knowing like, what does moral distress feel like in a clinical setting? Like, I mean, it's kind of easy for me to sort of have a sort of nebulous imagination, but yeah, what is that actually? Or what does mistrust feel like? Or what does clarity actually, what does like clinical clarity feel like? Proceeding from the idea that these are often ways that we're at least alerted to the presence of an ethical question. That was really great as well. And I guess a comment, and it is really interesting to me the extent to which sort of the symbolism of how positions are portrayed or, you know, the use of the bite and whatnot, that it can test its significance. And it reminds me of many years ago talking with one of the sort of early ethics people in a hospital. And so he was a PhD in philosophy, had gotten his clinical background, and sort of had been hired by a hospital. And at the time, ethicist was not really the accepted term. And so he said, you know, he wasn't really sure whether he should call himself an ethicist. He said, well, I shouldn't call myself an ethicist. So he was sort of playing with, well, what's the right term? And he said, well, maybe I should, you know, I do ethics in a hospital, like a physician. So he said, so, no, I'll be the efficient, like the physician. And so he got a white coat, and it said, efficient. And so he said, you know, he's very proud of his white coat and went to see the patient because there had been a consult for ethics. And he walked in and said, you know, I am Dr. Sons of the Ethnician. And the patient said, oh, my goodness, thank you so much for coming. I was afraid I wouldn't get my hair cut. Because he thought he was the beautician. And he does strike me that there is a, I mean, so you're putting aesthetics and ethics together, I thought, actually, that would be interesting. Well, it's also, it's difficult to research also because esthetician, like, so you get a lot of like the ethics of estheticians. And I'm like, well, not, you know, so like just, you know, in, you know, again, in, in Googling or in like sort of library searching, yeah, there's a lot about like aesthetic surgery, for instance, which is not, actually, I mean, I think I probably actually would be very interested, like I don't feel well equipped enough to delve into it for this. But yeah, it's also so eth-eth-tish, how do you say that? Eth-tish. Eth-tishian. Yeah, I've never found out. Yeah, no, it's a hard bunch of syllables for me to pronounce in English. Yeah, that is fascinating. Also, I mean, again, just a good, you know, well, it's funny because actually my, my thought is that my, my, my sort of, again, my gut impulse is that like, gosh, wearing a white coat, if you're not a doctor, seems a little unethical. Like, you know, like, a little bit like, you know, I don't know. But anyway, that's, that's, again, that's my, my own non-like sort of gut impulse reaction. Thank you. Yeah. I don't know if you, I don't know if you've heard about the dramas of the morning. It's been so much fun. I thought it was about, right. 1030, I'm like, hey, where are you?