Sep
7
HISTORY OF MEDICINE
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Maggot Therapy
Written records have documented that maggots have been used since antiquity as a wound treatment. There are reports of the successful use of maggots for wound healing by Maya Indians and Aboriginal tribes in Australia. There also have been reports of the use of maggot treatment in Renaissance times. During warfare, many military physicians observed that soldiers whose wounds had become colonized with maggots experienced significantly less morbidity and mortality than soldiers whose wounds had not become colonized. These physicians included Napoleon’s surgeon general, Baron Dominique Larrey, who reported during France’s Egyptian campaign in Syria, 1798–1801, that certain species of fly destroyed only dead tissue and had a positive effect on wound healing.
A Wound Cleaned by Maggots
Dr. Joseph Jones, a ranking Confederate medical officer during the American Civil War, is quoted as follows, “I have frequently seen neglected wounds … filled with maggots … as far as my experience extends, these worms only destroy dead tissues, and do not injure specifically the well parts.” The first therapeutic use of maggots is credited to a second Confederate medical officer Dr. J.F. Zacharias, who reported during the American Civil War that, “Maggots … in a single day would clean a wound much better than any agents we had at our command … I am sure I saved many lives by their use.” He recorded a high survival rate in patients he treated with maggots.
During World War I, Dr. William S. Baer, an orthopedic surgeon, recognized on the battlefield the efficacy of maggot colonization for healing wounds. He observed one soldier left for several days on the battlefield who had sustained compound fractures of the femur and large flesh wounds of the abdomen and scrotum. When the soldier arrived at the hospital, he had no signs of fever despite the serious nature of his injuries and his prolonged exposure to the elements without food or water. When his clothes were removed, it was seen that “thousands and thousands of maggots filled the entire wounded area.” To Dr. Baer’s surprise, when these maggots were removed “there was practically no bare bone to be seen and the internal structure of the wounded bone as well as the surrounding parts was entirely covered with most beautiful pink tissue that one could imagine.” This case took place at a time when the death rate for compound fractures of the femur was about 75-80%.
While at Johns Hopkins University in 1929, Dr. Baer introduced maggots into 21 patients with intractable chronic osteomyelitis. He observed rapid debridement, reductions in the number of pathogenic organisms, reduced odor levels, alkalinization of wound beds, and ideal rates of healing. All 21 patients’ open lesions were completely healed and they were released from the hospital after two months of maggot therapy.
Aug
23
HISTORY OF MEDICINE -Daniel Elmer Salmon (1850-1914) Discover of Salmonella
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Daniel Elmer Salmon (1850-1914) – Discover of Salmonella
Daniel Elmer Salmon, D.V.M.
Daniel Elmer Salmon was the son of Daniel Landon and Eleanor (Flock) Salmon. His early education was at the Mount Olive District School, Chester Institute, and Eastman Business College. In 1868 Salmon was enrolled in the first class at Cornell University, which had been established three years earlier in New York. He graduated from Cornell as bachelor of veterinary science in 1872.
After graduation, Salmon married Mary Thompson Corning from Ithaca, New York, and settled as a veterinary in Newark, New Jersey. For reasons of health he moved to Asheville, North Carolina, situated in the Blue Ridge Mountains at an altitude of 600 meters and known for its mild climate. Two years later he gave a series of lectures on veterinary medicine at the University of Georgia, and the same time commenced a special study of diseases of hogs. Daniel Salmon was granted a doctoral degree in veterinary medicine from Cornell University in 1876. This was the first DVM degree to be awarded in the United States of America.
In 1879 Salmon distinguished himself as a key participant in the New York State campaign to wipe out pleuro-pneumonia in cattle. After this effort he was selected by the Department of Agriculture to study the widespread problem of livestock disease in the south, particularly Texas fever. In 1883 Salmon was asked to organize a veterinary department, thus becoming founding director of the Bureau of Agriculture under the Department of Agriculture. Already the next year this institution was made into the Bureau of Animal Industry, headed by Salmon. He held this position until 1905, when a dispute with the head of the Department of Agriculture in Washington forced him to resign. During his tenure as bureau chief Salmon made epoch-making contributions to veterinary medicine, also becoming a leader in the field of public health administration.
Early in his career Salmon had been a skilled laboratory technician, but administrative duties gradually removed him from the daily details of research work. As head of the bureau he governed its policy, planned the assistants’ work and found time to write close to one hundred articles, alone or in collaboration with others. Together they cover almost the entire field of research in veterinary medicine in this period. One reason for the successful research being done despite Salmon’s administrative duties was the fact that he was probably quite a genius when it came to choosing assistants. Among them was Theobald Smith (1859-1934), one of the greatest names in American medical science who is today best remembered for his research on anaphylaxis (acquired hypersensitivity against proteins that are normally tolerated without problems). Anaphylaxis was long referred to as Theobald Smith’s phenomenon.
The relationship between Salmon and Smith, however, was less than heartily, because Salmon insisted on standing as the sole senior author of several research reports, including the one on the hog cholera bacillus – Salmonella cholerae-suis, which was first discovered by Theobald Smith. Nevertheless, together Salmon and Smith made a major discovery which, today, is still saving children from death or crippling disease. During the study of hog cholera they demonstrated that dead (heat killed) organisms could immunize animals against living organisms. This was the foundation for the development of a vaccine against typhus and Jonas Salk’s (1914-1995) production of polio vaccine.
Aug
16
HISTORY OF MEDICINE – Mass Food Poisoning
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Mass Food Poisoning
Salmonella
Food poisoning has been recognized as a disease of man since as early as Hippocrates. In the fifth century BC, the great plague of Athens, probably caused by contaminated cereals, led to the defeat of the Athenians in the Peloponnesian War. In the pre-scientific Middle Ages, illnesses resulting from contaminated food were often attributed to the wrath of God or malevolent spirits. Heavily infectious ergot, a poisonous mold that produces the potent toxin ergotamine, induced a spasmodic muscle condition, which the Church named “St. Anthony’s Fire” and interpreted as retribution by God on heretics.
The historical record of mass food poisoning in Europe offers a cautionary tale. From the ninth to the 19th centuries, Europe suffered a succession of epidemics caused by contamination of rye with ergot consumption of which induces hallucinations, bizarre behavior and violent muscle twitching.
These symptoms gave rise at various times to the belief that victims were possessed by evil spirits. Witch-hunting and persecution were commonplace–and the New World was not immune. One leading explanation for the notorious 1691-1692 Salem witch trials in the US relates to ergot contamination. Three young girls suffered violent convulsions, incomprehensible speech, trance-like states, odd skin sensations and delirious visions in which supposedly they saw the mark of the devil on certain women in the village. The girls lived in a swampy meadow area around Salem where rye was a major staple of their diet. Records indicate that the rye harvest was complicated by rainy and humid conditions, exactly the situation in which ergot would thrive.
Worried villagers feared the girls were under a spell cast by demons, and the girls eventually named three women as witches. The subsequent panic led to the execution of as many as 20 innocent people. The girls’ symptoms are typical of ergot poisoning, and when the supply of infected grain ran out, the delusions and persecution likewise disappeared. Even the madness of King George III, which played a role in the American Revolution, may have been induced by accidental arsenic poisoning.
The sale of rancid, contaminated or adulterated food was commonplace until introduction of hygiene, refrigeration, and vermin controls in the 19th century. Discovery of techniques for killing bacteria using heat and other microbiological studies by scientists such as Louis Pasteur contributed to the modern sanitation standards that are ubiquitous in developed nations today. This was further underpinned by the work of Justus von Liebig, which led to the development of modern food storage and food preservation methods. In more recent years, a greater understanding of the causes of food-borne illnesses has led to the development of more systematic approaches such as the Hazard Analysis and Critical Control Points (HACCP), which can identify and eliminate many risks.
In the twentieth century, there were heroic efforts of modern industrial societies to make food safer. In the early days of the FDA a “Poison Squad” was formed, consisting of young scientists who willingly acted as guinea pigs to test the toxic effects of chemical additives. Today, the government has focused on the hazards of food bioterrorism. Source: Henry I. Miller, a physician and fellow at the Hoover Institution, was the founding director of the FDA’s Office of Biotechnology. He is the co-author of The Frankenfood Myth.
Aug
9
HISTORY OF MEDICINE – John Snow’s “Grand Experiment” 1855
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John Snow’s “Grand Experiment” 1855
For 14 weeks in the late summer of 1853, London suffered one of its worst cholera outbreaks. The leading voices in medicine believed the disease emanated from the foul gasses of London’s polluted streets. John Snow, a prominent anesthesiologist, was convinced otherwise. With this map of South London, Snow believed he could prove that cholera was transmitted through drinking water. But while he would later become known as the father of modern epidemiology, his peers of the time rejected his theory. Now, some contemporary medical historians are agreeing that Snow may not have had an ironclad case.
Map of London 1855
Snow estimated 315 deaths per 10,000 houses for Southwark compared to only 37 for Lambeth – a seemingly closed case. But Snow based his numbers on a parliamentary report that didn’t have house-to-house resolution he required. Even Snow himself later admitted that he didn’t have that data to fully show the relationship between cholera and water supply. As such, his peers went unconvinced. “The grand experiment promised in the map was a failure,” says Tom Koch, author of the forthcoming Disease Maps: Epidemics on the Ground (where the map will be featured).
#1 – The colors represent the territories of two companies that piped drinking water to South London. The Lambeth Company (red) drew its water from upstream in a relatively clean area of the Thames. The Southwark and Vauxhaul Company (blue, now faded to green) had its intakes in the polluted waters downstream at Battersea Park. Snow suspected that Southwark was piping cholera into people’s homes.
#2 – This purple (now faded to brown) area came to be known as “the grand experiment.” It produced the perfect condition for an environmental study. The pipes in the area were so intermingled that Snow had a near random sampling of neighbors, virtually identical in every way except for their source of water. To show that the disease was carried through the tap, “all that [I] required was to learn the supply of water to each individual house where a fatal attack of cholera might occur,” Snow wrote in his book On the Mode of Communication of Cholera, where the map was originally published in 1855.
Additional contributions to medicine by Dr. Snow:
- Snow’s views in an 1853 oration of cholera and epidemic diseases in general, showed early understanding and promotion of infectious disease epidemiology
- John Snow in 1847 published a book on the use of ether as an anesthetic agent in surgical operations. While his fame in anesthesiology derived from his extensive work with chloroform, he also was a pioneer in the use of ether.
- Dr. Snow was prominent as an anesthesiologist. He administered chloroform to the Queen on two occasions.
- Birth of Prince Leopold
- Birth of Princess Beatrice
Jul
26
HISTORY OF MEDICINE
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Diphtheria
Until the late 19th century, diphtheria was a gruesome killer with no known cause and many ineffective treatments. In 1874, The New-York Times printed an advertisement for a medicine that would cure not only diphtheria, but also corns, bunions and “pains in the loins and back.” The same year, a news article began, “There has been spreading for some time an idea or hypothesis among the more philosophic medical men, and among the thoughtful ‘laity,’ that many species of disease have their sources in, and are scattered by, seeds or germs.”
But it was December 7, 1890, before The Times first hinted there might be a real cure for diphtheria. That day a Page 1 article about events in Germany reported that “Drs. Behring and Kitasato found that the blood of immune rats and mice had a destructive effect on the virus of diphtheria.” The reporter was apparently unaware that diphtheria is caused by a bacterium, not a virus, but in any case the treatment was as destructive to humans as it was to the germ. The article went on to report that two human patients transfused with the animals’ blood almost immediately dropped dead.
But progress was fast. On October 1, 1894, a headline on Page 2 read “Repression in the Reichstag,” over a story about European politics. In the ninth paragraph the anonymous reporter changed subjects. “A congress of German naturalists and physicians opened its sessions in Vienna on Monday,” he wrote, and then went on to discuss Emil von Behring’s “discovery of a cure for diphtheria by the inoculation of the patient with serum blood.”
On November 26, 1894, The Times reported that Behring’s “diphtheria anti-toxine” had been commercially imported for the first time, and a lengthy description of the substance and its manufacture appeared on December 9, 1894. That same day a brief article on Page 10 reported that in a diphtheria epidemic in New Rochelle, N.Y., “there have been several quick cures by the use of antitoxine, the new remedy, and the new cases will be treated with it.” By this time, serum was being produced from horse blood in New York City.
In the spring of 1913, Behring developed a vaccine against diphtheria. On May 15, 1914, a short article reported that the French newspaper Le Matin had declared the serum one of “the Seven Wonders of the modern world.” The other six were “the aeroplane, wireless, radium, the locomotive, human grafting and the dynamo.” The vaccine was not widely distributed until the 1920s. On March 13, 1921, a Page 14 headline read “Begins Work to End Diphtheria Here.”
Today’s vaccine, recommended for all infants and for adults who have not been immunized, is manufactured by treating the diphtheria toxin with heat and chemicals, destroying its ability to produce disease but allowing it to stimulate the production of antibodies. Because the vaccine is so effective and so widely used, diphtheria is rare in industrialized countries, but when it does occur it can be treated with diphtheria antitoxin.
In the United States, the medicine is available only through the Centers for Disease Control and Prevention, which imports it from Brazil, one of the few countries in the world that still manufactures it. By Nicholas Bakalar for The New York Times
Jul
19
History of Medicine
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A Case That Shook Medicine
A DAUGHTER LOST After Libby Zion died in a hospital at age 18, her father’s crusade led to changes in work hours and supervision of medical residents.
History shows how one man’s rage over his daughter’s death sped reform of doctor training. Many people have vowed to avenge the untimely death of a relative. Lawyer and journalist Sidney Zion actually did so to the benefit of patients and doctors-in-training nationwide. After his 18-year-old daughter Libby died within 24 hours of an emergency hospital admission in 1984, Zion learned that her chief doctors had been medical residents covering dozens of patients and receiving relatively little supervision. His anger set in motion a series of reforms, most notably a series of work hour limitations instituted by the Accreditation Council on Graduate Medical Education (ACGME), that have revolutionized modern medical education. Just about everyone involved in the Libby Zion case – her father, her doctors and the people who testified at the trial that eventually resulted – has a different account of what happened. But there are some undisputed facts.
Libby was a college freshman with an ongoing history of depression who came to New York Hospital in Manhattan on the evening of Oct. 4, 1984, with a fever, agitation and strange jerking motions of her body. She also seemed disoriented at times. Unable to diagnose her condition definitively, the emergency room physicians admitted her for hydration and observation. The physician of record, a senior clinician who had treated several members of the Zion family, approved the decision by phone. On the hospital ward where she was sent, Libby was evaluated by two residents: an intern eight months out of medical school, and another intern who had one additional year of training. They, too, were not quite certain of Libby’s diagnosis. One of the interns termed it a “viral syndrome with hysterical symptoms,” suggesting that Libby was overreacting to a relatively mild illness. The doctors prescribed a shot of meperidine, a painkiller and sedative, to control her shaking. The family doctor approved the plan by phone.
At about 3 in the morning, the intern went off to care for some of the 40 other patients she was covering. The other intern went to sleep in an adjacent building, where he would be available, if necessary, by beeper. After the doctors left, Libby became more agitated. The nurses contacted the intern at least twice. The intern ordered physical restraints to hold the patient down and prevent her from hurting herself. She also prescribed an injection of haloperidol, another medication aimed at calming her down. Busy with other patients, the intern did not reevaluate Libby. Libby finally fell asleep, according to the nurses, but when a nurse’s aide took her temperature at 6:30 a.m., it was 107, dangerously high. The intern was called and emergency measures were tried to lower the temperature. But Libby Zion suffered a cardiac arrest and died. The intern called her parents, telling them doctors had done everything they could.
To the doctors at the hospital, the case was an inexplicable “bad outcome’ in which a healthy young woman had died of a mysterious infection. But the more Sidney Zion learned of the circumstances of Libby’s death, the more he rejected this assertion. He became convinced his daughter’s death was due to inadequate staffing at the teaching hospital. And he grew determined to ensure that others not fall victim to the same gaps in the teaching hospital system that he blamed for his daughter’s death.
First, there was a question as to whether the meperidine, known to cause fatal interactions with phenelzine – Libby Zion’s antidepressant had produced the high fever. Second, Sidney Zion questioned the use of restraints and shots for an increasingly agitated patient. “They gave her a drug that was destined to kill her,” Zion later stated, “then ignored her except to tie her down like a dog.” Zion’s anger was exacerbated by what he learned about the hospital’s staffing on the night Libby died. In addition, the intern assigned to Libby, was covering a large number of patients; the other doctor on call, was never awakened; and the supervising physician, wasn’t called when Libby deteriorated.
Over time, the image of the bedraggled, unsupervised intern wreaking damage in hospitals would be featured in the pages of The Washington Post, the New York Times and Newsweek.
In May 1986 Manhattan District Attorney Robert Morgenthau agreed to let a grand jury consider murder charges. Although it declined to indict, the jury issued a report strongly criticizing “the supervision of interns and junior residents at a hospital in New York County.” In response, New York State Health Commissioner David Axelrod established a blue-ribbon panel of experts headed by Bertrand M. Bell, an outspoken primary care physician at the Albert Einstein College of Medicine in the Bronx, to evaluate the training and supervision of doctors in the state. Bell had long criticized the lack of supervision of physicians-in-training. In 1989, New York state adopted the Bell Commission’s recommendations that residents could not work more than 80 hours a week or more than 24 consecutive hours and that senior physicians needed to be physically present in the hospital at all times. Hospitals instituted so-called night floats, doctors who worked overnight to spell their colleagues, allowing them to adhere to the new rules.
Still, some physicians resisted reform efforts. Many institutions essentially disregarded the new regulations. Until 2003. In that year, the ACGME made reduced work hours mandatory for the accreditation of residency training programs across the country. The new ACGME standards look remarkably similar to those of the Bell Commission. Now it is commonplace to see chief residents at medical centers charting the numbers of hours worked by their staffs. Residents who wish to stay longer at work are at times sent home to sleep, a development that would have been inconceivable in the past. As might be expected, the new requirements are a work in progress. A study published in the Sept. 6, 2006, issue of the Journal of the American Medical Association found that 80% of interns nationwide still sometimes work excessive hours. Data measuring whether work hour limits have improved patient care are just coming in. One study published in the New England Journal of Medicine in 2004 did find that eliminating extended work shifts improved the attention span of interns.
Historians these days tend to distrust the idea that the actions of specific people truly cause large-scale change. Rather, many argue, change more commonly results from a complex interplay of cultural and political factors. In the case of Libby Zion, however, it is possible to trace a straight line from her death to Sidney Zion’s campaign to the Bell Commission to the ACGME regulations. To be sure, it took the social changes of the 1960s and 1970s to make graduate medical education susceptible to reform from the outside. But Sidney Zion sped things up considerably, ensuring that Libby had not died in vain.
In the winter of 1994, Zion v. New York Hospital finally went to trial. Court TV avidly covered the proceedings, which were full of vitriol on both sides. The jury hedged, attributing responsibility to both the doctors and the patient. Sidney Zion still calls the $375,000 jury award to him a travesty of justice. There is one other legacy of Zion’s crusade. By championing the cause of patients and families who believed they had been harmed by the medical profession, Zion helped set the stage for the medical-errors movement that began in the 1990s. To aggrieved patients and their families, Zion became a sort of folk hero.
Throughout his crusade, Sidney Zion’s anger was paramount. Indeed, it is quite possible that without this rage, he might not have accomplished what he did. Zion was “aggressive, narcissistic, self-indulgent, pushy, persistent and paranoid,” psychiatrist Willard Gaylin memorably wrote in the Nation, “but that is precisely the stuff successful reformers are made of.”
Barron H. Lerner is the Angelica Berrie-Gold Foundation Associate Professor of Medicine and Public Health at Columbia University’s Mailman School of Public Health. This essay, from the Washington Post, draws on his book, “When Illness Goes Public: Celebrity Patients and How We Look at Medicine” (Johns Hopkins, 2006).
“I left her there with an earache and a fever,” he has said, “and they sent her home in a box.” Sidney Zion, heartbroken father.
The Libby Zion Law –
Major Shift in Doctor’s Hours
New York State Department of Health Code, Section 405, also known as the Libby Zion Law, is a regulation that limits the amount of resident physicians‘ work in New York State hospitals to roughly 80 hours per week. The law was named after Libby Zion who died at the age of 18 under the care of overworked resident physicians and intern physicians. In July 2003 the Accreditation Council for Graduate Medical Education (ACGME) adopted similar regulations for all accredited medical training institutions in the United States.
Jul
12
HISTORY OF MEDICINE
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Interesting Glimpse of Mt. Sinai Hospital (NYC) in 1917
Update, July 11, 2010 by Mark L. Horn MD, MPH, and Chief Medical Officer at Target Health Inc.
Dr Horn continues to make his rounds at Mount Sinai Hospital in Manhattan.
Dr. Plotz’ home, The Mount Sinai Hospital in New York City, originally founded in the middle of the 19th century as the Jews’ Hospital, has a long and distinguished history in American Medicine. It has historically been a source of “clinician investigators”, physicians actively contributing to medical science while remaining active bedside clinicians. This history facilitated the transition of the hospital into a medical school – an uncommon if not unprecedented event – over a century after its founding, formally combining the basic science disciplines required to confer the MD degree with established expertise in clinical care and research. This integration of scientific discovery and clinical care, begun in the 19th century, evidenced by Dr. Plotz’ work on spirochetes in the early 20th, remains robust in the 21st.
Cultivation of Spirochaeta obermeieri By Harry Plotz (From the Pathological Laboratory of Mount Sinai Hospital, New York.) (Exp Med. 1917 July 1;26(1):37–39)
Up to the present, Spirochaeta obermeieri has not been grown from the blood of persons suffering from relapsing fever, nor has a spirochete of any species, as far as I have been able to discover, been cultivated directly from the blood of human beings. In this communication I wish to report the successful cultivation of Spirochaeta obermeieri directly from the blood of patients suffering from European relapsing fever. The studies were carried on in Serbia in the winter of 1915. The successful cultures, five in all, were made from cases clinically typical of European relapsing fever occurring in civilians and soldiers then residing in Macedonia. Following Noguchi’s successful experiments on the cultivation of other spirochetes, he succeeded in growing Spirochaeta obermeieri from mice infected with relapsing fever. This spirochete had previously been kept alive by continued passage from animal to animal for a considerable length of time. The question arose whether spirochetes thus propagated for a long time become more amenable to artificial cultivation. The method employed is the same as that used by Noguchi. All cultures were taken during the febrile period of the disease. After careful disinfection of the skin with alcohol and iodine, a vein in the antecubital space is punctured and 10 to 15 cc. of blood are withdrawn. A 15 cc. syringe with a thick bored needle is employed. It is important to withdraw the blood slowly, because rapid withdrawal may so injure the organisms that they will not grow. The needle is then removed from the syringe and the blood is slowly introduced into an Erlenmeyer flask containing 10 cc. of a 1.5 per cent sodium citrate solution in 0.85 per cent sodium chloride. The flask is gently agitated and the contents are then ready for culture. Culture tubes measuring 1.5 by 20 cm. are used. Into each tube is placed a piece of fresh sterile rabbit kidney tissue. The kidneys are removed aseptically and divided into about four pieces. About 5 cc. of the blood and sodium citrate mixture are added to each of a series of tubes. To this are added 15 cc. of sterile ascitic fluid. The ascitic fluid should be clear, free of bile and blood pigment, and should have a specific gravity of about 1.020. Noguchi has shown that an ascitic fluid which forms a fibrin filament when it comes in contact with the blood is best; no preservative should be added to the ascitic fluid and it should not be passed through a Berkefeld filter. Before use the fluid is tested out aerobically and anaerobically. Half the tubes are layered with sterile liquid paraffin. The tubes are incubated at 37°C. The cultures were observed over a period of 2 weeks, but no definite appearance of growth was noted in the medium. Occasionally a slight clouding at the lower part of the ascitic fluid appeared. The tubes not layered with liquid paraffin showed the best growth. Although only one or two spirochetes could be found in films made before culture, a distinct increase could be noted after 48 hours’ cultivation. In this series the maximum growth appeared on the 5th day and then gradually decreased. Preparations made from the junction of ascitic fluid and blood revealed masses and clumps of spirochetes. Preparations made from the upper part of the medium showed clumps and masses of spirochetes, but not so many as from the lower part. In young cultures the spirochetes appear shorter and thinner, but in older cultures they gradually become thicker and longer. The most striking appearance in young cultures is the spirochetal nodes which appears in practically every organism. These nodes are small thickenings which occur in the body of the spirochetes. From one to four may occur in the same organism. As the cultures become older these nodes become less numerous. I believe that these nodes probably represent the points where longitudinal division occurs. Transplants are made about the 5th day by withdrawing 0.5 cc. of ascitic fluid from the lower part of the medium, without blood. This is inoculated into a similar tube as described above, except that 2 cc. of defibrinated human blood are added to each tube. The presence of hemoglobin aids the subsequent growth. In this manner Spirochaeta obermeieri have been transplanted for five generations in two cultures.
Jul
6
HISTORY OF MEDICINE
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U.S. Malaria Deaths, 1870
While malaria still kills over 1 million people each year, most of those deaths occur in sub-Saharan Africa—the United States has been free of the disease since 1951. In the 19th century, however, malaria was extremely common within the United States, with over 1 million cases reported during the Civil War alone. The map below depicts deaths from malaria in 1870—10 years before the malaria parasite was even discovered.
#1 – Believed to have been brought to the Americas by Europeans in the late 1600s, malaria primarily impacted those in the Southeast and port cities, but extended as far north as the Dakotas, says Margaret Humphreys, a history of medicine professor at Duke University.
#2 – Of the five species of the Plasmodium parasite that can cause malaria, P. falciparum and P. vivax were the most common in the United States. “The malaria that is shown here north of the Mason-Dixon Line was likely vivax malaria,” Humphreys says, which “can hide out in the liver and re-emerge later, causing relapses.”
#3 – During the Civil War, the presence of malaria in the United States skyrocketed, killing some 10,000 Union soldiers annually during the war. The war brought “hordes of men into the swampy areas of the coastal south and along the major rivers”—such as the Mississippi, James, and Potomac—”who then took the parasite home with them,” says Humphreys.
#4 – In 1946, the Communicable Disease Center (today’s Centers for Disease Control and Prevention, CDC) was created in Atlanta, Georgia, with the primary focus of eliminating malaria from the South. Through a variety of efforts, including draining swamps, removing mosquito breeding sites, and spraying pesticides, malaria was considered eradicated from the United States within just 5 years.
Source: The-Scientist.com
Jun
28
HISTORY OF MEDICINE
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Lupus
Four main types of lupus exist: systemic lupus erythematosus, discoid lupus erythematosus, drug-induced lupus erythematosus and neonatal lupus erythematosus. Of these, systemic lupus erythematosus (SLE) is the most common and serious form of lupus. The history of SLE can be divided into three periods: classical, neoclassical, and modern.
The classical period began when the disease was first recognized in the Middle Ages and when a description of the dermatological manifestation of the disorder was recorded. The term lupus (Latin for wolf) is attributed to 12th-century physician Rogerius, who used it to describe erosive facial lesions that were reminiscent of a wolf’s bite, and the classic malar rash, that resembled a wolf’s scratch. The first published illustrations of lupus erythematosus were included in von Hebra’s text, Atlas of Skin Diseases, published in 1856.
The neoclassical period was heralded by Moric Kaposi’s recognition in 1872 of the systemic manifestations of the disease. Kaposi wrote, “… experience has shown that lupus erythematosus (“erythematosus” is Latin for red) … may be attended by altogether more severe pathological changes … and even dangerous constitutional symptoms may be intimately associated with the process in question, and that death may result from conditions which must be considered to arise from the local malady.“ Kaposi proposed that there were two types of lupus erythematosus; the discoid form and a disseminated form. Furthermore, he enumerated various symptoms and signs which characterized the disseminated form including (1) subcutaneous nodules, (2) arthritis with synovial hypertrophy of both small and large joints, (3) lymphadenopathy, (4) fever, (5) weight loss, (6) anemia, and (7) central nervous system involvement. The existence of a systemic form of lupus was firmly established by the work of Osler in Baltimore and Jadassohn in Vienna in 1904.
The modern period began in 1948 with the discovery of the LE cell by Hargraves and colleagues. The investigators observed these cells in the bone marrow of patients with acute disseminated lupus erythematosus and postulated that the cell “… is the result of … phagocytosis of free nuclear material with a resulting round vacuole containing this partially digested and lysed nuclear material …“ This discovery ushered in the present era of the application of immunology to the study of lupus erythematosus.
Two other immunologic markers were recognized in the 1950s as being associated with lupus: the biologic false-positive test for syphilis12 and the immunofluorescent test for antinuclear antibodies. Medical historians have theorized that people with porphyria (a disease that shares many symptoms with SLE) generated folklore stories of vampires and werewolves, due to the photosensitivity, scarring, hair growth, and porphyrin brownish-red stained teeth in severe recessive forms of porphyria (or combinations of the disorder, known as dual, homozygous, or compound heterozygous porphyrias).
Useful medication for the disease was first found in 1894, when quinine was first reported as an effective therapy. Four years later, the use of salicylates in conjunction with quinine was noted to be of still greater benefit. This was the best available treatment until the middle of the twentieth century, when the treatment of systemic lupus was revolutionized by the discovery of the efficacy of adrenocorticotrophic hormone and cortisone by Hench. Corticosteroids have been the primary therapy for almost all patients with systemic lupus. Antimalarials have been used principally for patients with skin and joint involvement on the one hand and cytotoxic/immunosuppressive drugs have been used for patients with glomerulonephritis, systemic vasculitis, and other severe life-threatening manifestations on the other.
Two other major advances in the modern era have been the development of animal models of lupus and the recognition of the role of genetic predisposition to the development of lupus. The familial occurrence of systemic lupus was first noted by Leonhardt in 1954 and later studies by Arnett and Shulman at Johns Hopkins. Subsequently, familial aggregation of lupus, the concordance of lupus in monozygotic twin pairs, and the association of genetic markers with lupus have been described.
Jun
21
HISTORY OF MEDICINE
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Herbs
Wild herbs were used as healing remedies long before records were kept. Otzi, the 5,300-year-old Iceman found in the Alps in 1991, had medicinal mushrooms among his personal effects, and herbs have been an integral part of Eastern medicine for centuries. Today modern medicine is beginning to realize that herbs may ease the symptoms of many ailments, from the common cold to arthritis, because they contain important health-promoting compounds such as antioxidants and anti-inflammatories. Listed here are five healthy and gentle herbs that have been used for centuries. Peppermint was first cultivated near London in 1750, and used as an effective remedy for indigestion. Peppermint appears to calm the muscles of the digestive tract to alleviate intestinal gas and cramping. It has been used to settle the stomach and to ease muscle cramps. Arab doctors in the 9th and 10th centuries called lemon balm the gladdening herb and prescribed it to dispel anxiety and heart palpitations. More recently, a panel of physicians, pharmacologists, and scientists appointed by the German Ministry of Health endorsed the herb for relieving tension, anxiety, and restlessness. There’s also evidence of cognitive benefits. In a small study published in Neuropsychopharmacology, 20 healthy young adults reported increased memory and improved mood after ingesting lemon balm. Another study found similar results among Alzheimer’s patients. The use of rosemary as a memory enhancer dates back at least to early Western civilization. Greek students wore garlands of rosemary around their heads, and students in Rome massaged their temples and foreheads with the herb prior to exams. Rosemary was also used to reduce joint pain. Rosemary needles were soaked in almond oil for two weeks, filtered, and then rubbed onto sore joints as needed. Valerian has been used throughout history as a sedative and sleep aid, valerian gets its name from the Latin valere, which means “to be in good health.“ “Just the smell alone of the sweetly scented plant is enough to relax some people. As an aid to sore throats, sage leaves were mixed with hot water and taken as a tea, and/or a gargle. Sage was also used to freshen breath. At the end of most days, 81-year-old botanist Dr. Jim Duke pours himself a cocktail. Hardly a Scotch on the rocks, this healthy concoction he’s aptly dubbed Creme d’Mentia is a blend of herbs, steeped in diluted vodka, that are thought to boost relaxation, mood, memory, and overall brain health. “It lifts my spirits and lowers my anxiety,“ says Duke, who worked for the U.S. Department of Agriculture for 30 years and is the author of The Green Pharmacy book series. If you want Duke’s special cocktail recipe, please contact Joyce Hays.